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Medical Forum / Diseases and Disorders / Prostate Cancer / September 20042nd Option on Biopsy - What to Do/Decide?
Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to some recommendations from this board) on my 2nd biopsy and they confirmed that I do have Tc1 staging, Gelason 6 (3+3), and a PSA of 3.4. Of the 16 core needle samples (this time) they only found cancer tissue in 1 core on the right side which consisted of only <5% of the total core sample. My urologist indicated that I have 3 likely options: surgery, seeds, and IMRT external radiation. I do have one problem that may (I'll know tomorrow for sure) that may eliminate seeds as an option since I do have a very weak urine stream and that is a concern for my doctor and seeds. I fully understand its my choice in terms of which option is best for me, but as so many before has cried out loud! HOW IN THE HECK DO YOU DECIDE!!!!!!!!!!! I am 68 and will be 69 in Jan. I have no health problems, not overweight, walk 3 miles 5-7 days a week and simply want the best chance to rid my body of cancer and be around 10-12 years from now. In short, I'd prefer to die of something other than prosate cancer. I am by nature a person that will be a little frustrated if I opt for the seeds (if this option is available) or external radiation. I would hate surgery and the 8-14 days of a tube to drain the urine, but to be perfectly honest knowing that the source of my cancer in my body will gone is very appealing to my personality. Yesterday I talked to the radiation oncologist at Wake Forest and in my case he indicated that either seeds or IMRT external radiation would be options for me that would cure rate equal to surgery. When pressed, he said either way would end up with the same results. That blew my mind since some of my readings and some views on this board tend to indicate that external radiation is not as successful as either seeds or surgery? He simply stated that seeds vs IMRT does the same thing but from different approaches: Seeds attacks the cancer in the prostate from within, and IMRT radiation attacks the cancer with precision from outside. Seeds is a one-time event with the possibility of an overnight stay, and IMRT radiation requires some 45-55 days of 20-30 minute doses of daily radiation. This radiation oncologist would not recommend both in my case in spite of several clinics that beat the drum for that route (i.e. Atlanta and Tampa). I still can't get over the equal comparison he made between the seeds and IMRT - either one is just as good as the other! Tomorrow I go back to my urologist and will make an appointment with an experienced surgeon that does both normal radical surgery and robotic. So, at the risk of starting an argument on this board, who would vote for surgery, who would vote for seeds, and who would vote for IMRT and why given my data and situation? Finally, can anyone refer me to some web sites that are not biased and show the cure rates comparing surgery, seeds, and IMRT? Sorry for cluttering up the board with the same old dilemma questions. Heeeeeeeeeeeeeeeeeeeeeeelp! Roy in Winston-Salem > Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 16 lines] > drain the urine, but to be perfectly honest knowing that the source of my > cancer in my body will gone is very appealing to my personality. I'm not voting one way or another but I can say from my experience surgery is not all that bad. I had surgery at 62, spent one night in the hospital and had the catheter out in 8 days. It was a an irritant but nothing to hate. Like you I wanted to get rid of the cancer and also wanted the removed prostate examined to see whether the cancer had escaped the capsule. My biggest problem has been incontinence but that's not unique to surgery. My Gleason was 3+4 preop and 4+3 based on the postop pathology. All margins negative, no migration. Five months later my PSA is .01. I'm down to 2 to 3 pads per day and improving steadily. Best of Luck whatever decision you choose. Roy, I'll dodge the vote, and just for the sake of argument ask you why you have to do any of those three things. There is a chance that your case will not develop at all. I don't know what those odds are (15%?), so ask the urologist if you want to know. When you say you want to live another 10 or 12 years, is that the normal lifespan of a man in your family? jimhoney > Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > some recommendations from this board) on my 2nd biopsy and they confirmed > that I do have Tc1 staging, Gelason 6 (3+3), and a PSA of 3.4. [Deleted] > So, at the risk of starting an argument on this board, who would vote for > surgery, who would vote for seeds, and who would vote for IMRT and why given > my data and situation? The good news is that you have an excellent chance of a complete cure whatever you decide. The difference between recurrence rates for surgery and radiation applies only after 10-15 years. That is because the major factor in the effectiveness of radiation is the dose. Earlier, the dose was not high enough because of fear of damaging surrounding tissues. With modern methods, the radiation is much better focused so they can use higher doses. But these methods haven't been in use as long. For the time they have been in use, they seem more or less equivalent in avoiding recurrence to surgery. Unless