It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 06-14-2012, 07:59 PM   #1
Junior Member
(male)
 
Join Date: Jun 2012
Location: NEW YORK
Posts: 26
Robert765 HB User
Recently Diagnosed Prostate Cancer.

Well I saw my urologist and fortunately the lab work showed no cancer outside the prostate. He says I'm an excellent candidate for any treatment I choose (age 62, PSA 2.5, Gleeson 3+3+6, postive 2 cores 65/75%) My choices, surgery (slightly better chance of no cancer in the future, but good chance of long term urinary complications), or radiation, (slightly less chance of no cancer in the future, reduced risk of long term urinary side effects, but if radiation fails, prostate surgery more complicated). Also within the radiation choice, EBRT, for many weeks, SBRT in five days...but newer SBRT not as much data for success as EBRT). And then he tells me the decision is mine!!!!!

For me, watchful waiting means missing this window of opportunity to eradicate the cancer. My gut reaction, take the EBRT with minimal side effects and hope for advances in radiation salvage in the future if I should need it.....that my reoccurrence of cancer...if it happens...might still be minimal and non-agressive and I can do watchful waiting at that time because I will be older.....or have my prostate removed and hope for no complications at an older age. Any one familar with stereotatic beam radiation therapy.....and/or Dr. Leonard Farber at the Farber Center in New York City?

 
Old 06-16-2012, 09:34 AM   #2
Senior Member
(male)
 
Join Date: Mar 2010
Posts: 116
Johnt1 HB UserJohnt1 HB UserJohnt1 HB UserJohnt1 HB UserJohnt1 HB UserJohnt1 HB User
Re: Recently Diagnosed Prostate Cancer.

Have you considered seeds (Brachytherapy)? Only a one hour out patient procedure with much better long term side effects than either surgery or external beam and slightly better cure rates across all gleason grades. The radiation dose given can be much higher, 100-150 grays vs 81gy for external and the radiation is limited to the prostate as radiation only extends 5mm so normal tissue in bladder and rectum gets very little radiation. For any radiation failure surgery is not recommmended as a salvage treatment, but you can be reseeded with low or high dose Brachy or do cryosurgery with the same effectiveness as salvage RT after failed surgery. There is also no risk of secondary cancers in Brachy.

 
Sponsors Lightbulb
   
Old 06-16-2012, 10:01 AM   #3
Junior Member
(male)
 
Join Date: Jun 2012
Location: NEW YORK
Posts: 26
Robert765 HB User
Re: Recently Diagnosed Prostate Cancer.

Thanks for your reply John. Yes, I have looked at the seeds. The problem is with every treatment choice I look at I find stats that support it as being the most effective with the least long term side effects. That is why this process of choosing has become so stressful. I settle on a choice eventually, but it has been a struggle. Robert

 
Old 06-16-2012, 02:17 PM   #4
Senior Member
(male)
 
Join Date: Sep 2008
Location: Irvine,CA
Posts: 141
dale2035 HB User
Re: Recently Diagnosed Prostate Cancer.

Quote:
Originally Posted by Robert765 View Post
Well I saw my urologist and fortunately the lab work showed no cancer outside the prostate. He says I'm an excellent candidate for any treatment I choose (age 62, PSA 2.5, Gleeson 3+3+6, postive 2 cores 65/75%) My choices, surgery (slightly better chance of no cancer in the future, but good chance of long term urinary complications), or radiation, (slightly less chance of no cancer in the future, reduced risk of long term urinary side effects, but if radiation fails, prostate surgery more complicated). Also within the radiation choice, EBRT, for many weeks, SBRT in five days...but newer SBRT not as much data for success as EBRT). And then he tells me the decision is mine!!!!!

