Still making up my mind: Let me see if I've got this right...

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naimnut
Regular Member


Date Joined Jan 2007
Total Posts : 93
   Posted 2/8/2007 3:39 PM (GMT -7)   
I feel like I've been on a roller coaster, deciding what treatment to go for. First it was going to be seeds, then da vinci robot, and now all of a sudden I'm reading very positive things about proton/ photon treatment at Loma Linda.
 
Best I can figure it, the pros and cons shake out like this:
1. Brachytherapy: Pro's, it is fairly quick. Treatment performed on an outpatient basis. Few side effects at first. Temporary side effects while the seeds are working. Long term prognosis for cancer recurrence, if performed by a top-flight team, are about as good as any other form of treatment, though there are not yet any longitudinal studies extending beyond about 20 years.
Cons: incontinence and ED can emerge as side effects after several years have passed.  Basic non-surgical treatment of either is the same as it always is, kegels, viagra and pumps, etc.
 
2. Da Vinci: Pro's, you get the whole prostate out so it can be evaluated closely, agressiveness of tumor accurately gauged, risk of micro-metasteses evaluated. Surgery has always been considered the gold standard, because it has been around so long and the survival statistics well documented. Da vinci, if performed by a top doc, has lower rates of incontinence and ED than open, if the open is performed by an "average" surgeon. For top-flight surgeons, the side effects of open surgery can be statistically be about the same as da vinci. Another pro, is recovery time is quicker than with an open. Also, if you have incontinence and ED, you'll know it pretty quick and can work towards improvement sooner. Probability of nonrecurrence is around 90% or so, right? Con's: recovery takes from two weeks to two months, though some guys remain incontinent longer, though that is less likely with a top doc.
 
3. Proton/photon: Pro's, well, it seems to work quite well. On protonbob i have not read about incontinence or ED. Do these not happen with proton/photon? I'm not clear.
Con's: It takes two months for the treatment. I do not know what the recurrence rate statistic is.
 
Questions: Does anybody know about the side effects of proton beam? Is there little or no risk of incontinence or ED? Is there a risk that these can emerge later, as they do with seeds?
 
Thanks for any input anyone can provide. My pro's and con's are not exhaustive, and are really taken off the top of my head this afternoon.
 
I'd like to read your thoughts.
 
Markus


Age, 53
PSA 3.76, Gleason 6, T1c, scans negative
psa doubling time 35 months
Still researching and deciding treatment options.  Leaning towards da vinci robotic.

Post Edited (naimnut) : 2/10/2007 7:25:59 PM (GMT-7)


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 2/8/2007 4:43 PM (GMT -7)   

Markus,

The protonbob site has some interesting links including one on side effects / toxicity in an article at "OncoLink". It has tables on acute complications and long term complications for Proton, Conventional, and Prostatectomy.

According to their tables, long term side effects of impotence and incontinence compare very well with other treatment options,

It talks about limiting the dose to normal structures, and higher doses safely delivered to the tumor itself minimizing side effects of therapy.

When considering Loma Linda a couple of years ago, I contacted Bob who gave me seven contacts here in Aus who had been to Loma Linda. All seven called me or replied to my email, and they were all very happy with their treatment and subsequent results.

Regarding surgery recovery time, it is major surgery, but it's surprising how quickly a top surgeon can have his patient out and about within a few days even with open surgery.

 

John

 


djhouston
Regular Member


Date Joined Jan 2007
Total Posts : 68
   Posted 2/10/2007 12:01 AM (GMT -7)   
Hi Markus,
Just my opinion, and I admit that I don't know much about proton radiation, but I like the 90% probability of nonrecurrence a lot more than the 75% with proton, and incidentally, this 75% figure was the same number my doctor gave me for the regular external beam radiation, the seeds, and cryotherapy seven months ago when I was deciding what to do. Take a look at my post to Lifeguyd. I am a worrier and not a gambler. I had a Gleason 7 cancer and wanted it OUT. I wanted someone to microscopically examine it and find out if the margins were clear. I had to know if there was anything microscopic in the lymph nodes or the seminal vesicles. I couldn't do this with radiation of any kind. That's where I came from. So put me down as a vote for daVinci.
These and the post on Lifeguyd's thread are my thoughts. It's a hard decision, but we are all with you and each other.
dj
dj's stats:
PSA (10/04): 2.9; PSA (2/06):4.4, on Androgel (serum T about 450) at age 56; negative DRE, no symptoms.
PSA (5/06):5.7 with a free PSA% of 8, OFF Androgel (serum T 163). 
Biopsy (5/06): 4/12 samples positive; postitive samples only on right side; max Gleason 4+3=7 (in 2 of the 4 -from area nearest bladder.
DaVinci robotic-assisted laparoscopic radical prostatectomy + bladder lift + Right nerve plastic surgery (8/23/06).
Catheter out 4 weeks postop, due to internal pinhole leak at bladder-urethra junction.
Final pathology report:T2c-both sides,but in capsule; neg. margins, neg. lymph nodes, neg. seminal vesicles; final max Gleason still 4+3=7.
Follow-up PSA (11/06): <0.008; serum T: 195 OFF Androgel (at present).


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 2/10/2007 4:48 AM (GMT -7)   

djhouston,

Are you saying that surgery has 90% success rate compared to 75% success rate for EBRT and proton?

Where are these figures available?


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 2/10/2007 6:25 PM (GMT -7)   
naimnut and the other gentlemen who responded

i don't know where someone is getting the 90% success rate on surgery and 75% on radiation, including proton radiation. you have to remember that success rates largely depend on your stage of PC. in the early stages of PC, the success rates from radiation can be comparable to surgery and it is certainly much better than 75%. you can search on the internet to find the 10-year statistics on Loma Linda's treatment of prostate cancer patients with proton therapy. depending on the stage of PC, I think you will find their statistics more promising than a 75% success rate. you must be very careful not to throw out broad statistics without any support, which can greatly mislead those who may rely on what they read on these message boards for purposes of making a final treatment decision. amen!

please see my postings elsewhere:

http://www.healingwell.com/community/default.aspx?f=35&m=720263&p=1

http://www.healingwell.com/community/default.aspx?f=35&m=721993&g=724181#m724181

cheers!

Dave
68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in third area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/22/07.


naimnut
Regular Member


Date Joined Jan 2007
Total Posts : 93
   Posted 2/10/2007 7:25 PM (GMT -7)   

pcdave,

you are absolutely right and I think I was wrong to throw out a statistic that may not be correct. If I can, I'll go back and edit my original post to remove it.

For anyone else reading this thread and wondering, please overlook my haste. I cannot vouch for the accuracy of my 75% figure.

Markus


Age, 53
PSA 3.76, Gleason 6, T1c, scans negative
psa doubling time 35 months
Still researching and deciding treatment options.  Leaning towards da vinci robotic.


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 2/10/2007 7:42 PM (GMT -7)   
naimnut (markus)

you are a good man! being able to edit posts after the fact is a great advantage of this chat room. i have had to make edit changes when i found my information not 100% accurate. good luck to you!

Dave
68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in third area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/22/07.


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 2/10/2007 8:04 PM (GMT -7)   
Mr. Markus: The choice of treatment is difficult for all of us. I was able to make my decision after significant reading of books/articles written by highly credentialed clinicians and academicians (I disregarded internet "junk" and marketing material posted by certain medical providers who didn't possess the experience to meet my criteria to be labeled "expert"); discussions with other men who have undergone the various treatments you are considering; and, consultations with a friend who is also an oncologist specializing in prostate cancer research at a renowned institution.

I suggest you follow a similar course. I think your ultimate decision will be easier to reach if you do.
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