Seeds for under patients under 50

I haven't been here that long, but my review seems to be that most of us under 50 opt for surgery. There was recently, I believe, one person here under 5O who chose seeds. Or, he may have been on the UsToo discussion site. Sorry that I can't be of more help, but hopefully others will provide input.

I agree with JNF - and would also add that there is now plenty of long-term data and statistics that show BT is as effective if not more so than surgery and with less SE's. I believe this is simply another piece of the "legacy" that just won't go away, the whole stigma of those that can't let go and realize that surgery is no longer the "gold standard" of PCa treatment.

Now before this turns into another ugly and unnecessary discussion of what treatment is "best", I will again caveat my opinion/position and say that surgery absolutely is a good option for some - once the individual's PCa statistics are considered if surgery is one of the treatment options that makes sense then of course it should be considered. My point is that I believe the treatment approach to PCa has not yet evolved based on current available modalities that now have sufficient long term results and data.

Continued best to you as you move along in your journey.

I'm 47 and just had robotic surgery.

You and I had very similar stats.

Unfortunately I came back with a sizeable positive margin, so almost certainly I'll be doing radiation as well.

My one comment would be that if you do decide to go with surgery get the absolute best surgeon you can.

Pay a lot of attention to their surgical margin rates. They can vary greatly amongst different surgeons.

I'm not sure I'd say I regret my decision for surgery.

I do regret that I allowed myself to be cowed by my insurance company into not demanding a better surgeon.

I can't think of any reason why a man under 50 should not consider brachytherapy as a front line weapon in the fight.

Would love to see data on patients under 50 getting seeds or radiation, and their risk for other cancers potentially caused by the radiation 20 years later. Does such long term data exist? Part of my reason for surgery. Everyone should do research and make the choice that works best for him.

brooklyn,
There is a lot of long term data for secondary cancers caused by radiation. the older ERBT radiation had a poor record of secondary cancers and the reputation has stayed with radiation ever since.
Go on the New Prostate Cancer Infolink and search for secondary cancers and you will find a few long term studies. There is no difference in the rate of secondary cancers with seeds as compared to a surgical cohort. There is a slight increase, around 1 to 2% for the modern radiation like IMRT.

Thanks to all for your help and feedback folks. Especially appreciative those younger guys that chimed in, as really starting to narrow this down and move forward.

Yes, you should really do some heavy research regarding potential secondary cancer from radiation treatments. John T says that these situations were mostly from less sophisticated radiation equipment from years ago and I have also read that this is true. Apparently, modern radiation equipment is much more focused on the target area and supposedly there is only a small chance of triggering another case of cancer 15-20 years from now.

However, you SHOULD check all of this out for yourself. I would consult radiation oncologists from BIG facilities such as Mayo Clinic, Johns Hopkins, etc. Find out what the stats say about all of this.

As for surgery, it DOES continue to be the GOLD STANDARD in curative cases simply because the cancer is no longer there to be treated. With the cancer gone with the prostate, there is no need to hope that radiation will cure you. You are (in theory) ALREADY cured.

So, until other treatments, including radiation, can match this 100%, surgery will remain the gold standard for cure.

However, I would not be surprised if other treatments someday DO match surgery and ultimately replace it in most cases.

Younger patients tolerate the surgery much easier than older men and generally recover better in terms of urination, sexual function, etc.

So, as I usually recommend to newly diagnosed forum members -- have consultations with VERY HIGHLY EXPERIENCED radiation oncologists and VERY HIGHLY EXPERIENCED urologist/surgeons. This will help you learn all the pros & cons of both types of treatment.

Once you have educated yourself on all of this, you can make a treatment choice based on your acquired knowledge based on your comfort & confidence levels with each option.

Wishing you the best,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-firm erections now happening 14 months post-op & slowly getting a bit stronger.

Colorado I was 56 when I had mine but I feel <50 ha ha.

Seriously, I think - as others pointed out - that the risk of secondary cancers is very, very low per data I read (sorry I can't find the link).

JohnT had a good idea: call Dr. Dattoli in Florida and I'd also call Dr. Grimm in Seattle and Dr. Moran in Chicago - those three must have 25-30k brachytherapy patients (I know Dr. Moran has 15,000 himself). I am certain you can get answers from them.

Take care.

Post Edited (Buddy Blank) : 4/11/2013 9:58:37 PM (GMT-6)

My sister-in-law lives in Denver.

You know, deciding on a course of action was one of the toughest decisions I've ever made. It was grueling emotionally and I was frazzled trying to understand it all and then pick. Up until they knocked me out I felt like Too Much Coffee Man. My poor wife.

Glad to see you contacted them. The more info from docs the better. Lined up questions for them and checked their stats is what I did.

+1 for Dattoli. I can speak from first hand experience he runs a quality operation down there. His results speak for themselves.

Highlander/Chuck - you can access my e-mail by clicking on my handle "A Yooper" in the upper left corner of my post, which will open up another window where you can simply click on my e-mail address.

Thanks.
Jeff