PeterD
New User
Joined: 03 Sep 2005
Posts: 1
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 Posted: Sat Sep 03, 2005 11:10 pm Post subject: Low risk treatment selection - side effects and other issues |
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Hi all.
I am age 64 and have been diagnosed with Pca, tumor T2a, 1/6 of organ, Gleason 6, PSA 1.7, negative CT and negative bone scan. Several surgeons and oncologists say that this is very low risk Pca, and risk of recurrence is low regardless of treatment. They say treatment selection for me depends mainly on: (1) my emotional feeling about removing the prostate vs. killing it and leaving it in place, (2) my preference for early vs. late information on margins and PSA nadir, and (3) consideration of side effects. Prostate volume is 43 cc. Have had mild BPH symptoms for 17 years, controlled by cardura but often noticable as incomplete emptying of the bladder.
I am now contemplating two options for teatment: robotic (DaVinci) prostatectomy by a guy who has done 520 of them, and High Dose Rate brachytherapy monotherapy, by a guy who has done maybe 1000 HDR + EBRT and only 170 HDR monotherapy (with good results but limited follow-up).
I am emotionally in favor of getting the thing out and knowing about negative / positive margins early. However, the side effects and one technical issue tend to make me lean slightly toward HDR monotherapy. Following are the issues. Can anyone shed any light on these by personal or medical experience?
1. Expected incontenency with RP is 3 - 9 months, with small percent, say 2-5 %, never fixed. It is said to be caused not by surgical damage, per se, but by removing the prostate which acts as a stricture. So my question about this is:
What is it really like to use pads (or diapers) after RP ? Is it a tremendous inconvenience or only a small bother? They say that it is usually reduced in a short while to stress incontenance and a few drops. Is this a problem for you or not? How would it be if I were one of the unlucky few who dribble forever? I can't really visualize it, but I imagine that a couple of drops would not be an issue. I have that now.
2. With RP, I can expect a great urine stream in time, fixing the BPH symptoms, if I can eventually control the flow. That's the good news.
3. With HDR brachy, the side effect of main interest to me is obstruction of urine flow caused by prostate irritation / swelling. I have seen printed words to the effect that people with pre-existing BPH symptoms may have a hard time of it. Self-catheterization is mentioned, which sounds awful. My HDR therapist says my BPH symptoms are not really bad and I should be OK, but I am not so sure of that. Has anyone any experience or advice with that? How bad can the stoppage be?
4. On the other hand, HDR brachy and all irradiation options have much less incontinence and slightly improved potency rate. So it looks like I am trading one urinary symptom for another and slightly better probability of potency.
5. The hooker in all this is that it is alledged that there may be some undetectable stray cancer cells, for example, caused by the biopsy itself, that could take root outside the surgical margins later. The RP will not get these. The HDR brachy might get them because the dose profile is designed with a 5 mm margin.
Can you say anything that will make this 50-50 choice any easier?
Thanks for taking the time to read and consider this. |
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DavidCohen
Regular
Joined: 05 Mar 2005
Posts: 37
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| Posted: Mon Sep 12, 2005 11:21 pm Post subject: Re: Low risk treatment selection - side effects and other is |
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A normal RP will give as good or better results than the robotic method. The robotic method only heals faster, but does not give better continence, potentcy, etc. Only healing.
Yes, it would be nice to know if the margins are positive. However, an excellent surgeon has a better chance of saving the nerve with a normal RP, not the robotic method.
I had a regular RP, and only used pads for one week. No continence problems now.
David
[quote="PeterD"]Hi all.
I am age 64 and have been diagnosed with Pca, tumor T2a, 1/6 of organ, Gleason 6, PSA 1.7, negative CT and negative bone scan. Several surgeons and oncologists say that this is very low risk Pca, and risk of recurrence is low regardless of treatment. They say treatment selection for me depends mainly on: (1) my emotional feeling about removing the prostate vs. killing it and leaving it in place, (2) my preference for early vs. late information on margins and PSA nadir, and (3) consideration of side effects. Prostate volume is 43 cc. Have had mild BPH symptoms for 17 years, controlled by cardura but often noticable as incomplete emptying of the bladder.
I am now contemplating two options for teatment: robotic (DaVinci) prostatectomy by a guy who has done 520 of them, and High Dose Rate brachytherapy monotherapy, by a guy who has done maybe 1000 HDR + EBRT and only 170 HDR monotherapy (with good results but limited follow-up).
I am emotionally in favor of getting the thing out and knowing about negative / positive margins early. However, the side effects and one technical issue tend to make me lean slightly toward HDR monotherapy. Following are the issues. Can anyone shed any light on these by personal or medical experience?
1. Expected incontenency with RP is 3 - 9 months, with small percent, say 2-5 %, never fixed. It is said to be caused not by surgical damage, per se, but by removing the prostate which acts as a stricture. So my question about this is:
What is it really like to use pads (or diapers) after RP ? Is it a tremendous inconvenience or only a small bother? They say that it is usually reduced in a short while to stress incontenance and a few drops. Is this a problem for you or not? How would it be if I were one of the unlucky few who dribble forever? I can't really visualize it, but I imagine that a couple of drops would not be an issue. I have that now.
2. With RP, I can expect a great urine stream in time, fixing the BPH symptoms, if I can eventually control the flow. That's the good news.
3. With HDR brachy, the side effect of main interest to me is obstruction of urine flow caused by prostate irritation / swelling. I have seen printed words to the effect that people with pre-existing BPH symptoms may have a hard time of it. Self-catheterization is mentioned, which sounds awful. My HDR therapist says my BPH symptoms are not really bad and I should be OK, but I am not so sure of that. Has anyone any experience or advice with that? How bad can the stoppage be?
4. On the other hand, HDR brachy and all irradiation options have much less incontinence and slightly improved potency rate. So it looks like I am trading one urinary symptom for another and slightly better probability of potency.
5. The hooker in all this is that it is alledged that there may be some undetectable stray cancer cells, for example, caused by the biopsy itself, that could take root outside the surgical margins later. The RP will not get these. The HDR brachy might get them because the dose profile is designed with a 5 mm margin.
Can you say anything that will make this 50-50 choice any easier?
Thanks for taking the time to read and consider this.[/quote] |
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