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Brachytherapy vs Surgery

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Posted 2/7/2007 7:52 PM (GMT -7)

I was set to have daVinci surgery until yesterday.  Went to Dr. David Schreiber in Denver to discuss radiation options.  Since I have cancerous cells in both lobes, he told me that I had a 50% chance of impotence with RP - either traditional or daVinci - because they cannot take any chances by taking less tissue on one side.  The nerves on both sides will inevitably be damaged.  I am Gleason 3 + 3 with a PSA of 5.1 and T1c.  Cancerous cells in one of 13 biopsy samples on one side (< 5%) and one of 10 cores on the other side (<5%).  I am now seriously considering seeds as the probablility of cure is the same and the probability of negative side effects is probably much less.  Because mine is early stage I will not have to take hormones or EBT.  Schreiber says he does 400 a year in his clinic and is one of the top 5 Brachytherapists in the country.  As well, this is outpatient surgery with almost no down time.  Some of the posts on this site and others report more side effects than the Doc told me, so I am still researching side effects of seeds.  He dispelled most of the myths that others report as negatives of radiation, including the myth that you can't have the other forms of treatment - RP, EBT, etc. - after seeds.  If my chances of impotence are much lower, I see no reason to have surgery at this point.  He uses new palladium seeds that are easier on the body than the old iodine seeds.  Best of all is that I will be able to get it done in about two weeks from the time I schedule.  I was at least two months out with daVinci.  I would appreciate any thoughts to sanity check the information I was given.  Thanks in advance for your input.  My best to each of you in your quest for a cure.

Steve

Posted 2/7/2007 8:06 PM (GMT -7)
Steve, My husband and I have also been heavily exploring our options. Though the seed option has not been looked into by either of us, we have explored the proton therapy route. You did not tell your age. My husband is 47. We have been told by more than one urologist that the seed option was not a good choice for us. If you are set on radiation, check out the proton therapy. www.protonbob.com has some good testimonials. Loma Linda in CA is said to be the best for this therapy. With proton tx, the radiation is the strongest when it hits the prostate, sparing more of the healthy tissue than anyother type of radiation. The scary thing for us about radiation is that radiation can cause cancer, which is why x-ray techs wear the lead vests. So even though we may beat the PCa, what will we be facing in 20 years? At that time, Kurt will just be at retirement age. Good luck to you. This is just where we have been. This is all still new to us (dx 1/29/07). There does appear to be great things with the proton therapy.
Kurt & Courtney

47 year old

Great Health prior to dx

Dx on 1/29/07

PSA 4.1

Gleason 3+3=6, both lobes

Stage T2c, I believe

Tumor involves 20% of cores, both lobes

Looking for Surgeon with lots of da Vinci experience

Live in OK, willing to travel

Posted 2/7/2007 8:18 PM (GMT -7)

Thanks Kurt and Courtney,

I will check out proton.  I just turned 58 and have two younger kids (21 and 16) so I have to do this right to be around for them.  What reason did they give to turn you off of seeds?  Thanks again for your input.  God Bless both of you.

Steve

Posted 2/7/2007 8:41 PM (GMT -7)
Steve, first doc said that it just wasn't an option. Some web site on proton therapy joked, "how do you explain radioactive seeds in your prostate to airport security?" Our 2nd doc said that With radiation, the beam starts out the strongest of course, at the machine and weakens as it travels. The seeds try to intensify the radiation in the prostate, however, the worst part of the beam has still had to work its way through whatever it hit before hitting the prostate, and again on its way out. The proton therapy is different in the way that the beam is intensified. If you can imagine the line on an EKG. ______^______ the (^) is the burst in the radiation. Hopefully on the prostate. The lines are min. radiation from the beginning, peaking at the prostate, and lessoning or dying before the rectum. This increases the prognosis and decreases the bowel problems that can occur with radiation since the prostate rests on the rectum (lying down). We too have alot to live for (ages 10 and 14) and to us, the option with the least chance of recurrance is our answer. There are other procedures that can be done in the worst case scenario (side effect wise) with surgery. We will all survive!!!
Kurt & Courtney

47 year old

Great Health prior to dx

Dx on 1/29/07

PSA 4.1

Gleason 3+3=6, both lobes

Stage T2c, I believe

Tumor involves 20% of cores, both lobes

Looking for Surgeon with lots of da Vinci experience

Live in OK, willing to travel

Posted 2/7/2007 8:47 PM (GMT -7)
The issue that I had with any of the forms of radiation is that you will always be hanging on to that PSA test for the rest of your life to know whether or not you beat it. With surgery the pathology of the removed gland is a finite result. In my case, I know the cancer is gone with the prostate. If you can live with that cloud hanging over your head in exchange for possibly not being impotent for a period of time then more power to you. I just did not have that in me.

Tamu
Diagnosed 7/6/06

1 of 10 core samples, 40%

Stage T1c, Gleason 3+3

Da Vinci on 11/01/06

Catheter out on 11/13/06

56 Years Old

Post Op Path

Gleason 3+3

Approx. 5% of prostate involved

Prostate Confined, margins clear

Undetectable PSA on 12/18/06

No more pads as of 1/13/07

Posted 2/7/2007 8:50 PM (GMT -7)
Kurt and Courtney, glad to hear someone else out here has young kids.  ;^)  There are no beams with the seed therapy I am considering.  They simply insert somewhere between 50 and 100 radioactive seeds in the prostate.  The radioactivity is so low that there is no chance of causing other cancers.  The seeds kill the cancerous tissue and them dissipate over the next 6 - 9 months.  There should be minimal side effects with this treatment as they do not have to shoot any beams of radiation at me.  You bet we will all survive and prosper.  Best of luck.  Steve

Posted 2/8/2007 8:01 AM (GMT -7)
Tamu-

If you plan on living the rest of your life without regular PSA checks, you are a fool.

