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IMRT or surgery

D_P_S
Posts: 5
Joined: Aug 2011

I was recently diagnosed with CaP. Normal DRE, 6 of 14 biopsies were positive, Gleason 3+3 in all samples. The options presented to me were DaVinci Robotic surgery, RP, or IMRT. I am leaning towards IMRT, but I have not found much information on IMRT as a primary treatment for CaP. Any input?

senkoman
Posts: 8
Joined: Dec 2010

I can only speak of my experience with IMRT as this was my choice when diagnosed at 56 with PCA in April 2010. I had 39 treatments at M.D. Anderson that finished in October 2010. During the treatment the side effects I noticed was fatigue, and a weak flow. The fatigue was managed by taking short naps every day and the weak flow was treated with flomax. No pain or discomfort. My energy returned about 2 months after the treatments were finished. In April of 2011, I discontinued the flomax. My 9 month PSA test was down to 0.8. So far I have not experienced any long term side effects. I am not taking any medications as a result of the IMRT treatments and do whatever I feel like doing. As for as ED, I was already taking Cilais about 4 years prior to finding out I had PCA and I cannot tell any difference today. All in all life is good now. I only get up at most once during the night to urinate. No urgency, pain, or flow problems.

Chosing the treatment is the toughest part of PCA. I would not hesitate chosing IMRT again and MD Anderson is an amazing facility. If I can answer any questions about IMRT, let me know.

Senkoman

D_P_S
Posts: 5
Joined: Aug 2011

Thanks for the first hand accounts of IMRT.

SALESMANAL
Posts: 5
Joined: Jun 2011

IMRT IS OBVIOUSLY BETTER THAN SURGERY, BUT BOTH ARE BAD. I HAD IMRT IN 2007 AND FOR A COUPLE OF YEARS MY SEXUAL ABILITIES WERE FINE,(EXCEPT FOR VERY LITTLE SEMEN IN EJACULATE) BUT THEN I GRADUALLY WENT IMPOTENT OVER A PERIOD OF THE LAST COUPLE OF YEARS. VIAGRA AND CIALIS DO NOT WORK ANY MORE, APPARENTLY BECAUSE OF NERVE DAMAGE FROM THE RADIATION THAT DOES NOT SHOW UP UNTIL LONG AFTER THE TREATMENTS. I ALSO GOT BLEEDING FROM THE COLON AFTER ABOUT A YEAR. A COLONOSCOPY CONFIRMED THAT THE RADIATION HAD CAUSED THE BLEEDING. OVER ABOUT A YEAR OR SO, THE BLEEDING GRADUALLY MOSTLY DRIED UP. I AM NOW TRYING HARD TO FIND A FIX FOR THE RADIATION DAMAGE. I GOT SOME HYPERBARIC BUT I NEED MORE. I AM ALSO LOOKING INTO FSM AND STEM CELL TREATMENTS. IF I HAD IT TO DO OVER, I THNK I WOULD DO "WATCHFUL WAITING" FOR ABOUT A YEAR AND RESEARCH ALL THE LITERATURE FOR AN ALTERNATIVE CURE.

Swingshiftworker
Posts: 635
Joined: Mar 2010

Why were you given just a choice between surgery and IMRT? Was it because of the 6 out of 14 positive cores, which suggests a more advanced stage of PCa despite your Gleason 6?

IMRT is "usually" prescribed along w/hormone therapy after failed surgery or for more advanced PCa which are not suitable candidates for other radiation treatments. On the other hand, the choice "usually" given to men newly diagnosed w/early stage PCa is between surgery and brachytherapy (BT). That's the choice given to me but I chose neither.

Assuming that you're eligible, there's also Cyberknife (CK) and Proton Beam Therapy (PBT) which are more precise and require fewer treatments than IMRT. FYI, I chose CK because IMHO it is currently the most advanced method of radiation treatment with the same probability of success touted for surgery and BT for men w/early stage PCa with much less risk of incontinence and ED.

I suggest you look into these treatments as alternatives to IMRT.

As for surgery, I'm outspoken in my opposition to it unless absolutely necessary and there are few cases that I've heard of where surgery is the ONLY option. For a detailed discussion of why NOT surgery, read this article: http://www.hifurx.com/prostate-cancer/prostate-cancer-after-effects/#1.

