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Posted 1/7/2013 10:37 PM (GMT 0)
I was diagnosed with prostate cancer almost 3 years ago and have been on the active surveilance program. My last bisopsy showed the cancer had progressed and it was time to consider treatment.  Out of 10 samples, two were Gleason 6 and one was Gleason 7.  I'm 52 and trying to decide on what treatment to take.  What I'm trying to decide is whether to go for the brachytherapy or the surgery.

At my age, I still plan on having a lot of years ahead of me.  What I want to know is over a long period of time, what is the recurrance rate with brachythearpy and over that time, what affect will the radiation have on the  areas surrounding the prostate. Decisions, decisions.

I've read a lot from people who've had the brachytherapy treatment, but not much from men who've had the surgery at my age.  If you've had surgery, it would be great to hear your thoughts.

Posted 1/7/2013 11:17 PM (GMT 0)
Hi and welcome to our little corner of the world - sorry you've got to join but sounds like you've had a good run with AS.

As you probably already know both choices are good and there are other approaches as well including proton and cyberknife. I'm sure your thread will soon be innundated with guys that will provide their own experiences to help you out. As you can see in my signature line I'm 55 and looked at all of the options before ultimately deciding on my course of treatment, just completed on September 21 of 2012.

There's lots of data out there on the internet and I would advise not only looking there but to also be sure to understand what the data base is in any of the reports or studies you come across. Also as I have offered in the past, during the learning phase of my journey I downloaded and purchased a number of studies and reports - in particular the "Grimm et al" study that looked at over 10 years of data on a comparative analysis of PSA free survival outcomes for patients with low, intermediate and high risk
prostate cancer treatment by radical therapy approaches. I would be happy to send a copy of this to you if you are interested, just shoot an e-mail my way and I'll reply.

Best of luck to you, again, there's tons of experienced guys (and supporting gals) out here that will help.
Posted 1/8/2013 12:32 AM (GMT 0)
welcome to HW , sorry you have to be here ( see my signature line ).
Had surgery on March 24, 1992 at age 54 , I was only affected by incotinence when I
laugh , cough.sneeze , or when i thought about sex PED which was fix by a penile implant . One month after surgery , I pitched a fast pitch softball against Osan AF base in Korea and won 3 -0 . March 24 2013 will be 21 years since I had my surgery .
good luck to you
Posted 1/8/2013 12:36 AM (GMT 0)
 

http://www.mskcc.org/cancer-care/adult/prostate/prediction-tools

The link above will give you data between the two you mention at MSKCC.

 

In the beginning I researched all PCa treatments and had a hard time deciding between Proton and surgery.

It was in my opinion that any form of radiation at my age had too many years of added risks.

That being secondary cancers, bladder or colon cancer. If I was much older, seeds would have

been entertained.  Unfortunately there are no easy ways out.  Surgery was my last resort, but became

my first choice.  I embraced debulking and sought the best surgeon I could find.

 

If surgery becomes your choice, be certain you find the best surgeon possible.

Thus far I am doing fine, no ED or incontinence, some are less fortunate.  However, the risks are there

and nothing is guaranteed.  The results here at HW are as numerous as there are choices. All cancers

are unique on where it’s growing, ages, PSA, health, as well as method and Doctor chosen.  I felt that

in my situation anything but surgery was taking the easy way out.  I accepted all possible risks associated

with my choice.

 

This is a tough choice for you to make.  Research all treatments that you can, and make the best educated

decision that you can, this is a one way street.  Best of luck, and keep an open mind on all treatments.

