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Posted 5/4/2019 9:00 PM (GMT 0)
Oldv8, if you're confirmed as G6, then the possibly least invasive treatment would be LDBT (low density brachytherapy)-- they implant radioactive seeds inside the prostate, and it cooks it from the inside out. The seeds are permanent--so it's pretty much once and done.

I had surgery, and I hit trifecta within 3 months (non-detectable PSA, fully continent, no ED issues). I'll also say that I seem to be fairly rare in here. I'll add my caveats: "continent" means that I'm as continent now as I was before surgery. I had some moderate BPH going on then, and I dripped a little from time to time. Not really different now. No ED means that I am on 2.5 mg of cialis daily. It also helps with the overall blood flow, which is important immediately after surgery.

There is one regular in here who is in your area--he bills himself as "Cyclone"--which tells you where he is in Iowa. There are others from that neck of the woods as well.

You commented about "missing the mark" with radiation--which is much less an issue today with some of the newer methods. SBRT, for example, implants marker seeds (gold?) in the prostate, and the radiation machine uses them to focus on, so hitting the spot is pretty much guaranteed.

Keep doing your research, and I'll note that most guys "know" when they meet "their team". It hits you in the gut, and you relax. Really. After that, you know you did all the legwork, and you'll know you're making the right decision..for you.
Posted 5/5/2019 10:33 PM (GMT 0)
Welcome. Here's another good thing to watch, regardless of what procedure you might choose.

Dr. John Mulhall of Memorial Sloan Kettering Cancer Center, as presented to the 2104 Prostate Cancer Research Institute patient Conference, "Optimizing Sexual Function Outcomes in the Prostate Cancer Patient": (59 minutes)

https://www.youtube.com/watch?v=4elsojpfnv8

Charles
Posted 5/6/2019 12:42 AM (GMT 0)
Another thing to know about radiation (from a Post Toastie, though) -- you commented that "sometimes their aim is a bit off. . . " Well, that is highly unlikely in the past 4 or 5 years. Almost all of the newer radiation therapies use one or another sort of marker inserted into your prostate to help the machine aim the beams.

I had CyberKnife radiation and a few things added to my confidence. First, they inserted four gold markers (called fiducials) into my prostate for adjusting the radiation beams prior to each treatment. Then, I learned that the CyberKnife system periodically, during each treatment, verifies its aim based upon the markers. During a typical 45-minute session, they said that the system used hundreds of treatment vectors, and that it verified targeting as it changed to each. The system was sensitive enough that on one occasion, it stopped my treatment because I had too much gas in my intestine, which was causing other organs and glands to be out of their standard locations. Once the gas passed, it re-started and completed the session.

So, I would not worry about side effects due to the RO or the machine not being able to aim and target properly. That said, yes, there can be side effects of the radiation itself because they often have to beam through other body parts to get to the target. All I can say about that is that my side effects were short in duration and not life-altering. My treatment spanned about 2 weeks, and during that time I did not miss a single day of work, nor did I miss a single daily workout at the gym. Oh, yeah, I was 68 at the time, so not a kid any more, either.

Learn as much as you can stand. Then, when you do make your final choice, it will be the one that is best for you. Doctors, as well as the folks here, can help you decide, but make no mistake, the decision must be yours.
Posted 5/8/2019 11:57 AM (GMT 0)
Thanks for that. Now having all of my preliminary tests,scans,probes MRI etc.it is down to my final visit with UR at IA city hospital to discuss final plans and a date. Seem to be back and forth now on fence about surgery or radiation. Heard a Lot about both, success rate seems close to same. With my added info from my biopsy Polaris report it indicates I am Just past the threshold of active surveillance with a molecular score of 5.1. It then goes on to say " when considering" radiation or surgery the patients 10-year Mestastasis (METS) risk with definitive treatment is 3.8% METS. They don't recommend either way. Only reason I was leaning towards surgery to begin with was because my original UR recommended it. Now kind of perplexed about it. Will feel better after talking with this new UR in IA city. He is the surgeon in the group. I guess if the less invasive treatment. of radiation will work just as well I may go that way. Will bear in mind he may be a little biased but go with my gut either way. I am usually pretty good at reading people, just can't make up my own mind some times lol. Again thanks for all of responses and info here, has helped immensely as well as been educatioal. Warren
Posted 5/9/2019 8:28 PM (GMT 0)
Warren,

Urologists are surgeons. Generally, they know surgery, the like doing surgery, they get paid for doing surgery, and they mostly talk about the benefits, and the best ones will say that they want you to talk to a radiation oncologist about radiation.

You're right, at your risk level, any of the typical first line treatments are likely to end with the word cured. The important considerations are the potential side effect profiles, and what you're willing to live with if you end up at the low end of the spectrum. Don't worry about what the failure 'second run' treatments might be....your likelyhood of needing them is really low. Like single digit percentages low.
Posted 5/9/2019 10:00 PM (GMT 0)

CuriousCharles said...
Welcome. Here's another good thing to watch, regardless of what procedure you might choose.

