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Posted 8/24/2013 9:44 PM (GMT 0)
On another thread, A Viking said:

"Buddy-your Posts have been extremely helpful to me as a newly diagnosed person.

Two questions if I may:
*How old are you?
*I there a way to email or message you (if you are willing)?

I am from MN & considering Chicago / Dr Moran so your experiences are. very helpful.
Age 51
Still evaluating treatment options (BT or surgery)
T2a Clinical Stage (positive DRE)
T2c Biopsy Stage
Biopsy 5/2013): RM 40% GS 3+3, RB 35% GS 3+3, RA 20% GS 3+4, LM 5% GS 3+3, LB 10% GS 3+3, LA no involvement. Overall 8 of 14 cores positive. 60% most involved core (right mid)
PSA 1.2 (2007), 3.6 (4/2013), 3.7 (6/2013)"

Welcome to you, Viking. Sorry you have to be here but hope you will get lots of good support and advice. I gave you your own thread so that you might get responses to your question from others as well as Buddy.

Personally, I am one of a number of brachytherapy patients who frequent this forum and you can see my long-winded story by copying and pasting the link in my signature. I did not use Dr. Moran but a number of our members did and I trust they will come along with some comments along with mine and presumably Buddy's.

Jim
Posted 8/25/2013 2:16 AM (GMT 0)
Hello A Viking, and welcome to HW. I was treated by Dr. Moran and the CPC, almost 1 year ago. You can see my PCa stats in my signature - we are very similar although I had a bit more going on than you do.

I could go into lots of details on my very positive experience and results with Dr. Moran, but I'm afraid we would be treading waters that would push the rules of this site. What I can tell you in summary is that I am absolutely, 100% ecstatic with him and the CPC as well as my current condition.

I think the best way to do this would be to connect via e-mail - you can reach me by clicking on the envelope / e-mail symbol, just below my handle "A Yooper" in the left corner of this post.

Best to you.
Posted 8/25/2013 3:44 AM (GMT 0)
Welcome, Viking.

Sounds like you are getting some great advice already. Please contact Yooper, sure he will give you all the details with his experience with Dr. Moran. I know some others here have used this doctor, can't remember the names.

David
Posted 8/25/2013 2:44 PM (GMT 0)
Viking,

I found that when I was choosing a treatment a lot of it boiled down to my own personality.  I wanted to know exactly where I was at and didn't what to have to worry if radiation or seeds got it all.  With surgery the dreaded PSA checks will pretty much tell the story.  I also wanted to know the extent of the cancer and the pathology report after surgery helped to ease my mind on that front too. 

Best Wishes,

Tom

P.S.  Your recovery will be greatly aided if you become a Packers fan--much less stress and disappointment turn

Posted 8/25/2013 2:44 PM (GMT 0)
Hi again Viking - to Purg's point our BuddyBland and erbob are two guys that come to mind that were treated with LDR BT by Dr. Moran and I'm sure both would be willing to share their experiences as well.
Posted 8/25/2013 2:52 PM (GMT 0)
Viking you can't go wrong with Dr. Moran and CPC. It's world class and the results are too.

EDIT: Oh, yeah - I'm 56.
Posted 8/25/2013 3:05 PM (GMT 0)
Welcome aboard Viking. I see the Brachy Boys have posted already. I am a surgery guy and with your numbers you could probably do well with surgery also. Like Tom said, with surgery you get a post-op pathology report which will show you exactly where you are after the prostate is removed and you can have radiation later if you have recurrence. Do your homework which is what you are doing now. Choose wisely for you! Good luck

Bill from Florida cool
Posted 8/25/2013 3:42 PM (GMT 0)
Hello Viking .......

   I too am a former patient of Dr. Moran and the CPC. For comparative purposes, you might be interested to know that I first saw him in 2003. My background below will give timeframes and procedures or medications since, but my trip started 10-years ago ..... and at the age of 60!

   Dr. Moran did the Brachytherapy procedure and recommended a radiologist at my current hospital for the initial radiation review adn it's procedure.

