Trying to make a decesion

54 in Sept 2010, Random check up in April 2010 showed PSA at 7.4, Dr suggested Appt with urologist but I had no clue what PSA was or meant.  Sister in law is nurse praticioner, saw test results and highly suggested another appointment.  In Sept saw urologist and cartoligist the same day .  Had heart cath the following day and got stint placed in right decending artry.  PSA came back at 9.2

Dec 2010 had biospy, with multiple samples finding PC is all areas from 2%  upto 22%.  Bonescan was normal and have been presented RP surgary or IHRT with seed implants as only options.  Gleason Score was 7 T2a or b

Found and spoke with several guys that had surgary but none that went with the

RT. Don't like the idea of surgary and leaning towards RT with seeds.

Would appreciate any input on RT pros of cons. Hopefully I have all the abreviations correct.

High EON,

I was similar with a Gleason of 7 and involvement in all cores. My urologist suggested against surgery as he said the probability of positive margins was significant and would probably require Salvage Radiation Therapy.

He suggested High Dose Radiation Brachytherapy and IMRT. I investigated HDR and Low Dose Permanent Seed Brachytherapy. I consulted with many practitioners including Dr. Frank Critz at RCOG (I live in Atlanta). I also researched some of the leaders in HDR including Dr. Jeffrey Demanes at UCLA and Dr. Martinez in Detroit. I found I had several HDR choices in Atlanta and spoke with them.

What I learned is that HDR is the more modern version of permenent seed implants. It is more accurate in the placement and doseage, does not leave anything in the body, solves the problems of seed migration and movement, and thus produces fewer and less significant side effects with increased effectiveness.

HDR is not new. Demanes has performed it since 1981 and it is used in many other cancers including breast cancer. The rad-onc practice I chose has been performimg it for more than 10 years and my rad-onc and urologist have done more than a thousand procedures. I found the best information to be on the website www.cetmc.com. It is very detailed and includes treatment results statistics. I would be happy to communicate with you directly to provide the details of my treatment.

Best wishes on you decision and we are all here to help.

EON,

My first reaction was to have surgery. After doing more research, including doing a lot of reading on this site, I changed my mind and went with a BT/IGRT combo. Primary reasons were I did not want to go through major surgery at my age and wanted to minimize side effects if possible. All indications were that BT/IGRT would accomplish that with equal  cure rates vs surgery. I have been very happy with my decision. The minor SE's I experienced have all but disappeared.

That said, you will find guys here that had surgery and are satisfied with their results as well. You are a candidate for both. Take your time, learn as much as you can, consult with your family and then do what feels most comfortable to you. Best wishes on the journey.

Joe 

EON, last June I was in the same boat you are in now..I chose surgery mainly because if it failed, a 50-50 chance for me, I could then move on to radiation..Well the surgery failed and I'm doing RT and HT now..The option of seeds and IMRT combined was not available to me in Denver plus there were insurance coverage issues..

So here I am, enjoying the side-effects of all three treatments (surgery, RT & HT) at the same time...(I'm tolerating it very well) At least I'm continent, a MAJOR issue with PC treatment...

Briefly, the combined seeds / IMRT treatment allows a radiation dose of around 150Gy to be administered safely. Studies have shown it to be very effective..

Most medical insurance covers surgery fairly well, but with radiation, especially radiation performed at out of area clinics, you better get pre-approval from your insurance before you agree to treatment...Costs can be staggering..

okay i may be wrong but here's a case of HDR more than  15 years ago.

http://www.phoenix5.org/articles/Fortune96Grove.html

and my buddy jerry T, a neighbor of purgatory, i know had HDR seeds about eight years ago.

after the rectal probings and procedures i'm starting to suspect that my uro is an alien from uranus .

ed

 

EON,
Combination therapy, brachy/IMRT, is commonly used with G7 or intermediate risk cancer and when there is any indication of extra capsular extension. Your Heart issues would also place you at greater risk in having surgery.
A combination treatment can deliver much more radiation 150 gy vs 81gy which is more effective on intermediat risk cancers and will also give a wider margin to pick up any cancer in the prostate bed.
I had combination treatments about 2 years ago and now have a 0.1 psa and no ED or any other side affects. I was able to continue all normal daily activities during treatments.
If you look at data from the Seattle prostate institute and Dattoli Cancer center for combination treatments for DiAmico intermediate risk classifications; 15 year cure rates are 81 to 90%. The comparable surgical cure rates from major institutions for the similar clasifications are 50% to 64%. This data was for patients treated in the early 1990s and current advances in imaging, seed placement and accurracy of the newer IMRT, patients treated today should have better results.
JohnT