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Any surgery guys wish they had done radiation instead?

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Posted 4/6/2011 2:02 AM (GMT 0)
Tony,

The stats are the stats. Of course individual outcomes will vary, some do better and some do worse. There are many that have no side effects from any treatment and others that have severe side effects as are seen daily on this forum. Using the very best doctors is one way to improve your odds. Age also has a significant affect on your ablility to recover from any treatment.

The stats I posted are a realistic expectation of what to expect from the various treatments. You cannot predict with any certainty any individual outcome, only the probability of an outcome. Years ago I managed the forecasting department for a major company. You can accurrately forecast the outcome of a large group of occurrances, such as the total units for a product line, but when it comes to forcasting how an individual product will do, it is very inaccurrate and the forcast will rarely be right.

This is exactly the same situation; you can predict with extreme accurracy how a large group of patients will turn out, the larger the group, the more accurrate the forecast. You cannot predict what any individual outcome wil be with any degree of accurracy.

They are a guidline of what to expect, not a garantee you will get that outcome.

JT

Posted 4/6/2011 2:18 AM (GMT 0)
My doc said it is pretty much out of the question to do surgery after radiation, where as you can have radiation after the surgery. With only a few options on the table after Dx, if the patient can handle surgery and all it's issues, why would anyone take it off the table?

So far my post op tests are great but if I should need further treatment I'm at least leaving one more bullet in the chamber. As one surged stated, with surgery you take the hit up front, with radiation you get hit later.
Posted 4/6/2011 3:03 AM (GMT 0)
Are you close to Jacksonville? You may want to check into proton radiation there.
Posted 4/6/2011 3:09 AM (GMT 0)

Ex fish,

I did surgery first, then adjuvant IGRT. Radiation only promised me an "up to 70%" success rate. If surgery didn't get it, radiation would not have either, so I'm good with what I did.

Posted 4/6/2011 3:17 AM (GMT 0)
One point to be made fir the surgery choice, is that it is the only way you will know several vital thIngs.

Gleason score. Until the prostate is removed and placed on the pathologists table, the final Gleason cannot be determined.

Escape of PC. Without surgery, it is cannot be determined if PC has escaped the capsule, invaded the seminal vessicles, or reached the lymph nodes.

That is just fact.

That being said, if I had a Gleason 6, low volume, a low PSA, seeds would have been a no brainer. As it is, with a Gleason 9, I am fighting for my life, so I was forced to take the "radical " approach of surgery. Side effects for me are just the cost of attempting to beat this sucker. I did it with my eyes wide open.

Good luck to you.
Posted 4/6/2011 3:46 AM (GMT 0)
I was lucky that my cancer was found very early and I had every option available for treatment--or nontreatment. I had a chance to research extensively, and while I did not turn over every stone, I had a pretty thorough knowledge from which to make a decision. I made a very individual decision, based on what was of importance to me. It may or may not be the same decision that someone else would make in a similar situation.
Posted 4/6/2011 4:39 AM (GMT 0)
This is an interesting thread.

I've noticed on the Yana site that it *seems* there are a disproportionate number of men who seem more pleased with their treatment and any (or lack of) associated side effects in the proton therapy group. Of course it's anecdotal, however I've also read through a number of posters on the Yahoo proton group and came away with the same conclusion.

Perhaps it's because surgery is much more radical and thus promotes more immediate messages, however when looking at the photon group vs proton, I don't have that same conclusion.

It seems for the past three, four or five years, it's something that I've noticed.
Posted 4/6/2011 5:22 AM (GMT 0)
Hi John
I don't dispute the idea that the stats can be used to try to predict probability, I agree with that. You can use any stats you want but you can be doing so with no bearing on how things will turn out for you. Many patients will base their decisions on statistics and that is not always the best plan... They don't apply to everybody and they also don't apply to every surgeon as we all know that surgeon experience matters. So when someone pulls out general study statistics and applies them regardless of age, stage, Gleason, and surgeon experience, and you use them, you may miss the opportunity to tailor your treatment plans using stronger logic. There are bad radiation oncologists out there as well so leaving that piece out of a decision process can backfire and I have seen it happen. (The VA Hospitals debacle with brachytherapy in Pennsylvania for example)

I will say that most will respond the question, regardless of treatment modality, that they don't wish for the "do overs". I completely agree with that. I have had men come up to me after RP and say they wish they had done radiation, and I have had men come up to me after radiation and say they wish they went another rout also.

My best advice for the poster is to get a top notch guy from both, gather the information they tell him, and make the decision that is right for them. Think about plan A, plan B, etc. Try to place the scenario that the first attempt does not work, what would you do next? And so on...