there is a surprise in the offing, this should continue as more data comes in, but until it does, we can't be sure. It also seems true that for someone your age, the likelihood and severity of side effects are about the same for surgery and radiation. But just which side effects are more prominent and when they occur may depend on the treatment. With surgery the side effects are immediate and then get better with time; with radiation, they may take up to two years to develop. Whether you are permanently impotent or not after surgery will depend a lot on the skill of the surgeon. Impotence after radiation is less dependent on the practitioner. So if you are not completely confident in your surgeon, radiation might be the better choice. But in either case, impotence can be treated and need not interfere with an active sex life. Patrick Walsh suggests the following way to help in the decision making process. Think about the situation several years down the line. Consider plausible things that might happen. (Don't think about all the awful unlikely possibilities.) Try to imagine how you might feel at that point about your decision. You may find, if you do this, that you are just more comfortable with one choice. If you really can't make a decision, then there is nothing wrong with flipping a coin. In fact, according to the formal discipline called decision theory, that is just what you should do where the information you have provides no rational way to make the choice. When you have made your decision, stop worrying about whether or not it is right. Concentrate on the treatment and getting better. Good luck. > Finally, can anyone refer me to some web sites that are not biased and show > the cure rates comparing surgery, seeds, and IMRT? There is a lot of data out there on the web, and it is very hard for a layman to judge competing claims. You won't get any better information that way than you already have from your doctors. > Sorry for cluttering up the board with the same old dilemma questions. > Heeeeeeeeeeeeeeeeeeeeeeelp! > > Roy in Winston-Salem > difference between recurrence rates for > surgery and radiation applies only after 10-15 years...snip... > For the time they have been in use, they seem more or > less equivalent in avoiding recurrence Hi Leonard...Most RT studies use the ASTRO definition for determining failure. Most surgical studies use PSA > 0.2 ng/ml as the definition of failure. How can one compare studies that use these different criteria for failure and conclude that the results are the same or different?..Best wishes and good health, Ron >>difference between recurrence rates for >>surgery and radiation applies only after 10-15 years...snip... [quoted text clipped - 7 lines] > criteria for failure and conclude that the results are the same or > different?..Best wishes and good health, Ron Good point. But to quote my urologist on another matter, this is not rocket science. Each of these criteria is supposedly based on what happens afterwards, not on the criterion itself. Presumably, a very large number of RP cases in which the PSA rises above 0.2 ng/ml later show evidence of metastatic disease. Similarly, a large number of RT cases exceeding the ASTRO definition also show such evidence. In other words both criteria are designed to be indicators of that same outcome. Of course, there is nothing all that precise about any of this, and there is still considerable uncertainty however you do the calculations. What that means is not that we know to the third significant figure that the likelihoods are the same, but that given the data, and the known uncertainties, there is no rational way to distinguish the two methods of treatment from onte aonther in terms of long term results. Critz at RCOG has performed a nice experiment to test the supposition that the two failure criteria are more or less equivalent (J. Urol., 167, 1310-13, 2002). 591 consecutive men were treated with RCOG's SI+EBRT procedure. Patient PSAs were tracked thereafter and biochemical failure was determined using both the ASTRO and PSA > 0.2 ng/ml criteria. Median follow-up was 6 years (range 5-8). 65 men experienced biochemical recurrence based on the ASTRO definition, 93 failed using the 0.2 ng/ml PSA cutpoint. 43% more men failed when the PSA > 0.2 criteria was applied as compared to when the ASTRO definition was used! When Kaplan-Meier statistics were applied this translated into a 10% vs. 13% biochemical failure rate at 5 years and an 11% vs. 16% biochemical failure rate at 8 years using the ASTRO and PSA > 0.2 criteria respectively. The forgiving nature of the ASTRO definition of failure, especially in the early years of a study, is well documented. When authors like Kupelian / Potters pronounce curative efficiency of various PCa treatment techniques as equivalent without discussing the limitations imposed by their use of two different evaluation criteria (43% more failures with one criteria than the other in Critz's study!) they do us a disservice. How much harder would it have been for them to apply the ASTRO criterion to all treatment methods (I realize some men in the RP arm may have sought immediate treatment upon PSA > 0.2, but probably enough would have been able to get 3 PSA increases measured before seeking treatment to permit analysis; at a minimum a patient would need to see at least 2 PSA increases before seeking