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To Seed Or Not to Seed? That is the Question ...

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Posted 2/23/2009 4:51 PM (GMT 0)
So caught up in confusion of seeds vs robotic surgery.

Can some of you guys tell me your experience with seeds?

Posted 2/23/2009 5:40 PM (GMT 0)
benj, it would be a help to those answering your questions if you would post a Signature listing the pertinent details of your Journey so far. Go to Control Panel, then Edit Profile, then scroll to the bottom and fill in the space there. Info shared is useful for all of us, especially when responding to someones question, if we know where they are and don't have to waste a lot of time asking for details. Several of the seeding guys will be along shortly, most likely.
Posted 2/23/2009 5:58 PM (GMT 0)
Calling Bro. Tudpock for some more answers on seeding!
Posted 2/23/2009 6:53 PM (GMT 0)
Benj,
One of the most important considerations for Seeds is the size of your prostate. I think 60 mls is around the cutoff point for a comfortable seeding -- any larger and it is too much. (Is possible to have it shrunk over a few months if you are not too far above I suppose ). Also your current BPH symptoms if any are a factor because any radiation treatment is going to make those worse (dunno for how lomg -- till swelling goes down?).

If you have had a biopsy there should be a section there that states the estimated volume of your prostate. (If you did not have any real BPH symptoms you are probably small enough).

jim
Posted 2/23/2009 8:09 PM (GMT 0)
Benj, brachytherapy as a sole therapy, has not proven to be successful long-term for cure of prostate cancer - showing an approximate 30% overall cure rate. That is to say that it is not as effective as radical prostatectomy in achieving PSA 0.2 ng/ml 10 years after treatment. The utilization of brachytherapy in combination with beam therapy shows more promise. This combination treatmen can either be the IMRT external beam treatment followed by brachytherapy, which has an approximate 65% overall cure rate, or brachytherapy followed by IMRT external beam treatment. The latter combination is utilized by a group in Atlanta called Radiotherapy Clinics of Georgia, and they have documented an overall cure rate of 83%, which is actually higher than RP.
Posted 2/23/2009 8:29 PM (GMT 0)

Dear BDJC

Can you tell me what the overall cure rate for surgery is and does that rate change if it is robotics surgery?

Posted 2/23/2009 8:59 PM (GMT 0)
The information we were given with respect to Brachytherapy vs surgery was the results were almost identical.  I know many will dispute it but we were comfortable enough with those research results to go ahead with Brachytherapy.

Particulars are listed in my sign off.  If you have any specific questions, please feel free to ask and I'll answer anything I can.

Good luck with your decision.

JustJulie

Posted 2/24/2009 12:31 AM (GMT 0)

Dear Benj:

I am a recent brachytherapy patient and am happy to answer any question if I can (David usually calls me in ...I think I will start sharing my commissions with him!!!).

First of all, the information provided by BDJC is misleading at best and incorrect at worst.  I did a TON of research on all of the treatments and, as Julie points out, the cure rates for brachytherapy alone are basically the same as for surgery.  The stats that BDJC provided about PSA levels are interesting but not particularly pertinent to brachytherapy patients.  After surgery, a patient's PSA should approach zero and stay there to indicate that the cancer is cured.  For brachytherapy, the PSA level will drop to a nadir, then usually bounce, followed by a further drop.  Sometimes that is between zero and .2, sometimes not. Because the patient still has a prostate (albeit a pretty nasty one), PSA will still be produced at a low level.  So, comparing PSA levels for surgery and brachytherapy patients is not necessarily appropriate.  The indication of cancer recurrance in surgery patients is almost any movement away from zero.  In brachytherapy patients, the indication of recurrance is multiple post-bounce increases in PSA from the nadir.

What IS necessarily appropriate is to compare survival rates at 5, 10, 15 years and beyond.  For brachytherapy patients and surgery patients with similar original stats, the "cure rate" is essentially the same.  If you don't want to believe me, feel free to read Walsh's book or simply google and you will see that this is true.

Now, I can't say that brachytherapy is right for you.  I suggest that any patient contact multiple EXPERIENCED docs, i.e. surgeon, radiation oncologist, prostate oncologist, etc.  And, do tons of research.  There are many sites recommended by this forum's administrators and these sites are excellent.

What I can tell you is that for some patients, brachytherapy is an excellent choice.  Julie feels that way and so do I from personal experience.  If you are interested in reading "first person" accounts, I refer you to "Just Julie's Brachytherapy Journey" on this forum and my own more recent journey, "Tudpock's Brachytherapy Journey", also on this forum.

Hope this helps and feel free to ask any more questions...I'll be glad to help any way I can.

Good luck!

Tudpock

P.S. to David:  The check is in the mail...

