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Just diagnosed 4+3, Considering HDR brachy, proton, and carbon ion

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Posted 9/9/2016 5:42 PM (GMT 0)
I was just diagnosed with early stage prostate cancer. I have perineural invasion. Left apex was 4+3 for 5mm of 20 mm , right apex 3+4 for 7mm of 13 mm, and right mid, 1 of 3 at 3+3, and all the other 9 samples negative. PSA 14.9, volume 46 cc.
I am 52, and potency is very important to me. My urologist wants a RP, but my fear is I will have all the side effects, and find out that my cancer has spread already. After all that surgery, to find out I still had cancer would be devasting.

So, I am leaning toward HDR monotherapy and LDR
I like the HDR better, the papers I have seen seem to indicate it is more effective than LDR
but also interested in Carbon Ion treatment in Shanghai. The carbon ions have 12 times the mass of a proton, and seem like theoretically would be much more damaging to cancer. Any thoughts?
Also, if most of the strong cancer is in the apex, and the rest is 3+3, can't I just have the apex treated, and do watchful waiting for the rest??
What treatments should I lean towards in order to maintain the best sexual functions.
I live in Michigan, but am considering Seattle or UCLA if I go they Brachy route, due to the world class prostate people at each, thoughts one way or the other
Posted 9/9/2016 6:03 PM (GMT 0)
Hi GDS and sorry about your diagnosis. In my case, I was learning toward surgery but when it looked like I had a good chance of needing radiation afterward I decided to go directly to radiation. Sounds like that's your thinking as well. I also understand your goal of maintaining potency (I was about your age at diagnosis) and you probably have a better chance of that with brachy than with surgery, although there are a lot of guys here that had surgery and have never had an issue with ED.

I can only speak to HDR brachy--I had mine at UCLA (in conjunction with IMRT and HT) and it is an excellent program. It's not uncommon for people to travel there for treatment. I live in LA so didn't bother to research other brachy programs. So far I'm doing well--only SEs are that I only pee about 75% as well I did, although Rapi-flo helps with that.

Good luck to you and I'm sure others will weigh in with their experiences and guidance.
Posted 9/9/2016 7:31 PM (GMT 0)
Hey GDS -- just wanted to drop you a note that I'm dealing with the same decision process you are... I'm 44 yrs old w/ G7 and my biopsy came back with a single hit in the R-Apex.

I keep flipping back and forth between HDR and Surgery...

Have you talked to anyone in Seattle or UCLA about the Brachy programs yet?

Zzarth
Posted 9/9/2016 8:18 PM (GMT 0)
Zzarth,
Have not talked to anyone yet, other than my regular urologist. I am not considering surgery at this time. Seems like your tumor is very early since you only had one core positive. That is an encouraging sign!
I am curious why you were upgraded, and how you got the second biopsy opinion from Hopkins? Do samples ever get downgraded?
Posted 9/9/2016 8:32 PM (GMT 0)
Hey GDS

Yes, they can get upgraded or downgraded ... all the info is located within the "Newly diagnosed READ THIS" link at the top of the forum thread list:

www.healingwell.com/community/default.aspx?f=35&m=2652250


I suggest you go make a nice hot cup of tea, sit back and read that thread, it's very helpful...

:)

Zzarth
Posted 9/9/2016 11:41 PM (GMT 0)
Hi GDS,

I'm also 4+3 with PNI. My tumor had already took up half of the gland by the time I had the biopsy. (I put it off for a year) I was planning on having surgery, but was advised to see a radiation oncologist since he said there's a good chance I'd have to have salvage radiation anyway. I was surprised to hear that from him, since he's the one that preforms the prostate surgery.

I ended up having radiation, Both low dose seeds and external beam, but no hormone blocking shots. My RO told me that his new machine combined with the seeds would be my best chance at a cure, and the hormone shots were optional.

Now 18 months later my psa is shooting up but so far no proof that my cancer has spread.

I don't regret my treatment decisions, but I wish I'd have had the biopsy, and started treatment sooner.

Good luck and keep us posted.
Posted 9/10/2016 12:04 AM (GMT 0)
Hi GDS, welcome to HW and sorry you have to be here. It is time for research and as Zzarth mentioned, time to read the sticky. A second opinion is always a good idea. You never know what might happen. Good luck on figuring out your treatment plan and this journey you are embarking on. Take care. -JR
Posted 9/10/2016 2:43 AM (GMT 0)
I'll refresh this website link that was recommended (Dr Lam) in another thread (yesterday?). Close to LAX:
https://www.prostateoncology.com/education/fundamentals_of_treatment
Posted 9/10/2016 3:21 AM (GMT 0)
I think carbon ion is great. Did they say they will treat you in that clinical trial in Shanghai? Also, that's one of the newer ones- they have one in Lanzhou that's been operating a lot longer. I would be wary of their experience at a brand new center, and working with radiation that powerful can be dangerous in the wrong hands.

Carbon Ion Radiation Therapy for Prostate Cancer

HDR brachy is great, and so is SBRT, which is radiologically identical. They have the highest rates of potency preservation.

LDRBT, IMRT and SBRT Quality of Life

High Dose Rate Brachytherapy (HDRBT) monotherapy – 10 year results

With LDR brachy, you'd probably need EBRT with it, which would diminish the SE advantage. Same holds true for protons, although UFJacksonville reported good results on intermediate risk patients just as a monotherapy. But if preserving potency is your goal, you probably want one of the other therapies.

Proton therapy at University of Florida Jacksonville – 5-year outcomes
Posted 9/10/2016 7:34 AM (GMT 0)
GDS -- honestly I think you're on the right track but I would consider a combination treatment because of the 4+3, both side being effected and PSA over 10. I do not consider your case "early stage" and to my eyes your case is AT LEAST intermediate risk and possibly high risk. take a look at my last post and my results and my lack of SEs. good luck in whatever you decide!

ed
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