CancerCompass message board discussion started by talkal1984 on 3/11/2008 http://www.cancercompass.com/message-board/message/all,21878,0.htm Thu, 04 Dec 2008 00:00:00 GMT Thu, 04 Dec 2008 00:00:00 GMT http://backend.userland.com/rss RSS.NET: http://www.rssdotnet.com/ my name is Tom - I am 51 and have just been diagnosed with PC. My gleason was 6 , PSA =4 and the biopsy found cancer in only the left lobe , 5-10% of the core sample. I am having a hard time determining whether to go with surgery or HDR brachytherapy as recommended by the raiation specialist . I want to go with the best long term option with the least side effects . I am not clear on what the options are if the cancer reocurrs with either option ? Also which option has the highest probability for no reacuurence .I would appreciate any input . Thank you and god bless. talkal1984 Tue, 11 Mar 2008 00:00:00 GMT Tom, your numbers make you likely for success regardless of the treatment you choose. You also appear to be a candidate for Active Surveillance, depending on the number of cores with cancer on your biopsy, and the number of total cores taken. With only one or two cores positive, as you described, from a set of twelve, there is no reason to make a decision today, this month, or for a while. Do not rush to any decision. Any conventional primary therapy would be expected to give you success. As you know, none is guaranteed, but your numbers are close to that standard. The problem with your choices as stated is that each treatment has side effects that can reduce quality of life and with opportunity for long term difficulties. Make no decision until you are certain it is the right one. You have the luxury of time to become a balanced student of this disease. Once you are sure of your status, have consulted the best doctors about their decision, asked every question you have considered, read, read and read some more about your disease, then you can move forward without regret, and without using me or others to be the deciding point.Best of health.  Thoosier Tue, 11 Mar 2008 00:00:00 GMT I agree with points made by Thoosier.There's plenty of information available on Active Surveillance, including criteria in the Johns Hopkins winter 2003 newsletter: www.urology.jhu.edu/newsletter.Biopsy readings are subjective, which is why it's important to obtain a 2nd reading by an expert pathologist if you have not already done so: what looks like cancer to one person might look normal to another, and gleason grades are often amended.It's really impossible to objectively compare treatment outcomes:  all treatments have improved greatly in recent years, and there are so many variables. Several options can probably provide similar prognosis, so it comes down to consideration of potential side effects and personal preference.Whatever treatment you might ultimately choose, most important aspect is to have the best doctor available, as he will have a large influence on your prognosis, and give you best chance of few side issues. Johnw100 Tue, 11 Mar 2008 00:00:00 GMT  On 3/11/2008 Thoosier wrote:Tom, your numbers make you likely for success regardless of the treatment you choose. You also appear to be a candidate for Active Surveillance, depending on the number of cores with cancer on your biopsy, and the number of total cores taken. With only one or two cores positive, as you described, from a set of twelve, there is no reason to make a decision today, this month, or for a while. Do not rush to any decision. Any conventional primary therapy would be expected to give you success. As you know, none is guaranteed, but your numbers are close to that standard. The problem with your choices as stated is that each treatment has side effects that can reduce quality of life and with opportunity for long term difficulties. Make no decision until you are certain it is the right one. You have the luxury of time to become a balanced student of this disease. Once you are sure of your status, have consulted the best doctors about their decision, asked every question you have considered, read, read and read some more about your disease, then you can move forward without regret, and without using me or others to be the deciding point.Best of health. Thank you for your time and input ! I am still investigating the options for both if reoccurence happens talkal1984 Wed, 12 Mar 2008 00:00:00 GMT I agree with the guys.  For men who choose watchful waiting for early prostate cancer, about 85% live longer than 10 years. For men who have surgery for early prostate cancer, about 90% live longer than 10 years.  Obviously side effects are a concern with surgery or brachy so the question is: for a small increase in survival are you willing to put up with the incontinence and impotence, especially given your young age.  Remember WW doesnt mean you do nothing.  Get regular checkups and PSA's so you can stay on top of any changes.  Oncrx Wed, 12 Mar 2008 00:00:00 GMT Agree with all of the above. P.S. The longer you put it off - the better the treatment alternatives.George  Georgealbert Wed, 12 Mar 2008 00:00:00 GMT HI Tom,    In response to your message about whether to have surgery or brachytherapy, I can tell you about brachytherapy.  For my background: I am 68 years old.  I was diagnosed last July with prostate cancer.  My PSA was 4.39 after a reading of 3.96 2 years earlier.  Mine was diagonsed as a T1c, with a Gleason score of 3+4=7. The urologist that did the biopsy suggested reading a book "Guide To Surviving Prostate Cancer" by Dr. Patrick Walsh of Johns Hopkins Medical Instituitons. It gives a lot of information if you can obtain a copy.  He spends more time in discussing surgery, because that is his specialty.         I had recently moved and decided to consult with the urologist that I had seen for some 20 years because of kidney stones.  He said that he had done many, many surgeries in his career but in recent years he had been doing brachytherapy.  