Just got injected for the bone scan this afternoon. I met with a dr yesterday. He is a surgeon. He mentioned that they all have the same cure rates. Basically it comes down to this, side effects. He did mention that the radiation side effects start showing themselves later on from the residual effects of the radiation over time. Does that sound right? Is proton therapy really like the magic bullet or is it all pretty much the same?
I am meeting with the radiation drs later today hopefully. Just to get the sales pitch from that used car salesman.
NavyChief,
Talk to everyone but make sure you talk to someone at the Proton Center. Side effects from surgery are immediate and significant for many people while Proton has fewer side effects than other radiation therapies. I had surgery at PSA 3.95 and Gleason 7 and I was told not to worry as it was "early days" but unfortunately I had positive margins and the surgery failed to get all the cancer. It's almost 3 years since I finished my Proton salvage and I have no noticeable side effects from it. After my experiences I do lean towards some kind of radiation therapy as opposed to surgery because it covers the margins and to me seems to be a better way to proceed.
Bob
LOL@used car salesman. Everyone has to believe their therapy is the best, I guess.
I don't agree with your urologist's assessment that they all have equal cure rates for intermediate risk PC. (They do for low risk PC). Most treatments use a measure called Biochemical Recurrence-Free Survival (bRFS) to give an indication of what the cure rate is. It tells you what % of men do not have an increase in PSA after a given period of time. For intermediate risk men, here are some comparative results at the best institutions (they are 5-yr bRFS rates unless otherwise noted):
Surgery - 77% (Dr. Hernandez et al. at Johns Hopkins)
Proton - 65% (Dr. Slater et al. at Loma Linda - among men with PSA 10-20)
SBRT - 93% (Dr. Katz et al. at 8 institutions)
SBRT - 99% (Dr. Meier et al. at 21 institutions, 3 year)
HDR brachy (monotherapy) - 94% (Dr. Rogers at GammaWest)
LDR brachy (monotherapy) - 97% ( Dr. Taira et al at UWSeattle)
IMRT (81 Gy) - 78% (Dr. Zelefsky et al at MSK, 8 years)
IMRT (86 Gy) - 86% (Dr. Spratt et al at MSK, 7 years)
Adding hormone therapy or a Brachytherapy boost may improve outcomes, but adding risk of additional side effects.
The reason that radiation generally has better cure rates than surgery for intermediate and high risk disease is because the radiation reaches into the prostate bed where cancer cells may have already migrated.
The side-effect profile of each therapy is different. With surgery, the risk of incontinence is high. A recent Duke U. study found 90% had some incontinence after 1 year. Only 37% of men have potency preserved even with nerve sparing, 13% without nerve sparing. Other common side effects of surgery include penile shrinkage, climacturia (urination at orgasm) and stress incontinence.
The various types of radiation have somewhat different side effects, but in general, urinary and rectal symptoms are mild and transient, reflecting irritation from the radiation. There is a transient peak acute effect soon after therapy, which may include getting up a few times at night to pee, some burning and maybe some diarrhea. All can be medicated if bothersome. The symptoms may recur a year or more later. Such late effects are generally transient as well. It's rare to experience any late effects after a couple of years.
In terms of potency preservation, here are the results I've found reported:
It's basically come down to minimizing side effects for me. I would much rather have the crap out of me to tell you the truth but, at 40 I am not exactly ready to carry around a wet noodle if you hear what I am saying.
My radiation damage was fully done at approximately 2 years after finishing 47 external radiation treatments. But then you live with the damage for life.
My radiation damage was fully done at approximately 2 years after finishing 47 external radiation treatments. But then you live with the damage for life.
So 2 years after all your treatment the residual radiation caused. What are you trying to say?
Say for example Chief that I remember being able to get an erection after the 2 months of external radiation treatments. A few weeks later I could no longer get an erection. The penile sensitivity got less and less over the months. I have daily diarrhea for 9 years also from the radiation. So I mean that the diarrhea was a minor problem during radiation but it continued to get worse for 2 years. I went from a couple of Imodium over the counter to 6 Lomotil prescription tablets daily. What else? My testosterone never came back after the Lupron shots to stop testosterone production. That one happened right away. Those are my big problems. Think Hiroshima and how people got sick years later from the radiation from the atomic bomb.
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Ok, that pretty much helps me live with my descision.
I had a bone scan yesterday and today I had a ENDORECTAL MRI.
Let me just go ahead and say, if they offer this without knocking you out, go ahead and just ask for death. That was what I figure being raped by a Clydesdale would feel like. It's funny now but, it was far from funny at the time.
