Re: (Prostate Cancer,Stage 1)

[Guest guest]

robotic surgery

Subject: (Prostate Cancer,Stage 1)To: ProstateCancerSupport Date: Sunday, October 30, 2011, 10:05 PM

I am 60 years old,and after a prostate biopsy,was diagnosed with prostate cancer. although that it is only in stage 1,and according to my doctor 60 is still young.I am trying to get opinions on the best course of treatment whether it is surgery,radiation cryotherapy,planting the seeds,or whatever. I'mlooking for the best course of treatment that 1. Has fewer side effects,and 2. Has the least down time.

[Guest guest]

It all depends on your Gleason score and pathology report. If the cancer is highly aggressive (highly unlikely), then aggressive treatment regardless of the side effects is in order. If the Gleason score is below 6, then these could be your treatment options:Active surveilance has zero side effects but if surgery with careful nerve sparing is a later option, the younger you are at the time of surgery, the less severe of side effects is done the younger you are. Proton beam surgery has many pluses going for it, but since there are less than ten centers where it is available, expense and travel need is a major consideration, but the side effects appears to be the least, by far. Should this treatment fail, the prostate is not damaged enough to make salvage

surgery difficult to impossible. Unlike the other treatment methodology, some semen production remains. The problem with other forms of radiation treatment has less side effects initially, but tend to develop on a delayed basis long term and remain permanent. Also, salvage surgery is much more difficult because the remaining gland reportedly is rendered in a waxy state. However, it is much more available than proton beam surgery and where surgery is less of an option (most unlikely in your case), it is likely to be the most available option. Robotic nerve sparing surgery in the most capable hands has the least downtime, but complete recovery of continence is likely to take up to six month, and with prompt initiation of aggressive penile rehabilitation, up to a year of recovery of good function. However all orgasim will be dry.

Louis. . . To: ProstateCancerSupport Sent: Sunday, October 30, 2011 10:05 PMSubject: (Prostate Cancer,Stage 1)

I am 60 years old,and after a prostate biopsy,was diagnosed with prostate cancer. although that it is only in stage 1,and according to my doctor 60 is still young.

I am trying to get opinions on the best course of treatment whether it is surgery,radiation cryotherapy,planting the seeds,or whatever. I'm

looking for the best course of treatment that 1. Has fewer side effects,and 2. Has the least down time.

[Guest guest]

> I am 60 years old,and after a

> prostate biopsy,was diagnosed with prostate cancer. although

> that it is only in stage 1,and according to my doctor 60 is

> still young.

> I am trying to get opinions on the best course of treatment

> whether it is surgery,radiation cryotherapy,planting the

> seeds,or whatever. I'm

> looking for the best course of treatment that 1. Has fewer

> side effects,and 2. Has the least down time.

I'll divide this into three questions:

1. Fewest side effects:

That is very hard to say. There are at least a couple of

problems in trying to compare side effects. One is that the

side effects of different treatments are different and

comparing them produces some apples to oranges problems.

Different men will rate them differently.

Another is that the same treatment will produce different side

effects in different men. Some men become impotent and or

incontinent from a treatment that doesn't do that to other

men. The best, most experienced doctors generally produce the

fewest nasty side effects (as well as the best cancer control

outcomes), but even the very best doctors have some patients

that do badly.

Another issue is what adjuvant therapy you get. If you get

androgen deprivation therapy along with radiation - which is

common for men with more aggressive cancers, there will be

side effects from that.

2. Has the least down time.

Of three main treatments, surgery, external beam radiation

(either protons or x-rays), and brachytherapy, I would say

that surgery has the most downtime.

For the other two, it depends. I had two HDR brachytherapy

procedures. For each one I went in to a hospital on a

Thursday, was kept overnight, and was back at work (albeit

sitting on a doughnut cushion at my desk) on Monday. Some men

go back to work the next day after brachytherapy, and those

who get low dose rate only have one procedure, not two, though

some of them also require supplementary external beam, as I

did.

I also had 25 external beam radiation treatments. For each of

those I went to the clinic in the morning, got the treatment,

then went to work. It cost me about two hours a day. The

treatment itself usually took 10 minutes (though on a few days

they did extra imaging work that added a half hour or so) but

there was time to get there, park, sit in the waiting room,

get my car, and drive to work that all added up to 2 hours.

The external beam caused me no full days away from work, but

25 x 2 = 50 hours was, in a way, more down time than the

brachytherapy.

Some external beam procedures, like Cyberknife, are much

faster, requiring only 5 days of treatment. Others require 40

days.

3. What will best control your cancer?

That seems to me the main question. If the cancer isn't

cured, you'll lose a lot more time overall no matter what

treatment you get or how quickly it's given.

What is best may vary based on your particular disease

characteristics and you need a really good doctor to figure

that one out for you.

You only get one shot at primary cancer treatment. If the

first treatment fails, your situation is much less likely to

be curable by subsequent treatments. I therefore suggest

finding the very, very best doctor you can.

Getting the best doctor and the best treatment is a big and

controversial subject. I'll hold off on that one for the moment

since it requires more time than I've got right now, and probably

a lot more expertise too. I will point you however to cancer

centers that the National Cancer Institute recommends. See:

http://cancercenters.cancer.gov/cancer_centers/cancer-centers-names.html

Best of luck.

Alan

[Guest guest]

Let me follow up on Alan's points, but from the perspective of one who chose

surgery. My age and numbers at diagnosis were the same as yours.

I talked to my urologist, a surgeon, and two radiological oncologists. As Alan

said, the projected sided effects were different. External beam radiotherapy

(EBRT) and brachytherapy both had a greater incidence of fecal incontinence

which weighed in my mind and less chance of ED and urinary incontinence.

But surgery was the only course of treatment that provided a post surgical

pathology report that provided either assurance that the cancer was contained or

information needed for the next step of treatment. So I chose surgery.

Today, about 6 years later, watchful waiting is now being followed by many men

in our situation. I would have thought long and hard about doing that, but it

was never discussed as an option 6 years ago.