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1 19th July 22:14
olfart
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Default New Kid on the Block


Been lurking for about a week and saw some interesting information so
thought I'd jump in.
An 68 yrs old and reasonably good health.
Nov 2003 got a PSA of 4.8. DRE was normal.
Biopsy showed carcinoma in 1 of the 8 tissue cores with a Gleason of
4+4=8
All other core samples were benign
Visits to an Oncologist and a Radiation/Oncologist have led to the
following course of treatment.
Last week - began antiandrogen therapy - Eulexin
Next week - will start Neoadjuvant therapy for approx 3 months
In 3 months - begin IMRT therapy for 5-6 weeks
After IMRT - Theraseed Implants

The opinion of all 3 doctors at this point is that even though the
Gleason was high, the fact that the cancer is small and is still
contained within the Prostate, the planned treatment should yield good
results.

Judging from what I have read from the group posts, the majority opted
for surgery. I would appreciate any comments form those of you who
have had treatment similar to that outlined above. Thanks to all.
George
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2 19th July 22:15
alan meyer
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My treatment is somewhat like yours. I had 2 months of
hormone suppression with Lupron, then a high dose rate
brachytherapy. I am now in the midst of 23 external beam
radiation treatments and will have one more high dose rate
brachytherapy near the end.

As near as I can tell from my reading, the results of radiation
when well done are as good as surgery when well done.
Either approach can fail if not well done, or if the cancer
has already spread beyond the prostate.

I chose radiation over surgery partly because I liked the
particular radiation oncologists I met, and partly because
I am hoping for fewer side effects.

So far, the side effects have been very manageable. I lost
two days of work for the brachytherapy (done on a Thursday
and held over in the hospital for one day, plus another due
to a bad reaction to Flowmax). But I was back at work the
next Monday and felt okay.

The Lupron I am taking has caused a big drop in libido,
and gives me hot flashes - which I find very tolerable in
the cold weather.

The external beam treatments are starting to aggravate
my hemorrhoids. I smear on lots of a petroleum jelly
ointment given to me by the medics.

The brachytherapy caused some small pain and tenderness
in the perineum, but it is temporary and not bad. I never
wanted any pain killers for it.

The primary difference between our therapies is that
you are using the hormone suppression for a longer
period - which is probably very good, and you are getting
the permanent low dose rate brachytherapy instead of
the two temporary high dose rate procedures that I am
getting. I would have accepted either of those approaches
but took the high dose rate because I am in a clinical
trial involving it, rather than because I thought it was
a better choice. The permanent seed implants you
are getting deliver more total radiation and may therefore
be a more conservative choice.

From everything I have learned, it sounds to me that
the therapy you are getting is sound, conservative, well
proven, and has an excellent chance for a cure.

Good luck with it.

Alan
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3 22nd July 07:20
steve kramer
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Wow, that's quite a plan. But, I guess with a Gleason of 8, he's going
after it aggressively.

--
MERRY CHRISTMAS
Prostate Cancer Survivor (so far), not a doctor
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000
PSA .1 .1 .1 .3 .4 .8
EBRT 05-07/2002 @ 47
PSA .3 .2 .2 .2 .3
Erection 05/12/2003 @ 48
Begin Lupron 07/21/2003 @ 48
PSA .1
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4 22nd July 07:20
beverley
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Hi, Welcome to the club that no one really wants to belong to but since
you've joined .......HI!

My hubby had 5 weeks of external beam radiation on a IMRT. Then he had
brachytherapy (permanent seeds - 121 seeds of Iodine long lasting "125"
seeds.) That was almost 20 months ago. He's had a few side effects. The
biggest problem he has was urinating. I couldn't get the stream going
without pain. Now he only occasionally has a dull ache and no longer takes
anything for it.

He has had some problems with erections but we manage in that department
with a little help.

His Gleason was 6 (3+3) and his PSA was 4.8, fPSA was 8.9 . At 16 months
(post treatment) his PSA was 0.16 and still falling. He is now 57.

The EBRT was a breeze. He did it before work each morning. Has his seeds
implanted on a Friday and so he missed almost nothing in the way of time
from work. His rad-onc is at the Massey Cancer Center - the Medical College
of Virginia. We were very pleased and still feel as though my husband chose
the right path for him.

