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Old 10-20-2009, 10:41 AM   #1
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Brachytherapy vs open surgery

New to this board after having been recently diagnosed with prostate cancer. I went for my annual physical and found out through blood testing that my PSA level was elevated (3.5). After being referred to an Urologist, he suggested that I have a biopsy done. Of 12 samplings 5 turned out cancerous, one at a 3+4, the rest at 3+3. Naturally I was in a panic at first. Next was the bone density and pelvis MRI to determine if the cancer had spread beyond the prostate, luckily as it turns out, the cancer is contained within the prostate. I was scheduled to have robotic surgery in early November But started to do some research on-line to see what other options were available. So I went for a 2nd and 3rd opinion. First to the Chicago Prostate Center to discuss Brachytherapy, then to Dr. Catalona. Dr. Catalona is most widely known for being the first to show that testing the levels of prostate-specific antigen (PSA) is the most accurate method for detecting prostate cancer and for having helped developed the "free" PSA test as a means of improving the accuracy of prostate cancer screening. So I felt I was in good hands with him. He suggested his specialty, which is open surgery by hand (nerve sparring technique) which he stated was better than robotics because of the manipulation of the nerve bundles. My concern was the recovery period. Two days in the hospital and up to a month at home, then between 1 and 3 years to fully have all my bodily functions back to normal if everything goes right. Brachytherapy also seems like a good way to go, it's less invasive, the surgery is done on an outpatient basis, sometimes getting back to work within a day or two. and the side effects seem to be less. The drawback to me was that I don't seem to find enough studies or reports on the long term results such as cure rates or recurrences of cancer. At age 54, I would hate to have to go back in 10 or 15 years with additional prostate issues. Now I'm trying to decide on which procedure would be right for me. Anyone out there have any thoughts ??

 
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Old 10-20-2009, 11:36 AM   #2
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Re: Brachytherapy vs open surgery

I'm sorry to hear of your diagnosis, but I'd like to welcome you to this board where, hopefully, you will benefit from the collective experiences of others.

Making a treatment choice is a tough decision. It sounds like you’ve done some homework and understand that each possible choice comes with some concerns. Nobody here will “tell” you what is best for you (nor should you accept that type of input via the internet, from people you don’t know). Different men have different clinical cases, different backgrounds, different current situations, and different personalities which all can figure into what might be the best choice for them individually. Because the overall outcomes are often assessed to be so similar for low risk cases, I think that after doing homework and understanding the treatment trade-offs, a lot of men will latch onto a particular treatment or provider that they felt most comfortable and confident in. Nothing wrong with that; in fact, I believe it's important as a patient to have confidence in your decision. I wouldn't worry about making a "wrong" decision; you seem to be already on a good path.

The general guidance with selecting a surgeon is to go with someone with vast experience, reputation and success, and then let him use the tools (open or robotic technique) that he feels most comfortable; you’ve already seen one of the most reputable surgeons in the region in Dr Catalona.

My suggestion, for starters, is to peruse through the “history file” of postings that this board has become for topics of interest to help learn about the specific experiences of others, then come back with more specific, targeted questions. An old Chinese saying goes: “If you want to learn about the road ahead, speak to those you pass on the return route.” You will find guys on this board who have gone through brachytherapy, open surgery, robotic surgery, photon radiation, proton radiation, hormone therapy, and active surveillance, and can help answer specific questions based on their personal experiences. Few of us have, however, gone through multiple treatments and can give a personal experience which compares the two.

Again, welcome to the board, and best wishes...

 
Old 10-20-2009, 03:38 PM   #3
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Re: Brachytherapy vs open surgery

Hi Amerirish,

I'll join kcon in welcoming you to the board! I've got some Irish Chicago roots myself and was at Northwestern in '65 - '67 for graduate school. Yep, went through the great blizzard. There was a heap of snow in one of the Northwestern parking lots as late as May. I've never been so cold in my life - 4 inches of ice on the inside of our bathroom window.

I'll try to add more comments later, but just wanted to mention that brachytherapy could be an excellent choice for your intermediate risk case. (If you do go to surgery, Dr. Catalona would be an outstanding choice for the open surgery option, as it appears you already know.) I'll insert a thought or two in green.


