HealingWell
Search Close Search
☰

Brachytherapy, VS HDR and Robotic

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
12
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 5/18/2010 9:07 AM (GMT 0)

Hello everyone.

I was recently given the bad news by my urologiest. I have PCa, my gleason is 3+3=6 Although I don't understand how it is derived. out of 12 cores, only 5 on the right side are affected, with majority in the middle, some on apex and some on bottom. I will post the exact % later.  My PSA was 6. In the past 3-5 years PSA was hovering between 3.5 to 5.1.  None of DRE showed anything unusual. last September PSA was 5.3, I was refered to a urologiest, his DRE showed nothing either. He told me to come back in 6 months. I re-did blood work as part of routine check for Chloestral, etc and did PSA test along. This time it came in as 6.  It was done in April, so I decided to see the urologiest again and he scheduled for biopsy. On 4/28/10.  2-3 days later I was told of my situation. In my meeting with him, he didn't show the ultrasound pictures. When I asked if the ultrasound showed my prostate enalrged, the response was no.  He suggested Brachytherapy.  The path report only shows the number, not the size of prostate and or its stage.  Is this abnormal?

I am doubting the test results, as I have never ever had problem with enlarged prostate, or  having to get up in the midle of night. During the day I visit bathroom few times , but that is due to drinking few cups of de-cafe coffee and water.

I have read the forum on this site along with articles else where such as google.  I an trying to find another uralogist and get a second opinion.  Does anyone know how long the Pathologiest will keep the sample tissue. Do I need to do another Biopsy? How long do I have to wait,  I have set appointment to see the oncologiest staff that will be part of team for Brachey in two days.

The HDR is not available locally, and the insurance company is strict on staying with the participating DR, within the network.  I have read just about all posts on this site, most are about RR, or Davinci or  robotic.

I need to make the choice rather quickly,eventhough my Dr says "it's not urgent, but don't leave it for 6 months".    Can someone please help me with my understanding pro's and cons? Those who have done Brachy would be my first  choice for source of information.  I read the seeds may

migrate. If they do then my goose is cooked. If they don.t work, do I have the choice of doing surgery at a later time? If not why not?

I am stressed out somewhat shocked    Quality of life afterwards is extremly important to me. I don't wish to wear diapers and I still have plans for my male anatomy.   I am in my mid 50's and If I can take care of this problem without surgery, or Brachy, I would like to learn about it.

I realize that at the end I am the one who has to make the choice, but If I have only one shot at it, I want make a good choice.  If nerve saving RP really works, then that would be my choice , VS Brachy, as the idea of having 90 to 100+ little cylinders in me for ever is not pleasing. Buth then again it sounds as if those with surgery have more complains. Has  anyone had experience with Brachy  Lastly where on line can I find comparison and patient feed back. The specialist tend to promote their own expertise.

Thank you

Posted 5/18/2010 9:30 AM (GMT 0)
Hi and Welcome,

I am sorry you need to be here, but there is good info to be had from this site. I recommend that you get the American Cancer Society's book - "A Complete Guide to Prostate Cancer" which explains all the treatment options and their pros and cons. You have time to do the research before making a decision. There are many other good books on the subject as well.

Please know that you are not alone and everything will be OK.

One important question to ask Doctors is what is Plan B - What happens if it recurs. How does your plan A choice effect Plan B.

Keep us posted!
Posted 5/18/2010 12:52 PM (GMT 0)

Dear Shaheen:

Welcome to this forum but I'm sorry you have to be here.  I think you will find this is a caring place with many educated and informed folks who will help you however they can.

My treatment choice was brachytherapy and you can read my "journey" by selecting the link in my signature.  I am personally a strong believer in this treatment as many long term studies (15 years +) have demonstrated that it is just as successful as surgery in treating prostate cancer with far less onerous side effects, i.e. better quality of life.  This forum is mostly comprised of surgery patients, many of whom have had difficult journeys.  There are a few of us brachytherapy guys and I expect a couple of them may weigh in on this thread.

Specifically to your question about questioning the test results because you had no symptoms...most of us did NOT have symptoms prior to the PCa diagnosis, so that should not be your standard.  However, it may be a good idea to get a second reading on your pathology slides if they were not read by one of the acknowledged prostate cancer pathology experts, e.g. Epstein at Johns Hopkins or Bostwick Labs. 

