John: Sounds like you've done your homework and you've made the
decision for treatment that's right for you and I am sure that it is going
to take care of your PCa!

I don't know if you have considered as a factor that yyour Gleason of
2+3 and the "microscopic amounts" are based on the biopsy and that
there is some possibility that you could have more cancer present and
of a higher grade.  You didn't mention how many cores you had in your
biopsy and how many were positive and what the estimated percentage
is.  The only reason I bring this up is that my own post-surgery
pathology showed much more extensive cancer than the biopsy
indicated and I was upgraded from Gleason 3+3 to 4+3.  In
retrospect the surgeon and I both agreed that surgery was the best
choice.  Unfortunately we don't always know this until after surgery.

Fred

Get a second opinion on the biopsy slides!  Gleason 5 is down in the
gray area.

jimhoney
standard RRP age 52, cured, no significant aftereffects

Hi, John....

Sounds like you have made the decision that is best for you... and that is
just as it should be.  We all have to look at the options... educate
ourselves... and then choose the best route for ourselves.  Brachytherapy is
certainly a very valid option these days!

I wish you well!

MikeH
30 months post LRP

Welcome to the club, John!  Sorry to report you've passed the single
qualifier to join.  But, it should be of some great relief to you to know
that of all the people I've met here in the last 3+ years, your Gleason is
among the lowest score I've seen and only have seen it among less than 2%.

As such, you have every option in the world and almost all of them will have
great chances to be cures.

Please keep us posted.

I, too, believe that you are making the right decision and that with such an
early stage of PC you will be just fine.  I wish you the best.

 .

With a Gleason 5 and microscopic tumors, I'm surprised no
one mentioned watchful waiting to you.  With a very small non-
aggressive, and slow growing cancer, you might be able to control
it just with diet.  Lycopene, gamma Vitamin-E and green tea
extract all appear to have some ability to control PCa and might
be all you need for a very weak cancer.  This is something you
might ask your doctors about.

The key part of watchful waiting is "watchful".  If you try it (or even if
you don't) you should probably get a second opinion on the biopsy
slides to make sure the cancer really is as non-aggressive as the
first lab thought.  Also, you might go to a more frequent PSA test
schedule to be sure that, if the cancer does start to grow, you'll find
out as soon as possible.

If you do opt for treatment, my totally amateur, non-expert and
not to be taken too seriously opinion is: brachytherapy is the easiest
treatment to get with the fewest common side effects.  It's not
recommended by itself for aggressive cases where surgery or
external beam radiation (with or without brachytherapy, and often
with hormone therapy) are used.  But it is supposed to be as
effective as the more radical treatments when used on relatively
easy cases.

If all goes well, you'll spend no more than one night in the hospital
and some patients don't even spend a night.  You should have
very little pain.  I had some soreness and used an ice pack off
and on for a day or two.

The radiation takes place over a period of weeks or months and
the side effects, if you get them, take a while to show up.  You
may have difficulty urinating due to swelling of the prostate
tissue around the urethra tending to close it off.  If that happens,
(it happened to me) Flowmax may relieve the symptoms and
you might be on that drug for a few months.

You might have blood in the semen.  You might have some pain
during sex.  Eventually, you might become impotent.  If that
happens, depending on how bad it is, you may be able to
overcome the problem with Viagra (though I don't know if
Viagra is advisable for a man who has had heart attacks.)  The
most common long term problem is impotence - but that is
true for all of the treatments.  In my own case I came out a
little less potent than before, but not much.  I can still rise
to the occasion.

Other serious side effects are possible, but less likely with
brachytherapy than with surgery or external beam radiation
(again - this is my non-expert opinion.)

Good luck.

   Alan

...

My uro also strongly advocated for surgery but allowed that Rad
was a viable alternative.  He did give me the "you're young" pitch,
I was 57 at diagnosis.  He referred me to Inova's cancer center
where he has a good rappor with the rad-doc.  

The two of them guided me through this, answering my questions and
taking me through the treatment.  Both were there for the seeding,
and I see both on an alternate basis every three months for a year
for followup.

I wanted the best shot at retaining potency and the minimum
interference with my work and life schedule.  Rad gave that to me,
I have no complaints.  

What's good is that you have made the decision for treatment.  There
are a few not-so-fun tests and preps but pretty much the same
discomfort as the biopsy.  

Post seeding, you'll probably do better that I did.  I was in the
middle of the 2nd Lupron shot and that knocked my blood sugar to the
sky.

I am 7 months post seeding and doing great.  I've cut out the
Flomax.  The two post seeding PSA's were < 0.1 which is just fine.

The rad doc said that I might see a PSA bounce the next time or at
the 1 year mark but he was optimistic.