Tony

Post Edited (TC-LasVegas) : 4/5/2011 11:25:18 PM (GMT-6)

Posted 4/6/2011 10:53 AM (GMT 0)
Dang, Viper...I feel for you, Brother. From all I've heard, your first two 'I's' should improve with time. The 50% will at least give you some flexibility in your job search. I wish you the best....God Bless.
Posted 4/6/2011 11:28 AM (GMT 0)
Tony,
It seems that for once we agree. Using stats is only one peice of an information string that we need in order to make better decisions.
I also believe that there are many things a pateint can do to sway the stats in his direction, and I think you are a perfect example of that. You chose an agressive combination adjuvant treatment up front and used the very best doctors to implement it. I have seen very few patients take this road, but many end up on it, and in the end take the steps you took sequentially over time. I'm a firm believer in hitting agressive PC with everything you have right up front in order to confuse the cells and kill them before they are able to mutate and adapt to sequential treatments.
You can't predict individual outcomes, but you can stratify outcomes of sub groups with relatively more accurracy. For example I can predict within 1%-2% the total number of people that will die this year from auto accidents, but it would be a million to one shot to predict the death of a certain individual. But I can say with certainty that a 20 year old returning combat Vet who drinks and owns a crotch rocket, is much more likely to die of an accident that a 70 year old lady teetotaler from Pasadena who owns a Rambler.
Certain conditions carry varing risks and stratifying risks enable one to make better choices; not 100%, but clearly stacking the odds in their favor like you have.
By the way, I'm writing this at 4 in the morning after going to the donut shop for coffee and donuts; happens about once a week and must be another unreported side affect from the dreaded radiation.
JT
Posted 4/6/2011 2:41 PM (GMT 0)
Viper;
I too surfer from the 3 I's.But only getting 1/3rd income. I really started to gain control after about 7 or 8 weeks. Now I'm down to 2 pads in a 24 hour period. It'll get better! I thought I was never going to stop peeing on myself.It so far has been the most aggravating part of this journey.
Sorry about your best friend. That's a hard pill to swallow!
Posted 4/7/2011 6:08 AM (GMT 0)
I had seeds one week ago and I agree with a lot of what has been said about fewer side effects than RP, but what hasn't been said is that seeds also treats up to 10 mm outside the margins of the prostate where most extra capular extensions are as well as part of the seminal vesicles. It can still be in the lymph nodes. The downside is you dont know the next week whether all the cancer is gone as you do with RP. With BT seeds you have to wait sometimes years to know if you have a biochemical reoccurrence. I was ready to accept that. My younger brother had RP in his 50's, was told the untruth that there was a 1% chance of impotency and then was made totally impotent. He trusted his local urologist who did the surgery.

Above all whether you go surgery or seeds or HDR or IMRT or ADT or a combination--- Please take the time to find an "artist" -- that is a doctor who has done a thousand or more of these procedures and who you hear praised to the heavens by multiple sources-- patients and other docs. They are out there but sometimes hard to find.

The artists I know in So Cal or WEst Coast are Strum,Scholz, Bahn, Demanes, Grimm. I would trust any one of them with my life. They all know each other and will recommend a doc somewhere near where you are--but then you can travel for the best.

Best wishes to you as you and your husband give yourselves time to pick the best treatment for you.
Richard

Gl 7 3+4 4.8 PSA ADT for 3 months in prep for Seeds, PSA March 2011 .04 , Seeds March 30
Posted 4/7/2011 11:25 AM (GMT 0)
I have to go with Richard0460 on this one. If I had a do-over, I would do the seeds over RP. The side effects of RP for a guy who likes a little sex every now and then is NOT WORTH IT. Not to mention the constant dribble effect under any kind of stress activity.

My surgeon scared me into the RP over any type of radiation. Since I was low grade I should have had seeds. I hate the way I am now.
Posted 4/7/2011 11:34 AM (GMT 0)
Viperguy,

I do truly feel sorry for the way it worked out for you. I remember well our discussions last year.

I pray you will get better.
Posted 4/7/2011 5:15 PM (GMT 0)
Fish, I am Gleason 9, surgery was a long-shot for me, but I took it anyway..A longshot is better than no shot..My surgery resulted in lymphosete forming which was infected with staph, resulting in another bad week in the hospital. The surgery failed to "cure" my cancer.

Hindsight is always 20-20....If I had to do it again, I would chose the combined brachythearpy plus IGRT which can deliver a 150Gy total dose which results in the highest cure rate in high-risk patients..It works well in low-risk patients too but so does surgery..Some men breeze through these treatments with few if any side-effects and some men suffer terribly..Your only defense is to choose the best people possible to perform them..

Best of luck to you...
Posted 4/7/2011 7:53 PM (GMT 0)
I'm happy with surgery, although I was a G-8 and mainly had surgery as a long shot all has worked out well so far, zeros, dry, and everything works, next test at the end of the month.

Personally radiation scares the heck out of me but I'm smart enough to realize that this is a personal bias and has no bearing on the effectiveness of the treatment.

