A website to provide support for people who have or have had any type of cancer, for their caregivers and for their family members.
Page 1 of 4 123 ... LastLast
Results 1 to 10 of 37

Thread: Decisions Decisions DaVinci Prostatectomy versus External Beam Radiation????

  1. #1
    Regular User
    Join Date
    Aug 2014
    Posts
    33

    Decisions Decisions DaVinci Prostatectomy versus External Beam Radiation????

    After talking with the Urologist/ Surgeon and reading the Walsh book and all of the online info I was convinced that surgery was the answer. My rationale was when you pull the prostate PSA goes to 0 and should stay there. A biopsy of the lymph nodes and the prostate will tell me if they got the cancer out. And I was accepting of the fact that i will have some pain, discomfort of the catheter and bag, and potential for some continence issues in the future. Even thought those may be small.

    But to be fair to myself I wanted to talk to a radiologist and I did that today. BTW i am getting a second opinon on both the surgery and radiology in a few weeks. I did not like the radiation because it lacked the surety of knowing I am cancer free. I also did not like some of the reports of urinary or rectal issues well after treatment.

    Well I come out of the Radiation Oncologists office, the same office that cured my Wife's breast cancer last year (with surgery too), and now my thoughts have shifted.

    The radiologist basically said that my cancer was caught very early and there is very little risk that it has spread beyond the prostate. He said that just about any modality would work and they all have about the same success rate at this early stage. Great!!

    He said that the urinary issues for him were very rare and were of the urgency nature. In all of the treatments that he has performed he only had rectal bleeding once or twice that was very small, occurred when BM's were forced, and easily remedied.

    I was also concerned about if the radiation failed and my PSA began to rise again that surgery was off the table. He agreed with that but the PSA increase if it did occur would be years down the road and would likely be at about the same rate it was before @.75 / yr and given when that would happen and my age at the time it just may not be worth doing much. He did also suggest that if it did occur, which was highly unlikely, that I could be treated with salvage radiation or hormone therapy. He said salvage radiation is vary rarely needed to be done. Hormone therapy BTW might be an issue with me as it might trigger bad things with a rare disease call Mastosystosis.

    So now I am being seduced by the promise of the same cure with no painful surgery, no catheter, no bag, and minimal continence issues.

    Any thoughts? I have heard that this forum leans toward the surgery. Right now if the second opinons mirror the first I am likely going to go with the External Beam radiation.
    Age in 2005 was 55
    2005 PSA 2.8 2008 3.2 2011 4.65 DREs all normal
    2011 Biopsy 12 samples all ok
    2012 PSA 4.85 2014 PSA 5.45 DREs all normal
    2014 PCA3 Test 90
    Aug 2014 Biopsy adenocarcinoma in 3/20 cores (one 5% (3+4), one 30% (3+3) and one 5% (3+4)
    Staged as T1C
    43 IGRT treatments Oct-Dec 2014
    Mar 2015 PSA 1.31
    Sept 2015 PSA 0.33
    Jan 2018 PSA 0.21 Some restricted urinary flow - getting urinary dialations with catheter once per day for next 6 months.

  2. #2
    Senior User
    Join Date
    Apr 2014
    Posts
    150
    Let me ask you this - why are you considering EBR when Brachytherapy is available? Talking to my urologist and radiation oncologist and they both prefer brachy unless there is some compelling reason to go with EBR.

    As for the more general question of radiation vs surgery: my choice was radiation via brachytherapy, for a lot of the same reasons you are thinking about. No major surgery and recovery, no issues with incontinence, a somewhat reduced risk of ED. Balanced against that is not having the post-surgery analysis, nor the option for radiation as salvage treatment, and also the radiation-specific side-effects like restricted urine flow or bowel damage. I have been fortunate to have very few issues with flow other than peeing somewhat more often than normal,and no bowel issues so far. But it's early days for me, 2 months post-op.

    Your odds of a cure, ie no additional treatment required after 10 years, are about the same with brachy or EBR compared to surgery.

  3. #3
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,206
    I often read that this forum favors surgery over radiation and always find it puzzling. We probably have just as many radiation patients here as surgery. LOL

    What we try to do in this forum is give fair/balanced information regarding ALL types of treatments, including radiation and surgery. What I usually recommend to a new patient is exactly what you have already done -- visit specialists in ALL possible treatment options and learn the pros & cons with each one.

    Then you can make your own informed choice depending on what makes you feel most comfortable & confident.

    I'm very glad to see that you have done this. As the radiation oncologist told you, it appears that your PC is at an early, curable stage.

    And, I believe that RobertG is correct about brachy also being an option for you.

    As I understand it, in your particular case, brachy, EBR and surgery would be your options and selecting one of them is your next task. It also would seem that all of these three options are equally curative.