Posted 2/24/2009 1:38 AM (GMT 0)
Tudpock, you read my mind! No seriously, I consider you the most informed on the subject, and if I meet someone first with an interested in your protocal, I want to make sure they know who to ask for. I am glad you are doing so well with it so far. I really was interested for myself at one point, but my dr. thought I had too serious a case going on at the time, had a lot of cancer % in the 7/7 positive cores at the time, and a strong gleason 7 going into it.

david
Posted 2/24/2009 1:42 AM (GMT 0)
PS to Tudpock, you are quite right, its not fair to compare between post surgery psa levels and "seeding" or even regular radiation post treatment psa levels. We are not even remotely talking apples to apples, so any comparisom to levels would be misleading at best.
Posted 2/24/2009 2:03 PM (GMT 0)

David:

I think if I had your stats and history going in, I would have made the same treatment decision that you did.  As it was, it was a close call for me...I had both procedures scheduled when I finally decided on brachytherapy and cancelled the surgery.

One of the tough things about this disease is that every man is different, every case is different and the available options are different.  All each of us can do is take the time to research the heck out of it, make an informed decision and hope (or pray) for the best.

This forum is great for sharing experiences and opinions and, hopefully, Benj will benefit from the interchange and feel confident when he makes a final decision.

Tudpock

Posted 2/24/2009 4:00 PM (GMT 0)
Tud,
My radiation/oncologist handled my prior radiation from 9 years ago, and even he thought surgery would give me the best shot. After what I went through with rad the first time, I told my urologist from the start that I was more afraid of radiation than surgery.

Yes, Benj needs to weigh it all out, and come to terms that best suits his stats, overall medical condition, age, personal life, etc, like all the rest of us, and like they say, stick to it, and not look back.

David
Posted 3/26/2009 2:30 AM (GMT 0)
In 1998, at age 47, I chose the seed implant feeling that potential problems with incontinence at that age was not acceptable. My doctor told me that the results comparing seed implant vs. prostate removal were basically the same. He also told me that if the cancer returned, that prostate removal would be a much more difficult surgery. I gambled. 10 years later, my cancer returned. At age 57, I chose the salvage prostatectomy over hormone therapy and external beam radiation due to my age.
Posted 3/26/2009 8:52 PM (GMT 0)
Hi there,

   My husband choose seeding vs. surgery due to his Multiple Sclerosis.  The Dr. told him that his risk of incontinence would be more likely with surgery because of his MS.  The Dr. also suggested 8 week treatment of radiation would be a good choice but the treatment center was 3 hours away and would have required my husband to live away from home.  Watchful waiting was also an option but my husband wanted the cancer out.

    It is a hard choice.  He probably would have opted for robotic surgery if given the choice.  The seeding is done, not a hard process at all and remember he's already weakened by the MS.  A healthy man would probably would breeze right through it.  He had the seeding done last Friday and today is suffering from low back pain.  He's had that problem for a few years now.  He felt a little swollen but today felt that was better.

     We saw many Dr.'s to explore our options.  I started a journal too so you could read our process.  Look at the signature below to find the thread.  The best advice we got was to slow down, check every option.  With prostate cancer there is time. 

Posted 3/26/2009 10:28 PM (GMT 0)
In low grade cancers, gleason 6 and below the cure rates are about the same, so the real question is the side affects.
Whith surgery you are sure you got it out and can review the pathology of the tumor. In seeds you are never sure.
In surgery you have to have a catheter for a couple of weeks and start with incontenince. with seeds you may develop incontinence in a few years, but the permenant incontenance rate is about the same.
There is little recovery time after seeds, a few week for surgery.
There is possibility of bowel problems with seeds as time progresses. Permenant bowel issues are about the same as with surgery.
In Surgery you are impotant for up to a year or two than hopefully recover.
With seeds you start off potant and may lose potancy after a few years; but permenant impotancyis about the same.
Surgery is a complicated procedure and many more things can possibly go wrong.
A lot of men choose surgery because of a reoccurrance you can do radiation. Salvage surgery is not a good option. I disagree with this line of thinking because the cure rate for any type of reocccurance is very low and you are just stacking on more permanent side affects. If I had a reoccurance I would go directly to Hormone therapy because most end up there in the long run anyway.
JohnT
Posted 3/26/2009 10:34 PM (GMT 0)
Benj,
I just noticed that you are a gleason 7. If you are considering seeds then look at having 5 weeks of IMRT along with the seeds for a more effective treatment. Seeds alone are OK for a low Gleason, but intermediate risk patients should have a little more kick just to be on the safe side.
JohnT
Posted 3/26/2009 11:19 PM (GMT 0)
Benj, in my neck of the woods, they would not reccomend doing seeds if you have a Gleason of 7 or above, and it would really make a big difference if the 7 was a 4+3, as opposed to a 3+4. The first combination is made up of a majority of more agressive type 4 cancer cells.

David in SC
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