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Old 09-26-2010, 02:10 PM   #1
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My Dad has prostate cancer... seeds or surgery?

Hi. I have been lurking on this most informative board for almost a year now. My dad was diagnosed with prostate cancer in November 2009. He is 69 years old, in excellent health and I want to keep him around forever. He, on the other hand, wants to live a life of quality vs quantity and therein lies the rub.

I do not have all of the information that I need to properly inform you of his status but this is what I do have....His PSA in Sept 2009 was 4.4 rising from 3.8 in March 2009. This is what prompted his MD to refer him for a biopsy. The biopsy was sent to Bostwick Labs and showed 2 out of 12 cores positive. Both are in the right base with the most peripheral being 10% positive and the one to the left of it 40%. He is a Gleason 6 (3+3). I believe it was determined to be a T1 tumor. His urologist (a surgeon) recommended radical prostatectomy due to his age and very good health/life expectation. We also saw a Radiation Oncologist who also sided with surgery due to my dad having a 50 cc prostate with urinary symptoms.
My dad considered Watchful Surveillance as he seemed to fit into the criteria. My mom did not find that acceptable.

So...seeds seemed to be the lesser of the two evils to my dad. He had the TUNA procedure to prepare him for seed implants. I learned that it was scheduled for OCT 11 and had a small coronary. I wanted to make sure we weighed all of our options (at least the ones he was willing to consider). IF he had surgery, he would have the DaVinci with Dr. Vipul Patel at Celebration Hospital. We had two scheduled appts which daddy dear cancelled.
My dad is most interested in the most amount of cure with the LEAST amount of side effects. He said for HIM there are worst things than being dead and he is speaking primarily of any life altering incontinence. He said he and my mom were never "Superstars" in the sexual arena which is something I did not need to hear.

With this limited information....what do you think? It is hard to get an unbiased opinion from doctors in their particular specialty. Surgeons want to cut...it's what they do. We have another appt with the DaVinci fellow and I am sure that is what he will recommend. But really and truly...which do you think offers the least amount of side effects overall and of course we want some time (my lifetime if I could have it).
Thank you for reading this never ending story and I really appreciate any and all help/advice.

D-

 
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Old 09-26-2010, 03:02 PM   #2
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Re: My Dad has prostate cancer... seeds or surgery?

If I had such a small amount of cancer of low grade, I'd side with your dad on Active Surveillance, but really active- like PSA checks every 3 months.There's a risk-- PSA/PSA doubling time is not always a reliable indicator - lots of false negatives and false positives. Most of the time PC is a slow-growing cancer, but there can be exceptions.

Is he on finasteride/dutasteride? That can sometimes shrink the prostate and make him a better candidate for some of the other therapies that have fewer side effects in a couple of years. Personally, I chose hypofractionated SBRT (usually called CyberKnife or Novalis Tx with RapidArc).

I agree with you that there is no need to jump into anything hastily, and that the type of doctor he sees usually predicts their recommendation. I think there are lots of avenues to explore, all with varying degrees of risks, uncertainties, and side-effects.

- Allen

 
Old 09-26-2010, 03:17 PM   #3
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Re: My Dad has prostate cancer... seeds or surgery?

Hi Myfavfellow! Here is the experience of one of my family members. He had skin cancer on his chest and they took it out and followed it with radiation. He seemed fine for almost as many years as the other relative who also got cancer at nearly the same time. His cancer returned in his skin. The other relative who did surgery, chemo and vege juicing survived and has been declared free of cancer for 8 years. I just don't respect radiation as much as I respect surgery followed by proper health support. Yes the funstuff such as certain intimate functions is fun but how about living longer for the rest of the family? They do make their own choices usually but perhaps if they hear the experiences of others.... it might be helpful

Last edited by sjb; 09-26-2010 at 03:20 PM.

 
Old 09-26-2010, 05:49 PM   #4
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Re: My Dad has prostate cancer... seeds or surgery?

I agree with Allen that AS will have the least side affects and if closley monitored can be treated with similar results as if treated immediately.
Seeds give the best opportunity for the least amount of side affects with the same results as surgery. The only concern is that current urinary problems may worsen with seeds. His 50mm prostate can be shrunk about 50% with 3 months of Casodex and Proscar and will make the seeding easier and more effective.