What you have said sounds as if they are being very aggressive. I think that
is positive. They don't want to miss any renegade cells. That Gleason score
is high but at least it was only in one sample. I wish you lots of luck and
if you have any questions that I might help you with please feel free to ask
either on or off the group.
Bev
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5 22nd July 07:20
olfart
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luck and

free to ask

Thanks for the reply. Sounds as though your husband received the same
course of treatment that is planned for me and his results sound very
encouraging. I'm glad that he is doing so well and hope he contimues
to improve. My best to you both.
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6 22nd July 07:20
ray walsh
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I opted for RRP for a number of reasons which I won't repeat here unless you
want to hear them.

My driving reason was simple and more psychological than anything else.

All the pre-RRP tests showed that it was likely that the PCa was contained.
I wanted the reassurance of the Gleason being confirmed and that surgical
margins were clear and that there was no spread to the seminal vessicles or
the lymph nodes. As far as I am aware, the only sure way of getting
absolutes on these issues (note I did not seek a guarantee that the PCa had
not spread. That's not possible.)

Therefore, in order, my priorities were:

1. Yank it out and inspect it and the surrounding area.
2. Continence
3. ED

The RRP was exactly 3 years ago. PSA is undetectable. I had continence
control from the moment the catheter was removed. No change in ED, but 2 out
of 3 ain't bad, and the overall prognosis for me is pretty good.

My readings at dx were: age 60, PSA 4.8 stage T1c bone scan clear Gleason
3+3 -- confirmed post op.

Hope this helps

Ray

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7 22nd July 07:20
jimhoney
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I'm no doctor, but my research tells me that your age makes you a
borderline candidate for surgery. It appears that surgery would cure
the cancer at one go, but you might have problems with incontinence
and impotence.

You might want to talk to a surgeon anyway.

What you should aim for is to choose a course of treatment and then be
satisfied with your choice and never look back.

jimhoney
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8 24th July 20:02
gourd_dancer
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George, Good Luck with your treatments...

I am 56 with a Gleason of 4+3 and opted for Palladium seeds last April and
90 days later 25 IMRT treatments. Only real problem that I have encountered
are urinary....no rectal problems at all....The urinary are caused by
inflammation (Protratis) caused by the implants. And that just takes a
little time to reduce the inflammation...No ED problems....

Mike
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9 24th July 20:02
olfart
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Glad to hear you are having minimal problems. My treatment will be
about the same as yours, but in reverse order. The doctors seem to
feel that external radiation *after* seed implantation can possibly
result in too much radiation which might cause damage to surrounding
organs (bladder,etc). Started Hormone Therapy today with IMRT in about
3 months. Good luck and have a Merry Christmas.
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10 24th July 20:03
leonard evens
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At your age, I think it is about even as to which has worse side
effects, surgery or radiation. If you don't have access to a first
class surgeon, you would definitely be better off with radiation, which
is less dependent on the skill of the doctor. Radiation will otherwise
not be as invasive.

The reason so many seem to have had surgery is probably that the group
here is younger on the average than the typical prostate cancer pateint,
who is over 70. Such patients are more likely to have radiation since
worrying about the cancer's status in 15 or 20 years is less of an
issue. It isn't that current methods of applying radiation are known to
give worse recurrence results than surgery in the long, long term. It
is just that data for that long has yet to be collected because the
methods currently in use, which use carefully focused higher intensity
radiation, haven't been around long enough.

If you were to have surgery instead, you would have the advantage of
whatever additional information the post-surgical pathology would
provide. This could suggest that the cancer was completely confined,
or, that it had probably escaped the prostate, at least locally. The
latter is more likely than for most cases because of the Gleason 8, but
less likely because of the small extent of what was found in the biopsy
and because of the relatively low PSA. Were that to happen, follow-up
radiation to the prostate bed would be the next step. In your case,
starting with radiation, that is already built into the treatment
method. They will get the cancer in your prostate for sure and they
hope to also get any small amount which may have escaped. The
particular characteristics of your case give you a reasonably good
chance of a complete cure. Good luck!
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