In general it is a good idea to get multiple opinions about treatment.  You will want to speak with a surgeon, a radiation oncologist and a prostate oncologist.  You should also read Walsh's and Strum's books on prostate cancer.  Being informed and your own advocate is the best way to make an educated decision.  Also, and this is VERY important, please make sure that the doctor you choose (whatever the treatment) is highly experienced.  Surgery studies have demonstrated a significantly higher success rate with better quality of life for surgeons who have done more than 250 procedures.  I would think the same thing is true for brachytherapy...my doc was north of 1000...

Re your question on seed migration, that is a very rare occurance these days.  Many (most?) radiation oncologists insert the seeds in "stranded" form so that they are tied together and the chance of migration is almost nil.  Even for those who do not strand the chance of migration is very low.

You may hear from some surgeons and some members of this forum that you should choose surgery because radiation after surgery is possible while surgery after radiation is not.  That is only part of the story.  The truth is that there are multiple choices for salvage treatment after brachytherapy and those salvage treatments are just as effective as the choices you have with surgery.  JohnT, who has also had brachytherapy and who is one of this forum's most knowledgeable posters, has had many posts on this subject.

Hopefully this is helpful.  Good luck and please let us know if there is more detailed information you need.  You can also feel free to email me directly.

Tudpock (Jim)

Posted 5/18/2010 1:05 PM (GMT 0)
First, welcome to HW. Sorry you have to be here.

Now then, regards your biopsy. Results containing cancer has no correlation to prostate enlargement, size or urinary function, day or night. Many guys here had only the psa test results to indicate any problems, no physical symptoms at all. So don't base your doubt of the test on that criteria. We always suggest a second reading of the biopsy slides, you will need to ask the doctor to send them out for another review, either his choice of labs, or yours. Several here can suggest some world-class guys who do referral reading of the slide.

If your doubting of the test results is a result of your refusal or avoidance of bad news, then that's a seperate issue you will have to address before you can mover forward in your journey. Denying the results or seeking other reasons why it can't be accurate is part of our progress toward acceptance of bad news. Sorry you have to make these steps.
Posted 5/18/2010 1:30 PM (GMT 0)
Hi Shaheen 10,

Welcome to the forum. My husband got his diagnosis 2 months ago to the day (3/18/10). Like you , he is mid 50's. It can be quite daunting and stressful in the beginning, but with a gleason 6 you have plenty of time to learn about pc and the treatment options. As Tim says, read everything you can and consider what your options will be if you have a re-occurence. This is especially hard since you will have to be the one to decide, but it also puts the decision in your own hands. The one bit of advice I can offer is to get as healthy as possible starting now-diet is extremely important for pc patients and being healthy will make your recovery from whatever treatment option you choose that much quicker. Dr. Snuffy Myers-a pc doctor and pc survivor-suggests a southern mediterrain or japanese diet. Lots of fruits and veggies, no red meat. Also try pomagrant juice and green tea-my husband loves them mixed together. You'll get good advice and support here from the members on the "other side" of the treatment issue-good luck on your decision.

Renee
Posted 5/18/2010 1:37 PM (GMT 0)
Welcome, also, to HW Prostate Cancer:

I agree with some of what you have already been told. I had no symptons, no enlarged or infected prostate, no urinary problems, and 6 years worth of negative DRE's behind me. What I did have, was a steadily rising PSA each year, starting at age 50. Took 3 biopsies to get the PC dx, but by then, my PSA had nearly tripled in one year. So based on "feeling", I felt great, and were it not for PSA tests, would have been clueless to ever having cancer.

Not sure why your doctor told you the "don't leave it for six months part". It would help to know the % of cancer in your 5 of 12 positive cores though. At this point, you are a Gleason 6, at least based on your biopsy.

Seeding is an attractive option for many men, especially if you do not have a large prostate and being in the Gleason 6 range like you are.

But its important to realize, any primary treatment has potential side effects and potential risks. You almost sound more concerned about the side effects then the cancer. It is very important to consider all of these aspects, but it should be number one in your game plan, the best method of hopefully erradicating the cancer, before it has a chance to spread elsewhere.

