Seattle Prostate Center Dr Grimm Seed Implants good or bad?

scottstoyan

I am a 52 Year old with a recent diagnosis of prostate cancer.  My psa is 9.4 and my gleason score is 4+3.  I have spent weeks researching all the different approaches to combat this problem.  My urologist spoke with me last week and gave all the reasons why he should conduct surgery on me...as he was talking I could almost imagine him sharpening his scalples looking at me.  I am not really interested in all the complications that most likely will happen with even robotic surger.  I have looked at proton therepy in Loma Linda but alas my insurance does not cover it.  I am from Washington state and I have an appointment with Dr. Grimm in Seattle at the prostate institute of seattle, He does seed implants and that seems like a more viable way to go.  Does anyone have any post implant suggestions good or bad for me?  He uses either iodine or cesium seed witch have a longer life than do palladium seeds.  I was reading about one center that uses a mix of IMRT and palladium seeds because the palladium have a half life after 17 days, this makes sense to me as the problem with seeds is you could over radiate the area opening the door for a host of other problems...any help would be appreciated

hopeful and optimistic

Dear Scott,

I am sorry for your diagnosis.

Have you had other diagnostic tests to determine the extent of the cancer; is it localized or outside the capsule...ie MRI with a Tesla 3.0 magnet.

An indication of localized or outside the capsule is information from the biopsy, how many cores were taken? How many were positve? What was the percent involvement of each of the cores were positive?

I've attended a lecture by Dr. Grimm he is world known and an "artist".  If you qualify for seed implants you will be in good hands.

Please get back to us with more information about your biopsy results.

Keep on posting here

dcirrotti

seeds are bad news.

Look into Cyro that treats only the tumor and leaves you with a functioning prostate like the lumpectomy for brest cancer, that is what I am doing also.

Data has show that focal cryoablation is as good for prostate cancer control as any other treatment—including surgery, radiation and hormone therapy—but it is less invasive and traumatic for patients, preserves sexual and urinary function and has no major complications. Interventional radiologists tailor treatment to each patient's disease. Instead of removing the entire prostate, or freezing the entire prostate or using radiation on the entire prostate, interventional radiologists can find out where the cancer is and just destroy the cancer," said study author Gary M. Onik, M.D., interventional radiologist and director of the Center for Safer Prostate Cancer Therapy in Orlando, Fla. Also challenge your insurance on proton and check with UF Proton in Jacksonville, seeds are bad news for us but good for the doc's and the insurance. I am in the decision mode just like you.

SeattleJ

Seattle Proton

Seattle Cancer Care Alliance (SCCA) did just open a new proton facility in Seattle so that is an option here as well.

Good luck!

John

 

 

scottstoyan

dcirrotti said:

seeds are bad news.

Look into Cyro that treats only the tumor and leaves you with a functioning prostate like the lumpectomy for brest cancer, that is what I am doing also.

Data has show that focal cryoablation is as good for prostate cancer control as any other treatment—including surgery, radiation and hormone therapy—but it is less invasive and traumatic for patients, preserves sexual and urinary function and has no major complications. Interventional radiologists tailor treatment to each patient's disease. Instead of removing the entire prostate, or freezing the entire prostate or using radiation on the entire prostate, interventional radiologists can find out where the cancer is and just destroy the cancer," said study author Gary M. Onik, M.D., interventional radiologist and director of the Center for Safer Prostate Cancer Therapy in Orlando, Fla. Also challenge your insurance on proton and check with UF Proton in Jacksonville, seeds are bad news for us but good for the doc's and the insurance. I am in the decision mode just like you.

combination therapy

Thanks for the info, I am now talking with the Dattoli cancer cener in Sarasota Florida, they do a specialized DART IMRT and palladium seed therapy for most patients with a 16 year track record.  I will look into focal cryoablation and would appreciate some follow up if you have this done

 

yankeefan

why not get a second opinion from another urologist....

if your urologist advised you to have a prostatectomy, there is a chance that he is giving you good advice and not just looking to make money from your surgery. How old is your urologist? Is he just starting out? If he's been around for a while and has a good reputation, my guess is he doesn't need your business...he's had plenty already and there's no shortage, unfortunately, of men with prostate cancer. You may be right, but then...so may he. I would advise to stay away from seeds as a first choice, but then that's my non-informed oppinion....we go to doctors because they are trained to know what to do...

Your urologist should have gone over all the options and explained the risks/benefits to each of them. For example, he should have given you the name of a radiation specialist to discuss radiation and another surgeon to talk about surgical options.

I know this diagnosis isn't one you want but I recommend getting a second or third oppinion before making your decision, which ultimately is yours.

best of luck

 

 

caseyh

Long term survival

UCSF recently published a study in the British Journal of Urology International that analyzed 232 papers published in the last decade.  The purpose of the study was to measure survival time after treatment.

"For men at low levels of risk, prostate cancer mortality was very uncommon, and differences among the treatment options were small. The survival differences increased substantially for men at intermediate and high risk, according to the analysis, with the greatest relative benefit for surgery seen for men at higher levels of risk."