Quote:
Originally Posted by amerirish View Post
... my PSA level was elevated (3.5). ... Of 12 samplings 5 turned out cancerous, one at a 3+4, the rest at 3+3. Naturally I was in a panic at first. Next was the bone density and pelvis MRI to determine if the cancer had spread beyond the prostate, luckily as it turns out, the cancer is contained within the prostate. ... Brachytherapy also seems like a good way to go, it's less invasive, the surgery is done on an outpatient basis, sometimes getting back to work within a day or two. and the side effects seem to be less. The drawback to me was that I don't seem to find enough studies or reports on the long term results such as cure rates or recurrences of cancer.

Actually, brachytherapy is among the best documented therapy options, and it also looks remarkably fine in long-term studies, sometimes paired with external beam radiation depending on the risk assessment. In fact, Dr. John Blasko, MD, of the Seattle Prostate Institute, gave a presentation on brachytherapy and other options at the National Conference on Prostate Cancer 2009 in September. He highlighted impressive results for brachy from an upcoming expert panel review of all therapies and risk levels that will probably be published within the next year.

If you want to do your own research, viewing abstracts of the same studies that doctors use in their education and decisions, go to www.pubmed.gov, a site we can use on this board because it is Government sponsored. Try a search string like " prostate cancer AND brachytherapy AND intermediate risk " (without the quotes). I just did that and got 190 hits. Be sure to see the second paper by Dr. Michael Dattoli that results from the following narrowed search - " prostate cancer AND brachytherapy AND intermediate risk AND dattoli m [au] ". You might also try substituting Dr. Blasko as an author instead of dattoli ( " blasko j [au] ").

Take care,

Jim


At age 54, I would hate to have to go back in 10 or 15 years with additional prostate issues. Now I'm trying to decide on which procedure would be right for me. Anyone out there have any thoughts ??

 
Old 10-21-2009, 05:48 AM   #4
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Re: Brachytherapy vs open surgery

Thank you kcon and IADT3since2000 for your welcome, support, and the information you both have provided me. Presently, I am still in the process in deciphering all the information about options dealing with prostate cancer and it's treatment. I am currently waiting for lab results from a new test called Prostate Px, where the biopsies are put through advanced medical and mathmatical analysis. During these analyses, important characteristics of the cancer are identified and measured to assess how aggressive the disease is. I realize that the decision on which course of action to take is mine and mine alone to make. I have read through many of the postings, which have given me a broader insight to the different treatment options through people sharing their experiences pre and post operative. This is a great board for obtaining info. Once again, thanks kcon and IADT3 SINCE2000.

 
Old 10-21-2009, 10:44 AM   #5
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Re: Brachytherapy vs open surgery

Thanks for the update. I was only marginally (very marginally) familiar with the Prostate Px, introduced originally (I believe) as a tool to predict probability of biochemical recurrence (BCR) or progression (spread)…but my understanding is that this was originally used for post-operative therapy decisions. Statistically, somewhere around 30% of men (I’ve seen it published between 15%-40%) who undergo RP surgery are diagnosed with biochemical recurrence (BCR) within 5 years after RP, many of which are subsequently treated with adjuvant radiation therapy (RT). It's been known for some time that quick RT treatment after RP is most effective, but standard practice is to monitor PSAs after surgery (and to use the post op path report is a prognostic tool). My understanding is that this was another tool to give "peace of mind" post-operatively.

This was the first time I had heard of its use pre-operatively, at the diagnostic stage. Amerirish, can you please tell us more about this, and also keep us informed of its use (and interpretation) in your case? I think others would be interested now and in the future about first hand experiences. I haven’t heard of any other first hand experiences on this board (although I may have missed them, but I did a board search and found nothing).

I just did a quick Google search myself, and (in my words) I learned that the product is now presented as a diagnostic stage tool to help detect high-risk patients that might otherwise be presenting with low risk characteristics (PSA, Gleason). Sounds useful to pre-operatively decide whether to skip RP and go straight to RT (perhaps like those 30% of RP patients might have wanted to do), and also to support whether Active Surveillance (AS) is a viable therapy option. I believe that today the PSADT is most widely used to predict aggressiveness, but there inherent variation in this which this tool seems to be a step forward.