   Please, bear in mind that these procedures were done over 9-years ago, and that there has been progress in PCa treatments since. Also note, that for close to 6-years after the Brachy/radiation ... it did appear that the cancer had been caught and eliminated.

   If I were to do this all over again ......... I would again use Dr. Moran and his recommended radiologist ..... but would not use the same Urologist (and he was not recommended by Dr. Moran).

   I hope this is of some help. Feel good about your choice.

Rob

 

Posted 8/25/2013 6:18 PM (GMT 0)
Viking,
Sorry that you had to be here, but your membership is approved! Even though you live on the wrong side of the "OK Mis", this "cheese head" applauds your diligence in researching all options. If you elect to go the bracky (seed) route, my limited experience on this forum indicates that Dr Moran and the CPC are the best. Members' recurrence rates and side effects of ed and incontinence are rare.

We have some "experts" on this forum such as Tall Allen, John T, Tony, and others who have informed us of success rates and freedom from side effects (ed and incontinence), and the treatment you are researching appears to be the best although some (many) will disagree.

I elected to do "it right the 1st time" and had imrt radiation and hormones vs non nerve spari:ng open surgery with extra tissue removal . If HDR existed at the time, I would have gone that route with radiation and hormones included..For me it was a QOL decision; I did not want to take a chance of wearing diapers the rest of my life and I would keep my nerves thank you! I wish you all the best!
Bill idea
Posted 8/26/2013 2:19 AM (GMT 0)
You guys are all very supportive & helpful, thanks so much! Kind of pressed for time right now, but I do plan on following up soon with those who have so kindly offered.

Just want this decision over with and to start moving on, but as of yet haven't had that "moment of clarity" where my treatment choice just becomes obvious. Maybe it's never going to be that clear, I don't know. Have been exhaustively researching & seeking multiple opinions, perhaps to the point of "paralysis by analysis".

Hardest part for me right now is I've been to one of the best medical facilities in the world at the Mayo Clinic, and some very experienced & well-respected medical professionals are recommending surgery. I just have an uneasy feeling about all of the SE's possible with surgery and whether it's for me, but I also have an uneasy feeling not following the advice of such a venerable and respected institution. They're pretty much advising me that even if the cure rates are similar with BT and surgery, given that I am in my early 50s surgery is the recommended choice because it leaves the option to radiate later in the event of a recurrence, and also doesn't carry the risk of secondary tumors somewhere down the road. However, as I understand it, reoccurrence after BT is rarely localized, so I'm not sure how to reconcile this. I also haven't really seen any conclusive data quantifying the risk of secondary tumors after BT.

I'm sure you've all felt the same way I am currently feeling when contemplating treatment choices. I want to treat this with the least destructive method that I can as long as it leads to a successful treatment. But I also don't want to be stupid and risk not curing this, just to avoid some potential side effects that may or may not occur long-term. Thank God I've got a tremendously supportive and understanding wife, as I spend what seems like most of my spare time reading and learning as much as I can.

Leaning strongly towards brachytherapy, but a bit concerned I'm trying too much to have my cake and eat it too. After talking to Dr. Moran at the CPC on the phone, his results sound amazing, almost too good to be true for someone hoping for a treatment choice that accomplishes the required cancer control with minimal side effects. You know, "no free lunch" and all that…

Thanks again all for the support, and Packer fans it's time to start considering that the worm might be turning in the good old NFC North!

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Posted 8/26/2013 3:17 AM (GMT 0)
Viking
If you go on the New Prostate Cancer Infolink and search secondary cancer you will find a number of studies.
All show that Brachy has a zero incidence of secondary cancers.
Posted 8/26/2013 3:44 AM (GMT 0)
Hi Viking,

Sorry for all you're going through...this is a tough period when you're reeling from a diagnosis, but trying to make a rational treatment decision. But let me give you my thinking about the "radiation as a Plan B after surgery."

