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QOL Brachyatherapy and surgery study

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Posted 1/29/2011 3:24 AM (GMT 0)
Tud,

Finally had to say something here. Your last post caught my eye. The criteria you state above is basically what I was told when I was dx in late 2008. I think it is still sound now. You know my story, I wanted seeding, but was outside the acceptable criteria on more than one count.

I wish more men would consider it, over surgery. Having had both surgery(s) and strong radiation, neither one were a picnic for me. I get frustrated when I see what appears to be instant treatment decisions on the part of some men, and we usually see them as newcomers.

Unless someone had evidence of a really advanced and/or aggressive case to start, its a shame there couldn't be a 6-month waiting period before a person was allowed to make what ends up being a life changing primary treatment decision, one that can't be reversed.

David
Posted 1/29/2011 11:32 AM (GMT 0)
The earlier reported standard of brachytherapy and RT for only locallized cancer and PSA under 10 certainly isn't followed by the real leaders in the field including Critz, Demanes, Martinez, Datolli, and others. They all have been treating low, intermediate, and advanced cases for more than 15 years (30 years for Demanes and Critz) and reporting long trem results equal to surgery. That Walsh won't operate on intermediate and advanced cases leaves me to wonder what should a guy like me do? If the best surgeon won't operate and the rad-onc standard says don't radiate, then what do I do....HT only?

Thankfully the modern rad-onc understands that radiation can be used effectively for all levels. For some it won't be curative, nor would the surgery, but it lightens the cancer load and hopefully enables the HRT to be more effective for a longr period of time.

Another question. Let's say one is diagnosed at age 44 and is told not to have radiation for the age based reasons we have seen stated. He has surgery and at 46 sees his PSA is rising and needs salvage treatment. According to the rad-onc SRT is out of the question due to the still young age. So how does one rationalize that RT is wrong for a primary treatment, but is OK for a salvage treatment under the same age-based circumstances?

The beauty and problem of our plight is that we have so many different options. They all have advantges and disadvantages and the person and his family must live, hopefully for a very long time, with the consequences of his decision. That this board is able to provide such insight and diversity of experience is why I am here. I have made my initial treatment decision and am living with the consequences and outcome. I have gained from the board and now I view my involvement is to advance the experience diversity for the next newcomer based not on studies or theories, but of my actual experience and outcome.
Posted 1/29/2011 1:45 PM (GMT 0)

I get frustrated when I see what appears to be instant treatment decisions on the part of some men, and we usually see them as newcomers.

And, from what I have observed, many surgeons appear to encourage these quick decisions. If I were the 'suspicious' type, and I am, I would almost think that they want to push (scare) the newly diagnosed into surgery before they have time to learn about other options. I have a friend who fits this picture right now. He was diagnosed in December, 2010. After visiting a very well-known surgeon in the Pittsburh area, he was told that while his cancer not advanced (one core GL5), he would recommend surgery. Listen to this argument! My friend said that he had a somewhat painful erection 2 weeks after the biopsy. The good doctor said that if he chose watchful waiting (which even the doctor said was a viable option at this point) he would have to go through this painful erection period each year when a repeat biopsy was done. 

Clearly this is an argument that only a novice would 'fall for'. Of course he won't have to worry about painful erections after the surgery!!!! To suggest that a temporary painful erection is anywhere  comparable to the discomfort after surgery is absurd. But it worked. He used this and other slick sales tactics to convince my friend that he simply had to have surgery ASAP instead of encouraging him to learn more about what treatment options are available. open surgery scheduled for Feb. 11.

This instance, and my own experience with surgeons leads me to believe that the practice of pushing the newly diagnosed into surgery before they are truly educated is common and intentional. Certainly, my opinion, but I have no evidence to the contrary.  

Posted 1/29/2011 4:12 PM (GMT 0)

Hey, believe what you want. I'm just tellin' you what I experienced and what my friend is going through. I don't care what choice anyone makes as long as they have educated themselves. Frankly, I don't care what choice you made. My comments are for the guys who have not made a choice  yet. I think they owe it to themselves to get information about all alternatives and not be bullied into one path or another.

By your reaction, one might assume that you are trying to convince yourself: 'Methinks thou dost protesth too much'.


Post Edited (GOP) : 1/29/2011 9:15:47 AM (GMT-7)

Posted 1/29/2011 5:07 PM (GMT 0)
GOP, have you considered that perhaps the fear fo the patient himself is what is driving him to an instant decision? I have never met a single doctor in my life that acted the way your described, etc. If this doctor is really like that, then he/she is the rare exception, not the rule. There's enough conspiracy theorists around here to fill a boat.
Posted 1/29/2011 5:08 PM (GMT 0)
questions: you bring out some good and valid points I beleive.
Posted 1/29/2011 5:32 PM (GMT 0)
>>I still think many of you brachy guys must not be as comfortable with your choice as you say you are because you have some never ending need to attack surgery. You must spend a lot of time pondering your decision and the option you did not take. <<

i'm very comfortable with my choice, and i made it on the initial consultation with my uro.  when we walked into the office we (four of us) were fully expecting  to be making a date for surgery.  i asked my uro what he recommended and he said i was not a good candidate for surgery.  he said that since i had a better than average chance of needing salvage radiation post surgery he didn't think surgery was my best option.  he said he did not want to radiate the prostate bed after the prostate was removed.

the way i see it is some guys who opted for surgery make some pretty wild claims about BT.  here are a few i've heard here lately:

-- he later got kidney cancer.  that's common for BT.

