I'm new to the forum and worried as crap

compiler said...
Viper:


Here is some of the logic I used:



1) I picked Da Vinci Robotic because the recovery is quicker. But, mostly, it was because my research led me to believe that Dr. Menon at Ford Hospital was the best surgeon. Had the best surgeon been an open guy, I would have gone that route.



2) I picked surgery because, psychologically, I wanted the darn thing out.



3) I also picked surgery because if it fails (and it appears this might be the case), I could do radiation as a backup. I liked the idea of a second bullet.


Mel

1 - I didn't pick DaVinci robotic because the uro/surgeon I went to first had only done 6 of them.

2 - I didn't pick surgery because I wanted the darn thing left in and the cancer cells killed and
I didn't want to have the surgery side effects.

3 - I picked radiation because I wanted to pick the thing that worked the best in the first place and not have
to do something that didn't work and have to come back and do the thing that works the best anyway.

I suppose you guys have all seen this chart before.

It's on page 117 of Invasion of the Prostate Snatchers.

Comparison of cure rates between institutions
risk________surgery_____seed implants
low_________ 85%_________95%
intermediate__70%_________85%
high_________40%_________75%


It is from a study done by Dr. Peter Grimm.

Dr. Patrick Walsh's surgery cure rates are almost the same, 85% for low, 68% for intermediate and 40% for high.

Anyone who thinks surgery is the 100% cure all solution might want to ponder this.

Wow! Information overload, LOL.

Here's my logic, I just turned 57, very healthy except for PC. I want (like all of us) to be around 20 years from now. Surgery will get that little sucker out of there that's causing a potentially deadly problem years down the road. I have read removal is very effective and if the cancer does return its easier to detect and treat.

On the flip side, radition (seeds and beams) are effective too. If I was 65 would go with the seeds. Once you have radiation, prostate surgery becomes very complicated and high risk. My concern is 15 to 20 years, what happens if the cancer returns with a vengence. Initial Radiation therapy does not promise a very good option with a relasp.

You guys seem to be very versed on all the positives and negatives and have helped me tremendously with choosing a treatment. I have a friend (about my age) who seen Dr. Merrick in Wheeling for the seeds. He's five years out and doing great. I have strongly considered the seeds but the relasp issue weighs heavy on my mind. Are there any folks out there that have had seeds and still kicking 15 years out?


I have asked my surgeon (doctor) to give me names of some of his most recent patients willing to share there experience. I will call each of them to find out how they are doing and probably base my final decision on those experiences. I can't thank you guys enough for sharing your thoughts and stories. You have opened my mind a little more about alternatives even though I'm leaning toward the "snatchers".

Viper,

Have you read up on the statistics of PC?  This is how it grows (this is from an article by Dr Martin Weissman)

Small-volume prostate cancer is often defined as 0.5cm³ or less in the whole prostate.  Small-volume tumors may still be multifocal and bilateral.^2,3 Consider that it takes an estimated total tumor volume of 4cm³ for metastasis and 20cm³ for death. Yet, slowly growing prostate cancers may have a doubling time of 3 to 10 years, or longer. If so, for a tumor to enlarge from 0.5 to 20 cm³, - over five doublings – could take over 30 years.

So, given your numbers, you have low risk disease and are many years from this disease really affecting you.  I look at things in terms of risk/reward.  My disease is much like yours, I see a lot of risk to any treatment, without, at this stage, much reward.  Giving yourself 6 months to a year to watch this and think about options isn't going to change any outcomes.  You think having it inside you is nerve wracking, but what if you're next 2 or 3 PSAs show no change?  It may become a "don't care" for you after you get used to it.  I hope you give it some time.

Oh and, for people with our numbers, almost everyone is "still kicking" 15 years out no matter what treatment they choose, it's just not that deadly for us.

Dave

Viperguy said...
Wow! Information overload, LOL.

Here's my logic, I just turned 57, very healthy except for PC. I want (like all of us) to be around 20 years from now. Surgery will get that little sucker out of there that's causing a potentially deadly problem years down the road. I have read removal is very effective and if the cancer does return its easier to detect and treat.

On the flip side, radition (seeds and beams) are effective too. If I was 65 would go with the seeds. Once you have radiation, prostate surgery becomes very complicated and high risk. My concern is 15 to 20 years, what happens if the cancer returns with a vengence. Initial Radiation therapy does not promise a very good option with a relasp.

You guys seem to be very versed on all the positives and negatives and have helped me tremendously with choosing a treatment. I have a friend (about my age) who seen Dr. Merrick in Wheeling for the seeds. He's five years out and doing great. I have strongly considered the seeds but the relasp issue weighs heavy on my mind. Are there any folks out there that have had seeds and still kicking 15 years out?


