Can not decide seeds or Robotic Surgery

I am new member and can not decide on the seeds or surgery.
Biopsy Right Base two core 18 percent Adenocarcinoma Gleason 6
Right mid prostate Gleason 6
Right Apex prostate Benign
Left Base Prostate Gleason 6 18 percent one of 2 cores
Left Base Prostate Gleason 6 3 percent of one of 2 cores
Left mid prostate Benign
Left Apex Prostate benign
Small prostate less then 20 ml
Do to family history brother and Father watchful waiting is not a option.
Would like to hear some thoughts.
If I did not post the right I am very new to this.
Thank You!

Jack,

Welcome to the forum. I hope we can help.

You look like you are low risk with a relatively small volume of low grade G6 cancer. What was your PSA? Under 10, I imagine. What is your age? Where are you located?

In my opinion you are in the position to choose the treatment that presents the least side effects. That would be brachytherappy. Numerous studies back this up. As you are looking at brachytherapy, please research both permanent seeds and High Dose Rate, that does not leave the radiation in the body.

Here are a couple of excellent websites from respective pioneers. For seeds, www.prostrcision.com, by Dr Frank Critz. He pioneered the use of seeds and adjuvant radiation and has recently published 25 year results. I met with Dr. Critz as one of my treatment options. For HDR (what I used) see www.cetmc.com, by Dr Jeffrey Demanes, the HDR pioneer and currently head of Brachytherapy at UCLA Medical Center. From Demanes informnation you may be a candidate for HDR monotherapy.

Both offer the same cancer control as surgery with less risk and generally less side effects. I am three years out from HDR and IMRT and have absolutely no side effects of loss of function from the radiation.

From one Jack to another, let me know what I can assist you with,

Jack

Hello Jack and welcome to HW. As Bill said, a little more detail about you would give us some insight that might make our advice better and more targeted. Nevertheless, JohnT did a good job of summarizing some of the considerations between the two options. With what we know of your stats, the chance of a cure is very high with either option so it will come down to reviewing what is important to you.

I would also recommend that you consider reading the sticky thread at the top of our forum that is designed for new members. www.healingwell.com/community/default.aspx?f=35&m=2652250

Finally (for now), a number of our members have their first person "journeys" of their treatment choices in their signatures (see mine below). You might want to check some of those out for anecdotal information from men who have made their choices.

Good luck,

Jim

Jack, while I don't live in the DC area any longer, that is where I had my treatment. If you care to email me (see the little envelope on the left) I would be glad to refer you to an good urologist for a second opinion as well as an experienced brachytherapist who has well over 1000 under his belt.

Jim

Jack,

One of the nice things about your low risk PC is that you have plenty of time to make a decision. I hope you will take that time and not rush into anything.

Family history does not preclude one from Active Surveillance, but worrying about it may.

Both surgery and LDR brachytherapy (seeds) are very sensitive to the quality of the doctor performing the procedure. That should not be a problem for surgeons at JH. Results for seeds are very uneven, so be sure you find a doctor who has a long record of success. The closest one I know to you would be Gregory Merrick who is the Director of the Schiffler Cancer Center at Wheeling Hospital in Wheeling, West Virginia.

Closer to home, Sean Collins at Georgetown U Medical Center has a great record of success using SBRT (see link in my signature).

Jack D said...
Thank you for your replies. I live in the Washington DC area.
Cat Scan,Bone Scan Clear
I wanted to have a consultation with a Radiation oncologist which I did.I have a appointment with the robotic surgeon next week and my urologist.I want to make a informed decision.All my Doctors are at Suburban/John Hopkins Hospital.
The stress in making a decision is hard I find.
Had 12 biopsy,s



Age 65 will be 66 in August
G 3+3 =6
PSA 5.3

Sorry you are now in the fraternity. Recently diagnosed myself and could not agree more that the decision is stressful.

Semper Fi
Walt

Jack,

I'm in Fairfax and had Da Vinci surgery with Dr. Simon Chung in February.  He is highly rated and you should consider a consultation with him.  He doesn't push surgery, but explains everything very simply.  See my signature information below and path report.  I'm very happy with my decision to go with surgery and chose it because I wanted to rid myself of PCa.  If I ever need salvage radiation I can still do that.  If I had seeds first, nerve sparing salvage surgery wouldn't be an option after radiation.  You are in a good area to find qualified doctors.

Best of Luck!

Jack - Surgery worked out absolutely perfectly for me. I may have opted for surgery if I were your age at the time of my diagnosis. Since then I have learned enough to know that I would give seeds a lot more consideration if I had been 65.

You would do fine with both but given your age I would venture a guess that you'd have a better response to potential SEs with seeds. That does not mean that you would be guaranteed potential SEs if you had surgery with a top guy. I just think that a lot of my fantastic recovery without issues was due to my age.

Thank you for all the support.I have to have a MRT3 on May 5.
I have decided to have surgery which it going to be on May 30.

On another note my brother who was a Gleason 8 PSA 25 had the surgery in January.His last post opt PSA were 0.03 and I just found out that there were five to six spots in his bladder that they are going to spot radiate.Does anybody have knowledge out that works. He is in Frederick Md area.
Will keep you updated on how everything goes.
Thanks, Jack

Jack,
I chose brachy when I learned the results were equal to or better than surgery with less of a chance for serious side effects That was nearly 5 year ago, and nothing that I have experienced since has changed my thinking.
I wish you the best.

Hi Jack,

Johns Hopkins in Baltimore has a session on Friday's where a radiologist, oncologist, surgeon, others all review your records and then talk with you individually about your specifics, link is here, you may want to consider since you are so close ==>

http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/prostate_cancer/prostate_multi_d_clinic.html

I did not do this as I had already decided what I was going to do. I did feel very comfortable at Johns Hopkins there in Baltimore, they seem to have a lot of information and knowledge that is shared between all of the different disciplines.

Best wishes on whatever you decide, I think there usually will be something that pushes you over the edge on what you decide. My two cents is you just want to be sure so that you don't second guess, I think that will just lead to emotional unhappiness, and you will not need that burden.

Jack,
An MRI is a good idea as it will give you confidence to continue AS or identify a more serious problem that you should deal with. It also establishes a baseline in which changes can be seen.
I would always recommend an MP-MRI for anyone considering AS.

Hi all
I had my MRI that didn't show any thing.I am having surgery on May 30
Thank you all for your support!
Will let you know how it goes
Jack