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

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

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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)

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

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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).

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:

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

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

cheers!

Dave

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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 (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

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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.