Complications using Seeds versus Da Vinci surgery

I considered seeds, but after studying HDR Brachytherapy it became my choice. You should look into it as well. I have had absolutely no urinary or bowel issues. One of the reasons I chose HDR is that it has less significant side effects than seeds. I know several men who used seeds and have done very well with no issues.

In your low risk situation I see any kind of surgery as overtreatment. It is not better than radiation for cancer control and it has inherently greater side effects than radiation.

I had seeds + IGRT +HT. the full monty. I have never been incontinent one day and while I have mild ED Cialis completely works for me. yes, there WERE urinary issues -- burning, frequency, urgency -- but I have never pissed my diapers (or wore diapers for that matter), and now everything is "normal".

honestly since radiation was almost a given even if I had surgery I am so grateful that my uro was against surgery. I think in MOST cases surgery is the least desirable treatment, but that is my bias due to my treatment choice and what I have witnessed after being here several years. no thanks!

as long as uro's are surgeons they will scare the hell out of you and operate.

good luck with your choice.

ed

I would echo Tall Allen's post that you should get a second opinion on your biopsy slides. There's a significant difference between 3+4 and 4+3.

I didn't go seeds (low dose brachy, or LDR), but instead used high-dose brachy (HDR brachy). And like Ed, I also had external radiation and HT, but we were considered high-risk, which doesn't seem to be the case for you. I'm doing well, which of course makes me partial to brachytherapy, but you really need to focus if that's good for you.

To that end, I think it's good that you're exploring your options and the key (in my opinion) is to find the best practitioner around, no matter what treatment you choose. Where are you located? Folks here might be able to make a specific recommendation.

I'd like to add my experience here. I went for surgery with similar numbers (G3+4 post surgery path), and I was fortunate to wind up with minimal side effects. My non-scientific survey of men that I know 'in the world' plus many in here suggests that the meme of "guaranteed bad SE's from surgery" is not entirely accurate. With good general health and no urinary/erectile issues pre-surgery, the highly skilled and experienced surgeons are getting very good results with many patients.

Choosing your treatment is a challenge. The key, regardless of which direction you go, is to find a team and a lead doc who have a lot of experience. Yes, the lead surgeon/oncologist is critically important. The experience of the team and facility is also very, very important. Reality is that your care will be taken care of by the residents and nurses...and their skills are the ones you'll really remember.

Hi RonBat

Firstly, impressed with the calmness of you post, wayyyyy better than my first jibbering post! Kudos dude!

I have little to add to the very wise views already shared with you but do want to make one point...

With a DaVinci robotic surgery the chances of any kind of hernia are beyond statistically improbable. The largest trocar (incision) used is 10-12mm in the vast majority of surgeries, that is NOT hernia territory I promise. Now... open prostatectomy would be a whole different story... but even then improbable with a good surgeon.

There is no doubt that the options are hard to choose between, but don't let fear of a hernia be part of your decision process... it's wayyyy down in the noise. Now... should you start working on your fitness (anyway)... you bet!!!

Paul

I ran across a paper not too long ago that concluded that urinary and bowel complications and BCR risk were worse for SB RT than either IBRT or LDBR. I think it was a doctor YU ??? at Yale.

Sheepguy,
The Yu study was an analysis of SEER/Medicare database, and had all kinds of problems (which you can read in the letters to the editor about it). The Evans et al. analysis is based on actual patient-reported outcomes. It's probably the best study we've seen short, of an expected randomized clinical trial.

- Allen

Welcome aboard RonBat...

My dad used to tell me..."When torn between your head and your heart, go with your head."

While I don't subscribe to this rule nearly as rigorously as he did, when it comes to our health...I think it may be a good rule to follow.

Sometimes I wonder if all of these studies. ..while essential and helpful...Always tells the whole story.

I sense you're on a good trajectory...

Keep us posted.

The urinary side effects your doctor is talking about is frequency and urgency which will last for 4 to 8 weeks with palladium seeds and 8 to 12 weeks for Iodine. Frequency means you will be going about every hour and urgency means that when you feel the need to go you better get to a bathroom ASAP. Both of these side effects are tolerable and should not affect daily activities such as work or play. You won't need diapers, but have something handy to pee in on long trips.
In general the SEs of brachy, any type, are much less than those of surgery and countless studies have recored Quality of life issues to be the highest for those who underwent brachy.

Ron...with only one positive core, I'm doubling down on my advice to get a second read of your biopsy slides by Epstein or Bostwick. While it may not change from the current reading of 3+4, there's also the potential of 3+3 (low risk) and 4+3 (intermediate/unfavorable), so there's a pretty wide potential swing there.

If you go down to 3+3 (and I'm not saying you'll be that lucky), you could do Active Surveillance with only one positive G6 core...

@ronbat: Welcome to HW. Many of us here have had successful seed implantation and quite a few with Dr. Moran who is one of the best. i think JohnT did an excellent job of summarizing the the typical urinary side effects which are typically a little annoying but certainly not debilitating. Dr. Moran, on his web site claims that fewer than 25% of LDR brachy patients suffer from decrease in sexual function. I think the overall average, including all LDR Brachy docs is more like 35% -- compared to an average of 50% of surgery patients.
One of our members, AYooper, used Dr. Moran and did signficant research before making a treatment choice. Yoop's email is shown via the envelope under his name on the left hand side of the page. He will be happy to share the results of his work. I personally had LDR brachy, but not with Dr Moran. My results were also excellent, however, and you can read my journey by copying and pasting the link in my signature.
Also, you should definitely get your biopsy slides read by a prostate cancer expert like Dr. Epstein or Dr. Bostwick. With only one cancerous core, you might find that reworked to a Gleason 6 or maybe not cancer at all. Be sure of your diagnosis before even thinking about treatment.

@Andrew. your comments about catheters and taking time off are true for some brachy patients. However, I should point out that MANY of us have the catheter removed before we leave the outpatient facility where our procedure was done and some of us, including me, never saw the catheter because it was gone before I woke up. Also, other than an little soreness I was fine by the day after the procedure and played tennis one day after that.

@ken: Well, it is true that surgery after a failed radiation is problematical -- but it can be done. However, what is left unsaid by your understanding is that there are many, many options for salvage after a failed brachy such as HDR Brachy, reseeding with another isotope, cryo, HIFU, etc. These work equally as well as salvage radiation after failed surgery so an argument that anyone should pick surgery because of a "backup" plan is typically flawed.

Jim

Thanks, Jim and Haplbert for your responses.