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Trying to decide between Davinci and seed implants

hesian
Posts: 4
Joined: Sep 2009

After beeing dignosed with prostate cancer and having a Gleason of 3+3 and a PSA of 5.3, my urologist told me that I was a good candidate for davinci surgery or Brahytherapy. Trying to decide which has been very difficult. At first, the thought of just getting it out seemed like the best idea and the advances in surgery including the davinci method seemed to make a lot of sense. Then came the visit to the radiation specialist and when I left, I was wondering why anyone would opt for surgery if the radiation was a good fit. Consequently, I'm looking for unbiased opinions of both. I'd like to hear both the good and bad sides from whomever is willing to share. Thanks

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

Hesian,
Sorry to hear about your cancer but you will find great support hear. I'm turning 55 this week and had the Davinci surgery on Aug. 12th. I've been doing very well so of course I'm prejuideced towards the Davinci. I've been 100% dry since the catheter came out. My gleason pre surgery was 4+3 and then downgraded after surgery to 3+4.

I had talked to one doctor that does seed implant/radiation combo. I chose the Davinci for three main reasons.

1. The seed implant doctor only gave me a 54% chance of being cancer free in 10 years following his procedure.
2. I decided I wanted the cancer out so the Doctors and myself new where I would stand for the future. It is difficult to have surgery post seed implant. Now if my cancer would come back they can treat me with radiation so that gives me another tool in the arsenal for possible future need.
3. Another reason was that with seed implants and or radiation the side effects will start typically later such as urine control and sexual functioning. You didn't say your age but I decided in my mind that at age 54 I can battle the Urine and sexual issues NOW While younger.
So far I've been 100% dry and things are starting to work sexually with assistance from Lavitra. Though remember every man is DIFFERENT. I wish all had success like I've been having but most are taking longer with surgery to get dry and start getting erections.

I'm good friends with a man that is in his late 70's that had the seed implants back when he was in his early 60's. He is doing very well health wise.

Based on your age make a wise decision. You might want to purchase and read Dr. Patrick Walsh's book on Surviving Prostate Cancer. He is up at John Hopkins and an excellent book.
You can order the book online from any of the booksellers.

Research, Read, Research and pray then make your decision.

Best of wishes to you.

Larry

hesian
Posts: 4
Joined: Sep 2009

Thanks for your comments Larry. I'm glad to hear that you are doing well. I turned 54 today, so we're pretty close as far as that goes. I've been told that surgery can be performed after seed implants but it's a little tougher.The main thing is that since the cancer is on both sides, the prospect of nerve sparing is a little bleaker. I'm going in for an MRI nxt Tuesday to try and determine whether or not the cancer is confined to the prostate. If it has spread beyond, then both the surgery and brachy won't work without external radiation which I've been hoping to avoid. Again, thanks for your thoughts my friend, I look forward to chatting again.

NM
Posts: 214
Joined: Jul 2009

Hi my name is Nick and in 52 yrs old. I had a 24 needle biopsy divided into 6 sections. Only 1 came back cancer free the rest cancer with perineural invasion. I researched for 2 months and talked to many doctors and I myself decided on Davinci robotic surgery. I am now 10 days post-op have no incontinence. My personal reasons beyond medical were get it out and then if necessary radiation. I actually switched both doctors and hospitals 2 months after diagnosis. I can only say to you that this is an extremely personal decision. Read,research pray cry,I did all of these. Then my wife and I sat down and decided,yes my wife helped me decide, what course my life would take. There is one thing you should consider and its with surgery expect 4-6 weeks off work with the seeds I am not sure. I didnt give you many facts and figures as I believe you should get them for yourself. One thing too, You dont have to rush into any decision, my doctor said take a month or so and think,research,pray.My advice to you is read all the old posts as they are from others who have already traveled the road your starting on. Get a second opinion,I chose John Hopkins for mine,and after you make your decision dont look back dont second guess yourself after the fact. Praying for you and yours and wishing you peace of mind as you start.......Nick

steckley
Posts: 100
Joined: Aug 2009

Hesian,

I agree with all of the points made by Larry and Nick. Probably the biggest factor in my choice of Davinci was the point made by Nick ... if I had surgery and still had cancer, I could then try radiation; however, if I chose brachy and still had cancer I could not have surgery to remove the prostate.