My uro also told me that after I was diagnosed. And it resonated with me. But as I dug deeper, it really didn't make sense. First of all, if radiation and/or brachy doesn't work, it's highly unlikely that your prostate is still cancerous. Unfortunately, it's much more likely that the your cancer is systematic instead. So if radiation didn't work, there's no real point in taking out the prostate at that time anyway since you're not treating the reason that radiation failed. And if you have surgery and radiation as a back-up you have the SEs of surgery PLUS radiation.

So given that the odds of a secondary cancer from radiation is just about the same as the odds of dying on the operating table, why not go for brachy if that's your preference? Your medical professionals have already said the success rates are about the same.

That said, I do think surgery is a valid treatment option and based on your stats, it's pretty likely that surgery, brachy or IMRT will all work. And you will find folks here that have had success with all of these. But if brachy feels best to you, that means something.

Good luck and I'm confident you'll do well!

BTW, may I ask if your doctors at the Mayo Clinic are urologists or radiation oncologists or medical oncologists?
Posted 8/26/2013 11:02 AM (GMT 0)
Viking,
It is truly not an easy choice. I was a bit older than you, but I chose brachy precisely because I was 'younger'. I was not ready for any life-changing side effects. I have stated many times that I could not be happier with my choice.
To be clear, I had a one-time stand alone treatment of LDR brachy.
There is quality life after a pc diagnosis. I wish you the very best.
Posted 8/26/2013 11:43 AM (GMT 0)
Viking, it is no secret that I am a "brachy fan" but either brachy or surgery should give you a curative outcome. I know how hard the decision is...I had both surgery and brachy scheduled and then took some beach time to get "clarity". That clarity eventually came for me and I have not looked back.

One of the problems with this d*mn disease is that highly respected experts may clearly differ on what is right for the same patient. That's why it is so important for each of us to do our own homework. If you have not done so, you might consider reading Walsh's, "Guide to Surviving Prostate Cancer" (he is a surgeon) and Scholz', "Invasion of the Prostate Snatchers" (he is a prostate oncologist). Between the two you will get a pretty broad perspective on our disease.

Good luck,

Jim
Posted 8/26/2013 12:16 PM (GMT 0)
Hey Viking -

Sorry you have to be here, but glad you found the place. You're getting some great advice, and it sounds like you're doing all the right research to get to a decision. I'd like to throw one more thing into the mix - apologies if it is in any way confusing or unhelpful.

I decided to go the surgery route - everyone I saw recommended it, and it matched for me. I was fully aware of the potential SE's (incontinence and ED), and had steeled myself for what was to come.

Much to my surprise, following the surgery I have no SE's - no incontinence, no ED - I'm just like I was before. While it is somewhat unusual to have that kind of result, it is apparently not as uncommon as I thought it was. A lot depends on the skill of your surgeon, the particulars of your anatomy, and the state of your health before your treatment - but of course, some of it is probably just dumb luck.

While there is no guarantee that you will have a similar outcome, I feel it is important to consider that you might. We focus so much on the negatives and potential disasters, it is easy to ignore the possibility that things might turn out ok.

The tough thing about PCa is that everyone's case is different - which makes the treatment decision so much harder. I had a lot more pattern 4 than you do, plus some perineural invasion - if I had been a G6, my decision tree would have looked very different. Every treatment carries risk - ultimately, we just have to decide which risks we can live with and which we can't.

Obviously, the right thing to do is to plan for the worst and hope for the best - I just wanted to add one small thing to the "hope" column.

Best of luck -

Doug
Posted 8/26/2013 12:23 PM (GMT 0)

Viking, I was diagnosed March 2012 and still trying to figure things out. I am currently following Active Surveillance but when I need to be treated I will choose Brachytherapy. Bubby's journey has convinced me this is the path I want to take.  Thank You Buddy!  Best of luck Viking.

Posted 8/26/2013 1:19 PM (GMT 0)
Viking,

For what it is worth, I was 58 at diagnosis and 60 now and like DouginLA have no major side effects.  I thought I was an exception, but I am finding more and more guys who are the same.  Surgery--like other options--have come a long way.  Which ever route you go, it sounds like you're doing your homework and choosing the best doctor possible and I truly believe that is the single biggest factor in a good recovery.

