Re: Surgery verses Bracytherapy

[Guest guest]

Goodmorning!

I was diagnosed in late 2000. Had PSA 4.7 and I believe my Gleason was 6. After much thought, researching, praying and made my decision to have external radiation, then about 3-wks.after completing that, Bracytherapy (126 seeds). Except for the weekend after my Bracytherapy, I never missed a day of work.

Yesterday, I got the results from my 12-year checkup and urologist said that for the past 10yrs (out of 12) my PSA has been undetectable. Dr.Lippman, believes I just may not have any future problems as far as prostae cancer is concerned.

Only complications I experienced was some radiation burns in the rectum area but that eventually cleared up. Other complication was that the radiation therapy hasten almost total onset of ED, which was actually caused by gradual onset of heart disease. The radation simply hasten the syndrome. I have since rectified both those problems.

Keep in mind, that regardless which way you go, there will be some complications of sorts....but those are minor compared to the alternative. Has the Urologist confirmed that your husband is a suitable candidate for Bracytherapy? Ask....in fact don't be bashful in asking ANY Questions....PERIOD.

Feel free to write me directly if you wish.

- Spring,Texas

>> My husband Bob 58 has been recently diagnoised with Prostate cancer on Feb 16 2012. He, as many of you know has many options which we have narrowed down to 2, either Surgery or Bracytherapy.> If any of you have gone through these proceedures and don`t mind sharing the outcome with us we would appreciate it. We are concerned that Surgery may leave him wearing pads, and he may have ED. The concern we have with Bracytherapy is the Prostate is still there, how likely is the Cancer to return.>

[Guest guest]

What is his PSA and Gleason? How aggressive does the doctor consider it to be?

Cancer can recur with either or brachytherapy. If there is a recurrence there

may be more options ie radiation if there is a recurrence. My husband had

brachytherapy in 2000 and it recurred within a year. His PSA was below 10 when

he went for brachy.

Lots to consider. All the best!

Ann

Sent from my iPhone

[Guest guest]

> My husband Bob 58 has been recently diagnoised with Prostate

> cancer on Feb 16 2012.  He, as many of you know has many

> options which we have narrowed down to 2, either Surgery or

> Bracytherapy.

> If any of you have gone through these proceedures and don`t

> mind sharing the outcome with us we would appreciate it.  We

> are concerned that Surgery may leave him wearing pads, and he

> may have ED.  The concern we have with Bracytherapy is the

> Prostate is still there, how likely is the Cancer to return.

I had two " High Dose Rate " (HDR) brachytherapy sessions together

with supplemental 3DCRT external beam radiation and 4 months of

Lupron injections for my Gleason 4+3, PSA 10 cancer.  That was in

the winter of 2003-4 and, knock on wood, I appear to be cancer

free.

HDR brachytherapy is similar to the more common low dose rate

procedure but the seeds are very " hot " (highly radioactive) and

are only implanted for seconds at a time in each location in the

prostate, then withdrawn.  No seeds are left in the prostate.

However I am told that, in some ways, the effects and side

effects are similar.

I experienced a number of short term and long term side effects

of the treatment.

Short term:

    Soreness in the perineum.  That's the region between the anus

    and the testicles where the needles are inserted to plant the

    seeds.  It lasted a couple of weeks.

    Blood in urine and semen.  Happened a couple of times.

    Difficulty urinating.  This was caused by the prostate

    swelling up after the radiation and clamping the urethra.

    The urine couldn't get through.  It was very uncomfortable

    and caused me to have to urinate about once an hour, which

    was most bothersome at night.  I had to take Flomax to be

    able to urinate.  The problem was most severe for about two

    months and had completely cleared up in about five months.

    Aggravation of some pre-existing hemorrhoids.

    Some proctitis - scarring and itching in the rectum.  The

    scarring is probably permanent but the itching is gone and

    everything seems normal.

Long term:

    " Peyronie's Disease " - the penis was a little bent during an

    erection.  This took about a year to develop.

    Impotence - This took a number of years to develop.

    Sometimes, if everything is just right and I've taken a good

    dose of viagra, I can achieve penetration, but mostly I can't

    and don't try.  However I can still have orgasms and still

    very much enjoy sex.  We have sex in other, equally

    satisfying, ways.

