seed treatment

fawnsbuck1

Can anyone talk to me about pro's and con's with seed treatment, removal surgery, radiation treatments

VascodaGama

Look for second opinions by professionals

Seeds is a form of radiaton therapy. I recommend you to get a copy of the book “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which will help you understanding the options between surgery and radiation.

Dr. Walsh is a surgeon so you may find his descriptions biased, leaning more to surgery, but overall it explains in detail about the radicals. The best shot is still to get consultations with several specialists from the same trade.

Best.

VG

fawnsbuck1

VascodaGama said:

Look for second opinions by professionals

Seeds is a form of radiaton therapy. I recommend you to get a copy of the book “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which will help you understanding the options between surgery and radiation.

Dr. Walsh is a surgeon so you may find his descriptions biased, leaning more to surgery, but overall it explains in detail about the radicals. The best shot is still to get consultations with several specialists from the same trade.

Best.

VG

Thanks

Thanks, I am getting all three books. I don't want to wait and watch but I will take all te time I need to deside which treatment I need.

VascodaGama

Proper diagnosis is a must

Fawnsbuck

I agree with your comment. However, I recommend you getting the best diagnosis of your cancer status because some treatments are more appropriate than others depending on the clinical stage one is "classified".

Also, give preferences to cancer centres with modern facilities and the latest equipments for testing and with professionals dedicated to prostate cancer. Some urologists or radiologists may be more specialized in other types of cancer. Look for the best, research and do not let things unattended.

In this forum you will find loads of exchanged opinions about PCa treatments. You can share your story here so that you may get help from survivors who have confronted the same doubts and done the same steps.

Wishing you peace of mind.

VGama 

fawnsbuck1

VascodaGama said:

Proper diagnosis is a must

Fawnsbuck

I agree with your comment. However, I recommend you getting the best diagnosis of your cancer status because some treatments are more appropriate than others depending on the clinical stage one is "classified".

Also, give preferences to cancer centres with modern facilities and the latest equipments for testing and with professionals dedicated to prostate cancer. Some urologists or radiologists may be more specialized in other types of cancer. Look for the best, research and do not let things unattended.

In this forum you will find loads of exchanged opinions about PCa treatments. You can share your story here so that you may get help from survivors who have confronted the same doubts and done the same steps.

Wishing you peace of mind.

VGama 

Treatment

Thanks, I havent decided what I'm going to do. I have a long time before I make my choice. I want to learn as much as I can about every treatmtent. I don't want to ever say, I should have.

Thanks for your advice

   Tim

bobby3800

fawnsbuck1 said:

Treatment

Thanks, I havent decided what I'm going to do. I have a long time before I make my choice. I want to learn as much as I can about every treatmtent. I don't want to ever say, I should have.

Thanks for your advice

   Tim

I was only 49 years old when

I was only 49 years old when diagnosed.    I had the seed implants last September....... .  my first PSA was at 6 month mark.....it went from 4.9 down to below 1.  I researched for months before deciding on treatment.  The results of the research i did indicated that the sucess rates are equal for the seeds or a radical prostectamy.  being only 49 i did not want to become impedent so young.  Had I been 60 or older I probably would have had the surger to remove the prostate.  keep positive with whatefer your decision is.

 

By the way, my uncle was diagnosed at age 50.......he had the beam radiation back then and is a healthy 68 years old today.

HolyMole

fawnsbuck1 said:

Treatment

Thanks, I havent decided what I'm going to do. I have a long time before I make my choice. I want to learn as much as I can about every treatmtent. I don't want to ever say, I should have.

Thanks for your advice

   Tim

Brachytherapy

fawnsbuck1, this is my first post, so be patient with me. Sounds like your situation is similar to what mine was.

At age 67, my 6.01 PSA in early May/12 got me a referral to a urologist. By late May, (before I saw the urologist), my PSA had increased to 8.2. I saw the urologist in mid-June/12, (this is Canada: things move a bit slower here). His DRE prompted a biopsy, done in mid-August/12.

(3 days after the biopsy, I spent 4 days in hospital with an e-coli infection....resulting, obviously, from the biopsy....but that's another story).

In early Sept/13, I was advised I had aggressive PC, T2a Gleason 9 (4+5).