secondary treatment in any case)? We all use this published information to make life and death decisions. Particularly when we are newly diagnosed we tend to "believe" what the doctors publish. The researchers need to design their experiments and present their results with this in mind...Ron > Critz at RCOG has performed a nice experiment to test the supposition > that the two failure criteria are more or less equivalent (J. Urol., [quoted text clipped - 11 lines] > definition of failure, especially in the early years of a study, is > well documented. I don't know what the purpose of Critz's study was. I have the impression that the people at RCOG would like to use similar criteria to that used for RP, and that may have been part of it. I suspect they would like to do that more for public relations purposes than for scientific ones, but I am only guessing. The point is that RP and RT are entirely different methods. After RP, there should be essentially no PSA if the treatment was successful. Miniscule amounts of PSA are produced by other tissue and of course there is a certain amount of error in measurement. Presumably it is also true that in some cases, cancer had escaped beyond the prostate but the patient's immune system is keeping it under control and will continue to do so. For this and other reasons I can't imagine, urologists have picked certain levels such as 0.2 ng/ml as the criterion for defining biochemical recurrence. I think this is more to provide a point at which additional treatment such as radiation may be considered than to provide a standard for definition of recurrence. After radiation therapy, it takes time for the cancer cells to be killed off. Even if all the cancer is destroyed, some prostate tissue will be left behind. Hence, one should not ordinarily expect the PSA to go to zero or close to it. What defines recurrence is not a specific level of PSA but the fact that it reaches a nadir and more or less stays there. That means the PSa is not being produced by cancer cells. Getting PSA to some level is not the purpose of treatment. It is to destroy the cancer. The PSA level is only relevant in helping to decide if the cancer has been destroyed. But the differences in the treatment methods should lead to different criteria. > When authors like Kupelian / Potters pronounce curative efficiency of > various PCa treatment techniques as equivalent without discussing the [quoted text clipped - 11 lines] > The researchers need to design their experiments and present their > results with this in mind...Ron Two questions I haven't seen anyone address re XBR--neither of which I have an informed opinion on: (1) Would receiving XBR for PCa potentially disqualify someone from receiving radiation treatment for another, future, unrelated cancer, e.g., colon or bladder cancer--due to danger from the total accumulated rads? Is there a lifetime rad dose--either whole body or just the abdominal region--that one shouldn't exceed and if so, how close to this limit would the new higher dose XBR PCa treatment go? (2) Does the XBR raise the risk of cancer to remaining (nonprostate) tissues that happen to be exposed, e.g., bladder or rectum? And if so, how much is the risk raised? I would assume that the answer to this question would require long term studies--which perhaps have been done. If either of the above issues were actually material (I don't know if they are, but I've wondered about them), then one might rationally choose an RRP over XBR--instead of flipping a coin--if other considerations subjectively appeared to you to be completely equal. Of course, the meaning of what is "material" could be the subject of debate. E.g., is a 1% risk material? 5% risk? Paul > Two questions I haven't seen anyone address re XBR--neither of which I have > an informed opinion on: [quoted text clipped - 19 lines] > > Paul Hi Paul...A number of studies have been published on these questions. IMO, the study by Brenner, et. al. (Cancer, 88, 398-406, 2000) is one of the better ones (higher statistical power, fewer assumptions). In this paper, the authors use the SEER database to retrospectively compare second malignancies in 51,584 men with PCa treated by either surgery or RT between 1973-1993. Let me quote the last 2 paragraphs in their paper, "Radiotherapy for prostate carcinoma was associated with an overall small increase (4%; P=0.08) in the risk of all second malignancies relative to those patients treated with surgery, and with a significantly elevated risk of second solid tumors (6%; P=0.02. This overall enhanced risk for solid tumors is larger for long term survivors, increasing to 15% (P<0.001) after >= 5 years, and to 34% (P<0.001) after >= 10 years. Although the increased risk of solid tumors in the radiotherapy group are significant, the absolute risks still are fairly small; our best estimate is that the risk of developing a radiation-associated second malignancy after radiotherapy for prostate carcinoma is 1 in 290 (all years), 1 in 125 for >= 5 year survivors, and 1 in 70 for >= 10 year survivors. Because the estimated absolute risks of radiation-associated second malignancies are fairly small, they might appear unlikely to play a significant role in choosing between treatment options. However, the trend toward prostate carcinoma diagnosis at a younger age and at an earlier stage, as well as recent improvements