Posted 1/8/2013 1:07 AM (GMT 0)
a lot of people have had a lot of success with both options. Either way you should do very well.

curious, id a G6 progress to G7 while you were on AS?
Posted 1/8/2013 3:11 AM (GMT 0)
i had the surgery and did well, you just have to weigh it out, and see what works for you , if you have a long life ahead , i would go with the surgery, if by some chance , you have a recurrance , radiation is still an option , just a thought , either way , im more than certain you will do well , just for the record , i hate going to docs or any medical proceedure, trust me , the worrying is far worse, than the proceedure , good luck  brother
Posted 1/8/2013 12:21 PM (GMT 0)
Decisions,
I had some success with AS as well, but after 2 years, I had brachy. I was 56 at dx, and I chose brachy precisely BECAUSE I hope to have lots of years left. As for the 'can't do surgery after radiation' argument: first of all, that is simply not the case. Skilled surgeons can indeed remove cooked prostates. Even so, I don't think one should make a decision based on the 'backup' plan. If brachy is done by a competent oncologist in the first place, a backup plan is very unlikely.
God bless you, Brother.
Posted 1/8/2013 12:43 PM (GMT 0)
I am 5 1/2 years post op from robotic surgery and I have no ED issues what so ever and all my post op psa's have been 0.  I do have a little stress incontinence that occurs when I sneeze or pass gas or get sexualy aroused, but nothing I can't live with..  I was 56 when I had my surgery in 2007 at the University of Rochester, in Rochester MY with a surgeon who had done about 1200 at that time. 

There are always chances with surgery that you will be one of the unlucky ones who gets ED or incontinence, but you can greatly improve your chances by the surgeon you pick. In my opinion, I would only pick a surgeon who had more than a 1000 surgeries under his belt, and  someone who does three or four a week. I would stay away from the guy who only does one or two a month.

Post Edited (NY-Sooner) : 1/8/2013 5:46:52 AM (GMT-7)

Posted 1/8/2013 12:52 PM (GMT 0)
You can read what I went through by clicking on the link in my signature. It's tough making a choice. Good luck to you.
Posted 1/8/2013 2:05 PM (GMT 0)
Can someone explain why AS in such a young person?

We know the cancer will progress eventually.
We know PC will kill you. Long drawn out, painfully.
Based on every other cancer treatments, the sooner treated, the higher the cure rate.
Isn't it true , the longer the cancer is there the higher the metastasis rate? Mets = poor outcome.
if you are in good health, life expectancy is around 80-85 years. Also recovery is quicker the healthier you are.

Surgery and radiation are the only cures, and then only if done before mets occur.

Why wouldn't one have early curative treatment?

Dave 56years @ diagnosis and surgery

Post Edited (Gasman117) : 1/8/2013 7:13:10 AM (GMT-7)

Posted 1/8/2013 2:28 PM (GMT 0)
My husband and I met with one of the leading surgeons in the country who does surgery after radiation when my husband was interviewing doctors to make a decision for his primary treatment. This surgeon told us that although he performs it, surgery after radiation is not a good idea because the side effects from that operation are very severe (such as total incontinence). I am not posting this to advocate making a decision based on the "backup plan". But since we actually interviewed this highly regarded physician who practices at Memorial Sloan Kettering I wanted to let you know what he told us. Good luck with your decision.
Posted 1/8/2013 9:56 PM (GMT 0)
Gasman'
I'll address your questions about AS.
1. 70% of low risk cancers never progress so it is untrue that the cancer will eventually progress. Some do but the majority don't; this is why careful monitoring is necessary in any AS program.
2. PC will not kill you in the vast majority of cases. The PIVOT study that now goes out 25 years has only a 5% mortality rate for untreated PC for both G6 and some G7. In most low risk cases PC grows so slowly you will eventually die from other causes. The vast majority of men over 50 have prostate cancer identified in their autopsies and never knew they had it when they died of other causes.
3. G6 cancers rarely matastize. They cannot live outside of the prostate. In 17000 surgeries on G6 cancers not one single case of matastisis was found.
4. PC is not like other cancers; most of it is slow growing and most low risk cancers never progress beyond a small speck.
prostate cancer is mainly three different diseases with many subsets of each type. Low risk cancer is exactly that, a very low risk that one may ever die from it. Intermediate risk is the type that can be dangerous if left untreated. High risk cancer is usually very aggressive, grows fast and matastizes quickly. Even with treatment there is a high risk of death.
You cannot think of PC as just one disease, and you mst fit the treatment to the disease you have. AS is appropriate for low risk cancers regardless of one' age.
Posted 1/8/2013 11:32 PM (GMT 0)
Thank you gentlemen for all your support and advice.