I was damned angry, because I had been diligent in having a DRE and PSA test every year since my early 50's. My PSA had been increasing regularly. In fact, I had a PSA of 6.18 in June/05 which prompted a referral to that same urologist. By the time I saw him 3 months later, my PSA was re-tested at 3.30 and he couldn't detect anything on a DRE. Between 2005 and 2012, my PSA varied between 3.3 and 5.96, until the 6.01 sent me back again to the urologist.

In retrospect, it's my opinion that British Columbia, (where I live), has set the levels at which a GP sends a referral to a urologist 'way too high. I should have been biopsied 3 or 4 years ago.

In any event, that's water under the bridge. Having been diagnosed with Gleason 9 PC, my urologist was a believer in having the patient make an informed decision as to a course of treatment. I couldn't get him to commit on the main issue: surgery or radiation. As a result, I spent the better part of two months reading everything I could get my hands on: trying to become an expert on prostate cancer treatment. I simply became more and more confused. My urologist tried, very subtly, to lead me to choose radiation. Finally, like getting blood from a stone, I got him to state that, while he was certainly willing to surgically remove my prostate - if that's what I wanted - he felt that, with a Gleason 9, there was a 50/50 chance that my cancer had already spread beyond the prostate.

After my first meeting with a radiation oncologist, (who agreed that surgery was not the best way to proceed), I decided on hormone therapy, followed by external radiation and/or brachytherapy. I took a 6 month shot of Eligard in mid-November/12, then spent the winter, as usual, in Mexico. During our vacation, I was notified that a review of my biopsy results had down-graded me to a Gleason 7 (4+3). This was good news, for I was now considered a "high-tier moderate risk", rather than a "low-tier high risk". My first question was "If this had been my first biopsy report, would surgery have been a more reasonable course of treatment?". The answer, from both my urologist and my radiation oncologist, was "no, radiation would still have been the best choice".

Following return from vacation, my radiation oncologist recommended additional hormone therapy, followed by brachytherapy. It was his opinion that I didn't require external radiation. So, I had a 3 month shot of Eligard in mid-May/13, followed by prostate brachytherapy (70 seeds) in mid-June/13. I'll be having my first post-treatment PSA and testosterone tests on 1 October.

I haven't yet asked what should have been an obvious question: If surgery wasn't the best option because there was a good chance that "the horse had already left the barn", (my urologist's words), then how will brachytherapy get those cancer cells that probably "have already left the barn"?   

 

 

VascodaGama

HolyMole said:

Brachytherapy

fawnsbuck1, this is my first post, so be patient with me. Sounds like your situation is similar to what mine was.

At age 67, my 6.01 PSA in early May/12 got me a referral to a urologist. By late May, (before I saw the urologist), my PSA had increased to 8.2. I saw the urologist in mid-June/12, (this is Canada: things move a bit slower here). His DRE prompted a biopsy, done in mid-August/12.

(3 days after the biopsy, I spent 4 days in hospital with an e-coli infection....resulting, obviously, from the biopsy....but that's another story).

In early Sept/13, I was advised I had aggressive PC, T2a Gleason 9 (4+5).

I was damned angry, because I had been diligent in having a DRE and PSA test every year since my early 50's. My PSA had been increasing regularly. In fact, I had a PSA of 6.18 in June/05 which prompted a referral to that same urologist. By the time I saw him 3 months later, my PSA was re-tested at 3.30 and he couldn't detect anything on a DRE. Between 2005 and 2012, my PSA varied between 3.3 and 5.96, until the 6.01 sent me back again to the urologist.

In retrospect, it's my opinion that British Columbia, (where I live), has set the levels at which a GP sends a referral to a urologist 'way too high. I should have been biopsied 3 or 4 years ago.

In any event, that's water under the bridge. Having been diagnosed with Gleason 9 PC, my urologist was a believer in having the patient make an informed decision as to a course of treatment. I couldn't get him to commit on the main issue: surgery or radiation. As a result, I spent the better part of two months reading everything I could get my hands on: trying to become an expert on prostate cancer treatment. I simply became more and more confused. My urologist tried, very subtly, to lead me to choose radiation. Finally, like getting blood from a stone, I got him to state that, while he was certainly willing to surgically remove my prostate - if that's what I wanted - he felt that, with a Gleason 9, there was a 50/50 chance that my cancer had already spread beyond the prostate.

