Hi Roger I'll try to answer your questions. Look between your text.

Seeding is just as effective as RP. When done correctly there will be no
prostate left. The only thing remaining will be the seeds and some scar
tissue around the seeds where the prostate used to be.

Seeding usually is not done on younger men because of the very minor chance
(less than 1%) of radiation induced cancer showing up in 25-30 years.
Apparently it is a very treatable cancer. I'm not sure but I think that the
longer you live the greater your chance of seeing this cancer appear.  So if
you live for another 40 years does your chance of radiation induced cancer
increase to 25%? I have no clue so that would be something to discuss with
the radiation oncologist.

Today's seeds are different from what was being used back in the 70's and
80's. So there is just barely a 15 year track record with these newer seeds
and the newer procedure. The effective radiation is less than a 1/4 of an
inch (.635cm). So they pack them into the prostate to cover all the prostate
tissue but they do it in such a way as to avoid damaging the surrounding
areas.

This seems to vary from doctor to doctor and patient to patient. Some guys
get hormone therapy prior to being seeded. My husband had external beam
radiation done prior to treatment. (RCOG does external beam radiation after
seeding but there is a big controversy about doing it afterwards as many
think that the seeds scatter the radiation beam when it hits them.)
Considering your situation I cannot image them doing any extra treatment
especially anything with additional radiation at your age.

That's a fallacy that keeps being perpetuated. If there is damage it will
show up immediately or within a few weeks of treatment.

RT as in seeds (brachytherapy), and potency as in erections or sperm?
Brachytherapy: your chances of having no interruption in ability to have
erections is very high. Our doctor does hundreds of seeds implants every
year and can count the ED patients on both of his hands and he admits all
but two are older men.

If you are concerned about fatherhood then bank your seeds now before any
treatment. (See answer to your next question.)

After external beam RT (EBRT) there is a chance of keeping your ejaculate,
it becomes thinner and clearer. The prostate is one of the few parts of your
body which is able to slowly regenerate. After seeding it's gone.

BUT orgasms will still happen so you will be able to enjoy what you do. It
will be different. BUT it is a difference you can LIVE with!  No one has to
sleep on the wet spot! There are lots of positive things about it which I
will avoid discussing. Just think about all the fun without the mess. LOL

Of course if it is raining you don't have to cut the grass.

Email me if you have any questions.
Bev (husband had 121 'Iodine 125' seeds after 5 weeks of EBRT on an IMRT,
May 3, 2002, age 56)

Hi, Roger,

One year ago, at age 62, I was seeded by the same oncologist that
seeded Beverly's husband, so my answers are going to be pretty much in
line with hers--although with a few minor differences.

First, I was given seeds only.  No pre-seeding medication, no EBRT.
The doctor said that EBRT would give me a very, very minor reduction in
the chance of recurrence in exchange for a greater chance of, as he put
it, "significant side effects."

As to the chance of developing secondary cancers later, he did not see
that as a serious risk for the reason you allude to.  The seeds are
planted so as to deliver radiation only to the prostate, not to
surrounding tissue.  At least, that's the plan.  Getting an EXPERT to
plant them is critical!!

I did develop ED after seeding. (I might be one of those two "younger"
men Beverly refers to.  Or maybe I'm too old for that category.  Not
sure where the doc draws the line!)  But I was having problems before
the seeding and had begun taking Viagara.  I have read that men who are
experiencing ED before seeding are likely to get worse.  At the
present, Viagara helps...sometimes.  Cialis is pretty much useless.

I'd be glad to answer any other questions you have (or try to).  Making
the treatment decision is one of the toughest things you'll ever do.
The best advice I can give you is, whatever you decide to do--surgery
or radiation, get the best possible person to perform the procedure.

All the best.

Ron Carter

Roger...My answers can be found interspersed with your questions...Best
wishes and good health, Ron

roger asked...snip...

You'd think so.  There is one radiation study relating to SI+EBRT
(Critz, RCOG) that shows bladder cancer to be a non-issue with this
treatment.  Of course with the prostate so close to the rectum, rectal
cancer would be a concern, but I'm not aware of any data on this
subject reltivie to seeds.  The studies involving secondary cancers all
use EBRT as the treatment, in these cases secondary cancers occur at
the rate of roughly 1-2% at 10 years post-treatment.  Secondary cancers
typically occur out past 10 years, so these numbers may well increase
as studies examine 15 years and beyond.  In any case, this is a reason
why RT is not normally recommended for younger men.

Depending upon the size of your prostate, hormones may used to shrink
it.  Depending upon the aggressiveness of your cancer hormones and / or
adjuvant EBRT therapies may be administered.

