Biopsy % Involvement at the APEX and treatment options

Hello,

My biopsy results showed the most involvement at the Right APEX 90%.  Some have brought up the fact that this area is near the nerve bundles and is hard to get a negative margin thru surgery.  Is this the case?  Have any had the robotic surgery when the biopsy results showed high involvement at the APEX?  What was your outcome? 

Some have stated that Radiation is the better treatment for this type of biopsy situation.

Any comments?

Thanks

You are correct about apex tumors and a much higher risk of both positive margins and incontinence. This means that surgery would not work, just that it has a much higher risk of failure.
Radiation,either brachy or IMRT, would be a better option.

Few men die from G-6 prostate cancer...Radiation and surgery work equally well at delivering a cure..And yes, a high degree of involvement at the APEX can be difficult for surgeons to deal with effectively..(to get a clean margin without leaving you incontinent).

The combination of Brachy and IMRT works very effectively. Find the most experienced R.O. that you can and have a long talk with him...

I again suggest that you should research radiation therapies as dilligently as you are researching surgery therapies. The apex involvement presents challenges to surgery that are not posed for radiation.

While both are effective for cancer control; radiation, both brachytherapy and IMRT/IGRT, has by definition a larger "kill" zone than what a surgeon can excise, but with much less in the way of risk and side effects. You have a desire to get a pathology report, which only surgery can provide. But you may only confirm what the biopsy provides at the risk of incontinence, ED, etc from the surgery.

Please remember that the definition of incontenance and ED used by surgeons is very different than what you define it as in your current daily life. My brother's brother-in-law had surgery at age 50 (he is now 60) and he reports that two pads a day really isn't a big deal. It would be to me. I had two forms of radiation and am without any side effects in the urinary, bowel, or sexual areas from the radiation. I don't need any pads and I do not drip when I sneeze, or lift something, or exercise.

I, and others, feel you owe it to yourself to perform proper research on all therapies that have proven to be as effective as surgery before committing to a treatment. None of them are perfect and the days of the surgeon pronounced "gold "standard is long ago with the current forms of radiation therapy available.

Let us know how we can be of assistance,

Jack

As a follow up to my post I found excellent information regarding brachytherapy on the following two websites: for HDR, www.cetmc.com for Dr Jeffrey Demanes the HDR pioneer that now heads the Radiation Brachytherapy department at the UCLA Medical Center, and www.prostrcsion.com for Dr Frank Critz the pioneer of permanent seed brachytherapy and adjuvant IMRT. I consulted with both these centers as part of my research.

Had I done seeds I would have used Critz as I am in Atanta. His practice performed my wife'd radiation for breast cancer and they were excellent. I ended up using HDR and had two excellent centers in Atlanta to choose from. I would be happy to provide you with information on each. I don't know or remeber where you reside, but that you looked at a surgeon in Atlanta I assume it could be a treatment location for brachytherapy as well.

Kdiev:

JohnT and others have done a much better job that I previously did of expressing why your due diligence should include a discussion with an experienced RO.

Jim