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Surgery or brachytherapy?

Posts: 1
Joined: Nov 2020

I'm 64 years old, I take no medicines, in very good shape, I exercise and eat healthy. My dad was diagnosed with prostate cancer at around 85, he had radiation, lived to about a month ago. I live in LA area, in California, and belong to Kaiser. I am an engineer working from home, probably till next spring-summer when we plan on returning to our offices. My surgeon is Albert Aboelkhair Mikhail. My radiologist is Dr. Barry Goy.

My PSA has been 1.0 for last few tests. A rectal exam in September yield an inflame prostate and some nodules. I made the mistake for not pushing for MRI first (none suggested by urologist either) and went directly to a biopsy. Biopsy revealed a 3+4, and seems to be located on left bottom side. Will be doing an MRI this Saturday. Surgeon was quick to push for surgery (a bit concerned he never mentioned MRI, but my radiologist was the one, he said we needed one).

Two avenues that have been recommended, surgery or seeds radiation. Putting the risks of surgery aside, it seems I have to decide to deal with embarrassing urine or unpredictable bowel movements. My dad, because of radiation, had many of embarrassing uncontrolled bowel movements and soiling just about everything. I am very actively sexually, so I am not sure which is the best option for the ED side effect and recovering from it. Am I missing anything? What else do I need to consider?

Those of us with HMO medical insurance, seems we have to go with what's available unless we decide to pay out of pocket. So how do I do my homework on the surgeon, and the radiologist? Especially the surgeon if I go the surgery route. I am not even sure if Kaiser is the right place either for these procedures. Help in this area is also appreciated.

I don't panic or stress about things, but usually I have more in my control to do research and in this case I am not sure what other research to do, whether I should pay for second opinions, or what exactly to consider or not.

Thank you, thank you, I know when my wife, 31 years ago, was diagnosed with Lupus, these type of forums gave us the information we needed and gave us hope.

Posts: 693
Joined: Jun 2015

Hi Rar,

You are wise to look into both surgery and other forms of radiation treatments.  Each treatment plan has its own unique set of side efects you need to study before you make your decision.  The best doctors + best facilities = best results in my humble opinion.  Robotic surgery and Cyberknife seem to be very good options for surgery and radiation.  I have included a couple of links to get you started.



Dave 3+4



Posts: 109
Joined: Jun 2017

Hi Rar,

Sorry for your diagnosis, but all is not as bleak as it seems.  I have had both surgery and radiation, and have neither of the side effects you mention.  Most men do not.  Ninety five percent of men will regain continence within a year of the surgery, most much faster than that.  In my case, despite having several strikes against me which could complicate the process, at the three month point I saw marked improvement in control, and by five months I was ninety nine percent there.  With radiation, the precision with which it is applied today means that side effects are rare, and usually short lived.  In my case I had thirty nine sessions of IMRT and had virtually no side effects.

hopeful and opt...
Posts: 2331
Joined: Apr 2009

As you I live in the LA area, Seal Beach. There are various support groups in the area that are informative  Here is one, that happens to be having a presentation this evening 11/19 at 7. There are also men who have a lot of knowledge that you can contact  

Prostate Forum of Orange County Hotline: 1-714-459-2058 www.ProstateForum.org email ProstateForumOC@gmail.com U.S. Mail only: 1519 East Chapman AV #380, Fullerton, CA 92831 USA Thursday, November 19, 2020 ZOOM Presentation. 7:00 PM to 8:30 PM PACIFIC STANDARD TIME ZOOM only meeting. LINK: https://us02web.zoom.us/j/82265639822 Meeting ID: 822 6563 9822 TELEPHONE: 1-877-853-5247 or 1-888-788-0099 “Management of Rising PSA After Primary Treatment"  Use of new genetic testing why it is so important  Whats with all these new drugs?  How to sequence which meds to get and back to the future  Value of chemotherapy in late stage disease Charles K. Metzger, M.D. Urologist (Retired) one of our most popular presenters. Dr. Metzger practiced for over 41 years. He earned his medical degree from Emory University in Atlanta, Georgia and completed his residency and internship at the University of Southern California Medical Center in Los Angeles, CA. He’s consulted for MedNet and organizations conducting clinical trials. He’s practiced at Kaiser Permanente and other hospitals in the Glendora, California area. OTHER MEETINGS AND SERVICES: We are working on bringing ADVANCED DISEASE and NEWLY DIAGNOSED meetings to Zoom. Watch your email for further developments. Our services are free of charge. If you want to make a voluntary donation, mail your check (no cash) to PROSTATE FORUM OF ORANGE COUNTY, 1519 East Chapman AV #380, Fullerton, CA, 92831 USA. “Small” donations gratefully accepted. PROBLEMS LOGGING ON? Call 1-714-944-3994 QUESTIONS: Call our Hotline 1-714-459-2058 or email ProstateForumOC@gmail.com The Prostate Forum of Orange County is a 501(c)(3) non-profit California Corporation. Donations may be fully Tax Deductible. Donations are being used in their entirety for the benefit of men diagnosed with prostate cance


You did not indicate how many of the cores were positive, or the involvement of cancer in each core that was positive. If there is a small amount of 3=4=7 you may be able to consider an active surveillance protocol, or if there are a lot of cores that are positive you have to look at things in a different way. Please share all details of your biopsy results.

As you are probably aware an MRI, and you want a T3 MRI, that is using the highest level magnet in clinical use, with greater definition..This may show extracapsular extension if it exists, so you can best determine a treatment choice, since some of the treatments are localized.

You might wish to read through this thread that another man posted with a 3+4=7. Part of the discussion is about side effects, expecially from surgery. This can be informative for you.





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