He told me that the success rates were about the same as any other methods with out some of the side effects, especially radical protatectomy.  I had the 'implants' done by him on November 29, 2007.    I had it done as an outpatient early in the morning.  I had him leave in the catheter because I live 100 miles from his office.  I removed it myself the following day without any difficulty.  I have had some discomfort urinating since then, but have continued to drink my coffee and soft drinks, plus a glass of wine occasionally.  These tend to irritate the sphincter.  I have not had any incontinence at all.  I have seen him once since the procedure.  I have not had a PSA test done since the procedure, but will have one in May. I wish you success in what ever treatment you have done.  According to some articles on CancerCompass website recently, there are really very little difference in results of either treatment. You age might be a factor. adepose Thu, 13 Mar 2008 00:00:00 GMT  On 3/13/2008 adepose wrote:HI Tom,    In response to your message about whether to have surgery or brachytherapy, I can tell you about brachytherapy.  For my background: I am 68 years old.  I was diagnosed last July with prostate cancer.  My PSA was 4.39 after a reading of 3.96 2 years earlier.  Mine was diagonsed as a T1c, with a Gleason score of 3+4=7. The urologist that did the biopsy suggested reading a book "Guide To Surviving Prostate Cancer" by Dr. Patrick Walsh of Johns Hopkins Medical Instituitons. It gives a lot of information if you can obtain a copy.  He spends more time in discussing surgery, because that is his specialty.         I had recently moved and decided to consult with the urologist that I had seen for some 20 years because of kidney stones.  He said that he had done many, many surgeries in his career but in recent years he had been doing brachytherapy.  He told me that the success rates were about the same as any other methods with out some of the side effects, especially radical protatectomy.  I had the 'implants' done by him on November 29, 2007.    I had it done as an outpatient early in the morning.  I had him leave in the catheter because I live 100 miles from his office.  I removed it myself the following day without any difficulty.  I have had some discomfort urinating since then, but have continued to drink my coffee and soft drinks, plus a glass of wine occasionally.  These tend to irritate the sphincter.  I have not had any incontinence at all.  I have seen him once since the procedure.  I have not had a PSA test done since the procedure, but will have one in May. I wish you success in what ever treatment you have done.  According to some articles on CancerCompass website recently, there are really very little difference in results of either treatment. You age might be a factor. Hi Tom,  I had HDR Brachytherapy in 2005. I am well pleased with the treatment. I had no side effects at all from the treatment. I still do everything as I did prior to the treatment. Oh, I was 60 then.    Bill Midwestern05 Thu, 13 Mar 2008 00:00:00 GMT  On 3/13/2008 Midwestern05 wrote: On 3/13/2008 adepose wrote:HI Tom,    In response to your message about whether to have surgery or brachytherapy, I can tell you about brachytherapy.  For my background: I am 68 years old.  I was diagnosed last July with prostate cancer.  My PSA was 4.39 after a reading of 3.96 2 years earlier.  Mine was diagonsed as a T1c, with a Gleason score of 3+4=7. The urologist that did the biopsy suggested reading a book "Guide To Surviving Prostate Cancer" by Dr. Patrick Walsh of Johns Hopkins Medical Instituitons. It gives a lot of information if you can obtain a copy.  He spends more time in discussing surgery, because that is his specialty.         I had recently moved and decided to consult with the urologist that I had seen for some 20 years because of kidney stones.  He said that he had done many, many surgeries in his career but in recent years he had been doing brachytherapy.  He told me that the success rates were about the same as any other methods with out some of the side effects, especially radical protatectomy.  I had the 'implants' done by him on November 29, 2007.    I had it done as an outpatient early in the morning.  I had him leave in the catheter because I live 100 miles from his office.  I removed it myself the following day without any difficulty.  I have had some discomfort urinating since then, but have continued to drink my coffee and soft drinks, plus a glass of wine occasionally.  These tend to irritate the sphincter.  I have not had any incontinence at all.  I have seen him once since the procedure.  I have not had a PSA test done since the procedure, but will have one in May. I wish you success in what ever treatment you have done.  According to some articles on CancerCompass website recently, there are really very little difference in results of either treatment. You age might be a factor. Hi Tom,  I had HDR Brachytherapy in 2005. I am well pleased with the treatment. I had no side effects at all from the treatment. I still do everything as I did prior to the treatment. Oh, I was 60 then.    BillThanks for the reply and the information . Did your doctor discuss if reacuurence happens whst could be doen after radiation ?   talkal1984 Fri, 14 Mar 2008 00:00:00 GMT You framed your question as "HDR Brachytherapy" being one of your choices, so you are probably aware there is also LDR (low dose rate) Brachytherapy where they implant the radioactive seeds permanently in the prostate. HDR uses only temporary dosing, but at "high" doses as opposed to the permanent seeds "low" doses.Studies have shown both HDR and LDR Brachytherapy to have very high longterm success rates (10 years+).I believe Dr Martinez (in Michigan?) published a study comparing toxicity of LDR and HDR, and showed HDR to have lower rate of side effects than LDR in the areas of impotence and incontinence.I believe several studies have also shown either LDR or HDR to have lower rate of those side effects than surgery.      FredB Sat, 19 Apr 2008 00:00:00 GMT