Update-Just had low dose Radioactive Seed Implant (Brachytherapy)

[Guest guest]

Here is my 

" CV "

I was originally diagnosed with Prostate Cancer in August 2007 (at the age of

59) and these tests as well as test results ensued:

Age-59

August, 2007-PSA 3.17. PSA had doubled in 22 months (in retrospect, my

Internist now says that I probably had localized prostatitis which raised my PSA

level).  Nevertheless I do have Prostate Cancer.

Clinical Stage-T1c 

Gleason score 6 (3+3)

Bone Scan-Negative

CAT Scan-Negative

DRE-Negative

Strategy-Active Surveillance, PSA every 3 months.

January 9, 2008, PSA test result was 2.13

April 9, 2008, January 9, 2008, PSA test result was 2.33

October 15, 2008 PSA test result was 2.95. Was put on Avodart.

March 10 , 2009 PSA test result was 1.41(on Avodart- it's " doubled " to 2.8)

April, 2009 -Had second biopsy in (10 cores) Gleason was 7 (3+4). Had tissue

samples sent to s Hopkins for reevaluation and they gave me a 6 (3+3).

June 2, 2009-PSA test result was 1.85 (was on Avodart- number is " doubled " to

3.75)

July 17,2009 -Had TUNA (Transurethral Needle Ablation-for BPH symptoms)

procedure on 7/17/09. My Doctor told me to discontinue Avodart 2 weeks

thereafter.

Sept 24, 2009-PSA test result was 0.79 . M.D. says it's due to the TUNA

procedure and resulting diminution of Prostate size.

September 29, 2009-Met with Urologist.-He did a DRE and " found nothing " . Had

long discussion and he is " prone " to me getting IMRT (preceded by 6 months on

Lupron). I am not " prone " to getting anything done yet, especially after the

negative DRE. My reading of the amount of overtreatment in this field has had

it's effect on me not to mention the serious sequallae following types of

" treatments " to the point where I would proceed with an intervention only if

there was compelling evidence that my cancer was " gaining " .

I am in a kind of a " limbo " because the fact that I have " cancer " doesn't freak

me out enough to get treatment just to placate my mind and am also taken by how

many times I've read that most men die " with " Prostate Cancer but not " because

of " Prostate Cancer.

I then asked him if there are any other diagnostic tests that might be useful,

like doing a CAT scan and regular MRI as I had done when initially diagnosed 2

years ago. He said to get the Transrectal MRI of the Prostate

October 9, 2009- Had Transrectal MRI of the Prostate done

October 12, 2009-Just had the results faxed to me:

IMPRESSION:

1) " There is obscuration of the fat planes lateral to the central gland and the

peripheral zone on the right side near the apex of the gland suspicious for

capsular invasion. There is also suspicion for neurovascular bundle invasion on

the right and several areas of probable tumor seen within the peripheral zone as

described.

2) Increased thickening of the walls of the seminal vesicles which could be

either inflammatory or neoplastic invasion.

3) No definite evidence of pelvic or inguinal adenopathy or any gross bony

metastasis identified in the lumbar spine. There are degenerative changes in

the lumbar spine.

DISCUSSION:

History: Prostate Cancer

Comparison: None

Multi planar MRI of the Pelvis was obtained on a 1.5 Tesla GE MRI Scanner.

There is thickening in the walls of the seminal vesicles seen on the T2 weighted

views which is non-specific and could be inflammatory or neoplastic. I cannot

exclude invasion of the seminal vesicles. There is also some bulging of the

prostatic capsule on the right with soft tissue in the region of the

neurovascular bundle very suggestive of invasion. There is irregularity seen

along the peripheral zone on the right near the apex of the gland extending

laterally towards the central gland and beyond this with obscuration of fat

planes. This is also very suggestive of invasion. There are also foci on the

T2 weighted views just to the left of the midline which is rounded measuring

6mm. in size on series 600, image 16 as well as some areas of low signal

intensity in the peripheral zone on the left in the mid portion of the gland

seen on series 600, image 14. Views through the bones show degenerative changes

in the lower lumbar spine without any gross destructive process.

END OF REPORT

I guess I am asking for feedback from those who have familiarity with the

findings and their significance. They don't sound too great to me especially

the insinuations by the Radiologist which he characterizes as " suggestive of

invasion " or similar.

For 2+ years I have been " sitting on the fence " so to speak inasmuch as my other

" factors " such as PSA, DRE and Gleason Score were not suggestive of a fast

growing and aggressive cancer. I chose this course because of all that I had

read about the large amount of overtreatment for PCA as well as the not uncommon

nasty after-effects of radiation and/or surgery. As mentioned previously , I

had quarterly PSA readings taken and met with my Urologist every few months to

get a DRE and to talk about options. I do trust and have faith in him but at

the same time am very aware of the lack of consensus on many issues having to do

with this disease and how to best approach the treatment strategy.

The fact that so many men die " with " Prostate Cancer and not " of " Prostate

Cancer has has also been a part on my decision making. In addition, because I

have an enlarged Prostate anyway I would have to be put on ADT (Androgen

Deprivation Therapy, in my case Lupron) in order to shrink the Prostate down to

size regardless of whatever subsequent treatment I ultimately may have done.

The possibly very unpleasant side-effects of a drug like Lupron has also played

a role in my decision making.

Obviously I'd like to hold off on any intervention as long as I can without

jeopardizing myself in the process but realize that there is a " tipping point "

where a difficult decision has to be made about getting treatment and what type

to get. For example, choosing between traditional Radical Prostatectectomy and

the DaVinci Robotic surgery might be one such decision. My Urologist has a

reputation as a very skilled surgeon but does not perform the robotic procedure.

He told me that he would refer me to a well regarded surgeon who has done many

hundreds of the robotic procedures.

From what I've read, studies don't indicate any advantage to the DaVinci

procedure as it pertains to post-op longevity (in controlled studies that

compare patients based upon their PCA numbers like PSA, Gleason score etc..) but

do indicate that there might be less discomfort and pain post-op because of the

elimination of the need for a very large incision as in traditional RP. On the

other hand, there seem to be some issues with the lessened view of the surgical

field because of the nature of the robotic procedure. Pros & cons on both sides

of this and other issues.

I apologize for rambling on but I am trying to rationally determine if I can

continue with my " active surveillance " or have my Transrectal MRI results become

the " tipping point " I referred to earlier. I will of course be speaking to my

Urologist at length next week but because this Group has been so helpful and

enlightening to me over the last few years i would appreciate any and all

comments and feedback in helping me to make my decision.

October 20-2009-

My Urologist advised me that because of the Prostate size reduction from taking

Avodart as well as having the TUNA procedure done last summer, I am now an

appropriate candidate for Brachytherapy without having to be put on a regimen of

Lupron (ADT).

Went to Radiation Oncologist who evaluated the situation and performed

Ultrasound to assess placement of Radioactive Palladium seeds.

January 12,2010, -Had about 70 Radioactive Palladium seeds implanted. Procedure

is quite easy. Some annoyances afterwards (urgency/difficulty voiding) but is

getting better after increasing dosage of Flomax.

Will be having 25 low dose EBRT treatments in March. So far so good.

Sy