For me, watchful waiting means missing this window of opportunity to eradicate the cancer. My gut reaction, take the EBRT with minimal side effects and hope for advances in radiation salvage in the future if I should need it.....that my reoccurrence of cancer...if it happens...might still be minimal and non-agressive and I can do watchful waiting at that time because I will be older.....or have my prostate removed and hope for no complications at an older age. Any one familar with stereotatic beam radiation therapy.....and/or Dr. Leonard Farber at the Farber Center in New York City?
Hi, Robert, I am not familiar with Dr. Farber or the Farber Center. I know nothing about the SBRT (I read that it was first used in UCLA Radiation Oncology...25 years ago...and only 5 treatments are required!!). Where I felt some kinship with you was your reaction to the very insightful thoughtful note from John. You appreciated it, but mentioned alternatives had claimed high effectiveness and low side effects. I found the same lack of confidence in my decision making, but did not want to engage in a lengthy research effort. I had some 4s in the Gleason and did not want to take months exploring options.
By the way ...you must have some competent and concerned medical staff...to get a biopsy with a low PSA. I presume the DRE showed some suspicious area. Your pcp's opinion would weigh more (in my opinion) than that of doctors who were more casual about this challenge to our health (did you notice the task force...chaired by a university professor ...of pediatrics!?).
With your catching this early (3+3!!)...your decision after a little more research ...will probably have very good results. My oncologist said my low PSA (even though I did not have your less aggressive Gleason) was the best predictor of his success. The Gleasons at 3 and the PSA below 3...you are envied by many of us.
The urologist who diagnosed my PC, recommended surgery (I read he is highly regarded with the use of DaVinci robot). He suggested I consult with a radiologist. I was very impressed with Dr. Tokita at his Irvine Cancer Center (my wife, who is smarter than I am) wanted me to choose that (but did not voice such a sensitive decision). I decided to drive the 52 miles to Loma Linda for proton therapy. I could not afford to stay there, but decided it was worth doing battle on the 91 (my wife joined me so I could use the car pool lane...not a small favor). My strongest motivation was survival. A secondary consideration was the advertised low side effects.
I took lots of space to make two points. One...from what I have read your numbers are highly conducive to you making a decision that is going to have a good outcome...and ..two.. proton therapy ...for me ...was effective (in 2008) and those marketing claims about low side effects were not overstated. I don't think NYC has that. Boston doesn't use their machine for prostate cancer. Hampton, VA and Philadelphia have joined the recent growth of sites (Florida, Illinois, Oklahoma, Texas, et.al).
Suggestion: when you make your decision, let us know...it may help another guy struggling with the sometimes confusing data. There are lots of guys, like John, who have lots of information that may address your specific questions. One surviving cancer patient who is generous here & has read everything written is Jim...with a handle ending "2000"---when he first start beating this. Good luck on your survival. Dale

 
Old 06-16-2012, 03:01 PM   #5
Junior Member
(male)
 
Join Date: Jun 2012
Location: NEW YORK
Posts: 26
Robert765 HB User
Re: Recently Diagnosed Prostate Cancer.

Thanks Dale for your reply and input. Actually was DRE was normal also. I chose to have the biopsy since I was having bouts of prostititis and my father and uncle both had PC when they were 65. I don't want to miss this window of opportunity to completely eradicate the cancer by watchful waiting. So I am hoping for the best with the treatment I select. Please stay in touch. Robert

 
Old 06-17-2012, 09:59 AM   #6
Junior Member
(male)
 
Join Date: Jun 2012
Location: NEW YORK
Posts: 26
Robert765 HB User
Re: Recently Diagnosed Prostate Cancer.

Thanks again John. I re-read your comment with a renewed interest in Brachytherapy. If you have any online resources you can share with me to support this therapy, I'd be very happy to receive it. I think I'll send a new post for other input as well. Robert

Last edited by moderator2; 06-17-2012 at 10:44 AM.

 
Old 06-21-2012, 10:12 AM   #7
Senior Veteran
(male)
 
Join Date: Nov 2007
Location: Annandale, VA, USA
Posts: 1,730
Blog Entries: 3
IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
Re: Recently Diagnosed Prostate Cancer.

Hi Robert and welcome to the Board!

I hope you have already benefited from the responses posted. (I have read through your latest, post #6. Thanks, Dale, for your kind comment.) Here are some additional thoughts.

You said in post #1 that you felt that "watchful waiting" might cause you to miss your window to eradicate the cancer. Your wording indicates you are not aware of the profound difference between "watchful waiting" (WW) and "active surveillance" (AS). WW essentially involves hoping you never experience the symptoms that would ultimately trigger treatment, usually when the cancer is well advanced and harder to treat, and when the opportunity for cure has usually been missed. In sharp contrast, AS involves first determining if you are likely to succeed with AS based on a number of generally agreed criteria, and, if you pursue AS, diligent monitoring to ensure that any stealthy aggressive cancer is caught in plenty of time, usually within two to three years, to achieve results as good as results would have been if you had been treated right away. We now have enough reseach to see that properly done AS is highly effective, with about 60% of eligible men not needing treatment long-term if ever, and many others typically gaining several years free of the burden of treatment.

However, you mentioned that the two positive cores were 65% and 75%. I'm taking that to mean they were 65% and 75% cancer. If so, while that does not violate the 2007 consensus criteria as the criteria did not include the percent of cancer in a single core, it raises a question. Some institutions with AS programs have been concerned about whether the percent of cancer in a core exceeds 50%. How many cores were taken? The criteria call for a Gleason <7 (you're fine), percent of biopsy cores positive versus all cores of <34% (2 of 12 would be fine), PSA of <10 (you're fine), PSA velocity of <2, PSA density of <0.15, and no nodules felt on DRE (you're fine). If I had your case circumstances (I'm envious), I would seriously consider AS but would want more imaging, such as color Doppler ultrasound (CDU) done by one of the few experts in the US. CDU or other imaging could be helpful in weighing the scales for or against other therapies as well.

