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Old 10-30-2008, 11:43 AM   #1
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Need your help: Seeds or Robotic Surgery?

Hi everyone, I'm 64 yrs. old & in pretty good shape. A couple of months ago my PSA went to 3.9 frim its usual 2.5 area & my urologist suggested a biopsy which came back positive w/ 3 out of 12. My Gleason score is 3+3 & the size of the prostate is normal.

I have no symptoms.

Met again yesterday w/ the Robotic Oncologist who described my particular surgery as a "chip shot". He's done over 300 of these at age 35 at Stony Brook University hospital on Long Island. Next week on 11/6/08 I will visit w/ the Radiation Oncologist to hear what he has to say.

Originally my first impulse was to jump at the surgery since I've already had melanoma & kidney cancer & both removed via surgery w/ excellent results.
However the more I read about the side effects of surgery plus the equally good results from Brachytherpy cause me paralysis by analysis.

Any feedback regarding which coarse you have taken & why will be apprecaited.

Thanks,
Jagguy

 
Old 10-30-2008, 12:26 PM   #2
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Re: Need your help: Seeds or Robotic Surgery?

Some of this sounds very familiar- it was just a little over a year ago for me. I was 64, PSA went up just like yours, although my Gleason was a 3+4 with 1 of 12 cores being positive. After meeting with my urologist, I scheduled robotic surgery (400 had been done to date). Then I started reading about alternatives (some of which were never mentioned by my doctors). As I got deeper into the process, I cancelled my surgery date while I completed my research.

I'd suggest you step back and do some due diligence before making a final decision. I eventually chose proton beam therapy after reading an excellent book and then emailing/speaking with a couple dozen who had done this. One person was already in the process of his treatments and it was after his urging that I finally scheduled a consultation. Once I completed that, I switched from undecided to clearly wanting proton radiation.

Thousands have had this form of radiation, which is highly targeted (no exit dose of radiation) so the side effects are not as great an issue. While more centers are now in process, including a major facility at Univ of Penn, there are five now. The one open the longest is in Loma Linda, California. I went to University of Florida Proton Therapy Institute in Jacksonville. It does require a much longer commitment for the treatment, because it takes place (for a brief period each day) over about two months. During that time, you pretty much have a normal life- albeit living temporarily somewhere else.

I've posted quite a bit on this, but I'd suggest you expand your list of treatment alternatives. The book that started me off on all this is one written by Robert Marckini, entitled "you can beat prostate cancer". As an aside, if you do choose surgery, you might want to stay with the tried and proven "open" method, or choose a doctor/facility where more than 300 procedures have been completed.

 
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Old 10-30-2008, 01:02 PM   #3
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Re: Need your help: Seeds or Robotic Surgery?

I went with brachytherapy because:

1. Horror stories of surgery after effects (as it turned out I wasn't eligible for surgery anyway)
2. Well documented record of successful treatments
3. Ease and speed of treatment (2 one day hospital visits)
4. Possible complete lack of side effects (achieved in my case except for repercussions of a previous treatment 25 years ago)

I've since found out that Brachytherapy is the most popular form of treatment in USA, and there are not many people on this site complaining!

All the best with your decision making,

T.
__________________
Peter, Brachytherapy in Guildford, England March 2008

Last edited by tumbleweed; 10-31-2008 at 04:21 PM. Reason: spelling corrections

 
Old 10-30-2008, 01:33 PM   #4
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Re: Need your help: Seeds or Robotic Surgery?

I went with RPR a year ago. Gleason 7, psa 5.
So far so good. PSA non-detectable, no incontinence, except few drops during rapid moves or lifting. ED still a problem. 50% there. VED helps.
My surgent was the best in the bay area. So that helped I guess.
Good luck

 
Old 11-03-2008, 12:19 PM   #5
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Re: Need your help: Seeds or Robotic Surgery?

Thanks Jim. I have read some studies on WW but may want to look at it more closely. Again , just starting the process but will consider everything at this point. Thanks for sharing your thoughts and information.
Did you have the PC and are you on WW?

The deacons are looking like a much better FB program past few years which is good for ACC. I am one of those diehard Tarheel fans though as my wife and children all went there.

 
Old 11-03-2008, 01:47 PM   #6
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Re: Need your help: Seeds or Robotic Surgery?

Quote:
Originally Posted by panthersfan7 View Post
Thanks Jim. I have read some studies on WW but may want to look at it more closely. Again , just starting the process but will consider everything at this point. Thanks for sharing your thoughts and information.
Did you have the PC and are you on WW?

...
I've been suprised how well Wake has done. My wife and I were classmates for four years with Brian Piccolo, and those were dismal years, with Piccolo one of the few fine players. My sons went to Georgia Tech and NC State, and my sister and brother to Duke and Wake - keeping it in the ACC.

I had a challenging case from the get-go nine years ago, so defering therapy was not an option, but I've learned a lot about it.

The term "Active Surveillance" is often used interchangeably with "Watchful Waiting," but the cores of the two approaches are quite different. Pure WW is waiting to treat until you get symptoms - often at a late stage of the disease, which just makes little sense in view of what we know now. AS takes advantage of results from the major programs to achieve great predictive power whether the patient's cancer is likely to remain indolent or turn aggressive. The major programs I know of that are publishing results and their methods, in addition to Toronto (Sunnybrooke - Klotz), Johns Hopkins (Carter as key leader), and Memorial Sloan Kettering (Scardino as the senior researcher), are Erasmus Medical Center in the Netherlands (Schroeder, or Schroder with an umlaut), MD Anderson (Babaian), and UC San Francisco (Peter Carroll). Dr. Klotz has probably been at this seriously for the longest time; my impression is that he is considered the foremost leader in Active Surveillance among these fine physician/researchers. I've learned a lot from reviewing his talks to medical conventions. I've also heard Dr. H. Ballentine Carter describe results from Johns Hopkins.

