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Brachytherapy or Radiacal Prostectomy?

jon11
Posts: 4
Joined: Jun 2009

Hi all special people:

I was recently diagnosed with PC. What a shock! I am a 51 year old in reasonably good health. 11 of 13 core samples were positive. I had a biopsy due to an elevated PSA. My Psa was 7.7 and my Gleason score was 6. The cancer cannot be detected by a DRE and the stage was give as pT1c.
Has anyone out there had a similar diagnosis and what treatment did you choose? This is a real dilemma as you all know I am sure. My main concern is curing the PC and doing as little collateral damage as possible. I would like to keep my potency, so I guess that is why I am leaning towards the brachytherapy. On the other hand the surgery (nerve sparing) offers a slightly better cure rate, but not much (about 7% better).
I would very much like to hear from anyone who has had brachytherapy around my age and surgery around my age and what their experiences were. I hope that I choose the right treatment and can put this bad dream behind me.

Sincerely,
jon11

RRMCJIM's picture
RRMCJIM
Posts: 149
Joined: Mar 2009

Hey Jon11,
I am 54, had di vinci robotic surgery about 18 days ago. I decided on robotic surgery mostly because of my age. I have too many years left to think of not having it removed. This was my choice. It might not be the one for everyone. I consulted with my Dr's and they all agreed with my decision. I would have stressed about it, had I left it in, and had it treated. I only had one of 12 positive core samples, G=3+3. No symptoms , excellent health, very active. Never even had a broken bone, and been down 3 times on my bike (over 40 years of riding).. go figure... I as of this date, have erections already, at 8 days post cath, but still having leakage while walking and standing. Most mornings I have woke up dry. I know it is still early, and I hope to get a handle on incontinence someday. But am taking it a day at a time. My Dr was able to spare the nerve bundles on both sides, and very little blood loss, about a shot glass full he said. Choosing your treatment, all the options, was at first the hardest for me. Talk to the guys on this site, and others out there, do your reading and research, and I am sure you and your Dr will figure out what is going to be best for you. Keep us informed...
Jim

MCSmith44
Posts: 13
Joined: Jun 2009

I was diagnosed at age 64 - clinical stage T1c, normal DRE, 4.92 PSA, Gleason score 6 in 2 of 10 biopsy sites. I did the normal internet research and subsequently spoke with men who had received seed implants from 8 to 13 years ago. None had experienced reoccurence. After consulting with prostate cancer specialists at M.D. Anderson Cancer Center in Houston, I chose seed implants less because of my age and more to avoid side effects as much as possible.

I underwent brachytherapy treatment at M.D. Anderson in May 2008. I have experienced no incontinence, but continue to have some urgency and burning that is expected to dissipate over time. My sexual function has declined somewhat, but Cialis has proven to be effective medication. In conjunction with the ACS, I'm starting a prostate cancer support group in York County SC. If you like, I would be happy to speak with you in more detail. My office telephone number is (803)802-8001.

jon11
Posts: 4
Joined: Jun 2009

Hi:
Just wondering how many men you spoke to that had the brachytherapy and what were their ages? All have had no recurrence in the last 8-13 years?

Sincerely, jon11

MCSmith44
Posts: 13
Joined: Jun 2009

I spoke with four men who had seed implants from 8 - 13 years ago, and none of them has suffered recurrence. I didn't note specific ages, but I think all of them are now in their 60's. Accordingly, I would guess they received treatment in their mid 50's or later.

mikebur
Posts: 24
Joined: Feb 2004

Hi Jon11!!! Sorry to hear about your diagnosis and will keep you in prayer. I had a radical prostatectomy (open surgery - not laproscopic) in 2003 when I was 54 (t1c - psa 4.7 - pre-op gleason score of 6 and post surgery gleason score of 7 with positive margins). My psa is still low since the surgery but I still have incontinence and impotence. In addition, I also have dysorgasmia (painful ejaculation) since surgery and also have bi-lateral inguinal hernias (had the right side operated on already and still need to have the left side hernia operated on). I have been told the hernias occcur because of the long incision during surgery(9" incision weakens the stomach muscle) and the removal of the prostate leaves an open area in the abdomen. You need to make your decision on what's best for you but I'm telling you about the dysorgasmia and hernias because these were not explained to me as possible complications before I had the open radical prostatectomy (the laproscopic surgery does not make a long incision but makes a few tiny holes and should not induce hernias).

