Seeds for under patients under 50

I had brachtherapy in 1998 at age 47. I chose that path over surgery for the simple reason that I was afraid of suffering incontinence at such a young age. What a foolish reason, but that was it. In 2008, at age 57, I underwent a salvage prostatectomy because the cancer had returned and I wanted it gone!!! I didn't want to take hormone therapy, or external been radiation, or anything else. I wanted it out. Unfortunately, a prostatectomy AFTER radiation is not an easy procedure. It's very difficult. The tissue has been "fried" and complications can develop.

My only comment is to ask your doctor what would be the course of treatment that he would recommend if you chose brachtherapy now and the cancer returns.

Wigs

Wigs I feel it is worth noting brachytherapy has changed a bit since 1998.

Hard for me to see any clear cut gold standard. If there was we'd all have picked it. I went over this with several of my doctors. The DaVinci surgeon was the only one who flat out recommended surgery for me. I asked for studies indicating the clear superiority of robotic surgery over the other treatments and he suggested PuBMed but could not provide links to studies when pressed.

I did see this today COLORADO:

Young men have equivalent biochemical outcomes compared with older men after treatment with brachytherapy for prostate cancer.
http://www.ncbi.nlm.nih.gov/pubmed/20044216
Burri RJ, Ho AY, Forsythe K, Cesaretti JA, Stone NN, Stock RG.
Source
Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York, USA.

Abstract
PURPOSE:
To evaluate retrospectively the biochemical outcomes of young men treated with low-dose-rate brachytherapy for prostate cancer.

METHODS AND MATERIALS:
From 1990 to 2005, 1,665 men with clinically localized prostate cancer were treated with low-dose-rate brachytherapy +/- hormone therapy (HT) +/- external beam radiotherapy and underwent > or = 2 years of follow-up. Patients were stratified on the basis of age: < or = 60 (n = 378) and >60 years (n = 1,287). Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/mL. Univariate and multivariate analyses were used to determine the association of variables with freedom from biochemical failure (FFbF).

RESULTS:
Median follow-up was 68 months (range, 24-180) for men < or = 60 years and 66 months (range, 24-200) for men >60. For the entire group, the actuarial 5- and 8-year FFbF rates were 94% and 88%, respectively. Men < or = 60 demonstrated similar 5- and 8-year FFbF (95% and 92%) compared with men >60 (93% and 87%; p = 0.071). A larger percent of young patients presented with low-risk disease; lower clinical stage, Gleason score (GS), and pretreatment PSA values; were treated after 1997; did not receive any HT; and had a high biologic effective dose (BED) of radiation (all ps <0.001). On multivariate analysis, PSA (p = 0.001), GS (p = 0.005), and BED (p < 0.001) were significantly associated with FFbF, but age was not (p = 0.665).

CONCLUSION:
Young men achieve excellent 5- and 8-year biochemical control rates that are comparable to those of older men after prostate brachytherapy. Young age should not be a deterrent when considering brachytherapy as a primary treatment option for clinically localized prostate cancer.

Copyright 2010 Elsevier Inc. All rights reserved.
PMID: 20044216 [PubMed - indexed for MEDLINE]

Wigs I feel it is worth noting brachytherapy has changed a bit since 1998.

also worth noting is there's no way to know how surgery would have turned out.

ed

 

First, with any reoccurrence from any treatment, it needs to be determined if the reoccurrence is local or systemic. For failed radiation which have a local reoccurrence, surgery is the poorest of all options. More commonly used and more effective salvage options are reseeding with a different isotope, HRD Brachy applied to the area of reoccurrence, Cryosurgery and HIFU.
Local reoccurrences are lower than for surgery as radiation renders the prostate tissue fallow and usually includes treatment of 5mm to 15mm into the bed and tissue around the nerves, these are the most common areas to have local reoccurrences from surgery (that's the only reason SRT works for a failed surgery).

F8 I was seeded a short time ago and if anything my erections are stronger post-seeding that pre-seeding. I never had ED pre-PCa. I don't know why that would be and is more than likely just in my head but - not joking - I've always read that low dose radiation is healthy for you.

i think it's safe to assume that you will not come out of any treatment with better erections than you had going in.

I think the truth is that both treatments are equally effective and that it's a matter of personal choice.

I chose surgery for many personal reasons but am sure that even at 40 BT would have worked well for me.

The five main reasons I chose surgery were that 1 - I didn't see as long term data with BT for my age group, that I wasn't prepared to go through weeks of treatment, that yes, I wanted what i considered a diseased organ out for good, that I wanted a definitive pathology post op, and that I liked the option of a backup plan of salvage radiation.

These might all be dumb reasons and easy to deconstruct, but they made sense to me.

That said, every surgeon I spoke with told me I'd do fine with BT and would beat this thing with surgery or with BT.

I do find it interesting that two very open minded patients on this forum were told by well kown radiologists to go with surgery because of their age.

colorado monkey, I just sent you an email. Any questions, you have my email address and phone number.

My DH's RO said cyber knife if there was a recurrence.