After my first meeting with a radiation oncologist, (who agreed that surgery was not the best way to proceed), I decided on hormone therapy, followed by external radiation and/or brachytherapy. I took a 6 month shot of Eligard in mid-November/12, then spent the winter, as usual, in Mexico. During our vacation, I was notified that a review of my biopsy results had down-graded me to a Gleason 7 (4+3). This was good news, for I was now considered a "high-tier moderate risk", rather than a "low-tier high risk". My first question was "If this had been my first biopsy report, would surgery have been a more reasonable course of treatment?". The answer, from both my urologist and my radiation oncologist, was "no, radiation would still have been the best choice".

Following return from vacation, my radiation oncologist recommended additional hormone therapy, followed by brachytherapy. It was his opinion that I didn't require external radiation. So, I had a 3 month shot of Eligard in mid-May/13, followed by prostate brachytherapy (70 seeds) in mid-June/13. I'll be having my first post-treatment PSA and testosterone tests on 1 October.

I haven't yet asked what should have been an obvious question: If surgery wasn't the best option because there was a good chance that "the horse had already left the barn", (my urologist's words), then how will brachytherapy get those cancer cells that probably "have already left the barn"?   

 

 

The barn

HolyMole

Welcome to the board. I hope the results are good and that your treatment successfully has knocked down the bandit (and his horse too).

Your query is logical, however I guess that your doctor may be thinking that the "the horse out of the barn" did not go far. Probably his 70 seeds protocol included several seeds placed in the gland closer to the outer shell. That would have effects on the surrounding tissues out of the "barn". Surely the treatment is based on guessing and some doctors prefer a more aggressive approach with a combination of seeds plus IMRT to “zip” the whole prostate bed. Both ways are recommended unless more detailed data is taken.
Have you done any MRI or PET scan to try in locating the cancer?

Thanks for the story.

Best

VG   

hopeful and optimistic

VascodaGama said:

The barn

HolyMole

Welcome to the board. I hope the results are good and that your treatment successfully has knocked down the bandit (and his horse too).

Your query is logical, however I guess that your doctor may be thinking that the "the horse out of the barn" did not go far. Probably his 70 seeds protocol included several seeds placed in the gland closer to the outer shell. That would have effects on the surrounding tissues out of the "barn". Surely the treatment is based on guessing and some doctors prefer a more aggressive approach with a combination of seeds plus IMRT to “zip” the whole prostate bed. Both ways are recommended unless more detailed data is taken.
Have you done any MRI or PET scan to try in locating the cancer?

Thanks for the story.

Best

VG   

How many cores were taken in

How many cores were taken in your biopsy. How many were cancerous, and what was the involvement(percent cancer) of each core that was cancerous. This will give an indication of the extensiveness of the cancer, and the likelihood that the cancer is outside the prostate.

As Vasco asked, have you had an MRI or a PET scan.

 

PS. Was the downgrade of the Gleason score as a result of you asking for an independent second opinion of the pathology? What occured?

 

HolyMole

hopeful and optimistic said:

How many cores were taken in

How many cores were taken in your biopsy. How many were cancerous, and what was the involvement(percent cancer) of each core that was cancerous. This will give an indication of the extensiveness of the cancer, and the likelihood that the cancer is outside the prostate.

As Vasco asked, have you had an MRI or a PET scan.

 

PS. Was the downgrade of the Gleason score as a result of you asking for an independent second opinion of the pathology? What occured?

 

Brachytherapy

To VascodaGama and "hopeful and opt..."

Immediately on being diagnosed with PC, I had a chest x-ray, bone scan and CT scan. Then the pre-brachy ultrasound, followed by brachytherapy. Post-op, I had another CT scan and an MRI.

My PC biopsy was 8 cores, 5 of which were positive. Total 29 of 129mm, or 22% positive. Clinical stage T2a, but the 5 positive cores were 3 of 4 on the left side and 2 of 4 on the right. (I still don't understand why, as a result of the biopsy, they don't change the clinical stage to reflect the fact that cancer was detected on both hemispheres of the gland....but what do I know.)