Please share more with us…

thanks

Last edited by kcon; 10-21-2009 at 12:00 PM. Reason: added the comment in parenthesis: "(and to use the post op path report is a prognostic tool)"

 
Old 10-21-2009, 12:42 PM   #6
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Re: Brachytherapy vs open surgery

kcon,
After being diagnosed with prostate cancer by my urologist, I went for a second opinion to the Chicago Prostate Center because of my interest in brachytherapy as an alternative to radical prostatectomy. I met for a consultation with Dr. Moran who is the Medical Director of Chicago Prostate Center, which he helped found in 1997, he has been performing prostate seed implants since 1994. He suggested that my biopsy slides be sent to Aureon Labs to run the Prostate Px analysis. Dr. Moran mentioned that this test would score the cancer on a scale of 1 to a high of 100, the closer your score is to 1, the less aggressive your cancer is. By looking at the results of this report, the doctor can then help in choosing the course of action that is best suited for me, and explain to me the all the treatment options.

Last edited by moderator2; 10-21-2009 at 01:07 PM. Reason: please do not post websites except as described in the Posting Policy

 
Old 10-30-2009, 11:50 AM   #7
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Re: Brachytherapy vs open surgery

Quote:
Originally Posted by amerirish View Post
kcon,
After being diagnosed with prostate cancer by my urologist, I went for a second opinion to the Chicago Prostate Center because of my interest in brachytherapy as an alternative to radical prostatectomy. I met for a consultation with Dr. Moran who is the Medical Director of Chicago Prostate Center, which he helped found in 1997, he has been performing prostate seed implants since 1994. He suggested that my biopsy slides be sent to Aureon Labs to run the Prostate Px analysis. Dr. Moran mentioned that this test would score the cancer on a scale of 1 to a high of 100, the closer your score is to 1, the less aggressive your cancer is. By looking at the results of this report, the doctor can then help in choosing the course of action that is best suited for me, and explain to me the all the treatment options.

To all,
Received the results from the Prostate Px test last week and my score was a 25, which makes me a candidate for the Brachytherapy. I had another consultation at the Chicago Prostate Center to address some questions that I had about the procedure. The next step for me is, I am going to a support group to talk with patients who have had brachytherapy and hear from them about any issues they may have had or are currently experiencing. Then in about a week I will have a volume study. The volume study is actually an ultrasound of the prostate, which uses the pictures to determine the exact size and shape of the prostate gland and create a 3-D image of the prostate. According to my doctor, after the volume study, it can be determined if Brachytherapy will be an option in my case. Then lastly, I will make a decision on which direction I will take in treating my cancer. If no one minds, I will keep everyone posted throughout the process, my decision, the surgery, and post op. progress.
Amerirish

 
Old 10-30-2009, 12:46 PM   #8
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Re: Brachytherapy vs open surgery

Quote:
Originally Posted by amerirish View Post
If no one minds, I will keep everyone posted throughout the process, my decision, the surgery, and post op. progress.

Definitely; please do keep us posted. There are some guys here on this board who have also gone through brachytherapy who might be another source of info for you. (Use the board's Search function, for starters, and/or post your questions.) Glad to hear that you are making progress in your learnings on what possible treatment may be appropriate.

I'm still curious to learn more about the Prostate Px, and would appreciate more info. Not much besides Aureon press release material is available on the intranet; no first-hand experiences. Not so interested in it for myself [no longer anything there to test!], but rather so that I might give more valuable guidance to others in the future.

You said your score of "25" makes you a candidate for brachytherapy. My understanding is that a score between 1 and 100 is returned from the biopsy sample re-test/analysis that scales the likelihood of post-therapy progression. Would you also mind sharing more about what you learned about the test & it's results, please? I'm sure others in the future might also benefit from your experience by also using the board's Search function, looking up Prostate Px, and finding your posting.

thanks, and best wishes...

 
Old 12-09-2009, 08:53 AM   #9
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Re: Brachytherapy vs open surgery

Quote:
Originally Posted by kcon View Post
Definitely; please do keep us posted. There are some guys here on this board who have also gone through brachytherapy who might be another source of info for you. (Use the board's Search function, for starters, and/or post your questions.) Glad to hear that you are making progress in your learnings on what possible treatment may be appropriate.