If you honestly don't trust the results, then by all means, get a second opinion. Or even a third. Wait a couple of months, and get a whole new biopsy if that is what it takes to convince you.

Denial is your worse enemy in dealing with cancer, knowledge is your best friend.

Please keep us posted, we have men experienced here with every possible primary treatment, even waitful watching, which is still possible for you if your Gleason 6 case is considered low grade and indolent.

Good luck, and thanks for joining in with us.

David in SC
Posted 5/18/2010 2:18 PM (GMT 0)
Shaheen, As you will see below, I had seeds and follow-up IGRT treatments 2 months later. I have been very satisfied with my choice of treatment and the minimal effect on my quality of life so far. As usual, Tudpock has summarized the Brachy position very well so I will only make (or repeat) a couple of points: Calm down and take your time. You don't need to make an immediate decision with out doing more research. In my case 8 DRE's all came back as "normal". The PSA was the red flag. My radiol/oncol has done 800+ seed implants and has never had a seed migrate. Finally, while I am admittedly biased toward Brachy, there are many men who have had successful surgery and find that the side effects subside over time. From what I have read and heard from talking to other PC guys, you are probably going to have to adjust to a new "normal" no matter what treatment option you choose. Please feel free to email me if you want to. Best wishes on the journey. Joe67    
Posted 5/18/2010 2:26 PM (GMT 0)
Hi Shaheen and welcome,

You listed lots of concerns, and have already gotten several good responses.  I will narrow my response to just one area of concern you raised, which I also feel is the first one you should address...

If you have a concern about the results of your biopsy samples, then you should pursue a "second opinion" reading by an expert in reading prostate cells.  If you had your results read at a local hospital pathologist (or one of many other labs), the pathologist is probably not an expert in any one field because they read kidney cells, then your prostate cells, then someone else's liver cells.  Getting a second opinion of prostate biopsy cells is very common and highly recommended.

Most people knowledgeable in the field concur that Bostwick Labs has the greatest expertise in reading prostate cancer cells, and they offer a "second opinion" service specially for this situation.  I suggest going to this link, then give them a phone call to discuss how to set up a second reading of your slides

https://www.bostwicklaboratories.com/global/services/laboratory-services/second-opinions.aspx

Get this "step #1" behind you before getting too far down the road. 

best wishes...

 

Post Edited (Casey59) : 5/18/2010 8:29:09 AM (GMT-6)

Posted 5/18/2010 4:17 PM (GMT 0)
Your 1st step should be to get a 2nd opinion on your biopsy slides from Bostwick labs or Dr Epstien at Hopkins.
Re you concerns with Brachytherapy. In many studies the cure rate is higher than surgery for all grades of cancer. The chance of a seed migrating is slim and if it does, it occurrs during the procedure and is immediately removed from the bladder. Even in the rare case of seed migration there has been no complications as the 1/2 life of Palladium is 17 days. The real effort should be to find a doctor that does at least 500 or more procedures and question him about his quality control. A urologist should scope the bladder immediately following the procedure, while you are still out. Two weeks later a CT scan should be done to insure seed dispersion and that there are no dead spots.
The advantages to Brachy are that you can return to normal activities the next day and the side affects are minimal for about 4 weeks, frequency and urgency. Longer term side affects are also minimal; incontinence is rare, bowel issues are rare and ED has a low risk if you have no problem with errections now.
I'm a year out and have had no problems.
JohnT
Posted 5/18/2010 11:57 PM (GMT 0)
From Shaheen10,

Hello to all friendly members who took time and responded to my post. I am grateful knowing that there are nice people out there who have had or have same issue as myself and are eager to send a consulting email. First I would like to provide the Test Results. As noted in the original email, the Pathology report doesn't indicate the stage, size, etc.

Prostate , Left MID, and Left Apex : Benign Glands and Stroma ( what?)

Prostate , Left Base: Focus of Atypical Glands ( see microscopic)

Prostate Right Base, two cores involved by prostatic adenocarcinoma, 18%

Gleason 3+3=6

Prostate Right Mid, two cores involved by prostatic adenocarcinoma, 42%
Gleason 3+3=6


Prostate right apex, one core involved prostatic adenocarcinoma 8%

Gleason 3+3=6

There were no Perineural invasion

Having read some of the other members result and percentage, I am not sure If I am in any better position than others, as my Dr eluded to.