The review that resulted in the downgrade of the Gleason score from 9 (5+4) to 7 (4+3) resulted from a routine review done by the pathologist at the Cancer Centre, and not at my request. My initial biopsy review had been done by a pathologist at the general hospital where the biopsy had been performed.

In my initial discussions with the radiation oncologist, he anticipated 6 months of hormone therapy, followed a month or so later by 3 or 4 weeks of beam radiation, then brachytherapy, then the balance of hormone therapy to provide a total of 1 year of HT.

Following the downgrade of my Gleason score, however, and after 6 months of being on HT, (Eligard), he felt that I was "on the fence" as to whether I needed both external AND seed radiation, or just the seeds. He did a DRE at that time and considered my prostate to be "unspectacular",  "unremarkable" and "subtle". Around the same time, my urologist also did a DRE and used similar words to describe my prostate, stating that "nothing stood out".

My radiation oncologist said that he considered himself (and he says his colleagues agree), to be aggressive in his treatment of PC, and that it was his opinion that brachytherapy alone would be best. As a result, I took another Eligard shot - this time a 3 monther -   and had my brachytherapy done a month later. In other words, I had been on HT for 7 months at the time of my brachy, and the last 3 month shot should have "run out", (I wish) by mid-August, for a total of 9 months HT. My oncologist said I did not require any additional HT.

He said the post-op MRI and CT scan were good, that the seeds were placed exactly as he had intended.

(As a aside concerning those 8 cores: under our medicare system, each province sets its own standards. British Columbia takes 8 cores. Other provinces take 8, 10 or 12 cores. Obviously, it all has to do with costs.)   

 

hopeful and optimistic

HolyMole said:

Brachytherapy

To VascodaGama and "hopeful and opt..."

Immediately on being diagnosed with PC, I had a chest x-ray, bone scan and CT scan. Then the pre-brachy ultrasound, followed by brachytherapy. Post-op, I had another CT scan and an MRI.

My PC biopsy was 8 cores, 5 of which were positive. Total 29 of 129mm, or 22% positive. Clinical stage T2a, but the 5 positive cores were 3 of 4 on the left side and 2 of 4 on the right. (I still don't understand why, as a result of the biopsy, they don't change the clinical stage to reflect the fact that cancer was detected on both hemispheres of the gland....but what do I know.)

The review that resulted in the downgrade of the Gleason score from 9 (5+4) to 7 (4+3) resulted from a routine review done by the pathologist at the Cancer Centre, and not at my request. My initial biopsy review had been done by a pathologist at the general hospital where the biopsy had been performed.

In my initial discussions with the radiation oncologist, he anticipated 6 months of hormone therapy, followed a month or so later by 3 or 4 weeks of beam radiation, then brachytherapy, then the balance of hormone therapy to provide a total of 1 year of HT.

Following the downgrade of my Gleason score, however, and after 6 months of being on HT, (Eligard), he felt that I was "on the fence" as to whether I needed both external AND seed radiation, or just the seeds. He did a DRE at that time and considered my prostate to be "unspectacular",  "unremarkable" and "subtle". Around the same time, my urologist also did a DRE and used similar words to describe my prostate, stating that "nothing stood out".

My radiation oncologist said that he considered himself (and he says his colleagues agree), to be aggressive in his treatment of PC, and that it was his opinion that brachytherapy alone would be best. As a result, I took another Eligard shot - this time a 3 monther -   and had my brachytherapy done a month later. In other words, I had been on HT for 7 months at the time of my brachy, and the last 3 month shot should have "run out", (I wish) by mid-August, for a total of 9 months HT. My oncologist said I did not require any additional HT.

He said the post-op MRI and CT scan were good, that the seeds were placed exactly as he had intended.

(As a aside concerning those 8 cores: under our medicare system, each province sets its own standards. British Columbia takes 8 cores. Other provinces take 8, 10 or 12 cores. Obviously, it all has to do with costs.)   

 

   A MRI may indicate if

 

  A MRI may indicate if there is extra capsular extension, that is if there is cancer  outside the capsule. MRI machines using high power magnets provide better definitions, and provide more confidence in results. There is a Tesla 3.0 magnet generally found in  centers of excellence that is currently the highest power used for patients. There is also a Tesla 1.5 magnet that is also very high power.