I'm still curious to learn more about the Prostate Px, and would appreciate more info. Not much besides Aureon press release material is available on the intranet; no first-hand experiences. Not so interested in it for myself [no longer anything there to test!], but rather so that I might give more valuable guidance to others in the future.

You said your score of "25" makes you a candidate for brachytherapy. My understanding is that a score between 1 and 100 is returned from the biopsy sample re-test/analysis that scales the likelihood of post-therapy progression. Would you also mind sharing more about what you learned about the test & it's results, please? I'm sure others in the future might also benefit from your experience by also using the board's Search function, looking up Prostate Px, and finding your posting.

thanks, and best wishes...
Kcon,
Here is what I found out about the Prostate Px test off Aureon Labs website. You were right about the analysis scaling the possibility of post-therapy disease progression. See Below:

A report will be sent to the physician within one week of the specimen arriving at Aureon. Each report focuses on the patient’s individualized results including:

Disease Progression Score (0-100): reflects the likelihood of the patient developing Disease Progression (defined as bone/soft tissue metastases, death of disease and/or androgen independent rise in PSA within eight years of their diagnosis)

Favorable Pathology: The favorable pathology endpoint predicts the likelihood of a favorable outcome post-prostatectomy, i.e., prostatectomy Gleason score <6 (no pattern 4 or 5), <pT2 and PSA nadir post-prostatectomy

Quantitative Morphometric Features: describes the objective quantification of a number of features from the digital image of the H&E sample

Photomicrographs: segmented and classified images
Biomarkers: provides an interpretation of a number of protein markers if ordered separately by the physician.

Tomorrow (12/10), I will be having the brachytherapy procedure performed at the Chicago Prostate Center in Westmont. Only time will tell if I will become cancer free. I feel confident in my direction on combating this disease. I will keep everyone posted on my post-operative recovery, probably on a weekly basis.
Amerirish

 
Old 12-09-2009, 11:05 AM   #10
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Re: Brachytherapy vs open surgery

Glad to hear you are moving confidently into your treatment phase. I recall how I felt a sense of relief once I made my treatment decisions. I wish you the best success, and look forward to hearing more from you.

 
Old 12-11-2009, 12:35 PM   #11
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Smile Re: Brachytherapy vs open surgery

Quote:
Originally Posted by kcon View Post
Glad to hear you are moving confidently into your treatment phase. I recall how I felt a sense of relief once I made my treatment decisions. I wish you the best success, and look forward to hearing more from you.
kcon,
Had my brachytherapy procedure yesterday at 11:00 am. After the procedure, I was taken for a cat scan and x-ray so they could check the location of the seed implants, (71) of them. I was home and resting by 3:30 pm. Had a little perenial pain from the needle, but am feeling much better today. I feel about 90% of my normal self. There is a trace amount of blood in my urine and after about the fourth urination I haven't felt any more of a burning sensation. Everything seems to be working the same as it did before the procedure. I was told that the prostate may swell because of the implants, causing you to have the feeling the need to urinate, but this hasn't been the case with me as of yet. Besides being a little tired, probably from the procedure and the medication, I'm doing fine and will be back to work after this weekend.....so far, so good
Amerirish

 
Old 12-17-2009, 02:06 PM   #12
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Re: Brachytherapy vs open surgery

Quote:
Originally Posted by amerirish View Post
kcon,
Had my brachytherapy procedure yesterday at 11:00 am. After the procedure, I was taken for a cat scan and x-ray so they could check the location of the seed implants, (71) of them. I was home and resting by 3:30 pm. Had a little perenial pain from the needle, but am feeling much better today. I feel about 90% of my normal self. There is a trace amount of blood in my urine and after about the fourth urination I haven't felt any more of a burning sensation. Everything seems to be working the same as it did before the procedure. I was told that the prostate may swell because of the implants, causing you to have the feeling the need to urinate, but this hasn't been the case with me as of yet. Besides being a little tired, probably from the procedure and the medication, I'm doing fine and will be back to work after this weekend.....so far, so good
Amerirish