I have asked my surgeon (doctor) to give me names of some of his most recent patients willing to share there experience. I will call each of them to find out how they are doing and probably base my final decision on those experiences. I can't thank you guys enough for sharing your thoughts and stories. You have opened my mind a little more about alternatives even though I'm leaning toward the "snatchers".

The chances of relapse are the inverse of the percentages as shown in the cure rate table I posted. Relapsed is the opposite of cured.
There are quite a few guys in my support group that are 5, 10 and 15+ year seed implant patients.
The first uro/surgeon I went to for my biopsy told me the same story you got about, surgery not being an option after you have radiation.
It's one of the biggest myths that the surgeons are pontificating on.
www.prostateimplant.com/top_3
That's one of the reasons I shyed away from the uro/surgeon. Anyone telling me myths as fact is not to be trusted.
I did ask for seed implant patients to call and talk to like you are considering. I called them all and spoke to each one at length about their experiences.
It's a good thing to do.

questionsaboutit said...
I would like to see where the authors got the pg 117 chart by Dr. Grimm. In this 2010 article, the same Dr. Grimm seems to be saying that there is not enough data to compare therapies and that RP, EBRT and Brachytherapy are all efficient therapies. http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confid=73&abstractid=30900


Viper, if you read Prostate Snatchers, remember that the "dr" author wrote incorrectly that the prostate produces sperm. I think I would rely more on these guys that wrote the article below rather than the authors of Snatchers since the dr doen't know what the prostate does and his co-author patient believes in UFO's and healing with ancient runes. How can y'all take this book so seriously?

Viper, despite the article I attached, I highly recommend you rely on your doctors and second opinions in choosing a treatment rather than any of us non-professionals on this forum. There are so many variables involved in choosing a treatment that your doctor sees and we don't. We are better for advice on incontinence, ED and various post - op personal experiences than advice on a critical decision like choosing a treatment. I do recommend you take someone close to you, wife, etc. when you talk about treatment options. Your mind will focus on a couple of key issues; a third party can take notes and ask questions you forget and help you interpret what the doctor said.

This article gives a different view of RP vs Radiation but you will also find articles with an opposite conclusion.

From the RENAL AND UROLOGY NEWS JOURNAL, MAY 2010:

Cover Articles
Improved Survival with RP vs. Radiation

SAN FRANCISCO—Radical prostatectomy (RP) is associated with significantly better intermediate-term survival than radiation treatment among men with clinically localized prostate cancer, data suggest.

It also is associated with better cancer-specific survival compared with external beam radiotherapy (EBRT).

The study, led by Andrew Stephenson, MD, of Cleveland Clinic's Glickman Urological & Kidney Institute, and Adam S. Kibel, MD, of Washington University School of Medicine in St. Louis, Mo., included 10,472 patients with localized prostate cancer treated with RP (6,493 patients), EBRT (2,260 patients), and brachytherapy (1,719 patients). The RP patients were significantly younger than the EBRT and brachytherapy patients (60 years vs. 69 and 68 years, respectively).

The investigators used prospensity score analysis to adjust for differences in observed background characteristics. Patients had a median follow-up period of 67 months; 1,550 patients had a median follow-up of more than 10 years.

The overall 10-year survival rates were 87%, 63%, and 60% for the RP, EBRT, and brachytherapy groups, respectively, Dr. Stephenson told listeners. Compared with RP, EBRT and brachytherapy were associated with a significant 1.7 and 1.8 times increased risk of overall mortality, respectively, after adjusting for biopsy Gleason score, comorbidities, age, PSA level, ethnicity, and clinical stage. Patients treated with the two radiotherapies had a significantly higher rate of androgen-deprivation therapy.

EBRT was associated with a significant 1.6 times increased odds of death from prostate cancer. Brachytherapy did not increase prostate cancer mortality risk.

“Physicians and patients should consider these potential differences when choosing among treatment options for localized prostate cancer,” the authors concluded.

From the July 2010 Issue of Renal And Urology News

The link you provided says "Content not found".

Dr. scholz does not say the prostate produces sperm as far as I have read. Can you quote the page number where you read this? Have you read the book?

He does say on page 38, "The prostate, however, has a strong capsule and a muscular structure surrounding it to compress and fire it's product, the sperm, at the intended target - an unfertilized egg."
Make what you will of that. I think what he means by product is the package that's being delivered, not that sperm is being produced by the prostate.

