New to Reluctant Brotherhood

MACH1

https://csn.cancer.org/discussion/comment/1725775#Comment_1725775

Capecodder - I'm in Northern California and had the procedure done at Mills/Peninsula hospital in San Mateo. Procedure was done by Dr. Steven Kurtzman of Western Radiation Oncology. Dr. Kurtzman was recommended to me by the radiation oncologist who would have performed the external beam radiation had I chosen to do that. Dr. Kurtzman has done over 8,000 brachytherapy procedures. Here are some links:

https://westernradiationoncology.com

https://www.youtube.com/watch?v=GZTK6IcGI-w

swl1956

Capecodder,

We can drive ourselves insane trying to make this decision. Even with extensive research and multiple doctor opinions there just is no one right solution that fits all especially in the medium risk categories. High risk and low risk the treatment options are more easily defined. Having been staged in the medium risk category, when I was trying to make my initial treatment decision my team of doctors at Fox Chase Cancer Center did not all agree with each other but were open to varying views. The urological oncologist surgeon discussed RP, but also encouraged me to be evaluated by the radiation oncologist as well. The cure rates between these standard of care procedures were about identical. I believe Brachytherapy has higher cure rates than external beam technologies. As I think you're aware, I chose a less traveled path of Focal Therapy due to my fears of side effects from RP or RT. Focal therapy is a valid option which is becoming more commonplace and successful for many men, however it's only a good option for those that the staging suggests they are good candidates due to varying factors. Unfortunately my cancer ended up metastasizing to the lymph nodes which at that point the treatment options were much more clear cut. (pelvic radiation and ADT). According to my doctors, metastasis would likely have occured no matter which treatment I had first chosen due to micrometastasis that was too small to be seen with the PSMA PET scan I had early in my journey. I don't think you should rule out Brachytherapy just because of you fathers experience. Sounds like he lived 20 years after being treated? I also wouldn't rule out ADT completely especially short term. It's very effective and not that big of deal (at least for me) with the newer pill forms (Orgovyx) which can be stopped anytime and have faster testosterone recovery than the older injectables. I agree with the others here that your your center of excellence Dana Farber is likely giving you good advice. Once you make your decision your stress level will lessen. It was a huge relief for me after stressing for over 6 months to make this decision. Perhaps my journey would have turned out differently if I had made a different decision or acted more quickly, but I have no regrets. I made the best decision I could for me at the time. I'm doing pretty well so far and hopefully will continue to do so for many years. The journey continues! Hopefully you'll be a lucky one with a smoother journey than some of us on here have experienced.

I think I've watched all of Dr. Mark Scholz's videos. I have much admiration for his intellect and demeanor in how he explains things.

Hang tough and please let us know when and what your decision will be.

capecodder

@swl1956 Thank you for sharing your experience! I have a call with my doctor late next week which will provide more information as I move towards a decision.

MACH1

Capecodder - I agree 100% with what swl1956 is saying. There is no one "right" solution when you are in the medium risk category. I agonized for seven months before deciding on the brachytherapy. We talked about focal but it was not in the cards for me. The cure rates for brachy vs external beam to me were statistically even so for me it came down to whether I wanted to devote to 5 1/2 weeks of daily radiation vs a one time procedure. I knew that I would just dread and not want to go the daily appointments and also knew that the side effects of the brachytherapy would come immediately vs down the line. I was willing to make that choice but as I wrote those effects were a lot more than I had anticipated although they have subsided. The intensity of mine had to be an outlier because no one I had talked to or communicated with on this forum experienced what I did. Am happy I chose brachytherapy?- I'm not sure because I do not know what I would have experienced down the line had I a taken another route. Dr. Kurtzman said that the procedure would get rid of everything so now it's a wait and see for me. I'll have another follow up PSA next month and am hoping for the best.

It's a hard decision to make so go with your gut feeling and don't look back if it doesn't work out. Just keep on moving forward and do whatever needs to be done. Stay strong and positive.

capecodder

@MACH1 Thanks for your advice!

lesjanes

Hi Capcodder, I was 68 2 years ago when diagnosed 3+4, 1 in 14 positive <.10. And no detected PNI. I had all options on the table since the tumor was deemed small, surgery, radiation, and AS. A 2nd opinion strongly recommended AS.

I decided on surgery, just wanted it out. Surgery 7/11/24....,post biospsy....gleason changed to 4+3, PNI detected as well as EPE...BUT Lymph nodes clean and all margins clean. Pca was near the outside wall and looked like a pimple on the prostate according to the Dr.....that is why the EPE. Dr is very optimistic.

Bottom line for me, I am glad I did not choose AS because it was just starting to escape the prostate.

1 and half years out....I was fully continent after 2 months. ED still, but appears to be improving.

I have no regrets on surgery, even if ED does not improve more. I have a great wife and relationship. So ED is not the psychologist issue it could have been. Especially since I still achieve orgasms.

PCa won't go away. Get educated, make a decision and live with your decision. But make a decision sooner than later.

capecodder

@lesjanes Thank you for the candid and straightforward advice. Much appreciated.