Generally the biopsy results are looked at by individual core, not as a total of all cores. A positive core  samples a lession; this will be an  indication of  how aggresssive that area is. There are cores reporting various Gleson levels, so it is best not to combine these different levels.  Additionally there are sample cores taken that do not show any cancer. Generally the docs look at the number of cores that are positive among the total cores taken to determine extent of the cancer. Not saying that your report of "Total 29 of 129mm, or 22% positive" cannot be useful, only saying this is not generally used.

At any rate, I am hopeful  that your reports,  resulting  from the braky will be favorable.

Best of luck.

PS. Good idea for you to obtain a copy of all your test results and records.

 

 

HolyMole

hopeful and optimistic said:

   A MRI may indicate if

 

  A MRI may indicate if there is extra capsular extension, that is if there is cancer  outside the capsule. MRI machines using high power magnets provide better definitions, and provide more confidence in results. There is a Tesla 3.0 magnet generally found in  centers of excellence that is currently the highest power used for patients. There is also a Tesla 1.5 magnet that is also very high power.

Generally the biopsy results are looked at by individual core, not as a total of all cores. A positive core  samples a lession; this will be an  indication of  how aggresssive that area is. There are cores reporting various Gleson levels, so it is best not to combine these different levels.  Additionally there are sample cores taken that do not show any cancer. Generally the docs look at the number of cores that are positive among the total cores taken to determine extent of the cancer. Not saying that your report of "Total 29 of 129mm, or 22% positive" cannot be useful, only saying this is not generally used.

At any rate, I am hopeful  that your reports,  resulting  from the braky will be favorable.

Best of luck.

PS. Good idea for you to obtain a copy of all your test results and records.

 

 

As far as obtaining copies of

As far as obtaining copies of all my test results and records, please don't misunderstand -- I don't want to come across as being ignorant-- but I have decided to let my doctors make the decisions they deem to be in my best interests. As I noted previously, I studied for hours and hours, made copious notes, read at least a half dozen texts by the acknowledged "celebrities" of the PC world, and was no closer to being able to make a decision as to the best course of treatment. The more I learned, the more confused I became. So, other than now being well-informed enough to discuss my situation in a reasonably intelligent manner with my doctors, I leave things up to them. I have found that decision to be liberating....I worry a lot less now than I did when I was studying to become a PC expert.

I'm not suggesting that "ignorance is bliss", nor am I a fatalist, religious or otherwise. One thing I learned from my studies is that the treatment of prostate cancer appears still to be as much an art as it is a science. 

In the same vein, I chose not to contact our local PC support group. It is comforting to know they are there, but right now I don't feel I need their support. That may change in the future. Likewise, I was a tad reluctant to join this forum, (I learned of its existence only a few days ago): did I really want to get involved in nitty-gritty discussions of PC? On the other hand, perhaps my experience so far - and I'm just a raw rookie in this game - could be of value or interest to others.

I'm going to regularly follow this forum, and will contribute when appropriate, unless and until I find that my anxiety levels rise to my PC studying days. And if my brachytherapy proves to have been unsuccessful, I'll deal with that then.

One other comment: As I noted previously, I was shocked and angry when first diagnosed with aggressive PC, considering that I had diligently checked my PSA and had DRE's every year since my early 50's. I already knew, from my own PSA tests over the years, that PSA  results could be erratic. For example, in June/05, my PSA was 6.18, prompting a referral to a urologist. Three months later, the urologist did a DRE and more detailed PSA tests, and the PSA came back at 3.30. He considered that a biopsy was not required.

So, I already knew that PSA results had to be taken with a grain of salt. (Which explains my puzzlement to read that some posters are concerned because their PSA is 0.3 when they think it should be closer to 0.1). But this relatively inexact PSA testing, along with a DRE, are the only first-line checks that the average guy has, to determine if he should be referred to a specialist. When I was diagnosed with PC at age 67, I asked my urologist: "How skilled is the average GP when it comes to DRE testing for prostate?" My urologist replied: "Not very". 

That's a scary thought.