Here's an excerpt from Dr. Walsh:

Part of the problem, is that "prostate cancer is a multi-focal disease. At the time of radical prostatectomy, the average number of individual cancers within the prostate is seven -- seven separate cancers in one prostate. This indicates that in order to cure prostate cancer, you can't risk leaving any cells behind. You have to eliminate the entire prostate."

http://urology.jhu.edu/newsletter/prostate_cancer56.php

This is why I lean toward surgery over seeds. Believe me, I would much prefer the seed procedure over the slice and dice but am not convinced of its long term success.

Viperguy said...
Here's an excerpt from Dr. Walsh:

Part of the problem, is that "prostate cancer is a multi-focal disease. At the time of radical prostatectomy, the average number of individual cancers within the prostate is seven -- seven separate cancers in one prostate. This indicates that in order to cure prostate cancer, you can't risk leaving any cells behind. You have to eliminate the entire prostate."

http://urology.jhu.edu/newsletter/prostate_cancer56.php

This is why I lean toward surgery over seeds. Believe me, I would much prefer the seed procedure over the slice and dice but am not convinced of its long term success.

Viper,

I was thinking about your situation as I'm getting ready to go to work this morning. We are both the same age. I didn't want to leave any cells behind either. For me the atomic bomb was a better way to
eliminate all the cancer cells than the wrecking ball and dump truck.

If I was to have 20 years and no one knows that but God, for me it was a choice of 20 years of incontinence and ED with surgery or 20 years of a happy sex life with my wife with radiation. That may not be the way it works out but in my case it was how I looked at it.

Viperguy said...
fulltlt said...


Viperguy said...
Here's an excerpt from Dr. Walsh:

Part of the problem, is that "prostate cancer is a multi-focal disease. At the time of radical prostatectomy, the average number of individual cancers within the prostate is seven -- seven separate cancers in one prostate. This indicates that in order to cure prostate cancer, you can't risk leaving any cells behind. You have to eliminate the entire prostate."

http://urology.jhu.edu/newsletter/prostate_cancer56.php

This is why I lean toward surgery over seeds. Believe me, I would much prefer the seed procedure over the slice and dice but am not convinced of its long term success.



Viper,

I was thinking about your situation as I'm getting ready to go to work this morning. We are both the same age. I didn't want to leave any cells behind either. For me the atomic bomb was a better way to
eliminate all the cancer cells than the wrecking ball and dump truck.

If I was to have 20 years and no one knows that but God, for me it was a choice of 20 years of incontinence and ED with surgery or 20 years of a happy sex life with my wife with radiation. That may not be the way it works out but in my case it was how I looked at it.




Thanks Fulltlt you make a good point indeed. I should probably consult with a leading Radiological Oncologist (Dr. Merrick) before the final decision. This doctor has a first class reputation for the seed implants. My next appointment with the surgeon is on 12/15. At that time I will discuss options, time frames, and possible second opinions about the seeds. It seems each doctor that has a speciality thinks their treatment is the best. I would love an objective opinion.

Viperguy,

I was thinking about you on the way driving to work. Whatever way you go we should get together for a beer in 5, 10, 15, 20 +++ years and compare notes.

I don't know your geographic area but it wouldn't hurt to call Dr. Brian Moran that did my seed implants and talk to him. He has done 15,000+ seed implants.
His number is 630-654-2525. I have it right here on a note on my keyboard.

Best wishes at this difficult time in life.

Viper:

Yes, do ask about the necssity of doing the CT Scan. I really question that.

I also remember one other reason I chose surgery:

You get the full pathology. You get the exact G-score and you know what's what. (I had my slides reread by Epstein).

Sadly, my pathology sucked. But, at least I knew

Mel

>>You get the full pathology. You get the exact G-score and you know what's what. (I had my slides reread by Epstein).

Sadly, my pathology sucked. But, at least I knew<<

in my case i could not care less about knowing the actual pathology; i just assumed it was probably worse and we hit the cancer with every weapon at our disposal.

ed

fulltlt

Did I read this correctly?  Dr. Moran, 15,000+ seed implants?

Lets see if one does 5 per day for 5 days each week, for 52 weeks each year, that equals over 11.5 years.  Man he is one busy dude and deserves some time off. 

Putt said...
fulltlt

Did I read this correctly?  Dr. Moran, 15,000+ seed implants?

Lets see if one does 5 per day for 5 days each week, for 52 weeks each year, that equals over 11.5 years.  Man he is one busy dude and deserves some time off. 

Plus, remember more than one seed goes in each person.  So 15K does not seem that unrealistic.