The short term effects of surgery and brachytherapy are quite

different.  However long term effects are thought by many doctors

to be very comparable.  It is believed, for example, that a

number of patients get Peyronie's from either treatment, and that

the rate and degree of long term impotence is about the same.

For more information and to see stories from more patients,

please try Terry Herbert's " You Are Not Alone Now " website at:

    http://www.yananow.org

He's got lots of great information there.  To see info about

specific treatments try:

    http://www.yananow.org/choices.htm

and click on one of the treatments.  It is also possible to see

stories from hundreds of men about their personal experiences.

Personally, I think brachytherapy can be a good treatment, but

the key questions are:

 1. Does your husband need treatment, or is " active surveillance "

    appropriate for his case?

 2. If he needs treatment, does he need aggressive treatment or

    standard treatment?

    Aggressive treatment might include hormone therapy and

    external beam radiation along with brachytherapy, or

    following surgery.

 3. MOST IMPORTANT!  Have you found a doctor you can trust?

That last question is critical.  Many doctors think their job is

to perform medical procedures, often as quickly as possible on as

many patients as possible.  But what you want is a doctor who

thinks his job is to cure patients.  There's a big difference

between performing procedures and curing patients.  Curing

patients requires experience, skill, honesty, patience, caring,

and commitment.

I'd rather have surgery from a surgeon I really trust than

brachytherapy from a run of the mill radiation oncologist, and

vice versa for a run of the mill surgeon and a trustworthy rad

onc.

Good luck is always a great thing too.

So I wish the best of luck to you, your husband, and your family.

    Alan

[Guest guest]

FWIW --

With brachy, yes, " the prostate is still there " . But the radiation field

extends a little beyond the prostate, and may kill cancer that the surgeon might

miss!

My " local " brachytherapy group (in Vancouver, working with patients from BC) has

tracked its results for over 10 years, and finally published about a year ago.

Their relapse rate (adjusted for cancer stage and Gleason score, I think) is

lower than reported surgical rates.

You have to be _very_ careful in looking at reported relapse rates. There are

several different definitions of " biochemical relapse " , and several different

ways of rating the patients coming _into_ the study.

And you also have to ask:

.. . . How does _my_ surgeon compare to the guys who are writing

.. . . papers?

.. . . How does _my_ brachytherapist compare to the guys who are

.. . . writing papers?

The side-effects tradeoff (as you probably know) is something like this:

.. . . Surgery: Immediate ED which may get better over the long run;

.. . . . . . . Immediate continence problems which will probably

.. . . . . . . . get better over the long run.

.. . . Brachy: No immediate ED, but ED is likely to develop over

.. . . . . . . . the long run;

.. . . . Possible problems with urinary blockage and/or

.. . . . radiation damage to the bowel.

I had surgery in 2007. Given what I've experienced, and information that's

become available since then, I'd probably lean toward brachy now.

But it's a close call.

The doctors seem to think there will _never_ be a properly randomized,

head-to-head trial of the two techniques.

..

>

> My husband Bob 58 has been recently diagnoised with Prostate cancer on Feb 16

2012. He, as many of you know has many options which we have narrowed down to

2, either Surgery or Bracytherapy.

> If any of you have gone through these proceedures and don`t mind sharing the

outcome with us we would appreciate it. We are concerned that Surgery may leave

him wearing pads, and he may have ED. The concern we have with Bracytherapy is

the Prostate is still there, how likely is the Cancer to return.

>

[Guest guest]

A few more comments:

1) If you read through YanaNow.org, you'll find a wide dispersion of side-effect

severity for _any_ therapy.

Yes, he _could_ end up wearing pads after surgery, and probably will for weeks

or a few months after surgery. But _most_ surgical patients regain continence

in somewhere between 3 months and a year. Some have longer-lasting problems.

He will _almost certainly_ have serious ED after surgery. That doesn't mean " no

orgasms " , it means " no erections " . There's reasonable evidence that he should

be on a " penile rehab " program. He will _probably_ recover some erectile

function, slowly. His age is in his favor.

My current status, 4 years after surgery (FWIW -- remember what I said about

" wide dispersion " ):

I'm fully continent in the mornings, with mild stress incontinence late

afternoons and evenings. Long fast afternoon walk = " wear a pad " . I could

improve the situation by doing Kegels, which I neglect.

For intercourse, Viagra isn't quite enough. I've been using injections for over

3 years, and they work very well.