"For intermediate- and high-risk cancers, both survival and cost generally favored surgery over other forms of treatment - although external-beam radiation and brachytherapy together were comparable in terms of quality of life-adjusted survival for high-risk prostate cancer."  This would suggest that the notion that surgery is not effective once the cancer has escaped the capsule is outdated.  Multimodal treatment plans are leading to increased survival rates.

Based on the UCSF study, surgery or external-beam radiation and brachytherapy together would be your best bet.  Note that both treatments "were comparable in terms of quality of life-adjusted survival."  The side effects of all treatments were pretty much comparable when taken as a whole.

I have been a patient at Datolli and their statistics are very impressive.  Datolli does combination external-beam radiation and brachytherapy.   If you have any questions about Datolli, contact me via CSN email.  I am a Gleason 7 survivor currently out 13 years.  I am confident that you have many good years ahead.  Take your time and study all of your options. 

Good Luck!

scottstoyan

caseyh said:

Long term survival

UCSF recently published a study in the British Journal of Urology International that analyzed 232 papers published in the last decade.  The purpose of the study was to measure survival time after treatment.

"For men at low levels of risk, prostate cancer mortality was very uncommon, and differences among the treatment options were small. The survival differences increased substantially for men at intermediate and high risk, according to the analysis, with the greatest relative benefit for surgery seen for men at higher levels of risk."

"For intermediate- and high-risk cancers, both survival and cost generally favored surgery over other forms of treatment - although external-beam radiation and brachytherapy together were comparable in terms of quality of life-adjusted survival for high-risk prostate cancer."  This would suggest that the notion that surgery is not effective once the cancer has escaped the capsule is outdated.  Multimodal treatment plans are leading to increased survival rates.

Based on the UCSF study, surgery or external-beam radiation and brachytherapy together would be your best bet.  Note that both treatments "were comparable in terms of quality of life-adjusted survival."  The side effects of all treatments were pretty much comparable when taken as a whole.

I have been a patient at Datolli and their statistics are very impressive.  Datolli does combination external-beam radiation and brachytherapy.   If you have any questions about Datolli, contact me via CSN email.  I am a Gleason 7 survivor currently out 13 years.  I am confident that you have many good years ahead.  Take your time and study all of your options. 

Good Luck!

Thanks for you input

Thanks for your detailed input,  I am taking my time and getting a second, third and probably fourth opinion.  I have sent my info to the Dattoli clinic and am awaiting them to contact me.  I would appreciate it if I could call sometime and talk about your experience...that would be very helpful.  

starr15

scottstoyan said:

Thanks for you input

Thanks for your detailed input,  I am taking my time and getting a second, third and probably fourth opinion.  I have sent my info to the Dattoli clinic and am awaiting them to contact me.  I would appreciate it if I could call sometime and talk about your experience...that would be very helpful.  

MD Anderson has a GU

MD Anderson has a GU multispecialty clinic in which one talks to radiation therapists ( IMRT, Proton, brachytherapy) and a surgeon one on one in order to choose a treatment.

robert1

scottstoyan said:

Thanks for you input

Thanks for your detailed input,  I am taking my time and getting a second, third and probably fourth opinion.  I have sent my info to the Dattoli clinic and am awaiting them to contact me.  I would appreciate it if I could call sometime and talk about your experience...that would be very helpful.  

Combination therapy

Hello scottstoyan:

One question we all ask ourselves before choosing a treatment option: "is there PCa outside my prostate capsule?"  Regardless of all the testing available, you may never know for sure.  If the disease is outside your prostate, the odds are extremely high that it hasn't traveled far.  I choose IMRT and seeds for this very reason.  I do not know what my long-term outcome will be, but I wanted to treat my prostate and as much periphery as possible with minimum collateral damage.   RT and RP both have excellent outcomes, but this perceived advantage of combination RT, and direct and written stories of side effects for both, sealed my decision.

I was treated by John Sylvester who used to practice with Blasko, Grimm and Sylvester. They wrote the book on seed implants. Dr. Sylvester is now practicing in Sarasota, as is Dr. Datoli, and all of these doctors have very long and impressive track records.

It is often more important who you choose to treat you that what treatment option you pick.  Make sure your surgeon or oncologist has at least 1000 procedures under their belt, and get a good list of patient referrals before moving ahead.  There are web sites like YANA that list stories from a wide variety of real patients, so you can also get information from patients not given to you by a specific doctor.  This really helped me.

It's a scarey time, but you will be fine.

God Bless You!

scottstoyan

robert1 said:

Combination therapy

Hello scottstoyan:

One question we all ask ourselves before choosing a treatment option: "is there PCa outside my prostate capsule?"  Regardless of all the testing available, you may never know for sure.  If the disease is outside your prostate, the odds are extremely high that it hasn't traveled far.  I choose IMRT and seeds for this very reason.  I do not know what my long-term outcome will be, but I wanted to treat my prostate and as much periphery as possible with minimum collateral damage.   RT and RP both have excellent outcomes, but this perceived advantage of combination RT, and direct and written stories of side effects for both, sealed my decision.