Hope this helps and God bless

Mike

kevinb
Posts: 4
Joined: Mar 2009

Hi Jon, It is always sad to hear of someone in you're position, however prostate cancer is quite curable.I am 61 years old. I had the robotic surgery done on May 1 2009. I had a psa of a 3.3 but a lot of family history. Gleason was 4+3=7. I also have incontinence and impotence,but that was explained long before my surgery. Talk to as many people as you can that have been down this road. It is scary thing to go thru be yourself. Think positive and have faith in God,yourself and your Dr. My prayer's are with you. Kevin

lwagner's picture
lwagner
Posts: 5
Joined: May 2007

My numbers were about the same as yours a couple of years ago. I chose the DaVinci surgery and the nerve spareing did not go to well as the margins tested bad so now I have to do the shot to get an erection. Big deal, it works fine and the good part is the PSA is still nill.

nb's picture
nb
Posts: 12
Joined: May 2009

I feel for you and all that you are going through. I was diagnosed in early May with pc; my psa was 5, 1 of 12 biopsy's were positive with a Gleason score of 3+4 - 7. After weighing all of the options and reading as much on information as I could on the topic, I have decided to go with Robotic surgery and have it scheduled for August 18th. This was based the fact I am 53 and did not feel comfortable with leaving the organ in my body and it was a bonus to find out that this surgery produces quick recovery times, is less evasive and has some tremendous support via testimonials on this website and others. The key for me was to identify an experienced surgeon and I have done this.

I will be praying for you as you walk through this experience.

nb

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

NB, my psa is also 5.1. I had 5 biopsys come back as Gleason 7. 3 at 4+3 and 3 at 3+4 I'm age 54 and scheduled for robotic surgery August 12th.

Drop me a note at lewvino@yahoo.com if you want to chat. Sounds like we ae in the same ball park with this.

Larry

hopeful and opt...
Posts: 1454
Joined: Apr 2009

I'm sorry to hear of your diagnosis. Remember, that prostate cancer grows at a very slow rate, so take your time to make the right decision. There is no rush, but be active. It is critical that you get a second opinion of your biopsy. There are various places that you can have the people who have your slides sent to; J Epstein at Johns Hopkins is one.

Speak to doctors in different disciplines. Go to support meetings, read book, become empowered.

Where do you live? Some of us may be in your area, and can give direction to the best doctor. You really want the best, even if you have to change location to get treatment.

We here, are all "brothers" with you, and are here for you.

Ira

ps. I'm 66, doing active surveillance. PSA 2.2, gleason 6, 2 of 12 positive cores with 5 percent or less in each. Stage T1

jon11
Posts: 4
Joined: Jun 2009

Hi:

Thank you for your words of encouragement. My biopsy was done by Geisinger Health System. I live in NE Pa (the Wilkes-Barre area). Who do you recommend for a second biopsy opinion? You had mentioned John Hopkins and a Dr J. Epstein. How do I go about getting a second biopsy? I have Blue Cross insurance, so I am sure this would be covered by them. Do I need to contact someone from John Hopkins or do I simply inform my doctor (the one who performed the biopsy) that I want a second opionion on my biopsy. Do you know of any facilities near my area other than Geisinger that would give me a second opinion on my biopsy? Any info. would be helpful.

p.s Have you had a second opinion and was it very different from the initial report? Sincerely, jon11

hopeful and opt...
Posts: 1454
Joined: Apr 2009

A quote from a very good book that I am studying--a primer on prostate cancer by stephen b. strum

if your gleason score has been given an interprettion that is lower or higher that that rendered by an expert, you may undertret or overtreat your cancer based on erroneous information

Two of eight referrals that this book gives are:

David bostwick virginia 800 214-6628
jon epstein johns hopkins 410 955-5043

I have seen these two recommended in other books as well.

You want an expert to examine your pathology. The above two are experts(artists in the field).

I had my original pathology examined at uc irvine in Ca., where the urologist who did the biopsy works. This is one of about 50 national cancer institutions. I had my slides sent, overnight to Johns Hopkins. JH confirned my results. I had contacted the pathology dept of uc irvine to have them sent.

Basically, doing the pathology is fairly complicated, and the slides have to be read very carelfully by an expert pathologist.

Ira

jon11
Posts: 4
Joined: Jun 2009

Hi Ira:

I am getting a second opionion on my biopsy from an expert. I also got the book that you had mentioned and plan on reading it thoroughly. I really want to know which is the best treatment for me. I don't want to over or undertreat for this. I get the feeling that if a surgeon is consulted, he will recommend surgery and if a radiologist is consulted he will recommend radiation therapy. What is your experience? Thank you for the information.

Sincerely, jon11

hopeful and opt...
Posts: 1454
Joined: Apr 2009

those from each discipline will recommend their own; additionally some are sharks and will tell you that you need to do something right away, and will give you the bums rush.

You did not mention the involvement in each postive core? You need to find out if the the cancer is contained in the prostate, if there is any nodule involvement before deciding on treatment. there are tests for this.