I will check with my urologist and ask to send it for a second reading. I am seeing a oncologist tomorrow, he is assistant to the surgeon who does Brachy around here. It appears this surgeon is popular. Dr Steven Kurtzman; He has been doing BT for a number of years and my urologist who works with him says between their net work they have done 500+, but how can one check and validate.

I was thinking of seeing another Urologist,however some the members recommend an oncologist.

Reading the post on this site as well responses received shows there is really no best treatment method.
even with BT, some folks have issues with ED. the Nerve sparing RP also doesn't warranty your normal regular status. Some men indicate no problem, others have to some degree.

To me it appears the main reason for those who took the traditional surgery was to remove and get rid of the cancer once and for all, assuming it is contained within the gland itself. However it seems as though many people have to go through post radiation. I also read the same for some BT. I thought with permanent BT, you have the radiation within you for at least 6 months, then why subject to more external radiation. That being the case wouldn't make sense to have just external instead of both.

Not sure what to believe external has worst side effects, because you expose other parts of the body to the radiation. on the other hand internal BT with close proximity to other organs can do the same.
My main concern with BT is I don't want other organs to get affected by radiation. Also how long will these seeds remain in the prostate. Do they dissolve by themselves over a period of times? If they do manage to get loose where do they end up? In the bowel movement and flushed down or within my body?


My urologist says after BT, the PSA will remain high or the same for a period of two years. That doesn't make sense to me. If the PC cells are dead, then they shouldn't contribute to PSA level.

I have been searching healthgrades.com to learn about potential Dr's, surgeon, etc. Does anyone find their report helpful?

Rene, I am sorry about your husband too, looks like his results are somewhat close to mine. I am already on lighter diet, and try to eat mostly salads vege.

I will check the Bostwick laboratory, just to ease my mind. Not sure how they can send slides? i thought the freeze the actual tissue?

Thank you all for your email, I will keep you posted. May god be with all of us and others who have being diagnosed with the C .

Regards
Posted 5/19/2010 12:51 AM (GMT 0)
Shasheen,
I'll try to answer some of your questions. There is less danger to other organs with Brachy because the radiation of the seeds extends about 1mm from the seeds. The seeds go inert and say in your prostate with no effect. once they lose their radiation in a few months they are harmless and if they eventually move they can do no damage. Radiation kills the DNA in prostate cancer cells and keeps them from reproducing. Since prostate cancer develops very slowly it make take a few months or a year for all the cells to die; this is why psa takes so long to reach its nadir (lowest point). You will always have some psa, but as long as it is low and stable it is considered a cure.
JT
Posted 5/19/2010 3:27 AM (GMT 0)
And remember, with seeding, you still have your entire prostate gland in place, so it will be producing legitimate PSA, while the seeds are hopefully killing off the cancer cells.
Posted 5/19/2010 5:17 PM (GMT 0)
Shaheen10,
I decided upon brachytherapy in 1998. I had no problem with incontinence or erectile dysfunction. I only offer this note of caution. Ask your doctor about the treatment options IF the cancer returns. If he does mention salvage prostatectomy, ask him about the pros and cons of that procedure. During radiation, the prostate is "fried". It becomes hard and therefore the removal surgery, or salvage, is difficult. It can be described in some cases, mine, as chiseling out the prostate. There is no nerve sparing and because it is hard to remove, there can be damage to other organs, etc. I ended up with a rectal / urethral fistula which over time was repaired. My doctors were top notch and I do not fault them for what transpired.

If you are concerned now about which procedure may leave you the closet to normal, I would think seeding would be at the top of the list. (I certainly was worried about incontinent issues at age 46.) However, had I known then the difficulty of the salvage prostatectomy as a treatment option if cancer returns, I would have probably chosen surgery the first time around. As a result of the salvage prostatectomy and the fistula issue, I now have an AUS implant and a penile implant. So much for being worried. Now I'm grateful for my new "friends".