Because of the number of positive cores in your biopsy, I'm not sure if you have the luxury of time that other Gleason 6 patients have in order to investigate the options. So, I'd encourage you to assess the other options available to you (as well as the availability of insurance to cover it) as quickly as possible.

Good luck!

D_P_S
Posts: 5
Joined: Aug 2011

I know IMRT plus hormone therapy can be used for recurrant cancer after RP, but 15-20 year survival studies on IMRT as a primary therapy are starting to appear, and they sound pretty good. I kind of feel as you do about surgery. I was told that I am not a candidate for BT because of small prostate volume. Still looking at CK, but will probably not get PBT because it is so new.

jerrybs
Posts: 3
Joined: Jan 2012

Shift Worker Please email me i have questions about your experience with CK. I am in a quandry as to the type of treatment to proceed with.
Thanks Jerry

sappinj@sutterhealth.org

hopeful and opt...
Posts: 1332
Joined: Apr 2009

The PSA is not a perfect indicator of P. Cancer, and the rise in your PSA may be attributatble to other factors..ie riding a bike before the PSA, a digital rectal before, or even a hard stool..additionally, you may want to consider having your doc treat for an infection, and see what happens with the PSA.

As you may know the cancer is slow growing, and even if you do have the disease, which a lot of men have at 82, you may wish to do Active Survellance, which is an appropriate treatment for a man such as yourself..

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Craston,

Welcome to the forum. Frankly, I am not even sure why they are doing a PSA on you at age 82 after so many years of low PSA scores. The blood in your urine could be caused by a number of factors not related to prostate cancer. Any of these can cause your PSA to spike. Since it went up, and then came down almost an entire point, I suspect there is something else going on here.

As Hopeful and Optimistic points out, using PSA alone as a prostate cancer detector is foolish and inaccurate. I hope you consult with other urologists who will help you find the cause of this difficulty.

Best to you,

K

mrdezzy
Posts: 23
Joined: Mar 2012

Did you go with the ProstRcsion treatment and if so How did it go..would you recommend it thanks

JBStuart
Posts: 3
Joined: Aug 2011

I just finished 45 courses of IGRT as primary treatment. I was diagnosed in April of this year. Stage 1C, Gleason 6 (3+3), PSA 4.5, positive in only 1 of 12 cores so luckily, I had several options. I did all of the usual research, consultations, etc. and narrowed it down to DaVinci and IGRT.

Potential side-effects seemed more extreme with DaVinci but if I was the type of person who would lose sleep over knowing there was a cancer growing in my body, I would have done it in a second so they could "cut it out and dump it in a bucket" as explained by a surgeon.

Anyway, I started IGRT in June. Had some annoying urinary side effects after the 3rd week in, but the Dr. prescribed Flomax which really helped. Some occasional minor bowel issues, but only the sensation of having to go when there was nothing there. Allegedly both should subside over the next few months but even if they don't they're only really a minor annoyance. Long term side effects and outcome? We'll see...

BTW, no ED at all, although after about two weeks, it was like someone turned off the semen valve. Everything feels the same, just nothing comes out. A little odd at first, but no big deal. An of course, I can't get anyone pregnant. Guess there's a silver line in every dark cloud haha...

robert1
Posts: 82
Joined: Apr 2011

Hello D_P_S:

Even with the number of cores found to be positive, you have many choices and should not feel rushed to make a decision. You will live with your decision forever. Make sure it fits you.

IGRT is CT image guided IMRT, and this treatment option has become very accurate. The documented success rate is very high and the track record is relatively long and excellent. The results for IGRT, CK and PBT all keep getting better and the side effects for each keep improving.

Like the guys here suggest, you should investigate Proton Beam Therapy and CyberKnife also. I had too many positive cores also, so I chose an aggressive option...the combination of IGRT and seeds. All of these options have delivered very good results relative to surgery with fewer negative side effects.

Do some homework and keep asking questions of patients and doctors. I believe the real truth is with survivors. One thing is for sure...whatever treatment option you choose, make sure it is done by a very experienced practitioner. This is critical.

Your choices are many, and your odds of a cure are excellent.