 
Old 09-27-2010, 12:32 PM   #5
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Re: My Dad has prostate cancer... seeds or surgery?

myfavfellow:
In July 2010 I had a bi-lateral nerve sparing open prostatectomy by Dr Catalona in Chicago. It was a very difficult decision but it was the right decision for me. Dr Catalona and the staff at the NorthWestern Hospital were excellent during the surgery and recovery process. He was able to remove the prostate completely and also spare both nerves. With the surgery I found out within a week from the Pathology report that the lymth nodes were negative, cancer was still staged at 3+3=6 with a very small amount of 4. Ten to twenty percent of the prostate had cancer, no cancel cells found in the blood; however there was an area where it appears that the cancer had penetrated the margin but that some small amount of margin remained clear. Dr Catalona stated that the odds are high that my PSA will remain at 0.0, but if it should change, I would need need some radiation targeted to this one location. All in all, I was very pleased with the outcome. Although I did suffer from incontinence the first two months, it only occurs now during heavy lifting (very minor leakage). Prior to surgery I suffered from the early stages of ED. After surgery, for the first month I took Cialis followed by penile injections as part of the rehabilitation process. In both areas, I'm satisfied with the progress. Most importantly for me, I feel that I was surgically cured of cancer. It's of great comfort to me and my family knowing that the cancer was contained and removed by an excellent surgical team. I'm sure that this is a difficult decision for your father and my heart goes out to him. For me the decision boiled down to one of certainty. I wanted the peace of mind knowing that the cancer was removed. I knew that I could live with short term pain for long term gain. I have a lot to live for with a wonderful wife, loving children and now several grandchildren. My hopes and prayers are with you and your family.

Details: Age 60, elevated PSA from 2.8 to 4.2, after antibiotics 3.9. Biopsy Apr 15, 2010 diagnosed with T1C, Gleason was 3+3 = 6 on the right side with 2 of 8 specimens showing cancer, and 3+3 = 6 on the left side with 5 of 6 showing cancer. Prostate enlarged 419mm. Apr 23rd bone scan and CAT scan negative.

 
Old 09-27-2010, 08:14 PM   #6
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Re: My Dad has prostate cancer... seeds or surgery?

Welcome to the Board!

I'll join Johnt1 and Tall Allen's chorus in favor of active surveillance, and I like the idea of using finasteride (or Avodart) as mild medical help. Also, now would be the time to put lifestyle tactics to work with vigor. I'll add a comment or two in green.


Quote:
Originally Posted by myfavfellow View Post
Hi. I have been lurking on this most informative board for almost a year now. My dad was diagnosed with prostate cancer in November 2009. He is 69 years old, in excellent health and I want to keep him around forever. He, on the other hand, wants to live a life of quality vs quantity and therein lies the rub.

I do not have all of the information that I need to properly inform you of his status but this is what I do have....His PSA in Sept 2009 was 4.4 rising from 3.8 in March 2009. This is what prompted his MD to refer him for a biopsy. The biopsy was sent to Bostwick Labs and showed 2 out of 12 cores positive. Both are in the right base with the most peripheral being 10% positive and the one to the left of it 40%. He is a Gleason 6 (3+3). I believe it was determined to be a T1 tumor. His urologist (a surgeon) recommended radical prostatectomy due to his age and very good health/life expectation.

Except for that one core with 40% positive, he is right in line with active surveillance criteria, and he deserves some leeway due to his age.

We also saw a Radiation Oncologist who also sided with surgery due to my dad having a 50 cc prostate with urinary symptoms.

That makes sense, but it does not rule out radiation.

My dad considered Watchful Surveillance as he seemed to fit into the criteria. My mom did not find that acceptable.

Your mom really needs to learn about active surveillance as well as about side effects from other approaches. AS is far from doing nothing, and many of the worlds leading prostate cancer surgeons are solidly in favor of it for appropriate patients like your dad. A lot of research has been done that backs that up. I could send you leads to some leading studies guidelines if you wish.

...
Thank you for reading this never ending story and I really appreciate any and all help/advice.

D-
Take care,

Jim

 
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