Now being fair minded, I did read a post recently where the individual had undergone a salvage prostatectomy without repercussions. All I am saying is make sure you ask ALL the questions. I didn't.
Posted 5/19/2010 10:56 PM (GMT 0)

Shaheen:

Wigs is living proof that there are risks to all treatments, even the ones like brachy with usually less onerous side effects.  To reemphasize Wigs' point, there are VERY FEW expert surgeons who can successfully handle salvage surgery after radiation.  If my brachy fails I will probably not look to salvage surgery.  Having said that, there are several salvage procedures post-brachytherapy that are every bit as effective as post-surgery salvage radiation, e.g. HDR, seeding with a different isotope, HIFU and, of course HT.

So...be informed but don't let the "salvage" issue drive your decision as there are choices after both surgery or radiation if the need arises.

Tudpock

Posted 5/20/2010 1:28 AM (GMT 0)
Shaheen,

Other options you may want to consider (i.e. google) are CyberKnife, Photon, and Proton therapy.  I am not very familiar with any of them, but I know some guys (on other forums) have made strong arguments for them ... especially CK.  I was DaVincied, and have been happy with the results to date.

Your doing the right thing by re-examining your biopsy and researching your treatment options.  It's a decision you get to live with for the rest of your life.  Good luck and best wishes. 

Posted 5/20/2010 2:52 AM (GMT 0)
Thank You all ,

I saw the Oncologists counselor this afternoon and got some positive feed back, asked some questions,

We did a DRE , just to make sure there is no bump on the prostate that would indicate possibility of Pc spreading.

He discussed various treatment option, he himself is Radiation Oncologist, not a surgen who works along with a team that do other treatment such as Brachy. According to him the Brachy surgeon does 300-400 per year and he travels across USA, teaches and does surgery as well. He is being doing Brachy for the past 10 years. Wow that makes it about 3000 -4000, sounds exaggerated, but I like to believe it.

Following are his Observation:

1- Traditional surgery . Most invasive and recovery could take a long time. ED and incontinence a major issue for most patients. It may be supplemented with radiation afterwards.

2- Laparoscopy ( done by hand aided with imaging) or Robotic nerve sparing. : less invasive, but there is still chance of cutting some nerves. still ED and incontinence, Catheter,pads, diapers, etc.
These are good choices for a person with higher Gleason number and or grade.

3: Permanent Brachy: Least invasive of all , suggested for those with low Gleason and early stage.
They use cesium, its useful life 9-10 days vs Iodine or palladium which could take 6 months.
They map the prostate, have Ultrasound camera inside and computer shows surgeon step by step where to and how many seeds to release. Because prostate moves within the body. this is considered real-time Brachy. Where as in the old days, it was pretty much manual.
Takes about 2 hours, general anaesthesia, no pain during surgery, no catheter afterwards. you can drive yourself home afterwards.

Successful rate: very high. in the event of recurrence, this particular surgeon can re-plant seeds?
Usually no issue with ED, unless one already had problem. Radiation from seeds don't extend more than 1mm outside the gland, so no side affect to other close by organs.

Drawbacks: Urgency and urinary burning sensation, and weak stream for about a month. got be close to bathroom for the first month. May cause temporary constipation. They will prescribe flow max, Ibuprofen, over the counter drugs. Results vary.

Temporary Brachy or HDR. they can do it, but not recommended, since now days seed planting is precise. Also HDR requires the operation to be done twice therefore subjecting the prostate twice with as many needles as it took the first time around. This means more aggravation and inflammation of the prostate.


CyberKnife: It is basically a external radiation, with computer assisted, to pin point the target.

Proton Radiation: he doesn't recommend, as the room will be full of neutron which can harm other part of the body. We didn't discuss this further, as I wasn't too sure about this. He suggests photon over Proton.

IGRT: requires 8-9 weeks every day for 15 minutes. It may cause temporary fatigue,etc

He agreed that I should send the biopsy slides to a different lab for their review.He says John Hopkins is the best.