    So I would boil it down to whichever one you feel would have the fewest side effects.

    Once you have made up your mind, it is best to just look forward to that particular treatment and never look back.

    If you feel that radiation (either EBR or brachy) is best for you, that is what you should do.

    In whatever you ultimately decide, we all wish you the very best!
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  4. #4
    Quote Originally Posted by bobkeenan View Post
    After talking with the Urologist/ Surgeon and reading the Walsh book and all of the online info I was convinced that surgery was the answer. My rationale was when you pull the prostate PSA goes to 0 and should stay there. A biopsy of the lymph nodes and the prostate will tell me if they got the cancer out. And I was accepting of the fact that i will have some pain, discomfort of the catheter and bag, and potential for some continence issues in the future. Even thought those may be small.

    So now I am being seduced by the promise of the same cure with no painful surgery, no catheter, no bag, and minimal continence issues.
    .
    You mention the continence issue twice, but no mention of erectile function differences between the two (or three) choices.
    Is that issue not a big part of your consideration?

  5. #5
    Regular User
    Join Date
    Aug 2014
    Posts
    33
    Comment on the above posts.... The radiologist did offer Brachytherapy. He said that it would be equally effective as compared to EB and prostatectomy. He said that it is particularly a good option for men who would find it difficult to be at the hospital 5 days a week for 8 weeks. He also said that, in his experience, there are a bit more side effects from the Brachy, during initial treatment, than with EB. Also the urologist and an prostate oncology expert (part of a prostate cancer seminar that I attended up here in portland that included Seattle and Vancouver BC) Said that brachytherapy was big in the 90's and early 2000's but was being done less now. So because of the added side effects and I prefer to go where most of the experience is these days.... I pulled Brachytherapy off the list.

    I also had a friend in the 1990's who did the brachy therapy. The cancer came back, metastasized and he eventually died. I am sure his cancer was much more advanced so its like comparing apples and oranges. And I know that all these treatments have improved since then. Not very logical, But it puts a stigma in my head.

    BTW they do IGBT for the EB.

    As for the ED. Because of the drugs that I have to take for this rare disease I have, called Mastocytosis, my erectile function is shot anyway and will stay that way. So that is one consideration that I do not have to deal with.

    I was relieved to hear that all the main treatments are almost equally good but with differing side effects.

    Right now I am like 60% for the IGBT and 40% for the da vinci surgery. I meet with the a full team (surgery, radiation, oncology) at OHSU on 7 OCT. If they not reveal anything new I will probably go with the IGBT that is at our hospital that is a mile away from our house. If they tell me something new... then it may be another decision.
    Age in 2005 was 55
    2005 PSA 2.8 2008 3.2 2011 4.65 DREs all normal
    2011 Biopsy 12 samples all ok
    2012 PSA 4.85 2014 PSA 5.45 DREs all normal
    2014 PCA3 Test 90
    Aug 2014 Biopsy adenocarcinoma in 3/20 cores (one 5% (3+4), one 30% (3+3) and one 5% (3+4)
    Staged as T1C
    43 IGRT treatments Oct-Dec 2014
    Mar 2015 PSA 1.31
    Sept 2015 PSA 0.33
    Jan 2018 PSA 0.21 Some restricted urinary flow - getting urinary dialations with catheter once per day for next 6 months.

  6. #6
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,206
    The good thing is that no matter what you choose, the chances for cure are very high.

    Good luck with your meeting on Oct. 7.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  7. #7
    Senior User
    Join Date
    Apr 2014
    Posts
    150
    Interesting. I had not heard of additional side effects of brachy vs EBR. Can you explain what they are?

  8. #8
    Googling "Mastocytosis and External Beam Radiation" and "Mastocytosis and Surgery" show some results which may be of interest. Have you spoken to any Mastocytosis experts or your Dr who is treating your Mastocytosis? Good luck
    BD: 1959 PSA 4.9 11/2012 (no symptoms)
    Biopsy 12/2012 Negative
    PSA 5.9 05/2013 (still no symptoms)
    Biopsy 6/2013 3+4 (thank goodness for PSA tests)
    1 core positive (upper left), 1 suspicious (lower left) out of 12
    DRE: bump right side T1c; PCA-III = 20 (normal)

    Da Vinci 7/18/2013: Invasive carcinoma involves left lobe of prostate only, extends from left apex to posterior mid region of left lobe Gleason 7/10 (4+3); G4 tumor comprises 75% of invasive carcinoma present
    Estimated total volume of carcinoma in entire prostate gland: 10%
    TNM: T2b NX MX (Stage IIA)

    8/13 11/13 2/14 8/14 2/15 8/15 3/16, 8/16, 3/17,9/17,4/18, 9/18 PSA undetectable
    3/19: .1 (damn), 4/19,6/29 retests: .1 (damn)


    My Story:
    T-Minus-36-Hours-until-da-Vinci...
    Catheter is Out!

