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seeds or RP?

BWILL
Posts: 3
Joined: Jun 2004

Seeking your thoughts - I'm newly diagnosed, PSA 4.9, Gleason 6. I'm leaning hard toward seeds rather than RP. There appear to be some experts with this treatment at the CTRC in San Antonio (near my home). Any help?

rogermoore's picture
rogermoore
Posts: 265
Joined: Mar 2002

Bwill,

I just saw your posting on whether to choose RP or Seed implant as a treatment. From your stats it would appear you have caught the cancer at an early stage.

I am a 3 1/2 yr survivor of a RP from which I have had excellent results. The choice, however, is one to be made by you. I would highly recommend 1) A second opinion from a reputable surgeon and oncologist and 2) Doing extensive research as to the side-effects, chances of cure, etc. You did not mention your age, and that is an important factor. Also, does PC run in your family, and how did you happen to discover the cancer, routine tests or symptons?

Incidently, the reason I elected the surgery option was that if I had gone the implant route and the treatment failed, the option of removal of the prostate at that time would have been virtually eliminated. Your options would have then been somewhat limited.

If you would like to communicate via e-mail see my address in my profile. Just click on my name to view the profile.

Best of luck and keep us posted.

Roger

P.S. Keep a positive attitude, it CAN be taken care of, in many instances with minimal side-effects.

BWILL
Posts: 3
Joined: Jun 2004

Thanks Roger (and Benji as well) for the response. I'm so glad yours is a success.

I'm 55, PC runs in my family. Annual checkup with my urologist showing PSA change from 3.2 to 4.9, then biopsy with 4 of 12 cores positive. Was not palpable or visible on sonogram.

Probably not unlike a lot of others, my urologist recommended open RP; second opinion by radiation oncologist recommended either LRP or seeds (he happens to be a seed implant expert).

I'm having a hard time seeing a success difference between RP vs seeds if confined. If not confined then in both cases it's some sort of salvage. Is the big difference the fact that with RP you would know right away about margins?

Anyway, I've heard a lot of positive feedback from the seed patients of the dr I'm considering. It's seems to be shaping up as the way to go for me. But this is not easy.

I'd really appreciate any other thoughts or advice.

Thanks again for the help,
Bwill

rogermoore's picture
rogermoore
Posts: 265
Joined: Mar 2002

Bwill,

Yes, it is a HUGE decision. However, it is your body so you are the one that ,in the end, is going to have to choose the method of treatment.

The way my Dr. explained it, in the case of implants the seeds have to be placed within a certain distance of ALL cancer cells in order to 100% successful. If one of the cancer cells is not close enuf to a seed, the possibility of it continuing to grow is still there. However, should the prostate be removed and the cancer has not escaped the capsule, then the cancer has been removed. Also, the lymph nodes can be checked at the time of surgery to further determine if any cells have escaped.

Don't know if I have helped or confused you, but I think I am correct in all my statements. I'm sure if I am not someone will correct me.

If you have any further questions please don't hesitate to contact me or do another posting.

Roger

Benji48
Posts: 117
Joined: May 2003

Hi,
I agree with Roger emphatically. Your age is a crucial factor. With a psa <10 & Gleason of 6, in my opinion, the odds of the seeds working are good. As he points out however, once you choose that therapy & it fails you've "burned" the RP bridge (no can do). Therefore think long & hard about the decision.
Good luck, Benji

nutt
Posts: 140
Joined: Sep 2001

Sounds as if you are approaching this carefully and I agree with my friends,Benji and Roger providing both situations are equal, ie.
You need to question both the surgeon (RP) and the Doctor (seed Implant) how many they have each done, success rates and references. Having RP or seed implant done by a less experienced professional does not make the procedure a success, it is the skill/experience of the doctor. From the posts I have seen and etc..., selecting a procedure should be made on getting it right the first time.

My good friends have advised you correctly on RP which gives you the option for radiation later. Having radiation gives you the option for more radiation but, hopefully you will approach this with the attitude to get it right and complete the first time. This would be a better approach.