Overall gave me a warm feeling about my situation. Will re-visit him after I get test result from the second lab.
Posted 6/4/2010 5:31 AM (GMT 0)
Hi Guys,

I had the result of my second opinion from John Hopkins. unfortunately the result was worse than the original one done by the local lab.
Also unfortunately it wasn't viewed by Dr Epstein.  Anyway not that it may change the outcome, but I paid and was under impression he would look at it. Otherwise no sense sending slides from west to east. I will pursue this further.  In summary , The Gleason is now 3+4=7 instead of original 3+3=6 on Right only.They found small focal at base of the left side this time and consider it 3+3=6 . My urologist didn't have a convincing answer other than they are measuring it according to new standard, etc. BS if you ask me. Don't know if I should find a new urologist or not.

Saw my future surgeon for the first time and showed him the second opinion result. He said things are changed now and he recommends low dose Brachy followed by low dose IMRT 4-6 weeks after Brachy, so as to ensure all is taken care of. He uses Cesium and he has done 3000 Brachy. Out of which he estimates 1000 was a Combo. Brachy/ IMRT. Sounds like Fast food!

He said he has 95-99% success rate. The Ed rate he estimates 25 to 35%. there should be no issue with incontinence. Post operation issue urgency, some small irritation of bladder, as if one had urinary infection, and some slow flow rate, which will be temporary and taken care of with flow max, etc. Radiation issue, could be small loose bowl, Diarrhea smhair For short time, Not sure what short time is?  Overall rosy picture or better peachy! tongue   I know am I may get a surprise. But I have to put up with it no matter which treatment I choose.


Asked some of the pertinent question TudPuk had suggested. He was pretty cool about it. He doesn't believe in RP, da vinci, etc, and thinks most of recurrence is because they leave tissue there. When asked what back up plan he has, he was certain that there would be no recurrence and usually the cancer is found else where , and not in Prostate. He also suggested Cryo as a backup. He thinks HIFU is a scam not reliable and data out there is rigged! He wouldn't suggest it.  He said he could re-plant but doesn't think there would be a need.

If I decide to do this , he wants a CT Scan done on my pelvic, for mapping, etc.  Anyway I didn't expect him to advertise for other group practitioner either.  Overall I found him trust worthy, honest and a nice person, being considerate about my health . He said he wouldn't recommend Brachy alone.


I think may be this is the  best choice for me, although I am not 100% positive, but then again I will never be till it is all over. One of the problem with the combo approach is the fact you have to be radiated for 5.5 weeks every day 10 minutes, this will be a problem for me trying to get to work everyday.  I think I have to take my chances rather than procrastinating. Hoping a new cure or technology  comes along in couple of years and solving this issue once and for all. 

Age: 55
PSA level varying within the last 5-6 years ranging from 3.5 to 5.2 , last 6.0 in March
Biopsy 4-26-10 Local pathology report, 12 cores, 5 out of 12 positive on right side only 3+3=6

Right base 18%, right mid 42%, right Apex 8%
left side was considered no issue.

Second opinion as a result of my request by JHU on 5-29-10 slides were sent to them out of 12 cores, now 7 positive

2 cores on the left base , small focus 3+3=6 mid and apex clear but suspicion for carcinogen

Right side Base 40%, Mid 75%, 42% apex 10% Gleason 3+4=7

Post Edited (Shaheen10) : 6/4/2010 12:12:47 AM (GMT-6)

Posted 6/8/2010 11:18 PM (GMT 0)
 

All,

Just thought I provide update. JHU, Dr Epstein finally look at the slides his colleague had looked earlier in his absence and reduced the Gleason back to 3+3=6. However the observation now adds two  more positive cores on the left side.   Based on this all indication is toward both Brachy and IMRT.

John T,

Thank you for your response. I didn't see it till today. As I have hard time finding my own posts.  I am glad you are  free and clear. It seems you had less cores involved than I do.  I hope I also get the same good results as you and Tudpock.( not sure if I spell the name correctly).  Regarding email address in profile.  I read somewhere in the by laws of this Forum, one is best not to put personal info, as much as possible.  If there is a secured site, I would be more than happy to add my email there.

A question to all guys specially those with Brachy operation. I have seen much lower  core and PSA reading on this forum than mine, yet some opted for traditional surgery, radical, etc.  In my case I assume based on the latest reading I am 3+3=6, yet I have 9 out of 12 positive.  Wouldn't these numbers put me at much higher risk, and thus dictate an RP, Davinci/Robotic.  My oncologist with 3000 Brachy and 1000 combo under his belt thinks he can do it, and is more inclined toward Brachy/IMRT, except half dose and only 5 1/2 weeks of IMRT.   Just thought may be someone out there has or had similar readings as  mine and can share.  I realize most folks here are not doctors or surgeons themselves. I  wish some doctor would also contribute and elaborate to what patience have reported on this site, with some data to back up.

