56 - surgery vs seeds/ good doctor in CT?

Hi Klains,

Glad to help. Cross referencing info is a key for me. If I read or hear something that seems contradictory---I ask, or find out why. And 99.9% of the time it ends up making a ton of sense and helps my decision-making. BTW, on the front of this where it lists the latest threads, on the top there is one with all of the abbreviations and explanations---that is helpful, as some people on here accidentally speak in code at times.

I do agree that we can become too obsessed with all of the information--it's the dark side of the internet. However, if we use the info to learn more to ask the right questions of our doctors and other experts, it's great. The other clue for me is the date and the source--if it's even a couple years old, it's probably too old. I also question is it someone's personal opinion/experience or fact and who is saying it. I read something yesterday that 50% of people who have PC treatment will have the cancer return in 3-5 years---that' a scary thought--but it was someone's comment, an individual, not a real fact from say a Sloan Kettering etc. Aside, from what I have seen from real sources, it's way off base. So who is saying what, is so important.

In terms of meeting this guy, my doctor introduced us and thought it would be good to talk. It said a lot to me about my doctor's confidence in his work. I think you could ask your surgeon if there is a patient or two that you could speak with, just to get a lay of the land etc. They should be fine with that. Obviously, as probably the case with mine, the person will have a good situation to relate---but still, it gives you a good overall sense of what to expect from a "real" participant.

Take care----hope your consultations are really good today. And if you need to email me ever, ours is [email protected]

Mark

I'm not sure about the order. Next time I am at the support group I will ask him. As far as side effects go I haven't really had any to speak of. They make you urinate after you are finished with the implant before they let you go home. Mine was clear yellow. I only had one time where I had a very tiny amount of blood in the urine and that was a day or two later. Other than that there have been no other problems.

The worst part of this whole thing was the initial biopsy which was performed by a different doctor who was very big on robotic surgery. When we asked him how many he had done he said 6. We ran away from him as fast as we could. He was the same one that told us the myths about being a young age and that robotic surgery was the only option I had. I have no respect for him whatsoever now.

Post Edited (fulltlt) : 11/15/2010 11:26:18 AM (GMT-7)

klains,

In the US it would be at best illegal (under the HIPPA law) for a doctor to offer a "reference" patient unless that person had agreed in writing, and even then there would be other concerns for me (motivation of the patient? "testifying" in a sense to the doctor's skills - what would happen if all went terribly wrong?) - I think it would be easier to go to a PCa support group for that area, and ask other survivors.  At least there the context is clear - share and support, with no "professional opinion" context.

John T said...
There is no data to support either position of seeds first or last; it is a doctor's preference and also used as a marketing differention tool by Datttoli and RCOG. It sems that the docs trained on the east coast use seeds after and the docs on the west coast the seeds 1st. I talked to a few radiologists about this and came to the conclusion that it really doesn't matter. The total dose in greys and the accurracy of the delivery system is what really matters.
JT

Interesting. I am an east coast person and had seeds first and IMRT second. And my doc was trained on the east coast (Sloan Ketterling).

However, he was a bit off on the severity of the two stages, at least for me. He suggested that in terms of shock to the body the seeds would be about an 8, IMRT about 2. In my case it was more like 5+5. Course, some of that could be due to the fact that during the five weeks I was doing the IMRT I had a severe bacterial infection from an abscess tooth that hospitalized me for two days, and surgery for a rotary cuff tear.

Sancarlos

I would recommend that you look at the options and choose the one that seems to offer the highest probability of initial success, with the fewest side effects. If the PCa is local and has not spread beyond the prostate then your chances of a cure are similar with both surgery and seeds. If the cancer has spread beyond the prostate chances are great that you will have to have radiation later even if the prostate is removed with surgery.

Surgery would not seem a good secondary procedure from my perspective following low dosage brachytherapy. A much better option is a procedure known as HDR brachytherapy. Like regular brachytherapy this procedure delivers the radiation just to the prostate and beyond by a few millimeters and causes less damage to surrounding tissue than external beam radiation. In the event I have a recurrence of PCa at some point in the future HDR brachytherapy is what I plan to have done, assuming of course that there is reason to believe that the PCa is confined to the prostate.

Unfortunately the odds are great, whether you choose surgery or brachytherapy, that if there is a recurrence of PCa it is because at the time of the surgery or brachytherapy it had already spread beyond the prostate, into the prostate capsule and the pelvic lymph nodes, if not farther into the bones.

It is reasonable to consider the long term effects of radiation, but I would not make a decision based on the possibility of having ED at some time in the future. The cancer is real, and it is now, and getting rid of it should be the most important concern. And the fact is there is a very real possibility of immediate ED with surgery so that should be factored into one's thinking as well as a risk of ED in the future from radiation.

