New member hello

Juliet,
Welcome, and as is the case with all the new friends, I wish you didn't have a reason to join us.

I did DaVinci surgery (at age 56), post op G 4+5. My biopsy was 7 of 12 cores G 4+4, 2 of 12 G 4+3, so I did not qualify for seeds (BT). With my post-op report, I was off to IGRT as soon as it was practical.

Many insurance companies only pay for 6 cores (as mine), but my uro will do no less than 12. We got that worked out.

I wanted to do seeds, but all of the doctors I talked to ruled it out. There are a number of members who have done seeds, as well as a combo of seeds with IGRT. I'm sure they will speak up.

My Radiation story is in the link (here on HW) in my signature.

Welcome Julie,

Cant answer your question about brachy,but most of us who have had surgery have gone back to work fairly quickly. I was back in 2 weeks, but had to take it easy. Not sure what Carter does for a lving but construction work would keep him out for a longer period of time. Glad you are here and educating yourselfs about PCa and looking at all options.

Michael

Thanks to each of you for taking the time to welcome us!

142, I read your journey, and it was helpful. We have much to learn about the differences between BT and other forms of radiation. Your story, and Fairwind's, are troubling in that surgery was not completely successful and radiation was still necessary. At this point, we are starting to consider that possibility, and may decide against BT knowing that followup treatments would be more problematic if the cancer was not eradicated.

Fairwind, I hadn't even thought about the travel issue. Time spent traveling to treatments for weeks on end could end up being far more time off of work than just recovering from surgery.

60Michael, good to hear that many can return to work quickly. I had read "5 to 7 weeks", which would be a sad situation for Carter. He is up for a promotion the first of the year, and convinced he won't get it if anyone thinks he can't perform at his usual fast pace. His job involves mostly sitting, but a fair amount of walking between buildings and not always easy access to restrooms.

Pipedream, thanks for the book suggestion. I will definitely go look for it, and the Walsh book as well.

I'm sure we'll have lots more questions. Consultation is tomorrow.

Thanks again!

Juliet

Juliet,

The Gleason 7 alone shouldn't stop Carter from having seeding. The size of his prostate could. Do you know how big they estimate his in c.c.? If it is too large, they can try to shrink it down to be suitable for the seeding procedure. The seeding method would probably allow him to get back to work the soonest. I had open Surgery, and then had complications. It would have been at least 3-4 months before I would have been healed and fit enough to return to work, but fortunately/unfortunately, I was also unemployed at the time.

The healing times from the robotic surgery men vary a whole bunch. It ranges from 48 hours later, they say they are as good as new, to those that are 2 months out, and still having physical and pain issues. Don't be fooled, even with robotic surgery, your husband would still be undergoing a very serious and complex surgery.

With his one core being Gleason 7, and all that High Grade PIN being found, its very possible there is more cancer that a low core biopsy like he had is missing the rest. In my opinion, being a confirmed Gleason 7, I would not reccomend AS or watchful waiting. You don't need to rush or be forced into a treatment, as you have sufficient time to do that, but the "4" element of that Gleason 7 is dangerous and unpredictible. Just my take.

Please keep us well posted.

David in SC

Juliet -  i can understand your hesitation for BT as a stand alone treatment.  i went with the combination of HT, BT and IGRT, which is about as aggressive as it gets.  good luck in whatever you decide.

ed

Thanks so much for the additional thoughts, guys. I am trying to learn as much as I can now about all the forms of radiation, and how they are combined. I am thinking we can find a radiation specialist fairly nearby, but would probably have to travel a bit for robotic surgery.

I do know the urologist told Carter his prostate was 'small', but didn't mention cc's. I added that to my list of questions and will ask tomorrow. If it is, that should mean a greater chance of success with regard to all radiation.... or just seeds?

I haven't noticed a lot of mention here of bone scans, but wouldn't that be necessary (or MRI) before proceeding with either treatment choice? Do we have to decide and schedule that ourselves? Or do we pick a treatment and then that specialist schedules additional screening tests? Should we find a medical oncologist? I googled 'prostate oncologist' but didn't find it near here.

Thanks for the warning on the 4 Gleason numbers. That is what makes me feel a bit pressured to hurry and decide. That and the fact that six cores (the same amount done on both biopsies) is, I agree, not a lot to use for assessment. We're feeling a bit overwhelmed, and trying to keep up with concentration at work and not tell anyone what is going on is stressful.

I'll try to start a new thread with any other questions after our appt. tomorrow. Thanks again.

Juliet

Yes, they will do additional screening tests, two or three of them, mostly for CYA purposes..These tests seldom find anything at this stage..Sometimes they find other problems not related to the PC which might have a bearing on treatment..

Remember, each specialist you see is going to try and sell you his product and bad-mouth the other guys product..Seeing a Medical Oncologist is worthwhile..Their insights on surgery and radiation are not likely to be biased as they do neither..But they have seen it all...Whatever treatment option you choose, that decision creates a big paycheck for many people...They will fight for your business...