 I have been reading lots of posts on this site and couple of books such as 100 questions and answers by Pamela  Ellsworth, MD John Heaney MD and Cliff Gill, interesting book.  It has helped my understanding, but also added to my confusion and making it hard for me to make final decision.

What is the best way of updating this post without having to repeat the entire history?

Regards

Shaheen 10

6/7/10: latest interpertation of Biopsy

Age: 55
PSA level varying within the last 5-6 years ranging from 3.5 to 5.2 , last 6.0 in March
Biopsy  on 4-26-10

Left base: small focus of adenocarcinoma of the prostate ,  Gleason 3+3=6  involving 2 out of 2 cores

Left Mid: Adenocarcinoma of the prostate, Gleason 3+3=6  2 cores Each 5%

Left Apex: Benigen Prostatic tissue.

Right base:  Adenocarcinoma of the prostate ,  Gleason 3+3=6  involving 2 out of 2 cores (40%  small focus )

Right Mid : Adenocarcinoma of the prostate   (90% discountinuously, involving  75% )  Gleason 3+3=6  involving 2 out of 2 cores<!-- Edit -->

Right apex 10% Gleason 3+3=6<!-- Edit -->   1 core involved

PSA: 6 in March 2010

5/27/10


Second opinion as a result of my request by JHU on 5-29-10 slides were sent to them out of 12 cores, now 7 positive

2 cores on the left base , small focus 3+3=6 mid and apex clear but suspicion for carcinogen

Right side Base, 40%,  Gleason 3+4=7<!-- Edit --> two cores involved

Right Mid : 90% discountinuously, 75%  Gleason 3+4=7  two cores involved<!-- Edit -->

 Right apex 10% Gleason 3+4=7<!-- Edit -->   1 core involved

Post Edited (Shaheen10) : 6/4/2010 12:12:47 AM (GMT-6)

 

*******************************************

Age: 55
PSA level varying within the last 5-6 years ranging from 3.5 to 5.2 , last 6.0 in March
Biopsy  on 4-26-10

Local pathology report, 12 cores, 5 out of 12 positive on right side only 3+3=6 

  4/28/10 out of 12 cores needle biopsy

Left base : 2 cores ,  Focus of typical Glands

Left mid, left  Apex, each 2 cores, Bening Glands and stroma

Right Base; 2 core 3=3=6  18%  Perineural absent

Right Mid: 2 cores, 3+3=6, 42%    "                "

Right Apex: 1 core   3+3=6  8%    "                 "

Posted 6/8/2010 11:48 PM (GMT 0)
Sounds like you have done a lot of things right in your quest for a treatment for sure, but the radiation guys always say the surgery guy's surgeons have a bias for surgery, and I am sure they mostly do, but from your details, the radiation doctors are showing their bias toward seeding and radiation.

Have you actually met with a good urological surgeon yet, and heard his//her take on your diagnosis, especially now that it has been revised? If you haven't, seems like it would be a good step to take.

Surprised the dr. said that HIFU was a scam, even though its still not approved in the US by the FDA, it will be at some point. Where it is legal, there have been good results. Not sure I would have gone for it, but I don't think its a scam.

David in SC
Posted 6/10/2010 5:39 AM (GMT 0)
Hello David,

Thank you for the reply. And yes i have heard that radiation guys promote their treatment and Surgeon theirs. This is natural and also expected, as they know their specialty the best, and have more actual experience and data to back their claim. I have yet to see a Doctor who is both Surgeon and Radiation expert.   My own urologist is not a surgeon and he believes Radiation combo Brachy/IMRT , same as my oncologist.  These folks work together and are part of a team.   Something I missed to note in my prior posts, I did see a Surgeon at Stanford, while he didn't push for Surgery, he admitted his experience was traditional RP and also Davinci/ Robotic.  He also told me that based on the report ( the original biopsy), I would have a very good chance no matter which treatment I choose

( brachy, EBRT, or RP).    As for my oncologist, his comment was more directed to the organization sponsoring HIFU from US to Canada, not the HIFU treatment itself. I think I should clarify this for all readers. He did say however there are limited data available and data presented by these organizations are  questionable. I found out that you can sign up for HIFU clinical trial in USA.  It is being offered at few Hospitals, spread across USA. The closest one to me is in Texas, then Alabama, etc. I did consider it. However once out of hospital in Texas for example, I would have to keep going back to those folks in TX for follow up. This would be an issue for me, as I have to get back to work as soon as procedure is over. It will not be economical either considering the amount of travel  involved.

