Well, Petermoo, it is not an easy decision. I made mine and am in Sarasota beginning treatment at the Dattoli Center. Just before I came here, I had a moment where I was doubting my choice. A client called and I would be unavailable for 6 weeks and eventually told her why. She related to me that her husband had PC and was doing fine. He had a Gleason of 9 and the urologist said, "Let's cut." They had a relative at the Mayo clinic and got a 2nd opinion and the opinion concurred with that of the urologist. That was 2 yrs ago and his psa is 0 and everythjing else normal.
I don't know what the rest of his stats were, but it made me pause and reconsider surgery.
I have looked at where I am on the Partin Table and I ggive myself a 56% cahnce that it has spread outside the prostate capsule. Now my doctor, who I saw today, put my number at 85%. He is the expert, I am the layman. I do think he may be a bit of a pitch man which was uneccesary since I was already in the door. Regardless, even with my figure at 56% that is basically a coin toss. Not good enough for me.
We went on to do an ultrsound with color Dopplar that shows so much more than the basic black and white. We were able to see the tumor and affected tissue on the right side that the biopsy indicated and what may be some activity on the left side that could have been missed by the biopsy. The tumor you could see reaching out from the prostate and the doctor said that with surgery that point reaching out could be snipped off and left behind.
We did some more blood work, a CT scan and everything indicated that the cancer hadn't spread and of course the bone scan that was done a week ago or so.
Well all in all, it was a good experience.The clinic is unlike a hospital setting. There is not the sense of the impending trauma that surgery carries with it. I had shoulder surgery 5 weeks ago. I didn't deal with that very well and that was day surgery.
I recently downloaded the John Hopkins White Papers on Prostate Issues. Pages 36 - 60 deal with prostate cancer and covers all the various treatments, the upsides and downsides. Comparing the radical prostectomy with radiation therapy, when it is all boiled down, the risks of each in terms of side effects are about equal so that shouldn't be a deciding factor.
Here at the Dattoli clinic they are planning a multiple modality approach, I believe it is called. Beam surgery for 25-30 sessions, then the braccytherapy, then a rest period of 2 to 12 weeks then back in for another 12 sessions. All the while I will be doing hormonal therapy. It is an option. I don't like the idea, though Jim has given me a liitle better understanding of the side effects, and the numbers support the benefits that can be derived. I'll be taking Avodart and Casodex orally and They will give me an injection of another one, not estrogen, pbobably Lupron or Eligard. Don't know about those two. Need to investigate. Jim, you out there? Any advice. They would like me to do the hormonal therapy for a year.
There is a good page, Peter, on the Dattoli Website, the faq page. Gives answers to a lot of questions. What you make of the answers, are they skewed, well, I don't know. They apparently have the numbers to back up their claims. you would need to do the research. They have a great reputation.
I have been given a 92% chance at being cured. Do I believe that? I would certainly like to but I would be happy with an 80% chance.
Yes I'm here and taking a break from 7 1/2 hours of working on my deck today. It's nice to get away from it. I'll intersperse some answers in green. Jim
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Originally Posted by bwhitney
...I ...am in Sarasota beginning treatment at the Dattoli Center. ...
I think you will be delighted with your choice, and I'm interested in your experience. If I ever decide on radiation therapy, it will almost surely be with Dr. Dattoli.
We went on to do an ultrsound with color Dopplar that shows so much more than the basic black and white. We were able to see the tumor and affected tissue on the right side that the biopsy indicated and what may be some activity on the left side that could have been missed by the biopsy. The tumor you could see reaching out from the prostate and the doctor said that with surgery that point reaching out could be snipped off and left behind.
Dr. Dattoli's center is one of only a handful of centers in the country that are skilled in using Color Dopper Ultrasound (CDU) imaging. I've seen talks on it and think it's a wonderful technology, giving a much better picture of the likely size, shape and location of the cancer. For those who do not know about CDU, it uses the Doppler signal to tell where new blood vessels are growing; they grow around the growing tumor to supply it, so when you image them, you get an excellent idea where the tumor is and what it looks like. Of course, part of that advantage is that you see if the tumors are near the capsule, are through it, near the urethra, or near some other weak points like the points where neurovascular bundles exit the prostate.