Juliet,

I suspect that you and your husband are feeling like information overload and it's only just begining.  The follow-up appointment with your urologist will be an important first step in gathering the information you need to make informed decisions about potential treatment options.  Just keep in mind that almost all urologists are surgeons and they almost always suggest surgery as the correct treatment.  Your doctor is required to inform you of other options as well but it has been my experience that surgeons will want to cut.  Radiation specialists, on the other hand, will present excellent arguments about why PCa is best treated with radiation.  I hope you meet with several specialists in different fields to get a balanced opinion.

There are potential side effects with just about any treatment course and they range from relatively mild to severely debilitating, as some of the posts in this forum detail.  When you are doing your consultations, insist that the doctors give you a full explanation of potential side effects in a manner that you and your husband can understand. 

Besides BT, there are other forms of radiation you ought to research as well and these include IMRT, HDR Brachytherapy, SBRT (CyberKnife or Novalis), and proton radiation.  Depending on how your husband's cancer is evaluated some or all of these may be options.

Hormone treatment in conjunction with either surgery or radiation is also often done.

I would also question why only six biopsy samples were taken.  While there is some controversy about the right number, it usually surrounds whether 8 or 12 is the right number.  Having only six may indicate your urologist may not be following the most up-to-date techniques.  The more cores that are taken the more likely it is that cancer will be found but it also helps to properly stage the disease with the appropriate Gleason score, a critical factor in determining a treatment.  (For example, if your doctor had taken more cores the first time, you may have been able to avoid the second biopsy...but then again, hitting a cancer spot is pretty much a guess unless they're going after a nodule felt on the DRE)

A second opinon on the biopsy is a good idea.

Good luck to you both.

 

Dear Juliet:

Welcome to Healing Well.  Sorry you have to be here but I think you will find lots of support and lots of good info on this site.  I am one of several brachytherapy (seed) patients who post here and will try to give you some perspective from my angle.  If you would like to see my "journey" with the seeds, feel free to cut and paste the link in my signature.

Your post raises a whole host of issues and I'll try to repond to all of them:

1.  A six core biopsy is hardly state of the art as you surmised (unless it is done in conjuction with a color doppler scan).  Most men here have 10 or more...I had 16.  So, sorry to say, that alone should give you some question about the competency of your current urologist.  At the very least you should inquire as to why he took so few cores.

2.  The question about prostate size is pertinent.  Most radiation docs like to seed prostates that are 50cc in size or smaller for best results.

3.  You should consult a radiation oncologist and a prostate oncologist (in addition to a surgeon) before settling on a treatment.  You definitely want to become educated re the options.  You may want to ask them about color doppler staging given the small number of cores in hubby's biopsy.

4.  BT alone is frequently done for men with Gleason 6 graded cancer OR G7 men with a small percentage of cores and/or a small percentage of cancer in the cores.  You will want to discuss this in depth with the radiation oncologist and the prostate oncologist.  They may want to add IMRT to the BT depending on their assessment of the cancer. 

5.  BT is HIGHLY CURATIVE in men who are eligible for the procedure.  The success rate is as high as for men who have surgery but with much less onerous side effects.  If quality of life is a concern, I suggest you seriously consider this option.  You may want to Google "New England Journal of Medicine Quality of Life" to read an interesting study re that topic.

6.  The books I suggest reading are Walsh's "Guide to Surviving Prostate Cancer" (a good primer), Strum's book (title escapes me now) and a brand new book by Blum-Scholz called "Invasion of the Prostate Snatchers".  Despite the title of the latter, it provides valuable perspective that I believe every patient should have..especially about quality of life.

7.  Experience matters.  Whatever treatment you choose, please make sure that the doctor has done hundreds of procedures.  Studies show that success is better at 250+ procedures and then it levels off.  It's no guarantee, but it gives you better odds.

8.  There are men who bounce back quickly from the surgery but I would say the norm is that it takes a while...don't be fooled by the da vinci ads. 

9.  The scans at this time are very unlikely to show anything and are likely a waste of time and money with G7 and PSA under 10.

I have tried to be fair in my assessments about but I can tell you that I am absolutely biased in favor of brachytherapy based on my research of this cancer as well as my own personal experience...so that's my qualifier.

Please feel free to email me or ask any other questions.  This decision IS a big deal.  You don't have to rush and you should get all of the info available before jumping.  Best of luck and please keep us informed about your hubby's path.

Tudpock (Jim)

Juliet,
I have nothing to add to Tud's post. If your husband has current urinary issures then Brachytherapy may not be the best choice other than that as most studies have shown it has similar or better results than surgery across all grades with less short and long term side affects. You husband should be back to work the next day with no major issues.
JT

Thank you, Aimzee! I will go read that thread right now. We are totally overwhelmed, and I am getting more anxious instead of less so. I have more questions for the group, and am so impressed with the willingness of so many to offer advice and encouragement. Hopefully, someday we can give back instead of just taking!

Juliet