One of my main question has to do with the fact That I see guys with lower number of cores involved opted for surgery, where as I am being told my case should be better of with Brachy/ IMRT.

Shaheen10

Posted 6/10/2010 7:20 AM (GMT 0)
Shaheen,
It doen't matter. The entire prostate will be radiated. The number of positive cores usually relates to the volume of the tumor. For a large volume prostate with a large volume tumor, surgery may be a better alternative. For a normal size prosate < 60mm it doesn't matter. I agree than a combination treatment would be better than seeds alone.
JT
Posted 6/10/2010 11:17 AM (GMT 0)
Hi Shaheen10....Lots of information here and lots of biases (as Purgatory suggests). CT and bone scans are a good idea although @ 3+3=6 your PC appears not all that aggressive BUT with the number of cores that were positive that little rascal is sick. You mentioned "middle" and base which to me be difficult to treat via radiation, seeds or Cryo WITHOUT damaging the urethra. Your posts suggest you are doing all the right things and whichever path you choose to take the experience of the doctor doing the procedure is just as important as the procedure itself. From your posts I haven't picked up on you having an enlarged prostate issue.

74 years old - six months PSA's began when I hit 4.0 six or so years ago. Two nine core biopsy's negative over the years with the last PSA @ 6.7 and a twelve core biopsy 12/23/09 found two of twelve positive @ 30% and 70% Gleason 3+4=7 BPH at 106 grams! CT and bone scans negative. Henry Ford Vatikutti robotic prostatectomy 2/10/10 by Dr. Peabody. Nerves spared, margins, lymph nodes, ducts clear. Five week PSA undetectable. No pads about two months out. In my case a very large prostate was a factor in my choosing removal vs. other treatment options.
Posted 6/10/2010 11:41 AM (GMT 0)

Dear Shaheen:

I agree with JohnT's post...it sounds like you are on a good path and with your stats the combination brachy/IMRT sounds like a good approach.  The number of cores alone would not suggest surgery over radiation. 

And, Gleason7, with Shaheen's PSA and G Score the "traditional" CT and bone scan are a waste of time and money.  The scan he is referring to (I think) is the volume and mapping study that is done pre-brachytherapy to determine number and placement of seeds.

Anyway, it sounds like you have done your homework and are close to a decision.  Good luck and keep us posted.

Tudpock (Jim)

Posted 6/10/2010 1:45 PM (GMT 0)
JohnT - usually you teach that in a lower case like this one, that any primary treatment will produce about the cure and outcome. Yet both your post and Tud's are clearly showing the expected bias toward seeding. You both know that I feel that seeding is an effective treatment method without a doubt to the right criterea. With this case now being a Gleason 7, and who knows what would be found if he had surgery and they do post pathology on his entire prostate, surgery shouldnt be blown off the table. It may be the best cure in the long run, as I am a firm believer in the danger and unpredictable nature of any Gleason 7 case. We know that surgery will produce more chances for quality of life issues, at least in the short term, but radiation and seeding is not without risks or side effects, even though you two have done very well.

David in SC
Posted 6/10/2010 3:05 PM (GMT 0)

David:

Please note Shaheen's June 8 post...Dr. Epstein re-rated his Gleason as 3 + 3 = 6.  But even if was still G7, the brachy/IMRT combo that he is considering  is a reasonable treatment.  And, yes I readily admit that I have a bias toward brachytherapy and anyone who reads my posts should understand that's where I'm coming from..unlike some posters who feign impartiality but also have strong biases...and I don't mean you because you have been clearly even handed when discussing options.

Tud (Jim)

✚ New Topic ✚ Reply
12