Well, it's been a week since the procedure. The first couple of days I had some mild perineal pain from the needles, but after the weekend the pain was all but gone. Now, the effects from the radiation has kicked in and I do feel a burning sensation and the frequency to urinate has increased. During the day I have to urinate at least once every two hours, when I go to bed I get up approximately twice during the night. I returned to work on Monday and besides the mild urinary irritation, I feel pretty good. I was informed that this irritation may last anywhere between 3 weeks to 3 months. Tonight I will try to do a light workout at the health club. All in all, things are much better than I expected. At this point, my body is functioning the same as it was before the procedure.
Amerirish

 
Old 12-21-2009, 08:23 PM   #13
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Re: Brachytherapy vs open surgery

My Urologist does all 3 procedures but because of my age - 59 - and otherwise good health and that the cancer was contained, we chose the DaVinci LRP. I had the procedure in the afternoon and went home the next day feeling quite good. The catheter was removed in a week and because I had religiously done my Kegal exercises before and after surgery, I had fairly good bladder control immediately. The uro did a good job sparing my nerves so in a few months I regained normal sexual function. I guess I'm a bit biased toward the DaVinci LRP because it worked out so well for me.
__________________
God bless you!
Deacon Michael
(DaVinci LRP Feb 21 2007)

 
Old 12-25-2009, 03:58 PM   #14
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Re: Brachytherapy vs open surgery

Quote:
Originally Posted by amerirish View Post
Well, it's been a week since the procedure. The first couple of days I had some mild perineal pain from the needles, but after the weekend the pain was all but gone. Now, the effects from the radiation has kicked in and I do feel a burning sensation and the frequency to urinate has increased. During the day I have to urinate at least once every two hours, when I go to bed I get up approximately twice during the night. I returned to work on Monday and besides the mild urinary irritation, I feel pretty good. I was informed that this irritation may last anywhere between 3 weeks to 3 months. Tonight I will try to do a light workout at the health club. All in all, things are much better than I expected. At this point, my body is functioning the same as it was before the procedure.
Amerirish
Merry Christmas all !!!!!
15 days post seed implants. Around the 7th, 8th, and 9th day the radiation from the seeds were at their worse. The burning sensation was at about a 7 on the scale of 1-10. Saturday night, the 9th day post procedure I took a couple af Alleve before bed and slept like a baby. The next day I woke up expecting the burning sensation, but it was completely gone. It has never returned. I still get up once or twice during the night to use the bathroom and go every 2 hours or so during work. I have resumed my workout routine at the health club, and after 10 days am at about 80% of my normal workout at this point. Couldn't be happier with the results I have seen so far. No urinary incontinence, nor do I have any problems with E.D.
Amerirish

 
Old 12-31-2009, 08:03 AM   #15
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Re: Brachytherapy vs open surgery

Quote:
Originally Posted by amerirish View Post
Merry Christmas all !!!!!
15 days post seed implants. Around the 7th, 8th, and 9th day the radiation from the seeds were at their worse. The burning sensation was at about a 7 on the scale of 1-10. Saturday night, the 9th day post procedure I took a couple af Alleve before bed and slept like a baby. The next day I woke up expecting the burning sensation, but it was completely gone. It has never returned. I still get up once or twice during the night to use the bathroom and go every 2 hours or so during work. I have resumed my workout routine at the health club, and after 10 days am at about 80% of my normal workout at this point. Couldn't be happier with the results I have seen so far. No urinary incontinence, nor do I have any problems with E.D.
Amerirish

Hello All,
Happy New Year !!!!
It's been 3 weeks since the implant procedure and I feel great. I'm back to my regular workout routine of 1+ hours at the health club and have felt no adverse affects from the procedure since around the 10th day. My urine stream isn't as strong as it was, but this should improve as the radiation and swelling of the prostate from the procedure diminishes. Not much else to report on, I will go for a PSA test in 2 1/2 months so it's just a matter of waiting now to see if the PSA number has begun to drop. I can only say that I'm glad that I made the decision to have the brachytherapy procedure. I realize that it's not for everyone depending on your diagnosis or personal preference. My only advise is to do your homework and research before making a choice and get a 2nd/3rd and even 4th opinion to make you feel comfortable with your decision.
To all, have a healthy and prosperous New Year !!!!!!!!!!
Amerirish

 
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