We did some more blood work, a CT scan and everything indicated that the cancer hadn't spread and of course the bone scan that was done a week ago or so.
...
That blood work almost certainly involves a Prostatic Acid Phosphatase test (PAP). Dr. Dattoli has been the champion of that test for helping to predict radiation therapy outcomes, and you can read his published research on www.pubmed.gov, a site we can use on this board because it is sponsored by the US Government. If you look for (without the quotation marks) " dattoli m [au] and PAP ", you will get five hits. More about that later.
Here at the Dattoli clinic they are planning a multiple modality approach, I believe it is called. Beam surgery for 25-30 sessions, then the braccytherapy, then a rest period of 2 to 12 weeks then back in for another 12 sessions. All the while I will be doing hormonal therapy. It is an option. I don't like the idea, though Jim has given me a liitle better understanding of the side effects, and the numbers support the benefits that can be derived. I'll be taking Avodart and Casodex orally and They will give me an injection of another one, not estrogen, pbobably Lupron or Eligard. Don't know about those two. Need to investigate. Jim, you out there? Any advice.
Basically you will be on my triple hormonal blockade therapy, though I take finasteride in place of the Avodart; I'm convinced that Avodart is a better choice for most men. I'm thoroughly convinced that triple therapy is best for most men, though some do well with just two drugs, and a few do well with just one, with surgical castration equivalent to the Lupron/Zoladex/Eligard/etc. type of drug ("LHRH-agonist") Accumlating research is indicating that hormonal blockade drugs help make radiation more effective, and they have a powerful separate effect of their own. Accumulating research is also persuasive that men with higher risk case characteristics, like your Gleason 8, do substantially better when hormonal blockade is added to support radiation. To me, it's an open and shut case in favor of hormonal blockade for higher risk men.
By the way, the eminent medical oncologist Charles "Snuffy" Myers, who specializes in prostate cancer, was treated by Dr. Dattoli for his own challenging case of prostate cancer. Two key elements of his therapy were the radiation beam/seeds combo and 19 months of triple hormonal blockade therapy. At his last (recent) report, he is doing very well at the ten year point since diagnosis with an undetectable ultrasensitive PSA. Now that's what I really appreciate: a doctor who cares so much about his patients that he gets the same disease so he can see what they are going through.
They would like me to do the hormonal therapy for a year.
It's likely the Dattoli team has carefully figured how much hormonal therapy you would need in view of the particular characteristics of your case. I would be highly confident in their decisions.
There is a good page, Peter, on the Dattoli Website, the faq page. Gives answers to a lot of questions. What you make of the answers, are they skewed, well, I don't know.
They apparently have the numbers to back up their claims. you would need to do the research. They have a great reputation.
Yes, they have the numbers, and to me they are stunningly encouraging, especially for higher risk patients. You can be confident in the numbers because Dr. Dattoli and his colleagues publish their results in major, peer-reviewed medical journals. The fact that he works closely with top experts from other institutions is a sign of his confidence and stature.
I have been given a 92% chance at being cured. Do I believe that? I would certainly like to but I would be happy with an 80% chance.
I know that estimate of 92% cure is surprisingly high for a patient with a Gleason Score of 8, but Dr. Dattoli and his team are scrupulous about staging each patient and have the research to back up what they say. Moreover, for you it is not the case of a doctor leaning on the Dattoli statistics because you are being treated by the originator.
The CDU and the PAP are two of the key tools they use. in 2003 they published an extremely interesting paper on their results with high risk patients, with emphasis on PAP. While they found that the PSA looked like a somewhat good predictor and that the Gleason score and PAP looked like really good predictors on first level analysis, when they went to second level (multivariate analysis), they found that most of what the Gleason score seemed to predict was really due to the patient's PAP level. In other words, many patients with high Gleason's also have high PAPs, but when you sort them out, those high Gleason patients whose radiation succeeds strongly tend to have lower PAPs.