 

 

hopeful and optimistic

HolyMole said:

As far as obtaining copies of

As far as obtaining copies of all my test results and records, please don't misunderstand -- I don't want to come across as being ignorant-- but I have decided to let my doctors make the decisions they deem to be in my best interests. As I noted previously, I studied for hours and hours, made copious notes, read at least a half dozen texts by the acknowledged "celebrities" of the PC world, and was no closer to being able to make a decision as to the best course of treatment. The more I learned, the more confused I became. So, other than now being well-informed enough to discuss my situation in a reasonably intelligent manner with my doctors, I leave things up to them. I have found that decision to be liberating....I worry a lot less now than I did when I was studying to become a PC expert.

I'm not suggesting that "ignorance is bliss", nor am I a fatalist, religious or otherwise. One thing I learned from my studies is that the treatment of prostate cancer appears still to be as much an art as it is a science. 

In the same vein, I chose not to contact our local PC support group. It is comforting to know they are there, but right now I don't feel I need their support. That may change in the future. Likewise, I was a tad reluctant to join this forum, (I learned of its existence only a few days ago): did I really want to get involved in nitty-gritty discussions of PC? On the other hand, perhaps my experience so far - and I'm just a raw rookie in this game - could be of value or interest to others.

I'm going to regularly follow this forum, and will contribute when appropriate, unless and until I find that my anxiety levels rise to my PC studying days. And if my brachytherapy proves to have been unsuccessful, I'll deal with that then.

One other comment: As I noted previously, I was shocked and angry when first diagnosed with aggressive PC, considering that I had diligently checked my PSA and had DRE's every year since my early 50's. I already knew, from my own PSA tests over the years, that PSA  results could be erratic. For example, in June/05, my PSA was 6.18, prompting a referral to a urologist. Three months later, the urologist did a DRE and more detailed PSA tests, and the PSA came back at 3.30. He considered that a biopsy was not required.

So, I already knew that PSA results had to be taken with a grain of salt. (Which explains my puzzlement to read that some posters are concerned because their PSA is 0.3 when they think it should be closer to 0.1). But this relatively inexact PSA testing, along with a DRE, are the only first-line checks that the average guy has, to determine if he should be referred to a specialist. When I was diagnosed with PC at age 67, I asked my urologist: "How skilled is the average GP when it comes to DRE testing for prostate?" My urologist replied: "Not very". 

That's a scary thought.

 

 

I respect your decision to do

I respect your decision to do what you feel is best for you. .eac of us are comfortable with different levels of involvement.......stress is not a good thing; it's good to aviod this stress..............  I wish you well.

I have copies of my medical records sinced I may change doctors at some point, and I simply have to present these documents. Additionally I take the viewpoint that I am the CEO of my case and the docs are my advisors.  Since I had a bad expereice with one of the docs who wanted to overtreat me, I believe for his financial benefit I feel it is necessary for me to be informed....but, this is right for me, not for you or others....we are all individuals.

 

Rakendra

Good Luck

Sorry about your condition.  You have done all you can and made the decision you are comfortable with.

"  Since I had a bad expereice with one of the docs who wanted to overtreat me, I believe for his financial benefit I feel it is necessary for me to be informed....but, this is right for me, not for you or others"

      Unfortunately, the above statement is all too true, not just in the USA, but every where.  When I complained about this in the Philippines, my ex-pat friends from USA and Europe all said the same thing happens everywhere.  This makes decisions and trust even more difficult.  And, no matter how well informed you may be, it is still very easy to make a poor decision.  "Right" diet or "Right" supplements are very difficult to be exactly sure of.  That is why this board is so valuable.  There are some experts here who have done it all, both the "Right" things and the "Wrong" things, and their experience and sharing cannot be replaced.

   Thanks for sharing.  Your views are important to all who are also seeking answers.  Good luck, love, Rakendra

balukajoe65

Seed Implants

Hi my name is Joe and I had 68 Seeds Implanted and 25 Radiation treatments back in 2001 and @ the time my PSA was standing @ 12.0

and now my PSA is so low it's barely on the scale , I am 72 years old and it is 0.03 which the Doctor says is very good and I have been

Cancer free ever since . When I had the procedure done the Dr used 68 neddles to put them in but I was asleep so I didn't feel anything

my age at least I am still alive . I would recomend it to anybody as long as they catch it soon enought , if you need anymore info just

drop me a email it is on my profile , and good luck my friend , Joe