Dr. John Mulhall of Memorial Sloan Kettering Cancer Center, as presented to the 2104 Prostate Cancer Research Institute patient Conference, "Optimizing Sexual Function Outcomes in the Prostate Cancer Patient": (59 minutes)

https://www.youtube.com/watch?v=4elsojpfnv8

Charles

. Dr Mulhall has a book "Saving your sex life" Never read it. In fact I made every mistake possible treating my pc before I started to educate myself. This video of Dr Mulhall should be required watching before your first URO appointment. I have it bookmarked and will pass it on to everyone I meet.
Posted 5/13/2019 11:24 PM (GMT 0)
As it turns out this Urologist I saw today was pretty clear on things. He also did set me up with an appt. with a radiologist to explore that option adding that in my case and heart history it could be a good choice. He indicated he would have no problem doing the surgery IF that is what I chose but in the same frame reminded me that with my abdominal scarring from previous surgery there could be complications. Appeared more concerned about whether my heart could take the stress. Leaving today leaning more towards radiation. Will see radiologist Thursday of next week and go from there. He did say the MRI showed an abnormal nodule of prostate not biopsied. Did recommend biopsy of that side if no treatment chosen. Treatment will take place so that will not be necessary. So after seeing the radiologist, should be pretty much decided. Learned a lot of information here and other on line areas which has been very helpful in getting to this point. Warren
Posted 5/14/2019 12:14 AM (GMT 0)
Glad you will be seeing an RO. Let us know what he/she recommends
Posted 5/14/2019 3:22 PM (GMT 0)
Warren, sounds like a more balanced plan. I'll just remind you once again that "RO" doesn't mean he/she is a specialist in all forms of radiation treatment. With your diagnosis I would recommend you chat with specialists in LDR Brachy, HDR Brachy and SBRT. Once you have done that you should be able to make an educated choice.

Jim
Posted 5/26/2019 1:41 PM (GMT 0)
Uupdate! Seen Urologist (2) in Iowa city University. Also visited with radiation oncologist. Since the original diagnosis in Jan. of this year it has been a roller coaster of tests visits, appts, and opinions and options thrown my way as well as the anxiety issues processing all of this crap. This forum has been one of the most helpful and revealing informational sources on ride. Bottom line my choice as many have mentioned in this post/topic . Although some may be biased on which way to go I have been given enough information to make a decision on treatment in my particular case. For those old timers here as well as newbies like myself here is what I have decided through process of elimination. First due to my Prolaris report on my biopsy indicating observation as an option is out, this leaves surgery or radiation. My local URO would not go there due to heart issues. Went to another in Iowa City University. He said he would do it but there is a risk with my heart issues . Was willing to do it but outlined the risk possibilities then referred me to a radiologist oncologist. He told me of his options for treatment. Still my choice. No good or bad,right or wrong just my choice. Something has to be done either way. I committed to radiation treatment. Mine will be where they first plant some (4) markers in the prostate. These to guide radiation beams more directly to target. Other option was radio active seeds planted in prostate one time shot. Mine is 40 visits of treatment. All of these treatment options have various side effects including surgery. Have read and studied them all. Still nothing really jumped right out at me. Still something had to be done. Chose this one I feel has better chance for me of dealing with after side effects of any. Will keep posted as treatment begins. Need to visit with local radiation oncologist first, then marker planting and begin treatment couple wks after that. Thanks again for all the help and info here. Warren
Posted 5/26/2019 2:02 PM (GMT 0)
Warren,
Great job! I just love it when a member methodically investigates their options. The RT should work just fine, and you’ll never have to come back here if you so choose.

Probably the most challenging part of the RT will be learning how much water to drink to have your bladder full, but not so full you feel like peeing in the oversized boxers they have you wear. 🙂 You May want to practice before you start treatments.

Let us know how it goes.
Posted 8/21/2019 9:06 PM (GMT 0)
Update:
Just finished 33 of 39 Radiation treatments 6 to go.. For those contemplating this option, this is my experience. I am in Ottumwa, Iowa. Treatment is local which helps. First of all my choice was process of elimination. 67, heart issues high blood pressure kept surgery out of contention . 1st , 4 gold markers put in prostate same procedure used as biopsy to insert them. Couple wks later MRI - CT SCAN then appts made for treatment. M-F 8wks . Same time everyday. Patients are on 15 min increments. Drinking roughly 12-16 oz water 45 min before appointment. Hold It!! They require full bladder for each treatment. Once done each day you may run to bathroom down the hall, lol. Every Wednesday after treatment get to visit with in house Oncologist regarding any problems if any. My first was about 3 wks in on a weekend. Excruciating burning when peeing. Called the on call number 5:00 am given me and actually got talk to the on call Oncologist. Said it was normal told me what meds to get at pharmacy to help with pain and to drink a lot of water during the day to help dilute the urine in my system. Radiation makes the urethra enflamed and the toxic urine burns going through, no crap!! Anyways taking more water daily 8- 10 glasses/bottles seemed to remedy that. Couple more weeks along got tough to start peeing or even start a stream and would not empty bladder. Prescribed Flomax and that opened things up. These side effects are normal for the radiation treatment. All in all I am pleased with the whole treatment program here. Good group of nurses and attendants working there. Toughest part is maintaining a full bladder daily, takes practice. Procedure itself is painless as mentioned above. This forum here really helped me out early on with information . Hope this experience of mine will help someone else with questions regarding treatment. Thanks, Warren
Posted 8/21/2019 9:14 PM (GMT 0)
Glad to hear you're doing well!

Andrew
Posted 8/21/2019 9:20 PM (GMT 0)
Oldv8fords, sounds about right. Your in the home stretch now, and here’s hoping in a year this will all bel in the rear view mirror forever
Posted 8/21/2019 10:13 PM (GMT 0)
Yep, it burned for me too. You should heal up well and be good to go.

Thanks for the update.
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