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Posted 11/14/2016 4:54 AM (GMT 0)
F8:

No deal whatsoever.

As I said, maybe I wasn't thorough enough at the time. It seemed surgery and the 38-sessions radiation were my choices.

I was definitely a "get it out" type person so I went into my research with that mindset. But, as I said, I met with experts from both fields.

I'm not going to get into another one of those protracted battles of surgery vs radiation. Roy doesn't need that.

But since you are a regular here, I'm sure you read about my additional unique situation regarding my BPH issues.

The surgery cured that aspect, which was slowly becoming a major issue for me.

But there were many valid reasons I chose surgery, and I have no regrets.

My only point -- and I won't belabor it any more, was that HDR was never mentioned.

I am still unsure if my research was lacking, or it just wasn't prominent at that time. Could be both!

Mel
Posted 11/14/2016 5:58 AM (GMT 0)
compiler -- we were treated around the same time and to be honest HDR was never mentioned to me, nor do I think there is much that difference between the two choices of delivery.

I just feel strongly that the gold standard is often the wrong choice especially when it's likely the disease has breeched the capsule.

ed
Posted 11/14/2016 6:15 AM (GMT 0)
ta:

Don't you also think assorted scans would be advisable, especially if he is still considering surgery?

If so, who is going to give him the best advise?

Will it be the surgeon who is intent on doing surgery?

Will the RO give him that information?

I would think the MO, looking on as an overall QB, might suggest that, and perhaps make very specific recommendations.

Roy -- as you can see there are very few aspects of this disease where we all agree 100%. Lots of grey areas/nuances.

Mel
Posted 11/14/2016 2:05 PM (GMT 0)
Both seeds and HDR brachytherapy with adjuvant external beam have been around a long time. Dr. Frank Critz started seeds and external beam here in Atlanta in the mid 70's and Dr. Jeffrey Demanes started using HDR with external beam in 1981. Both have been proven to be more effective than surgery in high risk cases like Roy, and with less side effects. In his case he will certainly have some course of ADT. If it were me, I would have already started ADT.

Again, if we apply the so-called surgical "gold-standard" the one who refined the nerve sparing surgery and wrote a definitive book, Dr. Patrick Walsh, says in his book that he wouldn't operate on Roy. Why? Too old (over 70) and too advanced/high risk. Walsh said that he would only operate on men over 70 if they brought both parents to the consult.

Cutting it out is no better than killing it with radiation. Either way the cancer within the treatment area is gone and will no longer be a problem. Radiation in all forms has a much broader treatment area than surgery. In each case if there is cancer that is outside the treatment area neither will address that and systemic treatments like ADT and chemotherapy must be used.

To me, this is a no brainer. ADT, HDR brachytherapy and IMRT/IGRT including the pelvic lymph nodes. Best overall cancer control and least risk and side effects when compared to surgery, which given the risk factors will most likely also need radiation and ADT at some point.
Posted 11/14/2016 4:54 PM (GMT 0)
Tall Allen

One point I want to clarify. The change in my Gleason scores between the "actively monitor" stage and the "get off the stick and check this out" stage did not happen over a four month period. It happened as a result of getting a second opinion of the same biopsy. Unfortunately, there was a four month interval before I asked for the second opinion.

After reading your responses and those of others, I'm interpreting the advice in this way. I should see a specialist (I believe to be a RO). That will get the process started. The form of treatment would obviously be up to the doctor, but this group seems to recommend the EBRT/BT followed by ADT route.

Am I reading you correctly?

When I got the results of the second opinion, I was in AZ for the winter. I asked my Urologist in MI to refer me to the Mayo Clinic in AZ. Unfortunately, Mayo does not recognize my insurance. The one in MN does, but not AZ. I'm sure that the cost I will incur in this process will be extensive, so the insurance issue may be one that I have to deal with as I search for a highly rated specialist.

Roy
Posted 11/14/2016 5:35 PM (GMT 0)
Roy -- I would start ADT ASAP. you want to stop the growth of cancer now. time is not on your side, imo. good luck man!

ed
Posted 11/14/2016 5:50 PM (GMT 0)
ADT precedes the radiation. First it serves to arrest the cancer now and second it makes the cancer more radio sensitive enabling the radiation to be most effective.

There is no magic to Mayo Clinic for you. Also look at other practitioners that are in your network. I take it you have a Medicare Advantage plan and are network limited. Expand your search and you should find practitioners in your network.
Posted 11/15/2016 2:35 PM (GMT 0)
Just read a good article (abstract) on this stuff.

Check it out:

http://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/92301-prostate-specific-antigen-psa-as-predicting-marker-for-clinical-outcome-and-evaluation-of-early-toxicity-rate-after-high-dose-rate-brachytherapy-hdr-bt-in-combination-with-additional-external-beam-radiation-therapy-ebrt-for-high-risk-prostate-cancer.html


The really good news:


>>>>>>>>>>>>>>>>>
Of all treated patients, 84.81% had no side effects. All reported complications in early toxicity were grade 1.
>>>>>>>>>>>>>>>>>>>>>>>..

(Roy - Grade 1 is the lowest)

Mel
Posted 11/15/2016 5:09 PM (GMT 0)

compiler said...

The really good news:


>>>>>>>>>>>>>>>>>
Of all treated patients, 84.81% had no side effects. All reported complications in early toxicity were grade 1.
>>>>>>>>>>>>>>>>>>>>>>>..



Well, that sounds pretty good.

Unless, and until, you understand that these are the short-term results only...and that radiation effects in the short-term are typically low, but can increase and cause problems later, which are called late-term side-effects. This abstract of double-dose radiation only reported on 1-year results.

I can understand how a noobie can get tripped-up by not reading closely.



Also, if I was 75 YO, I would be less worried about late-term side-effects of radiation...I'd be less worried about bleeding out of my butt 5-10 years later.
Posted 11/15/2016 6:05 PM (GMT 0)
i'd be more worried about being dead in 5-10 years or ending my life on Lupron.

ed
Posted 11/15/2016 8:26 PM (GMT 0)
Jackh:

However, I don't think your overtreated anthem will apply here.

Mel
Posted 11/15/2016 8:30 PM (GMT 0)

compiler said...
Jackh:

However, I don't think your overtreated anthem will apply here.

Mel



Sorry to further confuse you.

My comment is irrespective of whether one needs treatment or not...that is a different question. My comment is in regard to the link you provided, and the confusion you appeared to have understanding it. Re-read.
Posted 11/15/2016 8:40 PM (GMT 0)
Not confused at all. In fact, the title of the article, which was included, clearly referred to early toxicity.
You have to read the title -- I know it's a tad long

Mel

Post Edited (compiler) : 11/15/2016 1:44:43 PM (GMT-7)

Posted 11/15/2016 8:56 PM (GMT 0)

compiler said...
Not confused at all. In fact, the title of the article, which was included, clearly referred to early toxicity.
You have to read the title -- I know it's a tad long

Mel



Let’s just settle, then, on your comment about “really good news” being a simple case of noobian “misplaced enthusiasm” for the status quo.
Posted 11/15/2016 9:10 PM (GMT 0)
I thought it was good news. Silly me.

Mel
Posted 11/16/2016 3:31 PM (GMT 0)
That's ok...happens all the time...I'm not saying that headlines are written with nefarious intent, but they often catch the uninitiated off-guard and generate unwarranted ("misplaced") excitement, but to get some eyes on their content. Oldest trick in the book. Marketing.
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