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Posted 8/8/2009 3:27 PM (GMT 0)
David/CPA - I agree fully with your logic here in your answer.

With any of the radiation approaches as a primary treatment, Tud's tretise on side effects I feel is accurate and needs to be weighed into a final decision for treatment. However, with the radiation approaches, you do not know accurately where you really stand, and what do you do next, if your treatment fails?

In the old school approach, you have surgery, salvage radiation, and hormone treatment line in a row like ducks if needed to fight the monster.

I have no objections to my radiated or seeded brothers, they still made their choices on what they knew and felt at the time, on their own unique criteria.

It's just not as simple to tell someone new, that it doesn't really matter if you do surgery or radiation on the first pass, they are both equally effective. I wish it were that easy. I have said this before, I say it again, I wanted seeding, but did not meet a reasonable criteria with my known stats to make it seem like it would be effective.

David in SC
Posted 8/8/2009 9:05 PM (GMT 0)
The only thing I have to add to Tud's remarks are that any salvage treatment can only work if the PC is a local reoccurrance. The majority of reocccurrances are not local. If surgery and radiation are done properly the chances of local reoccurrances are low. Local reoccurrances in surgery occur because prostate tissue is left or a positive margin has left some cells in the prostate bed. Local reoccurrances in seeds occur because there was an uneven distribution of seeds leaving dead spots. Local reoccurrances in external radiation occur because the dose was not sufficient to kill the PC. Modern radiation plans radiate in high dose the prostate bed and the entire prostate killing any stray cells in the bed or in hard to reach areas such as around the ureatha and seminal vessels. Radiologists believe this gives a better chance of eliminating positive margins and local reoccurrances.
With any reoccurrance it is difficult to asertain if it is local or systemic. Pretreatment tests and stats can indicate the possibility of local or systemic reoccurrance and it takes a skilled specialist to properly evaluate this.
JT
Posted 8/8/2009 9:47 PM (GMT 0)
I agree with John T's post.

The other comment I must make is that biopsy Gleason and post surgical pathologic Gleason do not always agree.

I did not qualify for Brachy at least with my radiologist because I had a G 9. If I had a biopsy Gleason of a 7, I probably would have been able to have Brachy. But, without the surgical pathology, I may have been given a treatment that would not jave been adquate.

So many variables in these equations !
Posted 8/8/2009 11:37 PM (GMT 0)
goodlife,

shows how many different ways doctors look at the criteria for treatment. in my area, and in my case, seeds were ruled out, because my presurgery gleason was a 4+3, and I had psa well over 12, with a lot of velocity. the local rad people didn't think it would be likely that they could get it. so i moved on to surgery.

david in sc
Posted 8/9/2009 1:33 AM (GMT 0)

I wish to thank every one for their extermely helpful replies.

Sonny3, thank you for the reccomendation of Dr. Menon of the Vattikuti Institute at the Henry Ford Medical Center in Detroit.  I had seen the Vattikuti Institute and their Veil of Aphrodite Nerve-Sparing Procedure.  I'll add this name to my list.

Channelsurferdude, I've looked at proton theraphy and the Loma Linda and M.D. Anderson websites.  It is interesting, but I don't know how to critically evaluate their claims.

Tudpock 18, thanks for the link to the Dattoli Institute.

Since I posted this I attended two local PC support group meetings.  One PC support group member had Brachy four years ago using my urologist and the radiation oncologist I talked to.  He is extermly pleased with the results (PSA .01 and no side effects).  Other members had surgery done my Urologist's more experienced partners and recommended them.  One member said patints come to Omaha from Kansas City to have these guys perform their surgeries.

I'll continue to evaluate my options.

George

Posted 8/9/2009 1:37 AM (GMT 0)
Gee Tudpock, As I sit here swaddled in my Depend diaper with an extra pad, your description of Brachy is starting to sound pretty good. Can I call "Do over!"? Oh wait, I guess not...
Your summary is one of the best I have seen.
Thanks (in advance for the next guy)
Jeff
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