prostrate containment

Steve,

Stanford is worldwide known institution und runked high in urological specialty So it should be good choice if you decide to choose it.

You mentioned that with other treatments PSA goes down slowly but also SE are not hitting you straight in the face right away and not with same intensity as SE from surger. Surgery awarded every patient with unavoidable SE for long time and for some for ever.

Surgery is changing man for ever and that change is not good. Recovery is never ending if the guy is lucky to move from ground zero, if not stays there indefinitely.

What if you get unfavorable side of the coin? 

I made mistake and got one.

MK

Steve1961 said:

thankd old salt

i am leaning cyberknife  but it percisely targets the prostarte only from what i am told....maybe brachytherapy maybe better  because i think it may take care of anything that maybe outside the prostarte..good question to ask the brachytheraoy dr when i see him...thanks again everyone..this will help me make the right decison..this forum is a god sent...but i will move on and get the T3 MRI done  and as much as i am not looking forward to the ERC part i read it is far more superior in imaging and staging of  the PC than using the apron o well been thru worse lol

With SBRT the perimeter of the treatment can adjusted to go outside the prostate....with intermediate as you have, the radiation onocologist will want to have a wider margin.

The T3 MRI may show extracapsular extention; if not, the cancer may still exist, but you will have a better idea of where you stand

With  SBRT, a ct scan is used to place the markers for treatment; the primary use is not to dectect cancer.

Hi, 

From what I understand the T3 MRI is the best to offer at this point in time.  Pca starts inside the Prostate, that's why they call it Pca.  With the MRI it should show you the location(s) of the cancer.  If it's close to the edge of the gland then maybe some form of radiation teatment would be better.  If it's deep inside then surgery could be a good option.  Don't know how much tissue brachy kills surrounding the treatment site.  I feel you need to get the best treament to kill the cancer as your first priority, side effects should come second, but that's just me.  Don't be afraid to see other doctors if you still need more definition on the location of your cancer.  Ask lots of questions, study, study, study.

Dave 3+4

Steve, 

stay by your choice. Do not let other change your mind. Conclusion from Rob was not good one and was promoting fear of death for those who selected seeds route. I had surgery and regretted it 100 %. Worst what I could choose. Surgical SE are devils circle, once your in , your locket for ever.

Good luck with your choice.

MK

My final line was not anything I said about anyone I knew.  It was someone else here who posted that and I merely remembered reading it and passed it along.

But there are a few things to consider. Seed implantation is often chosen by older gentlemen who have other medical problems and may fear not surviving surgery, so if there's another way to do it they choose that.  I live in a seniors community and know several men who had seeds, and they are in in fact relatively poorer health. I never said that seeds don't work. But I also know men who had radiation and later developed bowel problems or blood disorders and there's no way of knowing whether or not radiation had anything to do with that. Some people develop these problems who never had radiation. Stuff just happens.

But my point was, once you choose radiation as your primary treatment, there's really not a whole lot of other options. Some mention HIFU and cryo and a lot of weird third line therapies, but for most men, prostatectomy is their first approach and a percentage of them require further treatment. It's about having options. If one route fails you have another route available, rather than a dead end.

Again, read the last line above... "To paraphrase ANOTHER fellow who posted here recently".  I did not bookmark his post and it's not easy to search for specific posts on this forum. But I do remember vividly what he said. And I said paraphrase because what I did was convey something that was written by someone else, NOT ME. But I felt it was a poignant observation, and relevent to the discussion.

The ONLY way to know what is going on in and around your prostate is to cut it out and examine it in the lab. External imaging can only give you limited information. So too is therapy which is based upon scans. It is like shooting in the dark. My MRI and biopsy indicated that my G8 tumor was close to the capsule wall. After everything was removed and examined it turned out that the cancer had escaped and invaded surrounding tissues. Over the past 18 months I've had follow up hormone therapy and radiation to the pelvic floor, and now my PSA is zero (0.00)

There were some bumps along the way, and while some guys will tend to dwell on side effects, one needs to realize that there are thousands of prostatecomies performed worldwide (I do not have specific statistics) but I would assume that there will be a percentage with less than optimum outcomes. I am personally familiar with most of the stats regarding long term SE's and have had most of them myself. But as a result I am looking forward to many years of continued *LIFE* with minimal concerns.

  To paraphrase another fellow who posted here recently, "I may be impotent and incontinent since my surgery, but all the guys I knew who had seeds are gone now".

I am surprised that you repeated the misleading and inappropriate phrase from the "other fellow". I and others would like to know who this "other fellow" is?

I wonder, if  you "repeated" in order to persuade others to follow the tretment that you pursued. I suggest that you would do better by providing facts , if this can be found, that show that surgery is a better choice. ...

ASA - Thank you for your sympthetic post and your understanding. Yes, I was an emotional mess last spring. It had been six months since my surgery and I was not regaining continence.  I was put on HT knowing nothing about the side effects. My wife was disgnosed with lymphoma with several tumors up and down her spinal column and I had to be her caregiver. Plus I had to decide on getting the AUS implant in order to be able to undergo the adjuvant radiation which was already past the recommended timeline. Yes, I was a mess, but not because of the surgery. The prostatectomy was one of the more straightforward procedures I've undergone and had an easier recovery than most of my others... well, except for the incontinence. At that, I was merely a statistic, one of the 5% who don't regain full control.

No, I was not upset about the surgery. That surgeon saved my life. I did speak with two RO's and learned that I did not qualify some procedures due to adverse pathology and others required a substantial time committment, something I did not have at the time. The surgery was most expedient in my situatoin and was entirely successful IMO. It would have been nice if my previous urologist might have considered doing so a year or two earlier, when I might have only had a G6 or G7, things probably would have been much cleaner. But at my stage, the surgeron used a broad cut and took out a lot of nerve tissue, but left me with negetive margins and negative nodes. I can't complain about that.

The IMRT was necessary because the EPE had invaded the pelvic floor via the SV. The surgeon did all he could about that. ART was delayed because of the time I had to devote to my wife, the indecision and healing time of the AUS and going thru PT in an attempt to avoid getting the AUS. And no one on that other board where we met could tell me anything about AUS's. I was pretty much on my own. But now that is all in the past. The radiation proctitis is now healing and in just a few more months I'll be able to get a coloscopy to check things out in there. The HT was cut back to 18 months, so a year from now my T will begin to return. I have seen a therapist and have some medications that really helped me get through the crisis. And getting a big fat 0.00 on my latest PSA was a nice pat on the back for all my trials.

I don't think that I actually recommend surgery to anyone, but I do point out that surgery is the only way to have one's prostate thoroughly examined by a pathologist. And I usually point out that even if there is no radiation toxicity, one may forever be hounded by doubt and uncertainty regarding the safety and thoroughness of radiation as a primary therapy... especially for any young man, who must live for 20-30 years "hoping" that the RT got all the cancer and didn't damage anything else.

If I ever run across that post that I quoted, I will bookmark it. I don't remember anyone making such a big fuss about it when it was frst posted. I don't even remember the guy's name. But I thought it was clever and happened to remember it.