Stevef999-

If you are unsure, speak to several radiation oncologists. Get enough "second opinions" from all specialties until you are very comfortable with the procedure and the doctor.

-Gordy
Posted 2/8/2007 8:12 AM (GMT -7)
Gordy - please re read Tamu's posts.  He gets regular PSA checks . . . just stated that once his cancer was "out" of his body and his PSA was NIL he didn't have to keep wondering and waiting to see if it was going down.  Tamu is a valued contributor to this form and does NOT deserve name calling because of a misunderstood statement. mad
Posted 2/8/2007 8:39 AM (GMT -7)
Lawink-

First of all, I've re-read Tamu's post 3 times and still am not convinced he intends to have regular PSA tests.

Secondly, if you'll re-read my post you'll see that I said "If you plan on living the rest of your life without regular PSA checks, you are a fool." At this point in my journey I feel that about any man, Dx'd or not.

-Gordy
Posted 2/8/2007 8:41 AM (GMT -7)
And, let me add, I include myself in that group - hadn't had a PSA done in many, many years before I was finally Dx'd with a PSA of 26.5 and Gleason 7 (4+3).

-Gordy
Posted 2/8/2007 9:46 AM (GMT -7)
eyes   eyes   eyes   cut the crap and just say oops, misunderstood. There...now was that so hard?  :-) :-) :-)

                                                                  yeah   yeah   yeah   yeah   yeah

Posted 2/8/2007 10:18 AM (GMT -7)

Swim

You go girl

Daveed

Diagnosed March 06

PSA 4.4

Two biopsies. One core of each 5% cancer, two suspicious

Gleason 3+3=6

DaVinci surgery Nov 1, 06

Cancer confined to prostate

Ist PSA 6 weeks post op less than 0.02

 

Posted 2/8/2007 11:21 AM (GMT -7)
Oops, I've been misunderstood.

-Gordy
Posted 2/8/2007 5:14 PM (GMT -7)
Steve999, we talked to an onocologist that we highly trust today. He said that the seeds were an option, but find a highly qualified person to implant the seeds. He said that if we were to consider radiation, proton was the only way to go and Loma Linda at that. He said that he personally would choose the da vinci by a qualified surgeon and they are not even really doing them here in OK. Just FYI for you
Kurt & Courtney

47 year old

Great Health prior to dx

Dx on 1/29/07

PSA 4.1

Gleason 3+3=6, both lobes

Stage T2c, I believe

Tumor involves 20% of cores, both lobes

Looking for Surgeon with lots of da Vinci experience

Live in OK, willing to travel

Posted 2/8/2007 7:01 PM (GMT -7)
Thanks for the info.  Here is the website of the guy I will probably use.  www.prostateseedcenter.com  I think he is a pro and his website is informational.  Best of luck.  Steve

 

Diagnosed 1-9-07 at Age 58

Gleason 6 (3 + 3)

Both lobes  - 2 of 23 cores (<5% each)

PSA 5.1

T1c - Negative DRE

Considering Brachytherapy vs daVinci

 

Posted 2/9/2007 7:11 AM (GMT -7)
Stevef999:

My husband opted for Brachytherapy because other options were not as viable.  You are correct in the statistics show equal success rates with surgery at 15-20 years out.  Surgery was riskier for him so we opted for Brachytherapy out of a Toronto, Ontario hospital.  His implant was 91 seeds (stranded) with relatively little side effect (other than fatigue).  His PSA scores are consistently dropping at every visit.

If you want to know more about Brachytherapy there is a post (JustJulie's Brachytherapy Journey) on this site - have a read, I tried to detail everything from the emotional roller coast to the actual procedure but if you have ANY other questions - just ask - I'm happy to help where I can.

As far as having young children, we have two who were 10 and 15 at the time of their father's diagnosis - do not exclude them from conversation - they need to know that the emotional roller coaster is not because of them - we included them in every stage of conversation.

Good luck to you in your decision making - ask anything you need to to help you make a confident decision.

Warm regards,

JustJulie

Posted 2/9/2007 9:52 AM (GMT -7)
I just talked to a close friend who is about six months into seed brachytherapy. He said that his PSA is now down to below 2 but he is having a very difficult time with infection and urination.

He developed an E-coli bacteria infection after his procedure and could not urinate or clear his bladder. He must now carry a portable catheter that he inserts when he needs to urinate. He says it is painful and difficult.

Is this a typical side effect of this therapy?
 

Da Vinci surgery 1/16/07

 

History

11/05 psa 2.9

6/06   psa 5.8

7/06   psa 6.7

 

biopsy 10/16/06

gleason 4+4=8

grade T2A

 

scans and post op confirm biopsy results

 

scans and post op pathology show clear for spread

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Posted 2/9/2007 9:55 AM (GMT -7)
We did not experience anything like that nor did the patient who shared our hospital room.  I cannot speak to all instances, just to ours but I believe that may be the exception and not the norm.

 

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