I had seed implant. Weighed all factors similiar to what we all do (or should).
FYI - I am now 60, had the implant 3-1/2 yrs ago.Our psa and Gleason very close to each other.
psa at .01 since.
Had hormone therapy B4 and after seed implant. Hormone therapy B4 physically reduced the size of the prostate so instead of 120+ seeds I only required 52.

SUPPOSEDLY, the other benefits of hormone therapy (besides shrinking the prostate) it deprived the cancer of the food it needs and made the cancer more suceptiple to the radiation (putting it under stress)? Don't know for sure about these two attributes but it does shrink the prostate causing less radiated seeds per sq-inch and less burning, recuperation time, etc...

I respect docotors BUT, be careful to get two opinions -- doctors are also business men and they tend to "push" their method as being "the one". More than likely, that is all they do or know and thus, may not be the best for YOU!

Also note, seed implant is now being viewed, tested and used in the treatment of ie. breast cancer and others in that it puts the cure into the cancer. Check this out. There may have been other advancements in seed implant or packaged with other treatments ("cocktails"), same with RP since we have all had our treatments. 3+ years is a long time in the medical world.
Good luck and God bless.
Joe

BWILL
Posts: 3
Joined: Jun 2004

Thanks for your input Joe, and I'm glad to hear of your results - sounds like your treatment did the job.

Your comments about getting it right and complete the first time are exactly what makes me nervous. The seed doc I'm considering apparently believes I would need only the implant - no hormones, or other treatment. I believe by prostate volume at time of biopsy was 37.

In my next discussion with him, I'll be sure to explore the monotherapy vs complementary in detail.

By the way, can you share also your side effects from the seeds? And why did you commit to seeds instead of surgery?

Sure glad I found this site - thanks again Joe for the help,

Bwill

nutt
Posts: 140
Joined: Sep 2001

BWILL -
Sounds as if you already made a decision - make sure you have looked at ALL options.

Now, the side effect from the seeds:
was no more than any radiation / surgery. Had the catheter for 3 days. Implant on Friday am and removed on Monday PM and was back to work on Tuesday. Since I was in sales, I drove some, carried a small brief case and did nothing physical for a few days. RP will and rightfully so should have a little more restrictions due to the incision etc...

As indicated, I only required 52 seeds verse the typical 120+ due to hormone shrinkage of the prostate. Radiation/number of seeds is based on the physical mass to be treated.

Radiation like Surgery requires healing time.Hopefully, Benji/Roger can share more data re: healing times and etc...

The hormone therapy was the real problem with side effects. It affects everyone DIFFERENTLY. I had hot flashes (no big deal).There are treatments - also understand an 81mg aspirin helps relieve hot flashes? Check with your doctor!

Some experience mood swings, more or less emotional reactions, wanted to shop a lot heh, heh, - NO sex drive until the hormones wore off but, I decided that was the side effect of selecting the treatment program that best fit my goal of killing the cancer. Check w/ your doctor -- older men are routinely prescribed hormores verse surgery/radiation in later life. Check into why and what benefits hormore therapy has on the cancer for you as an augmentation to seed implant. If, it has no benefit, why is it prescribed?

I had hormone therapy B4 and after (3 mos each)even though doctor did not think it necessary (he believed he got it all) but I went with it for whatever benefits it offered as it wasn't his cancer we were discussing. Check all of these out with your doctor B4 doing anything additional "just because" you can.

I was forturnate in that my urologist is teamed w/ a local oncologist so I had the benefit of tapping their experience between surgery, external beam radiation/seed implant/chemo etc... They did not always agree with each other but that was the beauty between two opinions. They each professionally believed their procedure best and was able to question them in depth.
You may want to ask Benji and Roger their experiences re: RP. Remember, neither is a cake walk and we all have been in your shoes. Some still are. None of this has touched upon when and if your sexual functions will return. That is another area that varies on so many factors. More oft than not - it will take more time than most doctors tell you or the 24 hours period most guys are willing to wait.
Best Regards,
Joe
ps: go into your doctors next appt. with a LIST of questions and do not leave w/o a clear understanding of the answers! Take someone with you to help keep track:it is an issue you are emotiionally involved in.
Joe

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