Welcome New Member ScientificLifestyle Who is Asking Some Questions

Prato:

I know it's possible to do the surgery, but it is much more difficult as stuff is kind of welded together from the radiation (ie: more fryable).

A lot has changed in the last 5 years. As I said, I don't think a B/U plan for failed radiation as primary tx. was mentioned to me.

That's changed now.

Mel

Can't believe there's still a discussion about the OLD argument of posturing surgery as a primary treatment because then if you have a recurrence then you can go the radiation route but not vice-versa. That's pretty much old/outdated thinking (unfortunately still being promulgated by many) right along with (cue music, "da da da daaaa!) "The Gold Standard."

There is plenty of information out there about the options if radiation fails - and as one would expect they come from the radiation guys. For example - from Dattoli: "Patients experiencing recurrence following single modality radiation are often eligible for additional treatment using a different form of radiation. For instance, the man who had EBRT alone may find benefit from a small dose of DART followed immediately by seed implant (depending on the location of the active cancer cells).

Men who had seeding (brachytherapy) alone might benefit from additional seeds of a different isotope. If he had Iodine-125 seeds, he might now have Palladium-103 seeds (referred to as a "crossover isotope"), or vice versa, and DART to the surrounding periprostatic tissue and relevant lymph nodes. Often these post-radiation recurrent patients will be prescribed hormonal therapy in addition to the new radiation."

There's plenty more out there as well, it's just newer information versus the old. I for one have done much research on this as I always have a "Plan B" in my life, and in the case of my own PCa for me should I have to deal with recurrence I would go to Dattoli. I made THAT decision as part of my own intensive due diligence leading up to my decision on primary treatment.

I took it a step farther with SBRT, that only encompasses a total of 40 Gy over 5 fractions versus the 79-81 G y with IMRT.

In the unfortunate case where more treatment may be needed, highly likely given I am G9, I still have another 40 Gy to burn (pardon the pun).

Also the so-called limit of 79-81 Gy (I know one can go higher but a general perception) only applies to the location where t was given. So more radiation can be employed to other portions of the body.

LupronJim

Hi All, Thank you for your help and for your challenging questions and statements.

I have looked at Brachy and have religiously read everything on the web and 6 books including Walsh. Walsh makes a very strong statement (that I cannot find right now) that a high percentage of cancer is near the urethra. In RT including BT, you want to kill all the cancer cells and ideally all of the prostate cells, but you don't want to damage the urethra. This is a tall order.

So I have chosen RALP because:
* High chance of negative margins and removing all of the cancer cells and all of the prostate cells
* Don't have to wait 1-2 years to see PSA drop to <0.1
* No rectal side effects to complicate/add to my Spastic Colon IBS problems
* I will know a lot more about my total pathology (are all of my cancers 6 and not something higher?)
* I understand the side effects risks with surgery, I have minimized them by surgeon choice and I accept the risk of these side effects
* RT and particularly low and high dose BT are not without side effects
* I want a fast, definitive result and want to avoid the anxiety of waiting for PSA to drop

I am very confident that this is the right choice for me, particularly in light of my family history.

Best Regards, Pat

__________________________________________________________________________________
Strong Family History of PC
Younger brother: PC at age 45 T2, PSA=2.95, + DRE > open Prost, doing fine now
Father: PC T4, age 55, PSA=20, Met to Lymph Nodes and Bones, Hormone, Rad, passed at age 64
GrandFather, Great Uncles all died of PC at age 62-64
Me: Year of Birth 1959
Diagnosed Oct 2014, Negative DRE, PSA=1, no symptoms, T1c
Biopsy shows 4 of 14 cores(with fragmentation) Adenacarcinoma 5mm, 2mm, 1mm max all G6(3+3)
Preemptive Biopsy due to Family History and age=55

Scheduled RALP 18 Dec with Dr. A. Martinez

Even though I also think scientifically, most of the time, my own decision had a nonscientific component. Namely, I was just more comfortable with the idea of surgery and not so comfortable with radiation. I know other guys who feel just the opposite. Fortunately, you can have a good outcome either way. Good luck!

Pratoman,

I have read a couple things that indicated that Dx at 65 may be more suited to BT than surgery. in Walsh's book he says that sometimes the anatomy as we get a bit older is not as easy to discect. I took this that additional growth is possible after 50s. I do not know how big of a factor this is. I think the most of this favoring of BT is that it is less invasive, less stress on heart/lungs than surgery.