I was treated by John Sylvester who used to practice with Blasko, Grimm and Sylvester. They wrote the book on seed implants. Dr. Sylvester is now practicing in Sarasota, as is Dr. Datoli, and all of these doctors have very long and impressive track records.

It is often more important who you choose to treat you that what treatment option you pick.  Make sure your surgeon or oncologist has at least 1000 procedures under their belt, and get a good list of patient referrals before moving ahead.  There are web sites like YANA that list stories from a wide variety of real patients, so you can also get information from patients not given to you by a specific doctor.  This really helped me.

It's a scarey time, but you will be fine.

God Bless You!

A lot of great info

Thanks for the comments Robert...I spent some time at the YANA website and it was very informative

scottstoyan

Updated Gleason Score

As an update I got a second opinion from Dr. Epstien at the John Hopkins Hospital and my revised gleason score is 4+5=9 ouch.  I am waiting for a call from Dr. Sorace from the Dattoli Clinic in Florida and will update with my thoughts on the initial consultation....I am trying to stay calm and sane.....take a deep breath....I am very glad to have joined this discussion board and appreciate all the comments so far

 

graumli

robert1 said:

Combination therapy

Hello scottstoyan:

One question we all ask ourselves before choosing a treatment option: "is there PCa outside my prostate capsule?"  Regardless of all the testing available, you may never know for sure.  If the disease is outside your prostate, the odds are extremely high that it hasn't traveled far.  I choose IMRT and seeds for this very reason.  I do not know what my long-term outcome will be, but I wanted to treat my prostate and as much periphery as possible with minimum collateral damage.   RT and RP both have excellent outcomes, but this perceived advantage of combination RT, and direct and written stories of side effects for both, sealed my decision.

I was treated by John Sylvester who used to practice with Blasko, Grimm and Sylvester. They wrote the book on seed implants. Dr. Sylvester is now practicing in Sarasota, as is Dr. Datoli, and all of these doctors have very long and impressive track records.

It is often more important who you choose to treat you that what treatment option you pick.  Make sure your surgeon or oncologist has at least 1000 procedures under their belt, and get a good list of patient referrals before moving ahead.  There are web sites like YANA that list stories from a wide variety of real patients, so you can also get information from patients not given to you by a specific doctor.  This really helped me.

It's a scarey time, but you will be fine.

God Bless You!

John Sylvester

My husband was recently diagnosed with prostate cancer and we consulted with JS. Since your post was from 2013, how are you doing now? We feel confident in JS's experience although we feel a little "rushed" after seeing him. The plan is to do seeds followed by IMRT (Gleason 4+3). Just when we thought the plan was in place, JS asked if we wanted Cs 131 seeds or Iodine. Needless to say, our confidence level evaporated instantly! Any input you could add regarding JS would be appreciated! Thanks.

VascodaGama

Brachytherapy seeds implant differ on their half-life

Graumli,

I hope some of the bracky patients of this thread will respond to you. However, the title of the thread may not be appropriate for appealing the attention of guys with such experience. In fact Dr. Grimm die in 2016, unfortunately. You could start your own thread with your husband diagnosis details and inquires. 

I have read a lot about brackytherapy (it was one of my choices back in 2000) and got friends who have done it successfully. Dr.  John Sylvester (a pupil of Dr. Grimm in Brackytherapy) is very experienced in radiotherapy and has published many research papers on prostate cancer treatment. His works has been used in the famous "Prostate Cancer Results Study Group" that together with Dr. Grimm produced a very useful table comparing treatments effectiveness in a large cohort of different cases (83,565 patients). I think your husband is in good hands by choosing Sylvester for the bracky, but he may want you to be sure that this is in fact your preference as a therapy. You need to investigate and know the basics. You need to become educated on the treatment, its risks and side effects.

Low Dose Rate Brachytherapy is done using various types of radioactive seeds. Dr. Sylvester uses Cesium-131 (Cs-131) or Iodine-125 (Io-125) in prostate cancer treatment. In other centers they also use Palladium-103. The treatment procedure is the same when done in combination with IMRT, but there are some differences in terms of the side effects experienced by patients. The seeds differ on how much radiation these manage to deliver (200 to 300 μCi/seed) and on their half-life (period in activity). Cs-131 has a short half-life of about 3-4 wks in contrast with the 8 weeks of Palladium and two months of Iodine. These will reflect in the length of the period of discomfort (symptoms) felt by the patient. I am not sure if the price is the same.

I think that you will get better explanation from Dr Sylvester. Just prepare a list of intelligent questions for your next meeting. Ask him which one is less linked to side effects, lesser prolonged period of discomfort and higher in treatment success.

The results from the above study group are in this link (press compare). You can judge your choice by comparing your husband's clinical stage/risk group ;

http://www.pctrf.org/study-group/ 

Best wishes and luck in his journey.

VGama