Trying to decide on treatment options

Hi Perry...

I am sorry to hear about your diagnosis.

Your numbers are very similar to mine. I was diagnosed in March, 2012 and I was 55 at the time. My PSA was 5.85 at diagnosis and my cancer was stage T1C with a Gleason score of 3+3=6 as well. My biopsy showed three cores positive, on on the left side and two on the right.I went through the same decision process that you are going through and narrowed my treatment choices down to Brachytherapy (seeds) or Proton Beam Therapy. After visiting a local clinic specializing in seed implantation my wife and I were fairly sure that we would take that route, but I had already scheduled an appointment at the Procure Proton Center in Warrenville, IL (I am in the Chicago area) so I decided to keep the appointment just in case.  I am very glad that I did.  The folks at the Procure Center were amazing and the place had a wonderful, caring atmosphere. The doctor that I spoke with was very knowledgable and went out of his way to make sure that I was comfortable and had all of the information that I needed to make a decision. In addition I checked some online resources, The Brotherhood of the Balloon, an online group dedicated to Proton therapy, and You Are Not Alone, a web site where other prostate cancer patients and survivors can share their experience with all forms of treatment. If you haven't checked these resources out I encourage you to do so.  I also talked to several current and past Proton patients about their experience both during and after treatment.

In the end we made the decision to go with Proton therapy. Various studies have shown that the success rate for PBT is similar to that of Brachytherapy but that the quality of life during and after treament is much better with PBT. My treatments last 9 weeks, 44 daily treatments, and I had only minor side effects.  I experienced some fatigue at about the half way point, but I worked during the whole time, and I experience increased urgency in urination.  Both of those went away shortly after the treatments ended.

I went back for my three month follow-up after Thanskgiving and my PSA had dropped to 1.42. I go back again at the end of February for another follow-up.

If you want more information about the treatments or want to ask more personal questions please feel free to contact me directly. You should be able to send me a message through this site and I can give you my e-mail address of phone number.

Good luck with you decision!

...ron

In addition to PBT (proton beam therapy) you should consider CyberKnife (a form of SBRT - stereotactic body radiation therapy) and HDR (high dose rate) BT (brachytherapy)

No offense to those who've received PBT, but CK is a more advanced method of radiation treatment that only requires 3-4 treatments over a week instead of 28 or more daily treatments w/PBT.  CK can also control the delivery of radiation to the sub mm level and can adjust for both body and organ movement during treatmetn (which is actually very important because any such movement can dramatically alter the delivery point of the radiation).  PBT cannot do this and in order to make sure that the radiation does not unintentionally cause collateral tissue damage, you are requried to be fitted in a body cast and have a water filled ballon inserted in your rectum during each PBT treatment. 

Several people here (me included) w/a similar diagnosis to yours have received CK with apparent success.  I received CK treatment in 9/2010 and, based on a recent MRI/MRSI scan learned that I am completely cancer free without any side effects whatsoever.  No ED and no incontinence or anything else.  Other men report who have received CK report similar results. 

Men who receive PBT also report low side effects and good success but in order to receive CK you need to live (or move) near a treatment center because so many daily treatments are required.  Not so with CK which can be done w/in a week.  There are also far fewer PBT treatment locations available than there are for CK.

As for LDR (low dose rate) Brachytherapy (or seeds as you call it), it is also reportedly very effective in treating the cancer.  However, the downside of the seeds is that they all remain in your body FOREVER (unless you happen to pass a few out through your urethra which happens due to seed migration) AND you are actually radioactive for about a year (the 1/2 life of the radiation in the seeds, so you can hold small children or be near pregnant women during this time period) AND you wil always set off metal detectors and possibly radiation detectors as well (and have to carry a card that verifies that you have a post-BT patient and not a terrorist).

If you want to go w/BT, the better method is HDR (high dose rate) BT which places the seeds in strings temporarily in your prostate -- a day or 2 at most -- and then removed.  CK is actually modeled on HDR BT. 

The thing you need to worry about w/either LDR BT or HDR BT is how well the RO plans the placement of the seeds and how well the urologist actually places them in your prostate.  Any error in the placement of the seeds or in the dosage of radiation applied to each of the seeds can cause havoc resulting in serious problems -- not only ED and incontinence, but also possible damage to the urethra, bladder and/or rectum as a result of excessive radiation which will probably require surgery to attempt to correct (and correction is by no  means guaranteed).

Don't let anyone rush you.! You have early stage prostate cancer and low PSA numbers and don't need to do anything right away.   If you have no idea what I've just been talking about, do the research and find out so that you can make an informed decision about which treatment makes the most sence for you.  You might also want to consider Active Surveillance until treatment is more clearly warranted.

Good luck!

thechef said:

Awesome info everyone. I see

Awesome info everyone. I see a cyberknife facility in Dayton, not too far away.

I also see several people with a positive view of that technology. I have run into a few "review" type articles that are LESS than positive about it, however. They tend to say things like "it's too new to judge." How do I sort that out?

There are already 5 years studies on the effectiveness of CK, all of which indicate that it is as effective as surgery and other radiation technologies BUT w/o the same risk/degree of side effects.  See, for example:

http://coloradocyberknife.com/first-five-year-outcomes-published-on-cyberknife-radiosurgery-for-prostate-cancer/

http://www.ro-journal.com/content/6/1/3

http://www.radiologytoday.net/archive/rt0711p24.shtml

http://www.cyberknifeofli.com/images/stories/content/PDF/ckprostatetcrtak.pdf

If you want to wait for 10-20 year data, CK will probably be made obsolete by newly developed technologies just as it has surpassed PBT.   Only you can decide "how much" data is necessary for you to make the choice to choose one treatment over another BUT I think there is already a sufficient record w/CK to justify its use now. 

5 years of data was good enough for me.

The fact that CK is NO LONGER considered an "experimental treatment" by many medical insurance carriers, including CA Blue Cross/Blue Shield which paid for my treatment is further evidence that CK is now an accepted method of treatment for PCa and is no longer "too new to judge" it as such.