Best wishes,

robert1

mrspjd
Posts: 693
Joined: Apr 2010

DPS,

Don’t know if you’re still reading this thread but, IMO, critical info is needed about your case before tx options can be adequately evaluated. Your PCa profile may or may not fit the tx criteria for certain PCa mono txs and, some PCa txs may not be appropriate for intermediate/high risk prostate cancers. In addition to the Gleason 6 and six of 14 cores positive, more info is needed about your PCa stage and risk level. Perhaps you already have the info but didn’t include it in your post.

What percentage of cancer was found in EACH of the 6 positive cores? For example, 5%, 15%, 25%, 70%, 100%, etc? The percentages may be a good indication of the cancer volume and, therefore, be an important factor in evaluating tx options with the highest rates for long term success for your PCa staging (low, intermediate, or high risk). Your biopsy report from the pathology lab (that analyzed the biopsy slides) should indicate the percentage of cancer found in each core. Ask your doctor for a copy of the report if you don’t already have one. It’s also a good idea to have the written reports from each of your consults with PCa specialists, such as urologists, uro-surgeons, radiation oncologists and PCa oncologists. These reports may contain info about your case that you missed in the actual face to face meeting with the doctors. PCa info and doctors’ language can be very confusing, so it’s best to have copies of all the written reports for your own records.

What are the results of your 2nd opinion biopsy report from an accredited pathology lab specializing in analyzing PCa biopsy samples, such as Johns Hopkins? Did it confirm the same Gleason 6 and percentages as the initial report from the local path lab? Was PNI (PeriNeural Invasion) identified on either biopsy lab report? PNI could indicate a likelihood that the cancer is outside the gland locally, even if imaging tests such as a bone scan and pelvic CT were both negative for distant mets. If you haven’t already sent your biopsy slides out for a 2nd opinion to compare it to the initial path lab report, you can read how to go about it on another thread: http://csn.cancer.org/node/212732.

With 6 of 14 cores positive, IMO it would be wise to obtain as much info as possible about your clinical staging and risk level before considering your tx options. That add’l info may, or may not, indicate that further diagnostic testing is necessary. While 6 positive cores is serious, if the percentages of cancer found in the cores are very low, and a 2nd opinion biopsy report confirms the findings of the first report with low %’s and a Gleason 6, this would be encouraging news. PSA history, age @ dx, pre-existing health issues, and lifestyle choices are also important factors when considering tx options, including all the various forms of RP, RT, ADT, or combination txs.

Making a tx decision that has the best chance for a successful outcome with the least side effects (short and long term) is no easy task and needs careful evaluation. That process takes both time and action. I suggest you take time to do your own research without delay. You may wish to learn more by reading several back pages of threads on this forum in order to find add’l PCa info & resources (books, reputable websites, etc.). You might also consider attending a face to face PCa networking group mtg in your community.

Hopefully, once you have more info about your PCa profile, staging and risk level (including your clinical stage of T1, T2, or T3), you will be in a better position to make a tx choice that is right for you. Good luck.

D_P_S
Posts: 5
Joined: Aug 2011

I am still here, though my password for a while (and went on vacation). My biopsy cores were between 5% and 40% possitive, with a weighted average of 5.5% (dont know if the weighted average is relevant). The clinical stage is T2a, and the Gleason score was confirmed by two pathologists. I am still doing the research and havent decided yet on a treatment. Statistically, I have a 98% chance of non-recurance with surgery based on a 2011 data. I have been told by 2 physicians that IMRT has similar outcomes, but I havn't seen the primary liturature yet. I will check out mpre of the info here.

Thanks again

D_P_S
Posts: 5
Joined: Aug 2011

I thought I was good at getting written reports, but I never even though to get some of the ones you (mrspjd)suggested.

chitown
Posts: 90
Joined: Mar 2010

went thru the similar cycle 18 months ago..CK and Proton were not option as they were new.
Radiation still left the prostate in the body and long term effects were concerns. being young and healthy at 48 (when i was diagnosed) surgery was the clean cut and understood options for me. went for davinci and now am fully recovered (no ED or incontinence problem) and less then 3% of relapse possibility for rest of life...

decision is tough on option..take your time am when it is made commit to if firmly in recovering and carrying on with your life..good luck

robert1
Posts: 82
Joined: Apr 2011

The more surgery and RT patients/survivors you speak to, the more clear your decision will be. Speak to as many as possible, and try to do so through multiple channels.

God Bless You,

robert1

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