Yes, a number of morbities (rectal, urinary and sexual) tend to show up
over time as radiation takes its toll on the prostate and surrounding
tissue.  Here is some data

Age-adjusted, Long-term (median 6.3 years) EPIC Domain Summary Scores
HRQOL Domain          BT     3-D CRT     RP     Age-matched Control
Men
Urinary Irritative     81†*   84           91                  89
Urinary Incontinence   78†*   86†          80*                 92
Sexual                 28*    35†*         39*                 63
Bowel                  86†*   84†*         94
96†
Hormonal               87*    89           91                  93
† Denotes significant change in HRQOL domain score from 2 to 6 years
of median f/u (p=0.05)
* Denotes significant difference in HRQOL domain score at 6 yrs of
median f/u vs. controls (p=0.05)

Conclusions: Long-term HRQOL outcomes vary based on type of therapy.
Late changes in urinary, bowel and sexual HRQOL may be anticipated
following BT and 3-D CRT, with improvements in some domains (e.g.
urinary irritation and bowel (BT)) and deterioration in others (e.g.
urinary incontinence (BT and 3-D CRT), sexual (3-D CRT) and bowel (3-D
CRT)). In contrast to these late changes in post-BT and 3-D CRT
outcomes, post-prostatectomy HRQOL was relatively stable after at least
4 years of follow-up.

See the Table, RP appears to have a significant edge of SI or XBRT, but
all three treatments are far below age-matched controls, at least in
this study.

Again it takes a few years for all of the prostatic tissue to die
following RT.  During this time you will still be able to create some
liquefied ejaculate.  As time goes on this will become less and less,
unless some tissue has not been irradiated.

Hi Roger.... my data is:

Brachytherapy: October, 1999
98 I-125 Seeds
No other treatment (no external radiation, no hormones, just SI)
Age at treatment: 62
Pretreatment PSA:  7.5
Gleason: 3+3 = 6
Most recent PSA: 0.1
No urination problem, not from the git-go

E.D. is a more complicated subject for me.  Basically I have overcome the
combination of no prostate + advancing age by using a vacuum pump which has
worked extremely well to achieve erections.  Orgasms still occur -- very
intense although mostly 'dry'.  Another factor for me has been periods of
depression, some rather deep, which have impacted my sex life.

-------------------------------

The procedures are "new" but more importantly, the docs and
treatment teams keep refining the technology  Brachy 2004 is much
different from Brachy 1999.

I clocked a PSA 10+ and a Gleason 7 (4+3) albeit in only one core
sample.  Given that, the rad-doc and the uro suggested the full
court press, 1) Lupron, 2) IMRT, 3) Palladium-103 seeds.  They
started the Lupron a couple months before the IMRT.  The couple
months was more to complete the various tests and schedule me into
the machine at Inova.

Old saw.   Here's the skinny from the chapter on side effects from
"the Prostate Cancer Treatment Book" ISBN 0-07-142256-0 (c) 2004.

  "A recent study shows tha one year after the implant, 90 percent
 of men who had good erectile function prior the procedure
 maintained erectile function.  About half of the these patients
 reported some decrease in the erection's firmness or durability
 but were still able to penetrate with the help of Viagra."

and

 "After five years, 50 percent of brachytherapy patients maintain
 the same erectile function as they had before seeds.   In
 addition, these brachytherapy patients are, on average, 10 to 15
 years older than patients that undergo nerve-sparing
 prostatectomy, as reported in the medical literature."

I suggest you get the book and read it carefully.    

Apparently some folk "interpret" the above to mean that the other
50% lose their potency  

That's not what the text says, it says 50% are as potent as before
the seeding.  Even 5 years later, these geezers are still waving
their poles around.

The 50% that aren't as potent as before?  Well, they take a
Vitamin-V and manage enough of an erection to, ah, penetrate.  
Again, if there's snow on the roof, it's not that bad if the furnace
needs to be stoked a little extra.

If you take a bunch of typical 65 year old seed patients, track em
for 5 years after the implant.  What kind of erections do you
expect?  The men are 70, their testosterone is waning and they might
be on heart pills or wracked with joint pain.  

In spite of this, the chapter on side effects describes a vigorous,
vital, and "swinging their limbs" bunch.  

My read is that RP is sadly worse.  The gals out-live us.  It's up
to those of us who are still alive to do our part.  

Well, the books say in most cases, it's greatly reduced and
continues to lessen over the years.  A small percentage of seed
patients don't experience much reduction.

My experience - it is less.   Is a half teaspoon of ejaculate
enough?