That said, these may not be applicable to you. Your self described good health and healthy heart, weight loss etc indicate that you are in better shape than the average 65 year old. And, because you are having an MRI pre-surgery, the surgeon can get at least some kind of look at your anatomy in the surgical field.

Good luck with your decision, Pat

Just got home, RALP, Dr Arturo Martinez. Surgery yesterday. Catheter care and waiting for first bowel movement. Not too sore. Final pathology next week.Hoping and praying for negative margins. I am praying for you guys, please pray for me Scientific Lifestyle

My prayers are with you Science. One day at a time, congrats for being on the other side of this.

Hi All,

Progress report. Day 4 and no pain meds for 24 hours. I pooped twice yesterday! I did get some relatively strong bladder spasm and leaked between catheter and urethra on each BM and again on stepping into shower. I have emailed my doc to ask for a med for bladder spasm. I am up and about more. When my son gets home from Costco, going for a walk. Praying for a good post-op biopsy report. Also praying for good urinary countenance and ED results a couple three months out.

Feeling pretty optimistic.

With Best Regards,
ScientificLifestyle (Pat)

Ah, the good old days with Cathy Catheter. Such good friends like you're joined at the tip. :)

Prayers for a great pathology report. Did they give you an initial report?

Be careful getting in and out of bed. I got a rather large hematoma trying to hurry myself out of bed because I had to drop logs in short order. I had the bladder spray also...very disconcerting. I had a Rx for bladder spasms and that seemed to work pretty well. Watch those coffee tables when you're walking...got caught on one late in the process. Ouch. Also, NEOSPORIN will really help with the dry tip issue...was a lifesaver for me.

Don't be alarmed if when they remove 'ol Cathy Catheter that you have zero urinary control. I peed all over the exam room floor upon removal. I needed several diapers to get home without a giant mess. Not what I was expecting at all. Walking after the removal was one pace one spray proportion type deal. Very alarming. Don't sit for too long... I sat and watched football all day and didn't walk after mine...to this day, i have numbness in my thigh that was present from that day forward. I should've walked but it was opening football weekend! Ha.

Don't lift anything heavy either... I couldn't follow that order very well. Costly. Take it very very slow. No eyes are bigger than my stomach thinking.

3 months out is a good target for pretty good urinary control. I was pad free at that point but did have some minor stress incontinence. I'm 16 months now and every once in awhile if I really really strain I'll get some. Also, I've had 4 or 5 nights since I was pad free where I peed my pants over night. Not exactly sure why? I guess I didn't use the bathroom before bed...do not go to bed feeling like you have to go at all. Other than those sporadic odd occurrences I've been pretty much bone dry and incontinence is not part of my daily thinking. Work those kegel muscles! It helps with continence and it helps with a more powerful orgasm...you will likely shoot urine in the beginning...that will abate also.

Lots of progress set out before you... step by step. It seems like a long way off but it went very quick. It often seems like I didn't really have the experience I had. Hoping you have a similar experience.

Prayers for ya, Pat!

Hi All,

Progress report at surgery +24 days. I am using 1 heavy pad a day and almost ready to switch to thin pad. No leakage so far today! Although since I went to mass yesterday, this has been a lazy reading, computer, football on TV kind of day. Need to go for a walk. Almost no abdominal pain. Abs feel stronger. Back to work on Thursday, probably working from home for a bit. ED as yet unknown, but encouraging signs. I am on generic Viagra 20mg/day.

Strong Family History of PC
Younger brother: PC at age 45 T2, PSA=2.95, + DRE > open Prost, doing fine now
Father: PC T4, age 55, PSA=20, Met to Lymph Nodes and Bones, Hormone, Rad, passed at age 64
GrandFather, Great Uncles all died of PC at age 62-64
Me: Year of Birth 1959
Diagnosed Oct 2014, Negative DRE, PSA=1, no symptoms, T1c
Biopsy shows 4 of 14 cores(with fragmentation) Adenacarcinoma 5mm, 2mm, 1mm max all G6(3+3)
Preemptive Biopsy due to Family History and age=55

Scheduled RALP 18 Dec with Dr. A. Martinez


Post surgery Pathology:
One positive margin, but additional tissue taken with no cancer in that area.
PNI inside capsule, no extra capsule cancer found
5% of post surgical prostate examined has G6 (3+3), No Upgrading!! Post surgery T2c
Stress and a bit of urgency UI, but only 1-2 spirts and the rest just drops. Almost completely dry at Surgery +24 days.
Willy works - partial erection yesterday with daily 20mg Viagra, those nerves are still there and working even this early!

Congrats on your recovery! Keep making us proud!