Dear Klains:

At the risk of stirring up an age old debate on this site, i.e. radiation vs. surgery, I would like to add some perspective to what I feel may be some inaccurate or incomplete posts on this thread from some of the surgery guys.

1.  While it is true that surgery after radiation may not be a good idea because of the difficulity of the surgery this "have a backup plan" is typically more a scare tactic than the whole truth.  The truth is that there are also back up plans after brachtherapy that provide just as good results for local recurrance as does radiation after failed surgery.  Some of these include HDR brachy as indicated by Sancarlos, seeding with a different isotope, HIFU and cyrotherapy.  So please don't be persuaded by just one side of the story.

2.  One poster implied that you would be reasonably certain the cancer was removed after surgery if you see clear margins.  Clear margins are certainly an indication but we have seen plenty of guys on this forum who had "clear margins" and now have a recurrance.  It is true that you have a definitive pathology after surgery but, "so what?".  You can read many posts on this forum about men who know their pathology but are now doing a form of active surveillance wherein they are not seeking additional treatment but are "watching" their numbers to see what happens.  So, post surgical pathology is interesting, IMHO, but harding prescriptive.

3.  One poster indicated that after 18-24 months ED from radiation is just as bad as from surgery.  The studies do not bear that out and, in fact, long term ED is less with radiation than with surgery.  I would encourage you to Google "New England Journal of Medicine Quality of Life Study" and compare the before and after numbers for surgical vs. radiation patients.

My overall perspective is this...both surgery and brachytherapy/radiation are likely to cure your cancer.  Then, given the equality of the most important item (cure), the secondary issues start to take precedence.  If one must "get it out" and "get the numbers", however silly in my mind, then surgery is probably the right choice.  But if one values continence, severity of the procedure, the ED issue, the size of one's penis, the issue of no ejaculate (except possibly urine) then brachytherapy or bracy/IMRT provide a substantial advantage to the PCa patient....IMHO.

In another thread, JohnT recommended 3 books and I concur with that recommendation.  I also concur with the folks here who recommend getting multiple opinions from experienced physicians, especially a prostate oncology specialist.  You get one try to get this right...this is a big deal.

Tudpock (Jim)

Casey you said:

"The side-effect profiles are inverted.  Surgery results in immediate effects which younger, healthy men generally put completely behind them in a matter of about a year or so (there are, of course, exceptions).  Radiation has some short-term effects but they are generally nominal, but the longer term effects (given the name "late term effects") arrive later and don't generally go away (there are, of course, exceptions)."

Unfortunately, here we go again... This statement you made is misleading at best.  Let's talk ED....there are long term ED effects from both surgery and radiation.  We can debate the %'s based on the studies we choose, but please do not imply that ED is not a serious long term side effect from surgery lest you get laughed out of this place.  You can choose to parse words by using "younger and healthy" as descriptors but then you should do so for both treatments...

Tudpock (Jim)

Casey,
There are some misconceptions and myths about radiation that continue:
There is no indication that brachy is better for older patients; biochemical reoccurrance rates are better or equal to surgery for all age groups. In fact younger patients have the most to gain by reducing long term ED and incontinence.
Brachy is only good for low risk cases: A combination of brachy and IMRT for high risk cases, a 14 year study by Dattolli indicates a reoccurrance rate of 1% after 5 years and an overall biochemical free of 81% at 14 years. This is far superior to surgery in this high risk group with 10% of all reoccurrances after surgery occurring after 10 years (24 year study out of Europe). Surgical cure rates for high risk patients is about 65% at 10 years.
Fear of secondary cancers from radiation: New Prostate cancer info link. Secondary cancers from radiation are similar to secondary cancers after surgery.
Side affects from radiation occurr much later: the fact is that for both surgery and radiation where you are at the 2 year mark is in all probability where you will be for the duration.
There are many good reasons to have surgery as there are to have brachy, but all patients are entitled to factual information about their choices, There is a far greater amount of misinformation and myths about radiation that keeps getting repeated on these forums that needs to be corrected. Some of this is due to the effects of older forms of radiation in use in the early 90's that is not applicable to today's advanced delivery systems.
JT

some guys who are adamant about not wanting radiation end up getting it anyway in the form of SRT.  if your PC has a high likelihood of being out of the capsule you might want to consider a combination radiation treatment rather than facing SRT after your prostate has been removed.  that's if you qualify for BT and you can handle the side effects of combination treatment.  in my case it made no sense to have my prostate removed and then risk side effects of SRT.  but that's just me.

ed