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Urologist equates Calypso Radiation same as surgery without the big risk - T2B, Gleason 3+4 and PSA 6.4

pbcsn00
Posts: 4
Joined: Dec 2008

My husband was diagnosed recently. He has a nodule that was staged as T2B, Gleason or 3+4 and 3+3 and PSA of 6.3. The urologist gave Radiation (recommended Calypso IMRT - probably 8 wks) the same survival rate of 85% as surgery (radical prostatectomy) with hardly any downside (no incontinence or impotence). Calypso radiation sounds so much better to my husband and me but what are we missing?

Almost everyone on this site talks about RP (either Da Vinci or Open) as the chosen option. Why would he consider surgery over the radiation?

bdhilton
Posts: 755
Joined: Jan 2010

You have come to a good place to ask questions and many have good information and advice…

I would question "no incontinence or impotence" and the other statement that this urologist you state has stated. Get 2,3 ad 4 opinions. Is this urologist a surgeon or radiologist?

My journey has recently begun but during your treatment selection process you learn a lot about yourself…Never second guess how you decide to treat this and believe that your choice is and was the best decision no matter what the outcome….

During my annual physical on November 20, 2010 my primary physician noted a “nodule” during my DRE. Made an appointment with an Urologist on Nov 30 with a PSA reading of 2.82. Dec 4 had a biopsy and on Dec 14 I was told I had a Gleason of 4+3 in 9/15 biopsy specimens plus I had a palpable nodule right base and right mid. On Dec 28 I had a bone/CT scan that were both negative and my official consultation with my Urologist….

Because my father had prostate cancer in his early 60’s (died at 81 from something else) and my older brother was diagnosed at the age of 56 (PSA over 400 now 61 PSA 280) I started to interview prostate cancer survivors, prostate clinics/doctors and research all forms of treatments from watchful waiting to HIFU in Canada from Nov 20, 2009-January 22, 2010… I choice to have the “old fashion” open surgery or what is still referred to as the “gold standard”. Dr Catalona from Northwestern will perform the surgery on March 3, 2010…This is what is best for me and me only…

From my perspective you need to make the treatment type decision and move on…My surgery date is about 4 ½ weeks out from today and I am already planning my recovery and workout plan. My goal is to climb Half Dome in Yosemite with one of my sons this summer mid July (no not the North Face…but I lived and climb Yosemite the first time over 43 years ago with my father and I lived there 37 years ago)…So my philosophy is to plan ahead and live life. As the old saying goes…Life Isn’t about waiting for the storm to pass…but learning to dance in the rain…

The best of luck but remember your husband needs to make this decision at the end of the day and what ever it is support him from as it is/was the best decision for him…

pbcsn00
Posts: 4
Joined: Dec 2008

Thank you for your information. Actually, the dr. we spoke to was a urologist but he has only done 100-150 surgeries, he is a young guy. He also has a vested interest (partner in the Calypso radiation practice) in the radiation so he may be biased based on his investment.

My husband does not know his biological father's history (he passed away in the 70's).

We are definitely getting more opinions. In fact we're meeting with Dr. Catalona next week for a consultation.We're interested to hear what he says.

bdhilton
Posts: 755
Joined: Jan 2010

do what feels right for you guys not what is marketeted to you... There is a good Di Vinci robotic surgeon in Atlanta Dr. Shah (google him he does not "market" himself...he does not need too...CNN did a piece on him back in 2006). He is the director of robotics out of St Joesph's Hospital and I believe has done 1200 or so di vinci surgries if this is something you are looking into...best of luck...as far as Dr. Catalona he has done over 5000 open surgeries with impressive stats... I believe the most important things in the selection process is the experience and sucess of the doctor performance not the process itself...just my thoughts..best of luck

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

I agree with your doctor and am living proof that radiation is just as effective in killing the cancer in the prostate as surgery and the side effects are much less. I do not understand why surgery is used so much and believe that within 40 years is will be looked back on as the equivalent of putting on leeches. I had a psa of 24 and gleason of 9 at age 52 and the radiation killed ALL the cancer in my prostate. This was verified by another biospy 5 years later. The side effects from the surgery were small to non-existent. Of course my cancer had already spread and surgery was not an option. I personally would tell anyone to go with radiation instead on surgery regardless of their situation because I've seen it work and heard too many horror stories on this site about the side-effects of cutting. Hope this helps. Thanks, Mark

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Wanted to chime in to encourage to you look at all options. Then make up your mind which it sounds like you are doing. I ended up choosing robotic after extensive research on Proton, radiation, seeds, Hifu, etc. One big selling point for me on robotic was that if the cancer comes back then my backup plan is radiation. If the cancer comes back after radiation then I believe the only back up plan is hormone therapy.

Larry age 55. Almost 6 months post Davinci.

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

It is constantly written on this site that the only option after radiation is hormone therapy if the cancer comes back. First of all this is not true and second of all the radiation will nearly always kill all the cancer in the prostate. If it fails to do so there are the options of seeds and more commonly freezing of the gland. Radiation is the more advanced form of treatment as compared to surgery but for some reason most men choose surgery whaich has much greater chance of side effects. WHY?

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

2nd Base...I don't think any one on this forum has ever claimed to be a doctor and typically comments are based on our reading and research and of course Lots of personal opinions.

I dug out my book by Dr. Patrick Walsh (John Hopkins) Guide on Surviving Prostate Cancer. He does go into lengthy discussions on the pros and cons of each of the above methods that you mentioned of Aditional Radiation, Cryo etc. following traditional radiation. Of course medical knowledge increases year by year and as we all know each person's case is so individual with so many factors. It is interesting to read that in studies done in the 1990's that 30-90 percent of men who received standard external-beam radiation therapy had a positve boipsy two years or more after treatment. Hopefully those numbers are getting better with newer types of radiation delivery. (Walsh p.312-313)

Walsh also gives some good guide lines to help determine what type of treatment to take after failure of radiation....The main point being is the cancer still local or do you have metastases?

Walsh points out that 25% of men that have additional radiation after primary radiation are incontinent within five years. (p. 321)

Cryotherapy after radiation showed significant problems in studies at M.D. anderson and Univeristy of California. In one study from M.D. Anderson the side effects for cryotheapy after radiation are "To High" (p. 321)

These along with other factors are again why I chose Davinci as my primary attack for my battleplan to beat this cancer.

I see you joined back in 2004 - I'm assuming you had radiation first. Good luck on your continued journey. My dad had proton radiation back in 1996 and is still cancer free which is the goal for all of us fighting this cancer.

Larry (age 55)

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