While most of the leaders prefer that their AS patients be older, Dr. Schroeder is comfortable with patients as young as 55, and Dr. Klotz is comfortable with patients of any age, provided that younger patients are reviewed and monitored with extra care. My impression is that age 62 is certainly not too young to consider AS.

Jim

 
Old 11-03-2008, 05:36 PM   #7
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Re: Need your help: Seeds or Robotic Surgery?

Quote:
Originally Posted by panthersfan7 View Post
...
And last, I am still a little confused on how the proton treatment works as to killing cancerous and not noncancerous cells....
While I did respond to this in my last post, you got me thinking so I looked at some of what was written in Patrick Walsh's latest book (one you have ordered I believe). It says that there is no evidence to suggest that healthy prostate tissue left behind after radiation therapy could turn back into cancer. In addition to its direct killing effect on cancer, radiation impedes the development of the new blood vessels that cancerous tissue relies on.

This discussion is on page 394 of that book.

There are also brief mentions of proton-beam radiation in this book. In one place it says that there is little evidence it's better at controlling cancer than external beam radiation. From other material that I've read, my opinion is the same. However, I believe that side effects are less likely or less severe with protons and that's why I did it. There is a description that proton beams are charged particles with the beam shooting in a straight line, penetrating through tissue with very little effect until it reaches a predetermined distance, at which point the cancer-killing energy is released.

 
Old 11-04-2008, 04:47 AM   #8
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Re: Need your help: Seeds or Robotic Surgery?

Mel,

If you have or get the Primer, it too has a description similar to what daff wrote:

Quote:
Originally Posted by daff View Post
... However, I believe that side effects are less likely or less severe with protons and that's why I did it. There is a description that proton beams are charged particles with the beam shooting in a straight line, penetrating through tissue with very little effect until it reaches a predetermined distance, at which point the cancer-killing energy is released.
The Primer covers Proton Beam on pages 119-122 and has a graphic about how it releases its energy on page 121. No doubt the Marckini book goes into much more detail about that aspect.

Jim

 
Old 11-04-2008, 07:50 AM   #9
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Re: Need your help: Seeds or Robotic Surgery?

I just got my package from UFPTC today. Quick response from them. And the Marckini book is part of their package. So now I will have two books but that is fine. I can give one to someother man who has our problem.
I really appreciate again how helpful, candid, and resourceful you and Jim and others are on this board.
I have so much information now to digest that I know will take awhile. I have the Second Opinion on Thurs. and have to be out of town a couple days. I will then refocus on all the materials I have and go back to this site and others for first hand experiences men have had with various treatments. I am about half way through Walsh book.
Again, thanks so much. I won't have internet access for a couple days but will let you all know what Second Opinion at Presbyterian opined on Friday or Saturday.
I do believe I will get a consultation in Florida if they will take me. Can't lose anything by doing so it seems.
Take care. You contribute so much to us guys who are scared and confused. Thanks so much.

 
Old 11-04-2008, 07:55 AM   #10
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Re: Need your help: Seeds or Robotic Surgery?

Jim, maybe I missed something but what is the Primer?

i appreciate your help in answering questions. I have looked some more at AS but I just don't believe I could ever get physically or emotionally comfortable with that option which may be a very good one, I recognize. I just want to get this durn thing killed permanently hopefully and with fewest side affects possible. I would always worry I believe that it would spread and then be too late for me to kill it. I am just not a gambler (although it feels like that with my investment portfolio results lately) with my health.

thanks, Mel

 
Old 11-04-2008, 08:07 AM   #11
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Re: Need your help: Seeds or Robotic Surgery?

Quote:
Originally Posted by panthersfan7 View Post
Jim, maybe I missed something but what is the Primer?

... Mel
Mel,

The Primer is the great book by Dr. Stephen B. Strum and Donna Pogliano, now in it's second edition, "A Primer on Prostate Cancer - The Empowered Patient's Guide." I'm sorry for not spelling it out before; I thought it had already come up in exchanges with you.

Being comfortable with a therapy approach and having confidence in it are important. In that respect, Active Surveillance is not for everyone even if the case is low risk!

Jim

 
Old 11-04-2008, 09:02 AM   #12
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Re: Need your help: Seeds or Robotic Surgery?

Quote:
Originally Posted by panthersfan7 View Post
I just got my package...
I do believe I will get a consultation in Florida if they will take me....
Mel-
Glad to hear you're getting the info you need to help you sort through this. It seems overwhelming, but once you get into things, it won't seem so daunting.
I don't know what kind of backlog they may have at Jacksonville now, but I might suggest that you get on their schedule for a consultation so you keep things moving on a couple different fronts. You can always cancel or reschedule. I'm not sure if this it's still their practice, but I had to have my biopsy slides sent to them for review-- all that took was a call to the hospital that had them. They also can help with your insurance company should you want to move forward.
Good luck on Thursday- you should learn a lot now that you're armed with information and can ask good questions...

 
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