in radiotherapeutic techniques, suggest that survival times after radiotherapy for prostate carcinoma will increase. In light of the long (5-15 years) average latency period for radiation-induced solid tumors, increased survival times would be expected to result in increasing radiation-induced second tumor rates, and thus radiation-related second tumor risk could, in the future, become a more significant issue." Here are a few other relevant observations from the paper. The most prevalent secondary malignancies were bladder, rectal and lung carcinomas, and sarcoma in or near the treatment field. In comparing the RT treatments typically used during the study to those employed today, the authors state, "Despite the recent trend toward higher prescribed doses for prostate carcinoma therapy, the adoption of smaller field, higher energy, radiotherapeutic treatments has resulted in lower doses to distant organs compared with those from earlier, larger field, 60Co treatments. By contrast, external beam radiotherapy treatment for prostate carcinoma typically is now performed using nominal photon energies > 18 MeV, potentially producing a significant and highly effective photoneutron dose (approximately 0.2 Sievert) to distant organs." IMO, for those men flipping a coin or for men diagnosed at a relatively young age, it is something to consider and factor into the decision making process...Best wishes and good health, Ron The "real" radiation from seeds extends approximately 1/4 of an inch from the seed so there is no radiation to distant areas. (It is very detectable but not enough to do anything to anything else.) The IMRT is so precise that there is almost no exposure to other areas of the body. I specifically asked our radiation oncologist about long term exposure and the chance of getting cancer from the radiation used to treat this cancer. Our doctor said yes it is a possibility but it would probably take about 30 years IF (a very tiny percentage) it were to occur. They will watch for it before that and if he does develop a radiation induced cancer it would be very treatable. But I think this is why radiation is not used as frequently on younger men as a first response. Bev > Two questions I haven't seen anyone address re XBR--neither of which I have > an informed opinion on: [quoted text clipped - 19 lines] > > Paul There is a difference in types of radition therapies. IMRT is the newst kid on the block with a more precise and directed beam that is not broad spectrum......It is characterized by a popping sound which is simply the ports opening and closing. Do a google search on radiation and review the different types available. Still there are facilities that do not offer IMRT because they have not bought the machine. Even three years ago, there were less than 50 nationwide...... Good luck on your decision. > Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 48 lines] > > Roy in Winston-Salem I just ran across this article dated in April of this year (2004) which tends to answer my own question about which treatment option has the best outcome. I fully recognize that this study does not span a prolonged period of time, but here is the bulk of the article ************************************************************************************************************************************ Three leading prostate cancer treatments have similar outcomes, study finds PSA Rising, New York. April 24 2004. -- A seven-year study of more than 1800 early-stage prostate cancer patients treated solely with either radical prostatectomy, external beam radiation therapy, or brachytherapy (in which radioactive seeds are implanted into the prostate), showed statistically similar outcomes with each of the treatment options. This is one of the largest head-to-head studies to date and included patients from the Cleveland Clinic Foundation (1178 patients) and Memorial Sloan Kettering on Long Island (641 patients). Lead author Dr. Louis Potters was chief of radiation oncology at Memorial Sloan-Kettering Cancer Center's Mercy Hospital, New York, at the time of this study. The study in the April issue of Radiotherapy and Oncology compared 746 radical prostatectomy (RP), 340 external beam radiation therapy (RT) and 732 prostate brachytherapy (PB) patients with T-1 and T-2 localized tumors. About three-quarters of the patients in each treatment group had an initial prostate-specific antigen (PSA) level of 10 ng/ml or less and a Gleason score of six or below. All three treatment groups had statistically similar outcomes at seven years. According to the authors, this study indicates that prostate cancer with these stages of the disease patients can expect "generally excellent" results regardless of their treatment choice. Comparison of treatments for prostate cancer is complicated because patients in many studies are treated with more than one therapeutic option. When hormonal therapy, for example, is used before radiotherapy or radical prostatectomy, it is harder to compare the main options, brachytherapy, external radiation or radical prostatectomy. All the patients in this study received a single therapy, allowing direct comparison of the treatment options. All the patients were treated at some time between 1992 and 1998. They were followed up for a median of 58 months for all cases (51 months for PPB cases, 56 months for RT cases, and 64 