Bob

Kentr
Posts: 111
Joined: May 2009

As Steckley correctly noted,

"if I had surgery and still had cancer, I could then try radiation; however, if I chose brachy and still had cancer I could not have surgery to remove the prostate."

I forgot to mention that possiblity - sorry. I figured at my age I'd roll the dice on that possibility and "bank" on the fact that if brachytherapy doesn't kill it all, it's slow growing and I'll die with cancer rather than from cancer.

Kentr
Posts: 111
Joined: May 2009

I'm 68 and had brachytherapy in January of 2008. My original diagnosis revealed a Gleason of 3+3, 3+3 and 3+4 (three out of ten areas) and a PSA of 4.7.

Like so mmany of us, I really had to work at figuring out which treatment would best suit my personal situation so you're doing the right thing by seeking out multiple opinions.

"Watchful Waiting" as an option was tossed out pretty quickly - as the doctor said, "Will you be waiting until we're at the point where we can't do anything to help you?" To make the decision even harder, my PSA actually dropped to 3.7 about a month before surgery and when I talked to the oncologist he agreed that the cancer was mosy likely very slow growing but he still felt I should proceed.

Then I considered the radiation therapy. It was five days per week for about seven weeks. I just didn't feel that confident with that approach - rightly or wrongly concerned about severe side effects.

I only briefly considered removal of the prostate and I can't really tell you why I didn't consider it further - maybe because I just don't like the idea of someone removing one of my organs?

OK, enough of that. Surgery was done at around 2:00 pm and I was headed home by around 6:30 pm but I barely remember the journey I was so dopey, LOL

After surgery I had a catheter for three days (hated that).

I experienced a great deal of "urgency" relative to urinating and bowel movements for a couple of months. I'm pretty much back to normal now. I never get up at night (never have) so that's good. Sexual drive is sadly lacking. Just recently experiencing middle of the night erections (not full but almost functional so maybe there's still hope?).

Best of luck to you!

novaguy
Posts: 76
Joined: Jul 2009

That's a tough call. My PSA was 5.6 and my biopsy Gleason was 3+4. I went to the radiologist for seeds, and was told that because of my numbers, if I had seeds I should also have external radiation. That's when I decided to have da vinci instead, because I'd be done with it, hopefully, and could always get the external radiation if the cancer came back. My pathology was Gleason 4+3 with 25% cancer, so I'm glad I had the da vinci, at least I know that the prostate and everything around it came out. My SV were negative, and so were my margins, so I'm hopeful that I'm cured. I still have not had my first PSA but if it's 0 that's another good sign. With seeds I would have more uncertainty, and as others have said, the side effects take a while to develop. With surgery, what you see is what you get. I'm dry and already have regained some erection, but both my nerves were spared.

Bottom line, this is an individual decision, and in your case I don't know what I would do. I would probably have chosen seeds if that by itself gave me good odds of a cure.

WHW's picture
WHW
Posts: 189
Joined: Jul 2009

Hesian,

I was diagnosed June of 2009 and confirmed in July. My signature at the bottom has all of my stats and numbers.

My situation is just a little different than the others although my ultimate decision was based on many of the same facts.

As most of the folks on this board know, my wife also has cancer- Multiple Myeloma. She has been dealing with it since November 2005. Hers is not curable. You only hope that with available treatments you can beat the numbers down to a manageable level take a break from the treatments and hope for new solutions to be developed before beginning the next round. We have known for a while that her cancer would not kill her, rather the complications and failures to her organs and immune system.

My thought process therefore was a little different. I weighed the pros and cons of alternative methods. I chose da Vinci Surgery.

My surgery is scheduled 2 days from now, the 17th, in Detroit. IN fact I am at this moment packing and wrapping up loose ends to fly out tomorrow.

I have read and been told the same things mentioned here. My numbers and gland confinement give me a better than even chance to have the cancer removed along with the prostate. I will know sooner from this method because of the post surgery testing than I would with radiation. I am a young 60 and in really good shape. I figure to be more able to handle the rigors of continence and ED recovery now than later. I have not talked to anyone on this board or others that have had radiation and at some point not had these issues slowly begun to creep up over time. My decision was therefore influenced by the fact that I need to be stronger now to help my wife and not face the possibility of decline down the road when she may need me the most.

Just as my wife is dealing with hers in hopes of continued development of newer and better alternatives, if the surgery doesn't get it all, I can then avail myself to the other methods (radiation,hormone therapy, etc.).

Each and everyone walks this path only with ourselves and our loved ones. We each make our own decisions based on our COMMITMENT to the treatment that we feel is best for us. And once that decision is made we must never look back and never start playing the what if game. To play that game is the same as saying "What If" I never got the cancer in the first place. To do that we stop living and move instead into a life of existence. That is something I refuse to do. As most of the folks here know my Mantra is 'EVERY DAY IS A BONUS'.

A friend sent me an email of encouragement yesterday and included a quote that could never be more appropriate that now; "Nobody can go back and start a new beginning, but anyone can start today and make a new ending."

Best of luck in your personal search for the right answer FOR YOU and YOUR LOVED ONES.

You will be prayed over and blessed by many on this forum as I have been. You have come to the right place for positive support, encouragement, and personal experiences and knowledge.

God Bless you and your family,

Sonny

60 years old
PSA November 2007 3.0
PSA May 2009 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

Surgery set for September 17th, 2009 with Dr. Mani Menon at the Henry Ford Medical Center in Detroit.

wxman
Posts: 19
Joined: Jun 2009

A lot of great comments here. As Kentr mentioned above, generally if you choose radiation first, it is difficult to do surgery second. If you choose a surgical procedure first, radiation can always be tried second. It also depends on your age. If you are young surgery is probably the best track. That's what I've learned from my doctor and wife who did a lot of research for me.

We'll be praying for you too WHW!

hesian
Posts: 4
Joined: Sep 2009

I truly appreciate all of your comments, suggestions, and prayers. Although this decision is a tough one, I take comfort in knowing not only that so many have dealt with it before me, but that you are willing to share your experiences with me and others. I will keep you up to date with my progress and hope that when my treatment is done, I can help others deal with this as you have helped me. My thoughts and prayers are with you all.

TucNav
Posts: 8
Joined: Aug 2009

I will have my surgery on Oct 6. I am 57 with a PSA of 6.0. Gleason was 3+3, 3 of 12 came back positive with 2 showing PNI. Because I have an enlarged prostate, 4.9 grams, I was borderline for seeds. As noted by most of the guys above, my choice was driven by getting the cancer out of my body and having the option for radiation later. One of the Docs I spoke with said that the radiation technology is advancing quickly so that if I needed it later it should be more effective and not as evasive as it is now. In addition, I was taken aback by the number of guys who had some very bad side effects from radiation. Talk to a lot of Docs to include the “cutters” and the “burners” then discuss with your closest advisor. Tough decisions but as one Doc told me, “If the cancer is encapsulated in the prostate, which your numbers indicate, then you will be cured. No cancer.” Best of luck! And welcome to our shared fraternity, brother.

MWA1028
Posts: 22
Joined: Aug 2009

Hesian,
Sorry to hear about your diagnosis, but as TucNav said, you are now a member of an exclusive fraternity, and have lots of brothers all over the world to help you through this difficult period of your life.

I'm 56 & in relative good shape. I had Da-Vinci surgery on 18-Sept. My daily post-op recovery process is listed elsewhere here. I'm going to have my catheter removed tomorrow. Several months ago, my urologist advised me that for 'young' men in their 40's & 50's, he felt that the best 'long-term' solution (mentally & physically) was to have surgery & then 'forget' about it. My feelings were already aligned along his way of thinking, so for me there was no other option. I wanted this diseased organ out of my body, so Da-Vinci was the only way to go. The key things are this - select an excellent hospital & more importantly, an experienced surgeon. You want someone who has done hundreds or thousands of these types of operations. Now, I know that having that little ***** removed does not mean that I can 'forget' about it. I will need to have my PSA checked several times a year for the next 5 years. Only then will I be able to say that I have truly beat this thing.

This is a tough decision you have to make. You have to choose what is best in the long run, both physically & mentally, for you. This whole cancer 'thing' will now be on your mind every day, for a long time to come. Don't be afraid of the da-vinci surgery. It's usually not a big deal, but as Larry said - everyone has a different experience. My urologist said seed implants have come a long way, and can be quite effective, but my mind was already set. Get it the hell out of me.

I wish you all the best in this difficult decision. Just research the crap out of it. Cut down a few trees & print out as much material as you can. Take it to your urologist, sit down, and discuss all the pros & cons in depth and detail. You have to make the decision & then be comfortable with it. All the best. My prayers are with you.

Marshall

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