The Primer has a couple of pages on PAP, featuring results from Drs. Moul and Dattoli, on pages 52 and 53; it has a more detailed discussion in Appendix B, Section 3.1, pages B4 and B5 in my 2002 edition.
That 2003 paper breaks out the PAPs into these ranges, with the approximate ("~") percent of success (by my eyes reading the graph) shown at about the 9 to 10 year point, with "failure" counted as a PSA of greater than 0.2:
Those are awesome success figures for high risk men, provided you have a decent PAP! On the other hand, I've heard Dr. Dattoli say that his approach may not be the best for men with higher PAPs. To me, that is not discouraging; rather, it is a great sign of progress that this technology can be used to predict when this radiation approach will be successful, and when it would be better for the patient to have a different kind of therapy. Adding hormonal blockade, and other advances in treatment that have come after these men were treated, should lead to even better results.
I'm also impressed that Dr. Dattoli's team collaborated on this paper with doctors from the U. of Washington in Seattle, one of the other great prostate cancer radiation locations in the world.
Here's the citation for the paper. Of course you can get a free abstract at www.pubmed.gov, but PubMed also offers a link to a free copy of this particular paper. I think you will be encouraged if you look at the details for yourself.
Long-term outcomes after treatment with external beam radiation therapy and palladium 103 for patients with higher risk prostate carcinoma: influence of prostatic acid phosphatase. Dattoli M, Wallner K, True L, Cash J, Sorace R. Cancer. 2003 Feb 15;97(4):979-83.
The 2008 paper by the Seattle team and Dr. Dattoli updates some of the figures. You can view the updated figures for the PAP ranges right in the abstract, but there is no link to a free copy.
There are other things the Dattoli center does to enhance success, such as a special way of putting seeds at the edge of the prostate. He says that this gives about 5mm of radiation beyond the prostate, and that is where most cancer is in the early time after it has exited the prostate.
I suspect that the Seattle experts also use these techniques, and I would be interested whether the Radiation Clinics of Georgia (RCOG) does, but I would not be surprised at all if many radiation doctors have not yet picked up on these advances.
You are just a wealth of information and in many case, comfort. Thanks once again, Jim
You are most welcome!
I just thought of another major development since the men in that encouraging study were treated: Image Guided Radiation Therapy (IGRT). Dr. Dattoli was one of the pioneers. In fact, he sends a fair proportion of patients to the Netherlands to get Combidex imaging when he thinks that would help, and he has a way of plugging in the results of that imaging with the other imaging his staff routinely does, futher enhancing treatment planning and targeting the cancer.
Dr. Dattoli has been a regular presenter to packed halls at the series of more or less annual National Conferences on Prostate Cancer, once called the International Conference on Prostate Cancer, a series which is aimed mainly at empowering patients. (I've been to four.) DVDs of his talks are available from the Prostate Cancer Research Institute (PCRI, mainly Dr. Mark Scholz, Stephen B. Strum, Richard Lam and their colleagues, including Dr. Myers and other leading experts on the board), and from the Foundation for Cancer Research and Education (FCRE, sponsored by Dr. Charles "Snufffy" Myers, his wife, and team). You are past the point where those talks would make a difference in your decision, but you might find them interesting.
By the way, another edition of the conference series is being held this September at the Los Angeles airport Marriott. Dr. Dattoli will not be presenting, but instead attendees will hear from one of the pioneering experts from the Seattle Prostate Institute, Dr. Blasko, a team with whom Dr. Dattoli has collaborated in research.) I cannot always go to the conferences, especially when they are on the other coast, but I find I learn a lot from the DVDs. But there is really nothing like being there. The sense of fellowship with around a thousand prostate cancer survivors and caring, expert doctors is priceless!
I'm greatly looking forward to your comments on your experience.
Starting Treatment: 
Hello again,
If I ever decide on radiation therapy, it will almost surely be with Dr. Dattoli.
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