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New to PC - TX

Posts: 2
Joined: Feb 2009

Hey! 62 years old, diagnosed a couple of weeks ago. 12 biopsy cores, 2 positive, 1 5% and 1 20%. Gleason 3 + 3= 6. PSA 5.1 . The urologist is strongly recommending IMRT. It appears the Da Vinci procedure is frequently being recommended here, even when the readings are not very high and the PC is in Stage 1. Is there a reason that I should NOT do the IMRT first, then if later there is a recurrence, resort to the robotic Da Vinci procedure? I'm scared and worried like everybody else. My brother had the radical surgery 10 years ago at age 49, recovered well, is doing well and happy to be alive!

Posts: 77
Joined: Sep 2008

First off, I'm very sorry to hear of your diagnosis, your with friends here, we've all shared in that experience.
My numbers were very similar to yours, however I am 42.
One thing that my doctor had told me and subsequently learned online, is that once radiation therapy is used (depending on the type and severity of the radiation treatment) that surgery is almost impossible as much of the tissue is damaged and can not be operated on. I would think surgery first, then radiation.
This is something I think you should ask your doctor about.
And then get a second/third opinion. Naturally, Docs tend to push what they know best.
You'll also find on this blog that many of us prefer the method that we used ourselves if the outcome was good. Mine was a DaVinci robotic with Dr. Tewari Nov 17 -08 in NYC.
See my outcome at http://csn.cancer.org/node/163769 and feel free to email me to the address in the thread, I'd be happy to share my experiences with you.
Also, mention here where you live, as many survivors here may have a recommendation for you in terms of facilities and doctors.
Good luck.

JoeMac's picture
Posts: 77
Joined: Jun 2008

Aloha Gman0821,
Before making any decision as to treatment, what is your PSA doing over how long a time? PSA is a useful tool once you are diagnosed with PC. Get second, third consults, do not take the first advice for treatment. You are 62, if PSA is rising slowly, you may die of something else before the PC affects you. EBRT/IMRT is not a good choice with your low biopsy results, did you get a second opinion? Biopsy results change as to the person performing the review. Get a second opinion. Any treatment can have life long affects.

Posts: 2
Joined: Feb 2009

I'm just getting into this, so I've a bit of a learning curve going on. I am scheduled for my 1st appointment with the second opinion Dr, March 13. Right after I posted the message with the questions last night, my brother called and gave me the info about the radiation really messing things up for later surgery. My PSA has been bumping along around 2.4 to 2.9 for 10 years, then in '08 it jumped to 4.3 with the '09 reading of 5.2. I'm just outside of Dallas, TX and am NOT averse to traveling to get what I need. Tomorrow I'm going to a support group meeting in Dallas. I need to get to as many of these meetings as I can to get some local opinions, as you suggested. Later. Jay

Posts: 9
Joined: Feb 2009

And then a third, and so on, until you are comfortable with your treatment decision. You really want to shoot for curing your prostate cancer with the first treatment, and not bank on follow-up regimens. With your pre-treatment characteristics, surgery is definitely a good option. IMRT alone does not have a great track record of achieving cure, particularly when the same definition of "cure" is applied that is used for radical prostatectomy.

Ultimately, your goal is to achieve PSA 0.2 ng/ml, and to have your PSA stay at that level forever. There are two forms of treatment that have a strong track record of achieving that goal. One is radical prostatectomy, and the other is a procedure called ProstRcision.

First, about radical prostatectomy - it is important to know that when it comes to radical prostatectomy, too much importance is placed on the procedure itself, and less on the ability of the physician that performs the procedure. If you decide to have the radical prostatectomy, don't focus as much on how the physician performs the procedure (whether he performs a traditional open radical, a laparascopic, or the DaVinci robotic radical). The most important thing is the experience and skill of the physician that performs the procedure. Why? Because the cure rates are the same from procedure to procedure. That is to say, men are not cured better via DaVinci than they are via traditional open RP. The only difference between the two is the length of stay in the hospital post-surgery.

These are the first questions you should ask of any doc who wants to treat your prostate cancer:

1. How many men with prostate cancer have you personally treated?

2. Do you track all the men you've treated in a database?

3. How many of these men have PSA 0.2 ng/ml 10 years after treatment?

4. If you were to treat my particular case of prostate cancer, what is my 10-year Individual Cure Rate (ICR)?

If a physician doesn't know the answers to these questions, or just cites some medical study of which he was not a participant, then he is just guessing at how well he cures men of prostate cancer. A note on the ICR - this requires that a physician track the results of all the men he has treated. To calculate an ICR for you, a physician would compare your pre-treatment characteristics with every other man he has treated that has similar pre-treatment characterisitics, and then give you an exact percetage of all those men that achieved PSA 0.2 ng/ml 10 years after treatment.

As I stated previously, there are two options, one being RP, the other ProstRcision. ProstRcision is a combined radiation procedure. It is a combination of brachytherapy and IMRT external beam that actually has higher cure rates than radical prostatectomy. I recommend you read the Q&A section on the http://www.prostrcision.com website

Also, I recommend that you fill out the form on the Contact Us page to be set up for a free phone evaluation with a board-certified radiation oncologist. They will also give you an ICR based on a comparison of your case to all the men, out of over 12,000, they've treated that had similar pre-treatment scores.

Remember, ultimately, the decision is yours - I encourage you to make a decision based on seeking cure at PSA 0.2 ng/ml. Best of luck to you.

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