As I understand, if you have radiation, the tissues become radiated, so if it is unsucessful you cannot have surgery afterward( or it is very, very difficult). It seems that robotic surgery is the gold standard now a days. You want to find an expert, one who is very experienced. You are only going to do this once, so if you have to relocate to do it, thats fine.

ira

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

Hi Jon,

I agree with many comments with this post.I was diagnosed in March 2009 with PC. It took me a while to get answers from my local doctors so, I did a lot of reading and research which led me to John Hopkins.
If you have radiation and the cancer comes back you cannot have the surgery because the tissue damaged is such that surgery is out of the equation. My decision was surgery davinci robotic method at John Hopkins.
I see improvements every day, sometimes a step backwards and sometimes forward.
Support and answers with details are here in this forum. Good Luck!

Jim (shubbysr)

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

When I saw my Surgeon on June 8th, He told me that he was going to send the biopsy slides to John Hopkins automatically for a 2nd opinion.
Larry

kevin mcpadden
Posts: 7
Joined: Jun 2009

Strongly recommend Dr Tewari Cornell/N.Y. Presb. (see my story)

tonybear
Posts: 92
Joined: Mar 2009

i had brachy thearpy done at the cancer treatment centers of america in tulsa. the one near chicago (zion) has a new choice for protate cancer. it is called body gps. you may want to check that as an option since it is new. the hospital i went to in tulsa was great. but i haven't heard anything about the one in zion ill. best of luck on your future.
tony

Watch.repair.man's picture
Watch.repair.man
Posts: 49
Joined: May 2009

Hi Jon.
I am sorry you too are going through this diseace.
I was diagnosed in May 2009 with PC.
I did a lot of reading and looking for answers.
I did find one thing that made me worry, that if you have radiation and the cancer comes back you most likely cannot have the surgery. My thoughts are that my prostate went bad this time and allowed the cancer to start, what would stop it from doing it again. If I have it removed it will not have the chance to do it again.
I did a lot of praying and looking for guidance from the Lord.
My answer was to have it removed which I did on June 15, 2009 by the davinci robotic method.
It's not a cake walk but everyday I see improvements.
Never forget he is there for you no matter what you believe in. All you need to do is ask for help.
This forum is awesome also. There are so many men having his disease. If you need an answer it is most likely here or someone here can relate.
I will keep you in my prayers and wish you the best on your decision.
Keven

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

I looked into radiation and seed implants. I asked my local Urologist about if you have radiation can you have surgery later. His reply was that is a 1/2 truth. The radiation makes doing surgery more difficult. That is why some surgeons refuse to perform surgery after radiation. He only performs traditional prostate surgery and was kind enough to recommend a Dr. at Vanderbilt for me that has lots of DaVince experience. He stated he will still provide me follow up care so I respect his answer to the radiation/surgery guestion.

Larry

dachem
Posts: 3
Joined: Apr 2009

I posted this reply on another thread, and then I saw this one, so, in case you didn't see the other thread, I'll post it here also.

I was age 62 when PC was discovered. Gleason of 6, PSA of 4.6. I chose seed implants and am totally happy with the outcome. That was 11 years ago, my PSA has stayed low and I have had no after-effects of the procedure at all. In fact, I played 18 holes of golf 11 days after the procedure and have continued to have an active life. I chose seeds because I thought they would have the smallest probability of radically affecting the quality of my life, and so far I think I made the right choice.

hesian
Posts: 4
Joined: Sep 2009

Hi Jon, I was diagnosed in August and have much the scores, Gleason 6, PSA5.3, and 8 out of 12 positive with 2 more pre-cancerous. I am doing the research as well and at this time I'm leaning towards the Brachytherapy due to what seems like less possible side affects.I'm 54 and have three small children, and the thought of having to keep them at arms length for 6 weeks after the Brachytherapy is a big concern for me, but when I look at the precentages, it still seems better that the surgery. I've been told that having the cancer on both sides increases the difficulty of nerve sparing as well. Take your time and good luck with your decision.

chorton581's picture
chorton581
Posts: 15
Joined: Dec 2009

The cancer treatment center in tulsa offers the HDR Brachytherapy.
Since the seeds are not left in you will not be as radioactive and should not affect your children

jbrick
Posts: 4
Joined: Dec 2009

Hi Jon,

I am a Jon too and at 52 years old I was just diagnosed with PC in the last month. The good news was that I only had 1 out of 6 cores come back positive. The bad news is my PSA shot to a 9.2 and my Gleason is a 4+5/9. In my case I am being told that surgery is not the best option. With that said I gave all treatment options equal billing.
I am leaning toward a very agressive radiation therapy plan which includes hormone therapy, brachytherapy and low beam therapy. My concern was and is same as yours regarding surgery. I have heard the same message from everyone and that is finding the best surgeon is huge when it comes to nerve sparing surgery.
What I am also finding out no two situations are the same so as others say it well" do your homework, get a second opinion and don't look back when you do make that decision.
Good luck!

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