-- it's harder to have the prostate removed after radiation (true but why remove it?)

-- it's difficult to have the pellets removed after BT (again why remove them?)

-- most men who have BT suffer from ED later

-- many men who had BT will later need TURP

-- i wanted save radiation as a plan B.

and it goes on and on.

i'll agree that surgery is the gold standard, and for most guys any of the treatments besides HT will be curative.  my  belief is you hit this disease with everything you have the first time. you don't hold back. for some that means surgery or IMRT or BT.  for others it's a combined treatment.   

ed

 

Posted 1/29/2011 7:07 PM (GMT 0)
GOP, have you considered that perhaps the fear fo the patient himself is what is driving him to an instant decision? I have never met a single doctor in my life that acted the way your described, etc. If this doctor is really like that, then he/she is the rare exception, not the rule. There's enough conspiracy theorists around here to fill a boat.

 

Of course it is the patient's fear (duh!!), and it is precisely that fear that the good doctor is preying on.  The poor guy is scared out of his mind, and this doctor is doing nothing to alleviate his fear. He also gave him the 'well, if you do have brachy and things go wrong, I won't do surgery on you'. Of course, he didn't bother to explain that, first of all, nothing is any more likely to go wrong than it is if he has surgery, and secondly, while he may not do the surgery later,  there are others who can and will. Biopsy in December and surgery in February..on a 1 core GL5? Sounds like a rush job to me. As to your conspiracy theories, if observing and then reporting constitutes conspiracy, then I'm all in.

Posted 1/29/2011 7:26 PM (GMT 0)
"I still think many of you brachy guys must not be as comfortable with your choice as you say you are because you have some never ending need to attack surgery. You must spend a lot of time pondering your decision and the option you did not take. "

Customer satisfaction with brachytherapy is higher in the study and on this board so I personally would not agree. And I fully believe that the decision to do brachytherapy was no less personal than choosing to go with surgery.

Tony
Posted 1/29/2011 9:02 PM (GMT 0)
GOP,

I am not into any of the conspiracy theories, period. And I grow weary of doctor bashing. For all the times I hear of a doctor getting the ninth degree, I would love to hear the doctor's side of the story. There are patients that are just plain non-compliant, non listening, and know it all types that think they can out smart the doctor. There's always two sides to a story.

And ps, most surgeons won't do salvage surgery to a failed radiation attempt. That's not an uncommon answer at all.

David
Posted 1/29/2011 9:16 PM (GMT 0)
Tud,
Your statement as being surprised that more patients don't consider seeds is not surprising at all. I've been studying how decisions are made since I did a project on decision making in managers in grad school. McClennen at Harvard did most of the work on this in the 1950's. The vast majority of people (80%) make decisions based on emotion, or feeling that a decision is right (think politics and religion). A miniority base their decisions on how it would make others feel (afraid to question their doctor's recommendations). A smaller minority base their decisions on pure data.
Feeling that surgery will cut the cancer out and it will be gone is a common thought process and on the surface very reasonable. A cancer Dx is an emotional situation and often results in an emotional response.
Patients doing a lot of research, reading multiple books and study data and getting multiple 2nd opinions from different fields of speciality are not the common practice.
Posted 1/29/2011 9:22 PM (GMT 0)
And ps, most surgeons won't do salvage surgery to a failed radiation attempt. That's not an uncommon answer at all.

Neither is it an accurate one. You act as if I just fell off the turnip truck. Grow as weary as you please: frankly I don't give a rat's a-- about this or any doctor. It is my lifelong friend who is getting pushed in a direction that may not be in his best interest. He (my friend) is at a distinct disadvantage in that it is his first go 'round' with PC, while Dr Goodknife has had considerable experience 'guiding' patients to surgery. He knows precisely which buttons to push. A surgery date so close to the biopsy suggests to this 'conspiracy theorist' that he doesn't want to give him time to explore other options....else, why the hurry in what many would call an 'insignificant' cancer that deserves to be watched, but not necessarily immediately treated.
Posted 1/30/2011 12:11 AM (GMT 0)
Calmly and politely, gentlemen, calmly and politely, please.....
Posted 1/30/2011 12:34 AM (GMT 0)
GOP, why all the hostilities? It's just an opinion, just like yours is just an opinion. Your friend is totally responsible for his own medical decision, no one is forcing him against his will. He needs to be his own advocate first, its his body, his cancer, and only his treatment decision. No reason to get all bent out of shape.

David in SC
Posted 1/30/2011 3:55 AM (GMT 0)
JT, of course you're right about this and I know that.  I spent a career being data driven and results oriented.  It's also my personality type.  Making logic based decisions is never more important than when considering medical options.  Perhaps "baffled" was a poor choice of words; maybe I should just leave it and say that I wish all PCa patients would take a more logical and less emotional approach to their decision making...

Tudpock (Jim)

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