What to do next??

HRD2: thanks for asking about my doc's appt. 

After Wed's appts with two different docs I drove home, parked my car, reclined the seat, and went to sleep.  I was completely exhausted from all of the activity.

Here's the upshot:  Had meetings with radiation oncologist and surgeon; the cancer is contained in prostate; bone scan was negative for cancer activity; PCa appears to be caught early (only one in 12 cores was positive for cancer). Placement and amount of cancer make me eligible for the full menu of treatment options.  Now I have the hard job of figuring out which of the options is the right one for me.  I have two more appts scheduled: another radiation oncologist and a surgeon that specializes in robotic method. 

My urologist is not a fan of the robotic method; He is not an early adopter of the method. He believes that the robotic technique is not able to discern nuances as when the surgeon uses his hands.  He says this is particularly important  regarding nerve sparing.

Not surprizingly, the radiation guy likes radiation treatment; the surgeon like surgical treatment.

I havn't the slighest idea what I will do.  At this point am leaning toward seeds.  This technique has shorter recovery time; less interruption of sexual performance; less (in many instances) urinary problems; no catheter (unless there is problem voiding); same cure rate as surgery; there is potential for recurrence.

The only thing the doc aked me to do was decide a date by when I will make a decision.  He says that men have tendency to postpone decisions and then not make a decision at all. I completely understand.

Question: what is experience of folks with seed implantation?

Hello Banker:

I'm just slightly ahead of you in the process so can clearly identify with your current feelings and anxieties.

First of all, in my opinion you are doing the right thing by consulting several docs.  I did the same thing and felt better about my decision because of it.  I see you are leaning toward the seeds...that is the decision I have made also but I think most men in this forum have opted for surgery.  It's an individual choice, of course, and all of the research I did showed similar cure rates.  Then it becomes a matter of evaluating the side effects plus how much you psychologically want to "have it out".  That's a big deal with many patients...not so much with me.

There is a lot of reading I could recommend, but three particular things come to mind:

1.  JustJulie's thread on this forum shares her and her husband's brachytherapy experiences.  I found her comments very helpful as were the comments of others on the thread.

2.  There was an excellent article in the New England Journal of Medicine, March 20, 2008, entitled "Quality of LIfe and Satisfaction with Outcome among Prostate-Cancer Survivors".  This provides up to date data comparing different treatments and I found this very useful.

3.  I posted a recent topic that I called "Experience Counts".  It cites info from Hopkins re the need to use experienced surgeons if you want the best outcome.  I'm sure this is true for radiation practitioners as well.  The guy who is doing my seeding has well over 500 procedures under his belt (so to speak) and I spoke to a number of his patients who were very pleased with him as a doc.  I think this experience thing is especially true when it comes to robotic as there are tons of urologists who are now "learning" it.  This was my second option and the surgeon I had chosen had 1000+ procdures.

Anyway, good luck in your decision making and please come back here and tell us what you decide.

Hi Banker..... My husband had brachy (seeds), and conformal external radiation and lupron for one year in 2001...It went well for four years, and we thought things would be fine. No incontinence, but problems with ED, that were just beginning to get better (after four years)....well, PSA began to rise.....at that point the only thing to do was go back on Lupron or have Salvage Surgery. The doctors at Sloan Kettering gave a chance of 50% total cure with salvage surgery citing probable side effects. The other option was Lupron. He decided on the salvage surgery. The SEs have been horrible for my husband. Surgery at first would have taken the cancer out, and then if it did return, he could have the the radiation at that point. But, you have to do what you think is best for YOU....and dont look back.. (I am trying not to) D

All of these posts are very helpful. Thanks.

Regarding"learners," I am particularly concerned. My surgeon has many surgeries under his belt, but i am still concerned about residents versus attendings conducting the surgery. IF I opted for regular surgery, I will have it done at a commmunity hospital instead of our big spiffy teaching hospitals. At the community hospital, i won't have to deal with residents...just my surgeon.

The idea of the cancer returning is the one that bothers me the most when it comes to the seeds. The cure rate between surgery and seed implantation is the same, but cancer can potentially come back with the seeds. I am not certainly I completely understand this. How can the cure rates be the same?

The recovery from surgery makes me quite squeamish...but the seeds have problems too with potential for urgency or catherization.

Everytime i think i KNOW what I want to do, I get another rash of questions and doubts. I completely understand the comment to make the decsion and don't look back.