If I had been a G-6 in a couple of cores I'd have looked at AS and seeds, EVERY case is different. I would encourage any diagnosed man to gather all the information they can and make the decision that feels comfortable for them.
Posted 4/7/2011 8:59 PM (GMT 0)
Looks like you are about a year out daveshan.  Glad everything worked out well for you.  Hopefully in a year or so I'll have similiar results.  Once again it's refreshing to hear excellent experiences and few side effects.  Is there any concern on the .04 PSA?  I'm not an expert and have no idea what your PSA should be after a year.  Thanks for sharing.

Cheers

 

Posted 4/7/2011 9:37 PM (GMT 0)
Viperguy,
My last PSA was at 11 months, the next one is this month, next appointment with my Uro is on May-3 . Our lab only goes down to 0.04 so <0.04 is undetectable. It cold be bouncing around 0.001 to 0.039 and I wouldn't know it 'till it got above 0.04, as long as the "<" is there I'm a happy camper.

Best of luck to you Viperguy, (car or herpetologist?) I had total ED and leaked quite a bit for the first month or so then things got slowly better. (hint) I made sure the little guy was reminded what he was there for every day, seemed to help (/hint)
Cheers
Dave in Durango CO
Posted 4/7/2011 9:46 PM (GMT 0)
Fishy,
I was a Gleason 9, and surgery was the stand-out best option for me at the time (dealing with a urologist, who of course does surgery!).

Three years out, I have ED, and proof in the form of rising PSA. that the PCa is not cured. But otherwise in excellent health. Do I wish I had done radiation instead? Only if I knew it would be successful. If I had radiation and it was unsuccessful, I would likely be in a worse situation than I am now.

If we knew ahead of time which treatment would be successful, then the path to follow would be obvious. However beforehand we just have statistics and all we can do is follow the path that gives us the best probability of a good outcome, allowing for side-effects.

Your hubby is a Gleason 6 which means that any of several treatments have a good prospect of a "cure". Your choice will probably be based on minimizing side-effects, and personal preferences have a big part to play here. Good luck in whatever you choose.
Posted 4/7/2011 10:56 PM (GMT 0)

I use to be a fish said...
I was hoping to get some feedback from the men who have had a prostatectomy, whether or not they wished that they had chosen one of the forms of radiation instead as their first form of treatment.

I would relate to the thought that most all who make a choice, stick by that choice. Like buying a car ! Few will admit that their in-depth investigations resulted in a dud.

Naturally, when we feel like making love, I wish that I could just "Do It", without saying "Back in a minute".
Radiation may have left me with that option. The RP sure has not, or at least so far ( 11mths post RP ).

In answer to your question, NO, I would not, because I had considered all the options and like other, I wanted it OUT, not dead or partly dead.
..
.IMHO
Posted 4/7/2011 11:30 PM (GMT 0)
Because I had G4+4 on biopsy (later upgraded to 4+5 after surgery), I had both radiology and surgery consults. Radiation oncologist said I would need seeds, external beam radiation and 2 years of HT. Surgeon at Johns Hopkins said surgery could help, but also that if I had recurrence, I could proceed in a stepwise fashion with other therapies, and that if my first post op psa was still detectable (it was not), I should go for adjuvant radiation. I liked the idea of having some plan of attack in reserve, so I chose surgery. Continent in 2 -3 weeks, probably aided by bladder neck contracture, which needed dilation 8 months later. Potency took 51 weeks almost to the day with Levitra, etc. Even with eventual salvage radiation 3 years later, I never regret my choice.
Posted 4/7/2011 11:49 PM (GMT 0)
I had surgery because if it failed I could still do SRT (an extra curative bullet).

It did fail and I am doing SRT.

I am having a much harder time with SRT than I had with surgery.

But, that's just me!

Mel

Posted 4/7/2011 11:50 PM (GMT 0)
Daveshan,

Excellent >.04, hope mine hovers at or below that mark come this June. BTW I'm a car guy, 2000 Viper GTS Coupe, red with silver stripes. So far no pee stains on the drivers seat however there are a few brown marks where the passenger rides when I put my foot down. (only kidding)

Keep those PSA's down down down..

Bruce
Posted 4/8/2011 2:55 AM (GMT 0)
If surgery fails and therefore radiation is used as a backup and it is successful, is it safe to say that radiation would have been successful from the beginning?
Posted 4/8/2011 4:38 AM (GMT 0)
Bruce,

One of my ex-bosses had a collection of serveral Dodge Vipers. He use to let me borrow this beautiful deep blue one, and I had a blast thundering the back roads here in western SC with it. Amazing amount of power, and pretty good handling all things considered. I do remember, however, that you could almost literally watch the gas guage go down when getting it on for long. I almost ran out of gas one time with it in the boonies, and had to limp home to fuel up.

David in sC
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