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Prostate Cancer
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Posted 4/17/2018 10:17 PM (GMT 0)
Hello all. I just joined this group and have already read some good stuff. I'm at the decision point for my treatment. HDRBT followed by 5 weeks of IMRT and 6-12 months of ADT (2-3 years if seminal vesicles are involved). Or DaVinci assisted RP. Both my Urologist (surgeon) and RO indicate either treatment would be appropriate. I'd like to hear from others with similar pathology who have gone through either of these treatments. I've been told that either should be "curative". I don't like the idea of surgery, but I have some concerns about radiation as well. PSA monitoring and spread of disease and pathological staging are the main things that make me lean toward surgery. Also, just getting this diseased organ out of my body is a plus. Not to mention less likelyhood of ADT. Thanks in advance

8-4+3, 4-3+4
cT2c 0M 0N
Posted 4/17/2018 11:16 PM (GMT 0)
Welcome, Crosstuner -

Here's a comparative study of surgery vs brachy boost in very high risk patients. With your Gleason 4+3, surgery may do better than among those patients, but your PSA of 18 adds to the risk:

/pcnrv.blogspot.com/2018/03/brachy-boost-therapy-and-surgery-extend.html

I'm not sure you really need the ADT with it, although it certainly adds to the confidence:

/pcnrv.blogspot.com/2017/12/is-adt-still-needed-for-high-risk.html

For your odds that surgery alone would get it all, try this nomogram:

/www.mskcc.org/nomograms/prostate/pre_op
Posted 4/17/2018 11:37 PM (GMT 0)
Hi Crosstuner,

I had HDBRT, IMRT and ADT. HDRBT is best to treat the seminal vesicles if you suspect their involvement. I am more than 7 years out with under table PSA and no negative side effects.

My risk level was too high for surgery as three surgeons all said I would also need follow up radiation. That is the worst combination for negative side effects and your risk level points that way.

In your shoes, I would treat as high risk given all cores positive (as I was) and a lot of G4 (as I was). Give yourself a couple more months and your PSA will be over 20 which is high risk (as I was). In fact your profile is in line with mine so take a good look at the combination of HDRBT, IMRT, and ADT. It has worked wonders for me. For excellent information see www.cetmc.com. This is the website of Dr. Jeffrey Demanes the HDRBT pioneer using it since 1981 and the head of the department at the UCLA Medical Center.

Let me know if you would like to talk about what to expect from this type of treatment. My email is in my profile and I will be happy to call you.

best regards,

Jack
Posted 4/18/2018 12:00 AM (GMT 0)
I did the HDR-brachy, IMRT and ADT combo and have done well as a Gleason 9. My only side effect at this point is a somewhat reduced urinary stream for which I take a Rapaflo every 5 days or so. My PSA has been low and steady. My personal thinking in choosing the "triple play" was that as a G9, I would likely need radiation as a surgical backup and I wanted to avoid the side effects of both surgery and radiation. As a result, I cut to the chase and had radiation.

That said, ADT is not particularly fun. In fact, it was by far the worst part of the process--maybe because it lasted so much longer. (In my case, 18 months.) I could see how you might be a factor in your decision. If you do go that route, you just need to power through it and then one day...it's over.

I agree with you on the surgical benefits of being able to monitor PSA and know right away if it worked. As to knowing the exact pathology, that info never had any value for me once I was treated. That said, I know that many guys here have felt that was important.

Good luck in deciding...most difficult part of the whole process!
Posted 4/18/2018 1:48 AM (GMT 0)
Thank you all for your input. Great stuff. I see my urologist Thursday and I have a lot of questions for him.
I'm scheduled for MRI Friday. It was ordered by my RO to determine exact location/position of prostate. Then one more meeting with him. Then it's decision time!
Triple play is sounding better all the time.
Posted 4/18/2018 4:47 AM (GMT 0)
Doesn't your RO want fiducials in place before the scan?
Posted 5/2/2018 6:11 PM (GMT 0)
MRI and DRE by RO revealed SV involvement. Upstaged to T3B. Had another meeting with Uro and phone call with RO. I had RP penciled in, but canceled and made my final decision for HDR Brachy followed by 5 weeks of IMRT. I go in Friday for Lupron injection and then wait 6 weeks for Brachy. Neither of my doctors pushed me to one treatment or another and both believe either has a good chance of curing. My main concern at this point is the ADT. Anyone have comments about their experience with Brachy boost and ADT treatment?
Posted 5/2/2018 6:14 PM (GMT 0)
Tall Allen

No fiducials
Posted 5/4/2018 2:53 AM (GMT 0)

Crosstuner said...
Anyone have comments about their experience with Brachy boost and ADT treatment?


For a lot of chatter about ADT, check out the "ADT and SRT Journey" threads. Bottom line: ADT sucks, but most guys find it bearable. Hot flashes (my bugaboo), fatigue, weight gain, loss of libido. Certain SEs, like osteopenia, come into the picture for long-term ADT (18-24 months) but not typically for short-term tx (6-9 months).
If you mean specifically the brachy-ADT cocktail, that's outside my experience but I'm sure others will chime in.
Posted 5/4/2018 3:22 AM (GMT 0)
I had HDR brachy, IMRT and ADT in late 2012-2014. I was originally on the surgery track, but since it seemed likely to fail I cut to the chase and started with radiation. I can think of a bunch of others here that have the "triple play"...if you're interested in experiences I'd bet if you started a separate thread that you could get a fair amount of responses.

As to the treatment, as you suggest it's the ADT that's the hardest part. It's a slog and you just have to keep moving forward. Having zero libido is weird (although kind of peaceful) and it makes you feel creaky and 15 years older.

But now that I've come out of the other end of the rabbit hole, my only long-lasting side effect is that I don't pee as well as I used to. But that's easily corrected with a Rapaflo every 4-5 days. All of my "equipment" still works, even though I had no interest whatsoever in using it when I was on ADT. (That's better now.) Oh...and this: my PSA has been low and consistent to the point where I only get it checked every six months now.

So in my experience, you can do this but you need to take a long view. And you have good chance of doing very well, but you'll need a ton of patience. Good luck to you!
Posted 5/4/2018 6:22 AM (GMT 0)
If I was 67 with your stats its highly likely I would not have chosen surgery and made the same choice as you. Good luck on your journey.
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