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Considering IMRT and DaVinci

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Posted 10/25/2009 5:00 AM (GMT 0)
I am weighing IMRT therapy and DaVinci surgery, and have a series of consultations scheduled at Dana Farber this week.  I probably am not a candidate for brachytherapy because my prostate at 57 cc is too large for that approach.  In meetings already with two surgeons, both indicated they would have to take the right nerve bundle, and at my age (66) I have a pretty good idea what that means for ED.  The track record data are not as extensive for IMRT as opposed to surgery, so (other than the risks of radiation, which are not inconsiderable if things go wrong), the 5 - 10 year recurrence and survival outlook is less clear for IMRT.  My Primary Care physician told me that an arbitrary cut off sometimes used is age 65;  that is < 65 calls for surgery because of a longer life expectancy.  My urologist said that if I were 70, he would recommend radiation, but at 66 would still go for surgery.  (Not incidentally, the median life expectancy of a 66 year old American male is 12 years.)

Any of your thoughts, as always are appreciated.

Age 66

PSA:  6.0  on 07/31/09 having risen from 4.2 on 12/02/08.  Free PSA 23.5%.

Other PSA History: 4.3 on 05/01/08; 3.3 on 11/15/07; 3.1 on 05/20/07; 4.0 on 11/30/06; 3.40 on 09/01/05.

Biopsy:  09/04/09  13 snips;  two positive.  Right Mid  3+4 = 7 and 15% of the total volume.   Right Lateral Mid 4+3 = 7 and 20% of the total volume.

 

Posted 10/25/2009 12:36 PM (GMT 0)
There are at least 2 people on here that have lost a nerve bundle and have had no problem with ED straight after the operation and I am one of them I do not know how many others are OK after time So if you are thinking that you always get a problem after losing a bundle it is not so
Posted 10/25/2009 4:28 PM (GMT 0)
Newspaper lover,
Like it or not at your age surgery is risky, us old guys just don't heal like we used to, and when something goes wrong it tends to be a lot worse and more often. Whoever told you that your prostate is too big for seeds doesn't know what he is talking about. The cutoff is 60cc, but smaller is better and more effective. You can easily reduce your prostate size to about 50% by taking 3 months of Casodex and Proscar; this will also kill any stray cells that may have escaped. My prostate went from 60cc to 32cc. With a G7 a more effective approach would be a combination of seeds and IMRT. The advantages are a much higher dose, about 20% to 25% with the same side affects of either treatment alone. Also two different types of radiation makes it better if your PC builds a resistance to one of them.
Do some more research on both surgery and radiation; combination therapy may be more effective than surgery with your stats and will certainly result in fewer side affects and pain.
JohnT
Posted 10/25/2009 8:44 PM (GMT 0)
As an old guy of 63 at the time of surgery, in good shape, I came through it without problems -- except ED, expected with non-nerve-sparing.

NewspaperLover, you are 66, and if you are also in good shape, then surgery is a valid option. If your health is not so good, then a non-surgical option will likely be better for you.
Posted 10/25/2009 11:56 PM (GMT 0)
Thanks for the input Colin45, JohnT, and Piano  --  this is the toughest choice I have ever had to make, and I appreciate the information and support you provide.  Except for PC, I am in very good health, and quite physically active.  I'll let you know how it goes at  Dana Farber.

 

Posted 10/25/2009 11:56 PM (GMT 0)
I did surgery at 66 because I felt that it gave me radiation options for later on. By the way, I survived. The surgery issue is your overall health, as judged by your surgeon (and in my case by my internist who saw no problem with surgery) Your biopsy shows a moderately aggressive cancer, but not a lot of it so you have a number of options.

My brother did brachy at age 55 and now at 60 reports PSA of 0.0 and no ED that is not handled by Viagra.
Posted 10/26/2009 2:26 AM (GMT 0)
Hi,
I had my Robotic surgery at the age of 67 and had no problems at all. I was walking 3 miles one week after my surgery. It really depends on how good a physical condition you are in prior to surgery.
Posted 10/26/2009 9:37 PM (GMT 0)
Talk to doctors you know..ask point blank what they would do....read everything...read old threads on this site...there
a world of research and common sense..

for me with lots of risk factors, I never considered radiation all nine 9 physicians including 4 uroologists recommended surgery, preferably daVinci.....the director of a unit of Johns Hopkins recommended Memorial Sloan Kettering as did 7 others.....do your homework and readh Dr Scardino's terrific book.

good luck
mbshine
AGE 62
DX 7/08
psa HAD GONE FROM 1.7 TO 4.3 IN THREE YEARS...DIGITAL AND ULTRA SOUND EXAM SHOWED NO ENLARGEMENT.
BIOPSY SHOWED 2 OF 12 CORES POSITIVE.
TWO TUMORS SHOWED GLEASON 4+3 AND 3+4
NO INDICATION OF ESCAPE FROM CAPSULE OR METASTASIS
STARTED CONSULTATIONS AT SLOAN KETTERING 8/09
DR GUILLONNEAU SAID NO SURGERY UNLESS MASSIVE WEIGHT LOSS.
AT DX 333 LBS, SLEEP APNEA, AND HIGH BP
BARIATRIC SURGERY RECOMMENDED.
LAP BAND SURGERY IN EL PASO, TX 1/23/09
10/1/09 276 LBS, TRIGLYC AND CHOL NORMAL, NO SIGNS OF SLEEP APNEA, ONE BP RX REMOVED AND OTHERS CUT DOSAGE IN HALF;

STARTED QUARTERLY ZOLODEX BY TAOS,NM UROLOGIST, WHO TRAINED AT MSKCC, INJECTIONS AND CASODEX 50MG DAILY 9/08

davinci done 10/19/09
Jackson pratt drain removed surgery plus 1 day.
Posted 10/27/2009 12:49 AM (GMT 0)
I had my surgery at age 69. Today, almost 11 months after surgery I feel great. Still 100% ED but at my age I don't really care. Still have mild incontinence, just enough to use a pad if I go out for long periods where I might not have access to a restroom.

Right now my daughter and I are training for a 5K run on Thanksgiving day. I feel that my qol is much better now than before surgery. My only problem is dealing with the ever present possibility that my PSA level will start to rise.

Wishing good health to all,
Bob
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