One more little dig:  Know why the Vikings chose Purple as their team color?  Because if you choked as much as they do, you'd be Purple too smilewinkgrin

Best Wishes,

TOM 

Posted 8/26/2013 1:25 PM (GMT 0)
I think both BT and surgery are excellent options.

I think you can probably narrow down your choice to a final choice by talking to experts in both fields.

Many of us have done wonderfully with surgery. SEs are a possibility, as they are with BT, but there are many factors to consider that can help mitigate these.

At 51 you would do great with either choice. The SEs are sometimes oversold. Going with great practitioners in either field could greatly minimize these. Interview them and ask them for their stats.

As for your Vikings, get a QB and stop riding AP so hard. You got a playmaker in Jennings, get him the ball now :)
Posted 8/26/2013 3:55 PM (GMT 0)
Viking I went through the same agonizing ordeal in deciding what to do. It was stressful, to say the least. I know exactly how you are feeling. I know how the wheels turn in the head over this terrible disease. I am sure every man on this forum does.

The minute threat of secondary cancers was never a factor for me. Radiation doesn't scare me in the least. It is a miracle that mankind can use this power of the atom to defeat cancer. I have always felt that way about nuclear medicine and nuclear energy. If it were up to me we'd have fusion reactors all over the world. "I am so pro-nuclear I glow."

My logic in deciding was: if the cancer was contained to the gland the radiation will cure me. If it wasn't contained to the gland no treatment could cure me. Maybe I am wrong to believe that. Others know more than I do about it but that was what pushed me to radiation and brachytherapy.

I didn't buy into the fallacy that if you have radiation you can't have surgery post-radiation. That was proven to be a myth spread by some surgeons and those who distort, and amplify, their words on the Internet (Dr. Google is not really a that good of a doctor). I also see no need for surgery post-radiation. I wondered why a man who has had radiation even need surgery post-radiation? What would be removed?

Sex with my wife is a big part of our lives. I can't think of much better than making love to my wife. Maybe our kids being born, or some other equal joy, but I know without sex I'd be crushed. I've said it before - being able to have sex was almost more important than beating the cancer.

With the help of people here, and research, I decided that brachytherapy had the best results with the least side effects.

I believe if you have brachytherapy Dr. Moran is among the best a man can do. I admit I am biased but in his field who is better?
Posted 8/26/2013 5:36 PM (GMT 0)
Viking you received some great advise from the "Brachy Boys" and I can't add much to that - other than to say you can have your cake and eat it to - the facts are out there.....

And when it comes to Moran's stats well those are also facts.

Re: Mayo, absolutely a top notch medical center no doubt - but you have to weigh in their standard approach.

I'm having trouble getting to my email and not sure if you contacted me yet but hope you will.
Posted 8/28/2013 12:25 AM (GMT 0)
Thanks very much to all of you for the advice and encouragement, I appreciate it very much!

Tudpock thanks for setting up a thread for me and for your comments. I will read the story about your journey. Especially appreciated this" "One of the problems with this d*mn disease is that highly respected experts may clearly differ on what is right for the same patient. That's why it is so important for each of us to do our own homework". FWIW I have read Scholz and Walsh, and several others for that matter. Like I said, paralysis by analysis certainly applies in my case.

Gizzy - very sorry to hear about your difficulties after a very encouraging number of years post treatment. The fact that you are still hear sharing and helping others is very appreciated. What were your issues with the urologist, and what do you suggest one should do differently based on this choice? I wish you the best going forward and will be watching...Keep a good attitude and keep up the fight, I'll be watching!

Buddy - thank you for sharing your age, and your thought process as you evaluated options. Very helpful to me!! When I read all that you considered and why, it really helps because it's some of the same things going through my mind. You make some great points!

Also thanks very much for the stories of those who chose surgery and why. That is also very helpful, especially with those of you who have had outcomes you are happy with and are glad for your choice. Really helps me to ask more specific questions of my potential surgeon when I have my "one more meeting" with him before my final decision.

John T, Michael, and GOP - all great points/observations that help as well, and offer hope and encouragement.

