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looking for treatment

MCJ
Posts: 59
Joined: Aug 2009

Hi guys, I was recently diagnosed with pc gleason of 7, psa last taken at 5.5, 60 yrs of age. I am now researching treatments. Has anyone heard of the radiotherapy clinic of georgia? They implant seeds and use outside radiation at the same time. Any long term survivors here that can tell me what trreatments they did do. I am not sure what to do. I have a friend that had his prostate removed and not much trouble, that was 14 years ago, but has ed. Not looking forward to that. But my main concern is to be around a few more years.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 2655
Joined: May 2012

Welcome, MCJ.

"Seeding" is a term for radiation delivery known as Brachytherapy . It is often combined with EB or "Externam Beam" radiation, but they are also often used alone, one or the other.

I am from neighboring SC, ,and have not heard of the Radiotherapy Clinics of Georgia, but it sounds, obviously, like they specialize in radiation to kill cancer, maybe exclusively.   [ I just went to their web site, and while they are very impressive in radiation therapy, beware that they may not be the best source for information regarding other treatment modalities. They claim to be the leaders in Brachytherapy, and to have treated over 14,000 cases of prostate cancer, with great outcomes. At the least, your first stop in your search was a very good one. ]

https://www.rcog.com/about-us

There are other common ways to treat prostate cancer, such as "Active Survelliance" and surgical removal of the gland.  Any prostate cancer patient should consider all three of these in some detail before deciding on which treatment to use. 

Who recommended the Radiation Center to you ? Was it your urologist, who did the biopsy ?  Most, or perhaps all, of the guys here would recommend that you get more referrals to other doctors (surgeons, medical oncologists) before making your decision. 

Best of luck. Please ask more questions as they arise,

max               

MCJ
Posts: 59
Joined: Aug 2009

Thanks Max, I seen an advertisement while looking at a tourist spot advertisement. Really weird the way it happened at this time with my health problems. Thanks again for the information, it helps a lot.

hopeful and opt...
Posts: 1998
Joined: Apr 2009

I didn't mention this, but for some reason, a long time ago, I remember reading about this Georgia Radiation facility that advertises all over town, with a special technique.......I think that I read something negative, but I'm not sure....at any rate I suggest you investigate this facility very carefully.

MCJ
Posts: 59
Joined: Aug 2009

thanks

VascodaGama's picture
VascodaGama
Posts: 2542
Joined: Nov 2010

MCJ

Seeds (Brachy) plus EB has been a treatment choice for many years. Nowadays some physicians add hormonal treatment to the RT protocol with successful rates. Please read these;

http://www.prostate-cancer.com/brachytherapy/survival-rates/brachytherapy-survival-rates.html

http://www.americanbrachytherapy.org/aboutbrachytherapy/qanda.cfm

There is another type of Brachytherapy named High Dose Rate (HDRB) which has a longer history in the treatment of PCa highly successful. The difference with the “seeds” is that the radiation dose is higher so that it is done in a short. The application in both is similar (invasive) with the insertion of rods into the gland. Seeds are implanted and left behind, losing the effects a few days later, but the HRDB rods apply the radiation at the moment of insertion and then are withdrawn. High dose radiation seems to have better responses in the treatment of cancer and such can also be applied by an external beam non invasive. Several machines do the job but CyberKnife become quite popular for the successful reports in regards to the side effects. Please read these;

http://emedicine.medscape.com/article/453349-overview

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502731/

http://en.wikipedia.org/wiki/Cyberknife

You can read the stories of various patients who chose Brachy (or other forms) as prime treatment in these links;

http://www.yananow.org/

http://www.google.com/cse?cx=012502927953566205825%3Aocjd945u1as&ie=UTF-8&q=brackytherapy&sa=Search&siteurl=www.yananow.org%2Fquery_stories.php&ref=www.yananow.org%2FExperiences.shtml&ss=4594j2236594j13#gsc.tab=0&gsc.q=brachytherapy

Can you share more details about your initial diagnosis?