I would love to hear from a person or two that has the surgery. That is where I am leaning toward now.
In the end my descision comes down to 3 things
1) get this cancer gone. All of them do that
2) not have it come back. That's subjective I think
3) actually be able to continue to operate.
I realize that #3 is typically gone after surgery but does come back more often than not she with some help
From what I have been reading about radiation is that the residual effects of it take it away over time.
I may be completely off base here with that one. I am far from an expert. Lol.
Keep in mind that Chris's experience involved hormone treatment as well as radiation -- the effect on erectile function is much much worse than radiation alone. Also, keep in mind that salvage radiation after RP has much worse outcome than if the radiation is done initially. I cringe when I hear Uro's say "you can always do the radiation later if it fails." It's true that you can do it, but the urinary and sexual side effects of doing one after the other are horrendous.
My experience with radiation left me with no residual side effects two years later. Fully potent. No urinary or rectal side effects. All treatments (surgery and radiation) destroy the ability to ejaculate at orgasm.
Well now. I have all my info where I can actually read it. I thought I would share.
I have now had 4 PSA tests.
5/2012 13.05
9/2012 14.5
9/2012 14.6
11/2012 16.6
I am scheduled for surgery on 19DEC2012. I am just happy to know that this crap is going to be for the most part out of me. I may have to do some radiation afterwards but at least the majority is going to be gone. I'll go ahead and post the results of my MRI and BoneScan for history's sake
BONESCAN
FULL RESULT:
Examination: Whole Body Bone Scan, 11/14/2012
Clinical History: This is a 40-year-old male with prostate cancer. He comes to MD Anderson in consultation.
Indication: Study is performed for staging purposes.
Technique: Whole-body images were obtained in anterior and posterior planes after intravenous injection of 19.9 mCi technetium 99m MDP. Additional views of the arms above the head were also obtained.
Findings: No suspicious sites of activity within osseous structures. Physiologic activity within genitourinary system.
IMPRESSION:
No active osseous metastases.
MRI
Clinical History: A 40-year-old male patient with history of prostate carcinoma, elevated PSA level of 16.6 in 11/2012. Biopsy confirmed Gleason (3+4) 7 disease. Here for initial treatment planning.
Indication: Initial staging for newly diagnosed prostate cancer.
Comparison: Bone scintigraphy, 11/14/2012.
Technique: After 3-plane localization, axial T1-weighted wide field of view imaging were acquired through the pelvis. Dedicated small-field-of-view axial T1-weighted, 3-plane T2-weighted, axial diffusion weighted, and pre- and postcontrast axial 3D LAVA sequences in dynamic phase, were acquired through the prostate.
Findings: The prostate gland measures 2.6 x 3.9 x 4.4 cm in AP, transverse, and craniocaudal dimensions. Multifocal disease is identified within the peripheral zone of the prostate gland, with a couple foci of tumor located in the midline posterior aspect of the peripheral zone on image 23, and at the same image there is another focus noted in the right lateral peripheral zone in the mid gland. There is subtle low T2 signal focus also noted in the left medial peripheral zone at the prostate base, image 20, series 4. These foci, with the exception of the left base low T2 focus demonstrate associated increased enhancement with early peak and associated slow washout, suspicious for malignancy. All of these foci do demonstrate low ADC value. There is suggestion of minimal extraprostatic extension bilaterally, image 21 through 23, right greater than left, including in the region of neurovascular bundle. There is no evidence of seminal vesicle involvement, however.
The urinary bladder is unremarkable.
There are nonspecific mildly prominent bilateral iliac lymph nodes identified, image 22 through 25. These are most likely reactive lymph nodes, considering their size and appearance.
There is indeterminate T1 hypointense, slightly heterogeneous lesion identified in the right iliac bone in the region of the sacroiliac joint, image 13, series 2. This is not seen on any other sequence. This lesion is not covered within the field of view of other sequences. No other suspicious bony lesion is evident. This lesion in the right iliac bone is not showing any uptake on bone scintigraphy from 11/14/2012.
IMPRESSION:
1. Multifocal prostatic disease with minimal extraprostatic extension in the region of neurovascular bundles, right greater than left.
2. No evidence of seminal vesicle involvement.
3. Indeterminate abnormality within the right iliac bone without corresponding increased uptake in the bone scintigraphy. Plain radiographs can be obtained of this region to further evaluate. Old imaging comparison if available of this region would be helpful.