months for RP cases). Biochemical relapse was defined as any detectable PSA value greater than 0.2 ng/ml for patients receiving RP, or three consecutive PSA value rises for those receiving EBRT or PI. Seven year success rates, measured as freedom from biological relapse, were closely similar for all three treatments, as follows: a.. Brachytherapy, 74% success. b.. External beam radiotherapy, 77%. c.. Radical prostatectomy, 79%. Multivariate analysis identified initial PSA and biopsy Gleason score as independent predictors of relapse. Type of treatment, age, clinical T-stage, and race were not independent predictors of failure. It is important to note than in a related study, Dr. Potters' team found that patients who receive a low-dose of external beam radiation (below 72 Gy) have "significantly worse" outcomes than those who receive a dose above 72 Gy. *********************************************************************************************************************************** I should point out that IMRT radiation is in the 80-82Gy range. This is just another piece of data that adds to the confustion. Roy in Winston In a nut shell. If you can't stand the idea that there is a cancer inside of you then opt for some form of RP. If you can trust something to do the job slowly then go for brachytherapy or some other RT or combination. If you still can't decide than begin to look at the doctors. Who has the best personal stats??? Go with whoever has the best outcomes. We wanted brachytherapy but had to have IMRT plus brachytherapy. At the time I wasn't so sure about that but now I know that the prostate is completely fried. There is no prostate left at all and the area around it has been zapped too. This would be the equivalent of a RP with follow-up radiation. That's about as good as it gets. Our doctor in Richmond, Virginia (M. Hagan, Massey Cancer Center) has not had a failure yet and he's been doing brachytherapy since 1989. We are very comfortable with what has been done. Yes, my husband had some difficulty with urination and some problems with ED but these things have lessened as time has passed. Rarely now does he ever have a problem starting his stream and unfortunately he is still having some problems with ED but even that has improved. My husband finished his treatments 28 months ago. He missed virtually no time from work nor would anyone ever know he's a cancer survivor. Here's a problem with the stats presented in the article. The seeds have changed and the equipment used to place them and "see" while they are placing them has changed - much more precise and accurate with complete and total coverage of the prostate. EBRT is now done on IMRT equipment - much more precise!! Bev > I just ran across this article dated in April of this year (2004) which > tends to answer my own question about which treatment option has the best > outcome. I fully recognize that this study does not span a prolonged period > of time, but here is the bulk of the article **************************************************************************** ******************************************************** > Three leading prostate cancer treatments have similar outcomes, study finds > PSA Rising, New York. April 24 2004. -- A seven-year study of more than 1800 [quoted text clipped - 52 lines] > Gy) have "significantly worse" outcomes than those who receive a dose above > 72 Gy. **************************************************************************** ******************************************************* > I should point out that IMRT radiation is in the 80-82Gy range. > > This is just another piece of data that adds to the confustion. > > Roy in Winston > Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 48 lines] > > Roy in Winston-Salem Hi Roy...If you have to have PCa, what you have is about "as good as it gets!" The question in front of you is, do I have indolent cancer or cancer that needs to be treated? You may be aware that autopsy studies have demonstrated that a high percentage of men (40-70%) in your age bracket had signs of PCa but never required teatment. Are you someone with indolent, low-volume cancer and the biopsy needle just happened to find the small bit of PCa present? You didn't mention your PSA history, but if it has been relatively flat and stable (i.e. a low PSA velocity) then you may have low-volume disease. Take a look at the Hopkins web page where they discuss their active surveillance program http://urology.jhu.edu/prostate/advice1.php you seem to meet the pre-requisites. Just a thought...Best wishes and good health, Ron >>Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to >>some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 54 lines] > studies have demonstrated that a high percentage of men (40-70%) in > your age bracket had signs of PCa but never required teatment. I think you were wise to bring the possibility of "active surveillance" to his attention. But in what you say above, I think you are overstating the case, and that could mislead other men. One has to be careful not to mix up apples and oranges. The statement that a high percentage of studies show that men in his age group show evidence of prostate cancer ON AUTOPSY is true, but as can be seen from the figures you give, it seems highly variable, so any precise number can't be considered established fact. What is important