Best wishes.

Welcome to the board.

VG

hopeful and opt...
Posts: 1998
Joined: Apr 2009

MCI

 I am sorry for your diagnosis.

 

WHERE DO YOU STAND

Knowing this is important to a best treatment decision.

What is the history of your PSAs

Did the digital rectal exam show abnormality

The biopsy....how many cores were taken..how many positive, what was the Gleason...was it a 3+4 or a 4+3=7, What was the involvement of each core....that is hat was the percent that was cancerous

 

Did the biopsy provide any other information, ie perennial invasion.

 

DIAGNOSTIC TESTS

Since interpreting the results of a biopsy is subjective, it is important to have an opinion from a world class pathologist so that you are not under or over treatment

Have you had any other diagnostic tests, ie a multiparametric MRI with a T3. If extracapsular extension is found this can preclude certain treatment types

 

Threads about the radiation center that you mentioned

http://csn.cancer.org/node/156136
 

http://csn.cancer.org/node/184149

Side effects of treatment cumulative, if you have more than one treatment type the side effects are cumulative, ie Brachytherapy and IMRT, not saying that these treatments are  or not necessary. Review of your history and future diagnostic tests will provide information for this determination.

Please get back to us with more information about you.\

Continue to research, read books, local support groups to find about more what is available, etc

We are here for you

 

MCJ
Posts: 59
Joined: Aug 2009

I can't remember all the numbers exactly. My psa was gradually increasing each year, low 2, high 2 low 3 high 3, then low 4. My doctor repeated the psa 3 months after it hit 4.2 and it was still there, she suggested that I wait another year. I went to a free psa exam at the Milwaukee Brewers Stadium, psa to 4.6 so I went to an urologist a few months later [recommended by a friend]. Psa wat at 5 then and I had the DRE also a few times before and it was negative. He did a biopsy and 3 cores were 3-3 at a low percent. He sent out a specimen to California for the oncotype dx test. It came back with a very low grade, lilke 20 %, meaning a very slow growing cancer. He suggested watchful waiting. We did. Next 6 month pas was still around 5. So after 14 monthes of the first biopsy i had another. It was six cores positive. 2 were 4-3, 1 was 3-4 and 3 werre 3-3. the 3-3 were 5-10 %, the others 35 an 50%. Results were very scary to me to say the least. And that is where I am today. 

 

I hate to say this but I.m having a hard time putting a lot of energy in this because my wie has been battling triple neg stage 4 breast cancer.

 

And thanks for your help and references  VG.  

MCJ
Posts: 59
Joined: Aug 2009

Thanks VG you are a big help, I have more info below. 

 

Or i guess see above

MCJ
Posts: 59
Joined: Aug 2009

Sorry VG I'm not getting my replies in the right spot, see below.

 And thanks to you Hopeful

You guys area big help

VascodaGama's picture
VascodaGama
Posts: 2542
Joined: Nov 2010

MCJ

Guys in this forum are a bunch of survivors with the intent in helping newbies, to the best we can. We are not doctors so that you should try obtaining details from reliable researches and then discussing the contents with PCa doctors. We all get anxious initially because we are fighting the unknown. PCa is problematic but allows time to get educated on the matter and the confidence on how to proceed. You should try reading past threads of this forum and probably getting a book on PCa for guidance. Below I list two good books but these were written by two famous surgeons (urologists from JH and MSKCC) so that the content is biased towards surgery, however, they explain well about radiation therapy too;

Guide to Surviving Prostate Cancer by Dr. Patrick Walsh (third edition).

The Complete Guide to Overcoming Prostate Cancer, Prostatitis, and BPH by Dr. Peter Scardino (second edition)

I do not know if you have already decided on the type of treatment but the radicals are the only ones providing cure. Both surgery and radiation have risks attached which ones we should know in detail because they can become permanent affairs and nightmares in our quality living.

