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Posted 2/6/2008 4:37 AM (GMT 0)
Today I met with radiation oncologist who performs HDR brachtherapy.  We discussed surgical and radiation complications.  I was pretty sure this was the way I would go.  Then this afternoon I met with a urologist who has done over 300 daVinci prostatectomies.  He gave me all the pros and cons from his point of view.  He feels at age 58 with T1c Gleason grade 6 that surgery is better.  He feels any leakage or incontinence problems can be treated.  In his hands, he has less than 5% lon term incontinence and 205 impotence rates.

At this point I am more confused than ever.  As with evryone with low risk disease, the complications scare me tne most.  Does anyone have any input on the HDR brachytherapy short term and long term?

Posted 2/6/2008 3:17 PM (GMT 0)
I will not be suggesting one treatment or another but I would like to throw out this thought. Surgery benefit can best be described as the saying goes, "Seeing is believing." The surgeon can inspect the area for cancer signs and then the post pathology report can reasonably confirm.

Having said that, I wonder if the best answer some surgeon should think about, might be to cut a small hole and put a scope and light in and look and see then give you their best assessment. then in a week or so you choose.
Posted 2/6/2008 3:22 PM (GMT 0)

Hello Acmd,

My husband is 57 and he was happy when the urologist called him a young man! We don't have your stats.: Size, stage, gleason score. I keep reading everything I can put my hands on and yes, the decision is tough. 2 books that helped me;

A primer on prostate cancer: The empowered patient's guide                                   

by Stephen B Strum and Donna Pogliano 

Very complete with all the tests you should look into, the treatments, and so many things I never heard of. Very interesting. It's from 2002 so Davinci was not that prominent like today but so informative.

Surviving prostate cancer

by E. Fuller Torrey

This one is from 2006 and up to date with treatments and latest news about nutrition. My husband couldn't put it down.

A website that answered many questions for me:

www.yananow.net/Mentors/GlenL.htm

at the same website there is lots of stories of people who picked all kind of treatments. Good luck. Lili

Posted 2/6/2008 5:09 PM (GMT 0)
The problem with hashing over all the studies and reading all the conflicting information on treatment is that the result is analysis paralysis. Try to keep things simple: Got cancer? Get rid of it!! Chose a treatment option, make a plan and execute it. Don't ever look back...

Jim
Posted 2/6/2008 6:43 PM (GMT 0)

ACMD

I too wrestled with the decision - surgery or brachytherapy - and got the same thing from the specialists:  the surgeon recommended surgery, and the radiologist, seeds.  I have to say that I'm glad I chose the surgery.  My pathology report was worse than expected, even surprising my surgeon.  As you can see by my signature line, then I was able to undergo a second treatment to get rid of any PC cells left over.  So far so good.  However, you could be one who has it entirely contained, and the seeds could work very well.  I thought it was strange that I had to choose my direction, but that's the nature of the beast.  Both treatments have their side effects, especially with continence and ed.  Take your time, careful not to get too overloaded, and make the decision you feel will be best for you.  Good luck!

Posted 2/6/2008 6:52 PM (GMT 0)
I see one really significant benefit to surgery for low grade, early stage cancers. A second oportunity at a cure.

If Paul had had the choice to make, he claims he would have given radiation much thought. It wasn't a choice for him. The body can only have so much in a lifetime and he's already glowing from the last time. Unfortunately, it isn't a choice down the road either. I guess he'll just have to commit to growing old and dying healthy!!! ???

Swim
Posted 2/6/2008 8:17 PM (GMT 0)

acmd,

Have you heard anything about ablatherm hifu?  There's no surgery or radiation involved, but it's not available in the US.  This website www.cmedtravel.com provides some details.  Evidently, it has been used in Europe for several years.  Good luck in your research.

tullamore   

Posted 2/6/2008 9:02 PM (GMT 0)

My father had surgery for prostate cancer at a young age, not as young as I, and did very well, both from an continence and ED perspective. Of course, it helped that he had Dr. Patrick Walsh as a surgeon. Certainly, my father's experience and Dr. Walsh's bias toward surgery influenced my decision to have robotic prostatectomy. My age, health and choice of a top-quality surgeon gave me confidence that the chance of side-effects would be made as small as possible.

Another factor to consider is how you will personally deal with post-procedure PSA tests. For me, I felt that I would do much better psychologically with the greater "finality" of surgery, including both the final pathology report and the PSA level that (hopefully) goes to an undetectable level. Waiting for that first post-surgery PSA test was still rough, and I'm sure my anxiety will increase before a number of subsequent tests. However, my hope is that a sense of being "cured" will come sooner than had I waited through a slower decline in PSA that a radiation route apparently takes.

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