though is that a much smaller percentage of men will be diagnosed with prostate cancer while alive. After all, the chances of being diagnosed for American men, at any time life, is about 16 percent, much lower than the lower 40 percent figure you quote. Moreover, it is currently not known just how many of the men who are diagnosed by PSA testing and DRE in today's environment will never be bothered by their cancers. One study I saw, which I don't claim is reliable, put that figure at 15 percent for men of European descent and 40 percent for men of African descent. Unfortunately, in the vast majority of cases today, there is no clear way to determine just which cases need treatment and which don't. For many men past 70 and for some men in their late 60s meeting stringent requirements, however, "active surveillance" does a reasonable alternative. > Are > you someone with indolent, low-volume cancer and the biopsy needle > just happened to find the small bit of PCa present? You didn't > mention your PSA history, but if it has been relatively flat and > stable (i.e. a low PSA velocity) then you may have low-volume disease. I have to agree with you that his case may fall in this category. He should certainly discuss this with his doctors, and if he doesn't like the answers he might seek yet another opinion. He might need further testing to see if he fits the Hopkins criteria for "active surveillance". > Take a look at the Hopkins web page where they discuss their active > surveillance program > http://urology.jhu.edu/prostate/advice1.php > you seem to meet the pre-requisites. Just a thought...Best wishes and > good health, Ron Roy: Please see the thread on this newsgroup entitled "Time for the Big Decision". There you will see how I got to my decision (IMRT), and some of the arguments for both surgery (RPP) and IMRT. I am yet to start my treatment, so I can't give you any results. From your numbers, I would guess (I'm no doctor) that your cancer is close to 100% curable with either surgery or IMRT. From what you said, your urologist and your radiation oncologist have advised you exactly what mine did. I think that for you, as for me, your choice will come down to what you are comfortable with, since either choice will probably give you a good result. What you need to do is understand completely what the likely side effects of each treatment are, and which ones are most important to you. I understand, so well, how hard it is for you to decide what to do, since I just did that. My advice, most of which I got from others on this newsgroup and from my friends and family, was to research the subject as much as you can; listen to your doctors; ask questions; pray, if you are a believer in such things; and then make a decision-- and don't look back. From all the things I learned from my research, you're in great shape. I wish you luck. Please contact me on the newsgroup or on my email if there is anything I can help you with. Jim Thomas > Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 48 lines] > > Roy in Winston-Salem Roy: Please see the thread on this newsgroup entitled "Time for the Big Decision". There you will see how I got to my decision (IMRT), and some of the arguments for both surgery (RPP) and IMRT. I am yet to start my treatment, so I can't give you any results. From your numbers, I would guess (I'm no doctor) that your cancer is close to 100% curable with either surgery or IMRT. From what you said, your urologist and your radiation oncologist have advised you exactly what mine did. I think that for you, as for me, your choice will come down to what you are comfortable with, since either choice will probably give you a good result. What you need to do is understand completely what the likely side effects of each treatment are, and which ones are most important to you. I understand, so well, how hard it is for you to decide what to do, since I just did that. My advice, most of which I got from others on this newsgroup and from my friends and family, was to research the subject as much as you can; listen to your doctors; ask questions; pray, if you are a believer in such things; and then make a decision-- and don't look back. From all the things I learned from my research, you're in great shape. I wish you luck. Please contact me on the newsgroup or on my email if there is anything I can help you with. Jim Thomas > Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 48 lines] > > Roy in Winston-Salem >Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to >some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 48 lines] > >Roy in Winston-Salem _______ Hi Roy. I too am 68 and will be 69 in January. (On the 25th; how about you?) And I was in much the same pickle back before Christmas when I was diagnosed after a routine exam showed that my PSA had soared from its normal 3 all the way to 18. Natually, I didn't know what to do. But then I figured ... well, I'll just have the seeds popped in, and that will take care of it. It turned out there were two problems with that simple solution. First, like you, I had a weak urine stream. I took three tests with that rather interesting machine that measures your stream like a polygraph or seismometer. "Cool gizmo," I said to the doc. "Yeah, isn't it?" said he. "When I was in medical school, we used to go out and drink at lunch and then come back and bet on who could