Gleason score 7 (4+3) is an aggressive cancer that needs care the soonest but not the earliest. I believe that in six months time the diagnosis would not differ. The PSA may become higher but the form of treatment would be the same as it has been ten years ago, with the same probabilities of success. What is important is to find an experienced physician (and team) we trust, chose a treatment we feel confident in and get the support of our families. Proper diagnoses are helpful in choosing the best which involves in locating the cancer. No one can throw arrows in the dark expecting to hit the target positively. Accordingly, if cancer is not localized then the chances in obtaining total success are much lower.

Surgery is for cases with cancer totally contained. Radiation is applied in localized (gland and surroundings) cases. In this concern, (your discussion regarding Brachy) the seeds would aim the gland and EB (IMRT) would target a wider field that could include lymph nodes at the iliac. This is also a good modality (treatment) in micrometastases cases. In aggressive forms of cancer (Gr4) radiation get better results when done with hormonal treatment. However, all therapies got their risks and side effects so that these will be wider and should be considered in a final decision.

I recommend you to get second opinions from two or three specialists in each field. It will be confusing but at the end you have chosen the best to your knowledge. Before consultations you should prepare a list of question. Surely having someone with you is better so that you can get notes easily.

I am sorry for your wife’s cancer case. She would be following a similar path to yours. We will try helping you in understanding matters based on our experiences while leading our cases.

Best wishes,

VGama

hopeful and opt...
Posts: 1998
Joined: Apr 2009

I previously mentioned the MRI test with a T3. it is important to do this, positive results will preclude surgery, and give insights to radiation treatments if undertaken. 

 

 

MCJ
Posts: 59
Joined: Aug 2009

Hopefull I will check with drs on mri

 

Thanks so much

MCJ
Posts: 59
Joined: Aug 2009

Hey Vgama

Not sure what you mean by the radicals only ones providing a cure? We have talked with a davinci surgeon [ he has been my treating dr throughout], and a radiation oncolgist, and a open surgeon, all suggested removal of the prostate. I have to ask them why no suggestion of ct or mri maybe because the dre has been negative. It seems the younger you are the stick with that treatment. The radiation oncologist did say he felt a firm spot but if he didn't know my condition he would not be concerned. Seeing a second radiation dr on Monday. I will get a list of questions.

Yes that 4-3 score has me more worried.

Thanks for all the info and concern you guys are the best, not much of a reader but I will now.

Old Salt
Posts: 477
Joined: Aug 2014

Vasco referred to radical prostatectomy when he wrote 'radicals' in his 3/07 post.

MCJ
Posts: 59
Joined: Aug 2009

thanks salt

hopeful and opt...
Posts: 1998
Joined: Apr 2009

Although there is a CT scan, it does not provide the definition that a multiparametric MRI T3 provides.

Many docs do not have the MRI available, so they do not prescibe, and instead guess on what is going on. In your case where you have a 4+3=7 and six positive cores it may be that there may be cancerous cells outside the prostate......you want to know about this before you undergo any treatment.

You mention the davinci surgeon....what are her qualifications....ie how many surgeries performed....there is a step learning curve. What is the surgeons surgical margin?, etc, etc

MCJ
Posts: 59
Joined: Aug 2009

Thanks Hopefull,

Two had high percentages 50 and 35 the others were like 5 and 10, I will check on the qualifications, golden information.

 

thaks again

VascodaGama's picture
VascodaGama
Posts: 2542
Joined: Nov 2010

Hi

Radicals are all forms of surgery and radiation treatments. Freezing the prostate or attacking it with ultrasound waves or heat waves or laser, are also modalities in use but the outcomes from these treatments are not published and are so rare that we cannot ascertain about success rates.

I would like to know the facts that made your doctors suggest surgery. It could have two meanings; either they diagnosed you as a contained case and propose the treatment with intent at cure or suggested surgery with the intent at debulking. The later is recommended in advanced difficult cases with cancer spread so that they get rid of the chunk; the whole prostate gland with the seminal vesicles and surrounding nerves, etc.