Regarding the questions about my choice of AS, my doctor informed me 3 years ago that I had low risk cancer and that I did have the option to not do anything until there were signs that the cancer was progressing.  He did say that if I felt uncomfortable about my choice at any time, I could opt for treatment.  He also informed me that since I was still young, that eventually I would require treatment, but it might not be for another 5, 10 or 15 years. Being the ultimate optimist, I thought 15 years sounded pretty good.  If I had known it was only goind to be 3 years, I probably would have chosen the treatment option immediately so there would be know risk of the cancer spreading beyound the prostate.

That said, it was still a big decision as I had to trust my doctor enough to put my life in his hands. From what I can tell, he's world renowned for prostate research and treatment.  I figure if I couldn't trust him, who could I trust.  In the end, I still got 3 plus years without having to worry about the side affects of any treatment.  If I choose surgery, he will be surgeon as he specializes in the Da Vinci surgical system.  I'm still trying to decide, but I've put a deadline to make my decision by the week of Feb. 4th.

The other option of course is brachytherapy.  The recovery affects of this treatment sound very appealing to me, but as I mentioned in my first post, I'm still concerned about the long term affects of the radiation.  Brachytherapy seems to show very good results for 10 to 15 years after the treatment but that only puts me into my mid sixties.  Any information going beyond that doesn't seem to exist, as I believe the procedure hasn't been around that long.  Do I gamble that the chance of secondary cancers arising from the radiation over a longer period won't arise, or do I just have it removed and be done with it.

I do have one addtional question for the group regarding brachytherapy.  The oncologist I was sent to seems quite young.  How many procedures do you think an oncologist should have under their belt before you would consider them an experienced practitioner?

Thanks again for all your advice.

 

Posted 1/8/2013 11:51 PM (GMT 0)
Thanks John,
Btw My tag didn't get added.
56 @ diagnosis, now 57

2/16/2010   PSA 2.75
4/12/2011     PSA 3.73
5/30/2012  PSA 5.31 now 57

11/12/2012 biopsy Gleason 3+4, 

12/27/2012  LARP
     48gram, pT3a-extra prostatic extension right base, margins negative
      Gleason 4+3
     cM0 -  R lymph nodes  neg (2)
     stage3
     Catheter 7 days, incontinent

Post Edited (Gasman117) : 1/8/2013 4:56:06 PM (GMT-7)

Posted 1/9/2013 3:17 AM (GMT 0)
Quality of Life issues are paramount for all of us. If you have not looked into it, check out proton therapy.
Does not seem to be so many side effects.

jmho

Regards
Posted 1/9/2013 3:33 AM (GMT 0)
JohnT, interesting stats there. Curious, do you know what is the survival rate for aggressive Pca that was treated early?
Posted 1/9/2013 4:43 AM (GMT 0)
Decisions: you've raised many issues in your thoughtful response. I'm a newbie here and certainly can't answer authoritavely other than to tell you my thought process as I researched this.

Re the dangers of secondary cancer from radiation: it seems to be very minimal and I would guess that it's similar to the small percentage of issues that derive from surgery. To me, this wasn't a deal breaker either way.

Re the chances of recurrence: from what I have been able to understand, the biggest worry is that some cancer cells have left the mother ship (prostate) and are floating around your body, potentially waiting to mess you up somewhere down the road. To that end, neither brachy nor surgery can help in that situation and it's probably the reason why their success rates are so similar. (Smart guys: please correct me if I am misconstruing this.)

If my assumptions are correct, then both brachy and surgery are very valid procedures for you and you should be assessing them versus factors such as 1) side effects and 2) your personal feelings about getting the prostate out instead of nuking the darn thing.

There is so much noise out there when it comes to treatment options, I think the most difficult decision is trying to figure out which factors are the most important to YOU and paying attention to those and downplaying the others.

Good luck! It's so hard when there's no right or wrong answer!

Michael
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