piss the hardest!" Hee hee. Anyway, I flunked all three tests. And was told by two urologists that seeds would swell the prostate and probably pinch the urethra shut. In which case, emergency surgery would be necessary -- and there would be close to a hundred percent chance of permanent incontinence! Arghh. But then the radiation oncologist solved any dilemma by telling me that photos of my prostate showed calcification that would block any attempt to place the seeds. So the choice was surgery or radiation, and after much dithering and throwing myself on the mercy of a couple of doctors, I decided on external beam IMRT. I was surprised, in fact, when I asked the urologist/surgeon what *he* would do. And he said: "I probably shouldn't say one way or the other, but I would opt for radiation." So I did. Forty-five sessions over nine weeks at the Hughes Cancer Center in Stroudsburg (here in the Poconos in Pennsylvania). And it was a piece of cake -- often quite literally, because volunteers would bake stuff and have it available in the waiting room. Not that there was much waiting. And it certainly wasn't the 20 to 30-minute doses you mention. They line you up very carefully, and the machine zaps you (at least in my case) for 15 *seconds* at five spots around your lower regions. The fastest I was ever in and out was eight minutes, but it usually was more like 10 to 15 minutes, counting time in the dressing cubicle. Okay, I didn't mean to dribble on here like this. But my experience with IMRT was terrific, and I wanted to tell you so. I finished the treatments on Aug. 10, and I went back to the rad-oncologist for my first followup just yesterday. I had my first PSA test to establish a baseline, and it was "below point-one." That's to be expected, of course, because I am still on the cursed Zoladex hormone therapy. But the doctor was pleased to hear that I have had almost no trouble with diarrhea or with any bleeding. I have had difficulty peeing, as I've said in a previous post (god, is there no modesty here?!) but Flomax has been a magic bullet. Actually, two bullets every night with the last of my bedtime scotch. So ... good luck. I'm sure you'll make the right decision. Regards, Marshall > >Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > >some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 7 lines] > >understand its my choice in terms of which option is best for me, but as so > >many before has cried out loud! HOW IN THE HECK DO YOU DECIDE!!!!!!!!!!! SNIP>>> Marshall --I Agree with the men who posted about IMRT -- Why put your self to the knife and all of the problems most of these men have with the Rp --I have been active with prostate cancer support groups here in Phoenix for the past ten years. Many men have had IMRT with excellent results -Just be sure you find a real expert doctor not just a location that has a machine. Most of the men in my support group that have proper insurance and funds to travel have gone to Centers of Excellence --Cleveland Clinic , M D Anderson --Orlando, MSK in NYC. These centers have been doing IMRT for the past 7 years. Take you time and make the best descion that is right for you and only you. Tom B in Phoenix > >Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > >some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 7 lines] > >understand its my choice in terms of which option is best for me, but as so > >many before has cried out loud! HOW IN THE HECK DO YOU DECIDE!!!!!!!!!!! SNIP>>> Marshall --I Agree with the men who posted about IMRT -- Why put your self to the knife and all of the problems most of these men have with the Rp --I have been active with prostate cancer support groups here in Phoenix for the past ten years. Many men have had IMRT with excellent results -Just be sure you find a real expert doctor not just a location that has a machine. Most of the men in my support group that have proper insurance and funds to travel have gone to Centers of Excellence --Cleveland Clinic , M D Anderson --Orlando, MSK in NYC. These centers have been doing IMRT for the past 7 years. Take you time and make the best descion that is right for you and only you. Tom B in Phoenix Unfortunately being a member of this club forces you to give up all modesty! Bev > >Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > >some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 122 lines] > > Regards, Marshall It certainly is a "problem" being a 68-year-old in good physical condition. You have all the options open to you. I'm sure you have already gotten opinions, usually along the lines of whatever the person giving the opinion selected. I'm no different. Surgery is my favorite recommendation and robotic laproscopic is my favorite within that category. However, you are correct that you have to decide and be comfortable with your decision. In that vein, I would continue to research until you have narrowed it down to one.  SignatureProstate 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 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .07 .05 Lupron 7/03, 8/03, 12/03, 4/04 non illegitimi carborundum > Well, I just recently received a 2nd opinion from Bostwick Labs (thanks to > some recommendations from this board) on my 2nd biopsy and they confirmed [quoted text clipped - 48 lines] > > Roy in Winston-Salem |
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