Guest guest Posted February 21, 2011 Report Share Posted February 21, 2011 Glen I am afraid that the term, "Use it or lose it.", is all too true. I had my Cryosurgery at age 72. Now, looking back, I wonder "What was I thinking?" Willie is in hiding. Perhaps feeling a little unwanted and unappreciated for the last 8 years of no playtime. "Il faut d'abord durer" Hemingway Seeds vs. daVinci I’m trying to decide between Brachy and daVinci as any other type of radiation is 100 miles away. My penis is now only a little over 2” long and I’m afraid that I’ll have to ‘squat to pee’ if I have surgery. What are my chances with Brachy?? Glen R. Fotre PCD, age 73 Dx 12/27/2010 bPSA 5.84 TRUSP volume 44cc 3/8 cores + on R with GS (4,3) 12% 1/5 cores + on L with GS (3,3) 1% Slides Reviewed by Bostwick Pathology Report Available CS T2b Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2011 Report Share Posted February 21, 2011 " Glen R. Fotre, CCIM " wrote: > I’m trying to decide between Brachy and daVinci as any other > type of radiation is 100 miles away. My penis is now only a > little over 2 " long and I’m afraid that I’ll have to ‘squat to > pee’ if I have surgery. What are my chances with Brachy?? > > > Glen R. Fotre PCD, age 73 > Dx 12/27/2010 > bPSA 5.84 > TRUSP volume 44cc > 3/8 cores + on R with GS (4,3) 12% > 1/5 cores + on L with GS (3,3) 1% > Slides Reviewed by Bostwick > Pathology Report Available > CS T2b Glen, I have read some articles that claim that surgery is the " gold standard " and has the highest percentage of long term outcomes free of cancer recurrence. I've read other articles that claim that the outcomes between surgery and radiation are about the same. My own personal, inexpert, layman's view is that a really good surgeon will do a better job for you than a mediocre radiation oncologist and a really good rad onc will do a better job than a mediocre surgeon. So I believe that picking your doctor is even more important than picking your mode of treatment. For a more expert view, here's a link to Memorial Sloan-Kettering's prostate cancer pre-treatment nomogram: http://www.mskcc.org/applications/nomograms/prostate/PreTreatment.aspx I entered your statistics as best I could and it told me that whether you get surgery or brachytherapy, your " progression free probability " at 5 years is 87%. In other words, it looked to me like they were predicting the same outcome at five years whichever treatment you get. They also gave a lot more information and you may want to go through their calculator program yourself to get details. The side effect profiles of the two treatments are different. Both have a high likelihood of producing impotence - though surgery does it immediately and you may get better over the next couple of years while brachy starts out good and gets worse over the next couple of years. I suspect both wind up around the same place. Surgery is much more likely to produce incontinence. Radiation is more likely to produce the opposite - difficulty urinating. Both procedures are capable of producing horrible side effects if not done carefully and skillfully. You need a good doctor for either one. I will say, having gone through it myself, that brachytherapy (assuming no serious complications - which is always a crap shoot and is one reason why you need a really good doctor), is easier to do. I had two HDR brachytherapy procedures. Each one was done on a Thursday morning. I stayed overnight in the hospital. I was back at work on Monday. I was a bit tender for a week or so and sat on a doughnut cushion, but I went home with no catheter, no stitches, no pain killers, and no requirement to stay home for a couple of weeks. Best of luck whatever you choose to do. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2011 Report Share Posted February 21, 2011 That was good advice that Alan gave you. The one thing that I want to add, and is the reason why I chose surgery, is with surgery you get the pathology of the tissue post operative. Once you have the seeds inserted the data is destroyed. Also with surgery if they didn’t get it all then you can always resort to radiation. Surgery can be performed after radiation it becomes more complicated. I chose surgery because it was not clear how far my cancer had spread. I ended up getting both. If I had gone with the seeds they may not have learned enough to know that I needed to have the whole prostate bed radiated. Seeds only effect the prostate itself. I also find living with pads easier to deal with than catheters. From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer Sent: Monday, February 21, 2011 11:50 AM To: ProstateCancerSupport Subject: Re: Seeds vs. daVinci " Glen R. Fotre, CCIM " wrote: > I’m trying to decide