I don't know if this will frighten you, or make you hopeful. But it's one data

point . . .

PS -- If you haven't read Mulhall's " Saving Your Sex Life: A Guide to Men with

Prostate Cancer " , this would be a good time to do it.

>

> My husband Bob 58 has been recently diagnoised with Prostate cancer on Feb 16

2012. He, as many of you know has many options which we have narrowed down to

2, either Surgery or Bracytherapy.

> If any of you have gone through these proceedures and don`t mind sharing the

outcome with us we would appreciate it. We are concerned that Surgery may leave

him wearing pads, and he may have ED. The concern we have with Bracytherapy is

the Prostate is still there, how likely is the Cancer to return.

>

[Guest guest]

I was looking to have Brachytherapy but as I had soreness in the urethra it was ruled out and I had surgery.

That was 16 years ago nearly.

My friend down the road had brachytherapy and faired well.

I don't think there is a perfect treatment, put the proc and cons down on paper and think which pros do I want, which cons can I live with

Surgery verses Bracytherapy

My husband Bob 58 has been recently diagnoised with Prostate cancer on Feb 16 2012. He, as many of you know has many options which we have narrowed down to 2, either Surgery or Bracytherapy.If any of you have gone through these proceedures and don`t mind sharing the outcome with us we would appreciate it. We are concerned that Surgery may leave him wearing pads, and he may have ED. The concern we have with Bracytherapy is the Prostate is still there, how likely is the Cancer to return.

[Guest guest]

Thank you all so much for sharing your experiences with us. We are going to see the Radiologist tomorrow to speak further regarding Bracytherapy. We now feel a bit more educated on the subject and know what to ask them.

I will let you all know the outcome of our visit.

As you all know, knowing you have the big C reguardless of what type is a scary thing. Having input from people that have gone through proceedures and seeing your successes give us hope and relief.

I will most likely have more questions to come, and will be getting back to quite a few of you.

Thanks again

[Guest guest]

:

Your post describes the SEs for surgery but implies none for brachytherapy. As

others have noted there are SEs to brachytherapy.

ED takes a while to develop, but I believe the data shows it to be less than

surgery. Brachytherapy has much higher incidence of rectal incontinence than

surgery which is very low. Surgery has higher incidence of urinary incontinence

due to cutting out the bladder sphincter.

The following caused me to select surgery: 1) higher rectal incontinence for

brachytherapy- yuch!! 2) availablity of a pathology report on the removed

prostate gland which gives you another piece of data that may suggest further

treatment or give you peace of mind, and 3) a very immediate indication of

success- a negligible PSA reading.

With brachytherapy, you have a long period of hopefully declining PSA readings

until you know the PCa has been " cured " .

[Guest guest]

In an excellent post wrote:

> Your post describes the SEs for surgery but implies none for

> brachytherapy. As others have noted there are SEs to

> brachytherapy.

Yes indeed.

> ED takes a while to develop, but I believe the data shows it to

> be less than surgery.

I've seen claims, e.g., in Dr. Mulhall's book " Saving Your

Sex Life " that, after 3-5 years, the incidence of ED is about the

same for surgery and radiation.  Much depends on the age of the

patient, how potent he was before the procedures, how skillful

the doctor is, whether " penile rehabilitation " is started soon

after the procedure (that one is still controversial), and the

general dumb luck that seems to be a factor in every cancer case.

There are different sexual side effects for each procedure (e.g.

some surgery patients experience climacturia), but ED is one that

has a fairly high likelihood with both.  After a while there will

be some recovery after surgery and some loss after radiation but,

for most men, the net result will be that, even if they can still

manage some of the time and/or with the aid of drugs, they aren't

as potent as they were.

I personally think it's important to be prepared for this but

also important NOT to allow it to destroy physical intimacy,

which I believe can still be just as satisfying to both partners

after ED as before it.

....

> 3) a very immediate indication of success- a negligible PSA

> reading.

>

> With brachytherapy, you have a long period of hopefully

> declining PSA readings until you know the PCa has been " cured " .

I agree with that but I think I might phrase it the other way

around.  Surgery gives you an immediate indication of failure if

you don't have a negligible PSA shortly after the procedure.

Whether it was really successful is, like with radiation, a

question of time.

Whatever treatment he chooses, a patient should find the very,

very best doctor he can to apply it.

    Alan

[Guest guest]

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