I know I missed some of you, but only to keep this shorter. I am reading all of what each and everyone of you saying, and I appreciate it more than I can convey in this note.

The key point to me so far is that you can have successful treatment either way, it just depends on your personality and what choice feels right for me. That's been the hard part, feeling like 1a is surgery, and everything else is potentially a less effective treatment method and taking additional risk. I'm learning that's not necessarily true. They are both good options (surgery and some form of radiation), and I'm starting to feel that I'm not settling by picking one over the other, which gives me more freedom to pick what feels right for me.

God bless you all, you are so kind to share you stories and encouragement. I hope that I can someday inspire and help others like you are doing for me!
Posted 8/28/2013 1:47 AM (GMT 0)
Davidg,

I read in another thread (Debunking Peter Grimm study) that you stayed away from seeds because of what you saw your boss go through.  Would you care to share that experience, or add a little more info?
Posted 8/28/2013 2:01 AM (GMT 0)
It wasn't that bad. I think stories like Yooper's are far more indicative of what to really expect.

As I recall, my boss did seeds, radiation and HT for a G8. He did so at Mt Sinai. He is extremely pleased with his results and is scoring a big fat zero some 4 years out. I think he was 64 at the time of treatment.

He basically had two side effects during treatment. He would wet himself and had issues with urgency, and he became a bit erratic and lost some sharpness during HT (not sure how to really put that but we work in a very detail oriented environment and he struggled to keep up for a bit).

The urinary issue went away very quickly and he didn't care one bit. Even at the height of it he would take the train out to the Hamptons on a friday, come back to the office the next Monday and joke about himself and how he wet himself on the train surrounded by the Hampton crowd.

My boss would not have done anything differently.

There are potential SEs to any treatment and they all hit us differently. You will do great if you go with BT.
Posted 8/29/2013 3:14 PM (GMT 0)
To A Viking ..........

Personal issues I've had with Urologists (3):

First Urologist ..... he was there with Dr. Moran during the seed implant so that seemed to be a big plus. He was the first Urologist I had ever seen - and that was just prior to having a biopsy and seeing Dr. Moran for his first consultation. He was pretty old .... and when going to see him on the first follow-up visit after the brachytherapy, he simply asked me "what are you doing here" and he seemed very oblivious to what was going on. I must add, he was not associated with the office of Dr. Moran or the CPC Center.

Second Urologist ...... was from the same office as the first urologist, but he was much younger and more personable - at least, initially! As it turned out, he actually shrugged off a PSA reading of over 4.0 and said something like let's watch it in 6-months. Note ..... this was about 5 to 6-years after the brachytherapy and radiation - so I had history!!!!!! Shortly after that appointment with him, I read an article in the Chicago Tribune about doctors who were reimbursed heavily by the drug industry for representing their drugs in some manner - to other physicians. It was an expsose article listing the 5 best paid doctors (by the drug industry) .... sure enough, my Urologist was one of the top 5 in the Chicago area. So I immediately looked for a different Urologists office.

Third Urologist ....... the one I have now and have had for about three years. He is competant and has a good bedside manner if you will. My only complaint has been from a couple of mistakes by some of his staff members. But ... I like him well enough to keep from looking elsewhere. My Oncologist also happens to think the office of the five Urologists I'm going to is the office he would and does recommend. And I might add to that ...... that my Oncologist was referred to me by my Primary ... and not the Urologist. So their are no suspicious ties there.

   The above is simply my personal experience. I trust most people have better experiences withtheir Urologist ..... hope you do!!!

   I, yesterday, had some bad news, with unfavorable catscan and bonescan results ... and am in the evaluation process right now of what to do. My Onco has suggested Provenge - and their office is investigating the costs and coverage of costs right now. My two month Xtandi experiment was nto sucessfull - afraid to say. Down in the dumps too righ now.

Best of wishes to you though.

Rob

   

Posted 8/29/2013 3:38 PM (GMT 0)
Dear Viking:

Many opinions and you have a tough choice to make. You should put Proton Therapy in the mix as some of us have found it to be very satisfactory. Good luck and low PSA's to you.
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