There is an excellent analysis of AS as well as other therapy choices in the 2010 book "Invasion of the Prostate Snatchers (Blum and Scholz).

John emphasized seeds as a choice, which I am considering seeds myself, along with other non-surgical approaches. (My story is long so I'll leave it out here.) An interesting point about seeds is that the doctor's expertise appears to make a substantial difference. At centers of excellence, seeds for "low-risk" patients like you have an awesome record of success per published research: very near 100% with impressive follow-up time. However, at community practices, the results for seeds for low-risk patients are more in line with somewhat lower but still excellent results involving well done surgery, proton beam, and very well done EBRT. As you are interested in success records, take a look at the work of the Prostate Cancer Results Study Group. They have excellent graphics that track studies meeting their sound quality criteria. The color and symbol coded graphics display study results by degree of success (freedom from PSA recurrence) according to the length of average ("median") follow-up. Results are separated by patient risk level (low, intermediate, and high), which helps remove clutter that would otherwise interfere with comprehending what is going on.

The color coded symbols indicate the type of therapy. The last time I looked, there was no study reported for SBRT. That's because the follow-up was not long enough, and that may already have changed. SBRT is looking highly promising, but, as you noted earlier, the track record is still short and the number of published studies is small. On the other hand, we now have median follow-up of five years, an important milestone for illuminating side effects of radiation. My impression is that the radiation community is getting ready to embrace SBRT, but some doctors are definitely waiting for at least a couple more years of follow-up (7 years to cover some late developing side effects), and they would also like to see a greater number of studies. If you are interested in SBRT, you might want to check work being done at UCLA (especially Dr. Christopher King) and Stanford (where Dr. King practiced until about a year or two ago). Tall Allen has posted a number of times about SBRT (especially the CyberKnife version).

We can mention the PubMed website here according to Board rules because PubMed is government sponsored. The address is www.pubmed.gov, and you can search for details of studies in any area you want. For example, you can use PubMed to get details of studies appearing in the Prostate Cancer Results Study Group tables.

Well, this is getting long, so I'll close by wishing you well as you and I both work on finding the best therapy for each of us.

Take care,

Jim

 
Old 06-21-2012, 08:41 PM   #8
Junior Member
(male)
 
Join Date: Jun 2012
Location: NEW YORK
Posts: 26
Robert765 HB User
Re: Recently Diagnosed Prostate Cancer.

Thanks Jim. A lot of really good things for me to think about. To answer your question to me, I had 12 biopsy samples taken. Two came back positive for cancer. One the percentage of cancer was 65%, the other was 75%. I do seem to fit most of what I read is the ideal candidate for Active Surveillance (yes I did mean that but used watchful waiting), but I failed in completely meeting their criteria in that they said "no more than 2 cores positive with less than 50% cancer in each core. As far as Brachy is concerned, my third consultation is a Dr. who does that. Today, my second, I had the EBRT/IMRT doctor, which seemed very appealing (as much as these things can be), when compared to the doom and gloom meeting with my first consultation, a surgeon that said RP was the only way, and that you can't believe your Gleason scores, or biopsy % because they can be false, and I might have more cancer, and more agressive cancer then what was detected. Ugh. I want this to end. And yes, the group has been ENORMOUSLY informative and comforting during all this. Thanks everyone.

Last edited by Robert765; 06-21-2012 at 08:43 PM.

 
Closed Thread




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Join Our Newsletter

Stay healthy through tips curated by our health experts.

Whoops,

There was a problem adding your email Try again

Thank You

Your email has been added




Top 10 Drugs Discussed on this Board.
(Go to DrugTalk.com for complete list)
Casodex
Cialis
Cipro
Flomax
Levaquin
  Levitra
Morphine
Proscar
Tylenol
Viagra




TOP THANKED CONTRIBUTORS



Tall Allen (174), IADT3since2000 (148), Baptista (97), Gleason9 (28), harpman (27), Johnt1 (22), honda50 (9), tumbleweed (6), flyfisher37 (6), GUAMJOHN (5)

Site Wide Totals

teteri66 (1162), MSJayhawk (990), Apollo123 (890), Titchou (825), janewhite1 (823), Gabriel (757), ladybud (737), sammy64 (666), midwest1 (665), BlueSkies14 (610)



All times are GMT -7. The time now is 01:45 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!