between Brachy and daVinci as any other > type of radiation is 100 miles away. My penis is now only a > little over 2 " long and I’m afraid that I’ll have to ‘squat to > pee’ if I have surgery. What are my chances with Brachy?? > > > Glen R. Fotre PCD, age 73 > Dx 12/27/2010 > bPSA 5.84 > TRUSP volume 44cc > 3/8 cores + on R with GS (4,3) 12% > 1/5 cores + on L with GS (3,3) 1% > Slides Reviewed by Bostwick > Pathology Report Available > CS T2b Glen, I have read some articles that claim that surgery is the " gold standard " and has the highest percentage of long term outcomes free of cancer recurrence. I've read other articles that claim that the outcomes between surgery and radiation are about the same. My own personal, inexpert, layman's view is that a really good surgeon will do a better job for you than a mediocre radiation oncologist and a really good rad onc will do a better job than a mediocre surgeon. So I believe that picking your doctor is even more important than picking your mode of treatment. For a more expert view, here's a link to Memorial Sloan-Kettering's prostate cancer pre-treatment nomogram: http://www.mskcc.org/applications/nomograms/prostate/PreTreatment.aspx I entered your statistics as best I could and it told me that whether you get surgery or brachytherapy, your " progression free probability " at 5 years is 87%. In other words, it looked to me like they were predicting the same outcome at five years whichever treatment you get. They also gave a lot more information and you may want to go through their calculator program yourself to get details. The side effect profiles of the two treatments are different. Both have a high likelihood of producing impotence - though surgery does it immediately and you may get better over the next couple of years while brachy starts out good and gets worse over the next couple of years. I suspect both wind up around the same place. Surgery is much more likely to produce incontinence. Radiation is more likely to produce the opposite - difficulty urinating. Both procedures are capable of producing horrible side effects if not done carefully and skillfully. You need a good doctor for either one. I will say, having gone through it myself, that brachytherapy (assuming no serious complications - which is always a crap shoot and is one reason why you need a really good doctor), is easier to do. I had two HDR brachytherapy procedures. Each one was done on a Thursday morning. I stayed overnight in the hospital. I was back at work on Monday. I was a bit tender for a week or so and sat on a doughnut cushion, but I went home with no catheter, no stitches, no pain killers, and no requirement to stay home for a couple of weeks. Best of luck whatever you choose to do. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2011 Report Share Posted February 21, 2011 Is that size erect or are you able to stand at attention now? If the problem is the latter then “maybe” an implant post treatment may help. From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Glen R. Fotre, CCIM Sent: Monday, February 21, 2011 10:52 AM To: ProstateCancerSupport Subject: Seeds vs. daVinci I’m trying to decide between Brachy and daVinci as any other type of radiation is 100 miles away. My penis is now only a little over 2” long and I’m afraid that I’ll have to ‘squat to pee’ if I have surgery. What are my chances with Brachy?? Glen R. Fotre PCD, age 73 Dx 12/27/2010 bPSA 5.84 TRUSP volume 44cc 3/8 cores + on R with GS (4,3) 12% 1/5 cores + on L with GS (3,3) 1% Slides Reviewed by Bostwick Pathology Report Available CS T2b Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2011 Report Share Posted February 21, 2011 Glen, According to the s Hopkins Partin Table you have a 75% average probability of cancer outside your prostate as described below so your best result would likely come from adding IMRT to the Seeds. Preferably Seeds before IMRT, but if you can't go to the primary place for that treatment then find a closer center of excellence that provides IMRT before Seeds. According to a recent comparison of 60 medical journal reports the best (0.2 ng/ml adjusted) IMRT before Seeds treatment has a 31%/17% = 1.8 greater failure rate than Seeds before IMRT. When you factor in serious urinary, rectal and sexual side effects the estimated failure rate ratio is 57/37 = 1.5. Unfortunately, these are average numbers so your numbers will be higher. You can contact to get more information on Seeds before IMRT treatment and if you can get your pathology report forwarded to them they will have one of their doctors call you after they review your entire situation - I believe still at no cost. Carl Partin Table Lookup Organ confined: 25 (19-32) Extraprostatic extension: 47 (38-55) Seminal Vesicle Invasion: 15 (9-23) Lymph Node Invasion: 13 (6-21) Glen R. Fotre, CCIM wrote: I’m trying to decide between Brachy and daVinci as any other type of radiation is 100 miles away. My penis is now only a little over 2” long and I’m afraid that I’ll have to ‘squat to pee’ if I have surgery. What are my chances with Brachy?? Glen R. Fotre PCD, age 73 Dx 12/27/2010 bPSA 5.84 TRUSP volume 44cc 3/8 cores + on R with GS (4,3) 12% 1/5 cores + on L with GS (3,3) 1% Slides Reviewed by Bostwick Pathology Report Available CS T2b Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2011 Report Share Posted February 21, 2011 Glen, Soon after I was diagnosed back in 1996 at the age of 54, a man who called himself Lorenzo Q Squarf burst on the prostate cancer Internet scene. He caused a number of problems because he questioned all the current beliefs. Since I was doing the same thing, but in what I thought was a less confrontational way, I found what he had to say both interesting and amusing. He eventually gave up trying to change the prostate cancer world and went on his way, closing down his web site. I saved some of it and it is here http://www.yananow.org/Squarf.htm This is the bit I thought you might think about: I am not a Luddite. Let me clarify my go/no-go criteria for hurling yourself into the great maw of urological mayhem: If you are in your 50s, avoid biopsies until and unless you have negative urological symptoms which clearly indicated the need for a biopsy to determine what might be going on. If you have a suspicious DRE that does not clear up you fall into this category. If your PSAs are beginning to sequentially rocket upward you fall into this category. Absent these criteria, avoid urological procedures. If you are in your 60s, the same criteria apply. If you are in your 70s, ditto, but be very fussy about what constitutes negative symptoms. If they are not all that distressful consider treating the symptoms. Think amelioration of discomfort rather than aggressive intervention, but, if ordinary stuff can't suppress your discomfort, why, discuss your particulars, and especially your personal values, with a urologist who listens carefully, and who seems to care more about you than his theories of aggressive intervention. If you are in your 80s don't play the therapy game. Period. No. Don't do it. It will destroy the rest of your life. Ameliorate negative symptoms with medication. You can probably do this in an agreeable manner for a longer time than you might imagine. Smile. You have won. All the best Prostate men need enlightening, not frightening Terry Herbert - diagnosed in 1996 and still going strong Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Glen R. Fotre, CCIM Sent: Tuesday, 22 February 2011 2:52 AM To: ProstateCancerSupport Subject: Seeds vs. daVinci I’m trying to decide between Brachy and daVinci as any other type of radiation is 100 miles away. My penis is now only a little over 2” long and I’m afraid that I’ll have to ‘squat to pee’ if I have surgery. What are my chances with Brachy?? Glen R. Fotre PCD, age 73 Dx 12/27/2010 bPSA 5.84 TRUSP volume 44cc 3/8 cores + on R with GS (4,3) 12% 1/5 cores + on L with GS (3,3) 1% Slides Reviewed by Bostwick Pathology Report Available CS T2b Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 24, 2011 Report Share Posted February 24, 2011 UPDATE: Earlier this week I visit with one of the top rated Radiation Oncologists regarding Brachytherapy and the ‘grandfather of deVinci’ Urology Surgeon in the Phoenix market. These were their summarized comments. Keep in mind, that I live 100 miles from Phoenix and a two month stay in Phoenix nor a daily commute is not a consideration. The Radiation Oncologist’s recommendation was Brachytherapy plus a month of ERBT. He questioned that the Brachy in and of itself, would cure the cancer, but he would do it if it was my choice. He was taught in Seattle and has been doing Brachy since 1988 and estimates that he has done over 3,000. The Urology Surgeon recommended the daVinci procedure (surprise?) but also agreed that Brachy without ERBT was a questionable choice. He has been doing daVinci since 2003 and does from two to five per week. He brought the first daVinci machine to Arizona. I taped both sessions and requested a list of prior patients and will review the tapes and talk to the patients, but the final answer is beginning to become more clear as time progresses. Glen R. Fotre PCD, age 73Dx 12/27/2010bPSA 5.84TRUSP volume 44cc3/8 cores + on R with GS (4,3) 12%1/5 cores + on L with GS (3,3) 1%Slides Reviewed by BostwickPathology Report AvailableCS T2b Quote Link to comment Share on other sites More sharing options...
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