In each meeting try to clarify as many doubts as possible and get a phone number to call later in case you need extra clarification on a matter discussed that you forgot or did not understand totally. Many patients prefer to leave all concerns with the doctor and just follow their suggestion but in the end, before the treatment, we have to sign an agreement indicating that we understand what is going to be done, reliving the doctor and the hospital from any wrong doings, risks or unsuccessful treatment.

Do not forget in have the lipids checked. If you decide on radiation, it would be better to know in advance if you are prune to ulcerative colitis. This is a status that would be affected very much by the treatment.
Just add these to the list of questions.

Best

VG

hopeful and opt...
Posts: 1998
Joined: Apr 2009

it is important to have a copy of all diagnostic tests and office visit notes....also, good idea to bring someone with you to the office visit....you might even wish to ask for permission to tape the visit.

This will facilitate visits to docs in other specialties.

MCJ
Posts: 59
Joined: Aug 2009

Hey VG,

What I mostly understand the reason for removal is my age and the degree of cancer. They believe that I have 5-10 years of no cancer, and then if it returns they can use radiation to beat it down again. I have been told I have 2-3 months to decide, but I'm not taking that long, I'm getting more anxious the more I think about it, which can be all the time. I'm leaning 90% on de vinci. 

thanks so much for all your info

 

mcj

 

hopeful and opt...
Posts: 1998
Joined: Apr 2009

When we are diagnosed, we all go through intense anxiety, and all of those negative feeling. This usually lasts two to three months. During this time we are faced with making a potentially life changing decision , that is choosing the best treatment option with the least side effects.

It is very important for you make your decision based on all the facts that are and can be available about your case. Since PCa is a slow growing disease two or three months in not critical in this decision making process.

Since the side effects of doing more than one treatment choice are cummulative, you want to avoid this choice (surgery), if the cancer has already escaped the capsule, since the cancer will still spread and you will still need to treat with another treatment choice.

Previously I posted to you on this thread, "have you had any other diagnostic tests, ie a multiparametric MRI with a T3. If extracapsular extension is found this can preclude certain treatment types" Basically what this means is that you want to know if the cancer is already outside the capsule; if this is so surgery is not appropriate. You really need to have this test before you undergo this surgery.....(while surgery is effective in curing cancer in the prostate, it can have major side effects to include, but not limited to incontinence and ED. Why undergo this if it will not be effective in curing the cancer.Additionally surgery is age dependent: a surgeon can do the exact same operation on a fifty year old and have excellent results and have negative results for a seventy year old.

The above is my laymans two cents. Hopefully Vasco and others will provide more information tha t will be useful for you.

VascodaGama's picture
VascodaGama
Posts: 2542
Joined: Nov 2010

MCJ

Deciding on a treatment for prostate cancer is not easy. None of them can assure the perfect outcome and all got attached side effects that could become permanent nightmares in one’s life time. You should read firstly about the risks each treatment entails and then choose the one you most feel confident with, independently of the Gleason you got.

I think that choosing surgery because the treatment may fail later is not proper. Surgery is good if the cancer is contained, providing high rates for cure. When the case is very “messy” then surgery may be chosen for debulking. Your doctor should be highly experienced to provide the best possible clinical stage. If in doubt then you better get second opinions from several specialists.

Wishing you luck in your decisions.

VG

CJ613
Posts: 6
Joined: May 2015

I had cyberknife. Now I have not much control of my bowels and urine. Forget about ED, Viagra is a great thing. IMO, I would look into that robot surgery. Just my opinion. You have to make your own choice. Just get a good doctor and facility.  Good Luck!

Swingshiftworker
Posts: 1002
Joined: Mar 2010

I haven't heard of many men who have had any negative side effects after treatment w/CK.  I believe you are the 1st man who has been treated w/CK who has reported a negative experience.  Just noticed that you reported elsewhere on the experience and I will comment further there.

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