  9. #9
    Quote Originally Posted by bobkeenan View Post
    Also the urologist and an prostate oncology expert (part of a prostate cancer seminar that I attended up here in portland that included Seattle and Vancouver BC) Said that brachytherapy was big in the 90's and early 2000's but was being done less now. So because of the added side effects and I prefer to go where most of the experience is these days.... I pulled Brachytherapy off the list.
    .
    I've been reading this forum and others almost daily for many years, in addition to reading other sites often, and this is the first time I"ve ever heard such about brachytherapy. If anything I'd heard it is more popular now than ever. Nor have I heard it described as having more "significant" side effects.

    Perhaps someone can give us a link to such opinions about trends in brachytherapy. Sounds very strange compared to what I always read.
    Just wondering, that prostate cancer seminar you attended, were any of the doctors who put it on individuals who actually performed brachytherapy? Very often, the doctors who do external radiation have a strong bias as to their method being superior. Same with surgeons.

    Having said that, your other options are both excellent and all offer you about the same outcome as to treating the cancer.
    Some might even include AS as a good choice since your 3 cores were about the same as getting 2 cores in someone doing 12 samples. Also your 3+4 is only 5%.

  10. #10
    Senior User
    Join Date
    Oct 2009
    Posts
    223
    Otega ASKED, "Perhaps someone can give us a link to such opinions about trends in brachytherapy."

    My response:
    Hi Otago and ALL, - Here are the results of a formal Study done on the subject, based upon SEER results at the time! - [email protected] (aka) az4peaks.

    Prostate Brachytherapy Use Decreasing

    The proportion of cases treated with this modality decreased by 14.3% from 2004 to 2010.


    Brachytherapy for low-risk prostate cancer (PCa) may be on the decline, according to study findings presented at the American Society of Clinical Oncology annual meeting in Chicago. In addition, a growing proportion of low-risk PCa cases is not being treated.
    Kamran A. Ahmed, MD, and collaborators at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla., analyzed recent trends in the management of clinically localized PCa using 2004–2010 data from the Survival, Epidemiology and End Results (SEER) database. The study population consisted of 216,785 men with low-, intermediate-, and high-risk PCa.

    For patients with low-risk PCa, use of brachytherapy decreased by 14.3% over the study period, whereas the use of no treatment increased by 15.7% and use of radical prostatectomy increased by 7.6%.
    In multivariate analysis, patients were more likely to receive no treatment if they were single, diagnosed in 2010 compared with earlier years, had low-risk disease versus high-risk disease, were African American versus white, and were older than 65 years compared with 65 or younger.

    A decline in the use of brachytherapy for localized PCa has been documented previously. In a study of 1.5 million patients treated for localized PCa from 1998 to 2010, Marc C. Smaldone, MD, and colleagues at Fox Chase Cancer Center in Philadelphia found that the proportion of patients undergoing brachytherapy peaked at 16.8% in 2002 and then declined steadily to a low of 8% in 2010, according to a paper published online ahead of print in Cancer. Meanwhile, during the study period, the percentage of patients treated with radical prostatectomy increased from 46.1% in 1998 to 59.1% in 2010.

    The change in clinical practice with the greatest impact on the use of brachytherapy during the study period is likely the substantial increase in the number of radical surgeries performed, possible due to the adoption of robot-assisted laparoscopic prostatectomy, according to Dr. Smaldone's group.

    In adjusted analyses, increasing age and Medicare coverage were associated with a greater likelihood of receiving brachytherapy. Patients with intermediate- or high-risk PCa, Medicaid insurance, increasing comorbidity burden, and later year of diagnosis were less likely to receive brachytherapy. -30-

 

Similar Threads

  1. What I Need to Know About External Beam Radiation Treatments
    By HighlanderCFH in forum Prostate Cancer Forum
    Replies: 100
    Last Post: 04-25-2018, 06:49 AM
  2. Decisions, Decisions......
    By Walnut in forum Prostate Cancer Forum
    Replies: 54
    Last Post: 03-12-2014, 04:49 PM
  3. Looking for your experience with external beam radiation
    By lynn6703 in forum Uterine and Endometrial Cancer Forum
    Replies: 3
    Last Post: 04-27-2013, 10:17 PM
  4. Big decisions
    By Thoughtful in forum Breast Cancer Forum
    Replies: 7
    Last Post: 10-17-2012, 11:11 PM
  5. Hdr plus External beam radiation
    By marlin in forum Prostate Cancer Forum
    Replies: 3
    Last Post: 02-04-2010, 08:05 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •