John, that sounds like the CyberKnife procedure.

http://www.cksociety.org

or Google cyberknife for the manufacturer's site.  It's a lot of
"breast
beating" and "pats on the back" self-serving type press releases, but
there are many details about how it works.

Basically, the external beam homes in on the implanted seeds to
track the prostate during the procedure.   A patients doesn't have
to restrain his breathing and stop all movement while on the table.

CyberKnife was originally FDA apprived for treatment of brain
tumors, then lung cancer.  It's now approved for PCa.

Approximately five 90-minute treatments vs 40 half-hour stints on
the table.

Radiation, just like surgery, experience counts.

First, the seeds you are ref to are not radioactive seeds. They are
usually
gold seeds that are tracked by computer to make adjustments to the
beam. These are much more accurate because they are along the actual
surface of the prostate... versus skin marks for intersecting beams.
Keep
in mind that the skin moves, and so does the prostate. The prostate
moves in space with respirations. Unfortunately, even with the tracking
gold seeds, the actual beam does not move. I think that will be the
next
great advance in external beam. Real-time tracking of the prostate
during
treatments.

You're being smart, thinking about the next step. Prostate cancer is
soon
going to be like breast cancer. Everything will be multi-modal therapy.
Not just surgery, or just radiation. But combo therapy. I have an
obvious
bias.. but in my opinion, surgery is the best front-line treatment.
Surgery
following failed radiation is dismal with most men ending up
incontinent.
However, after daVinci robotic laparoscopic Prostatectomy, you will
most
likely be 100% dry. If you need radiation later for a slow rising PSA,
you
will likely stay dry. As for extracapsular extension, you are right
there
also. I don't know your age, but I would not advise doing a
nerve-sparing
surgery, at least on the side of your dominant cancer. If you had no
cancer
found on 1 side, I'd consider doing a limited nerve-sparing for the
benefit of
your urinary control and hopefully to improve your response to ED
drugs.

I know Menon and Patel. Both high-volume surgeons. Make sure you know
and clarify who will be doing your surgery. Vip is a quality guy.

Best wishes!
===
http://www.DrYew.com
http://www.SanDiegoRoboticProstatectomy.com
*IMPORTANT* Any comments by me are for general informational purposes
only, and should never be used to diagnose or recommend  treatments for
any condition without face-to-face consultation with a qualified
health-care provider. Thank you.
===

Hi John...Dr Critz has published a lot of RCOG's data over the years.
Their I-125 seeds plus XBRT approach has produced excellent results.
This combined seeds plus external radiation approach drives the PSA low
enough that RCOG uses a PSA>0.2 ng/ml as a metric for biochemical
failure, just like surgery.  I've read that a couple of the key docs
who helped Critz run the place have left in the past year or two and
now have their own facility.  I'm not sure what effect, if any, this
may have.  You might want to wander over to Don Cooley's website

http://www.prostate-help.org/

He was treated at RCOG many years ago.  He maintains an active
discussion list with as many participants as we have here, perhaps
more.  Many of the men on the list are also RCOG graduates.  You could
probably get a lot of good information there.  They do discuss the
effect of the other docs leaving from time to time.  When I've compared
the published RCOG data against the Hopkins RP long-term biochemical
recurrence data, the two institutions seem to produce very similar
outcomes for stagings from low-risk to high-risk...Best wishes and good
health, Ron

John,

My cancer may have been similar to yours.  I had a
Gleason score of 4+3.  My last PSA reading was 10.3,
though that may have been a bit high due to prostatitis.
I had 8.7 a couople of months before.  MRIs taken
before treatment showed a pretty ugly tumor right
against and perhaps a bit beyond, the prostate
capsule, but all tests for metastasis were negative
and the MRI didn't show anything in seminal vesicles
(though it wouldn't show tiny metastases.)

I chose a treatment somewhat similar to yours, but with
HDR brachytherapy plus external beam instead of
permanently implanted seeds.  If I hadn't chosen that
I would have chosen the one you are considering -
permanent seeds plus EBRT.  The only reason I chose
the HDR was that it was a clinical trial at the National
Cancer Institute and, because I make a lot of my living
programming computers for NCI, and because I had
great confidence in the doctors there, I felt some need to
put my body on the line for their clinical trials.

My choice of radiation was based on a number of factors,
chief of which was a belief, rightly or wrongly, that the
success rate was equal to surgery and the side effects
less.  Also, rightly or wrongly, I imagined that a Gleason
7 with extensions outside the prostate might be better
treated by radiation than surgery.  My rad onc said she
would be treating the area one centimeter all around the
prostate.

There is a LOT of debate about whether either of the
above assumptions is true.  There are people, including
serious doctors, who believe that radiation is about as
effective as voodoo.  My personal view, based on my
reading of the literature, is that it's effective, and I bet
my life on it.  But I'm no expert and my opinion really
isn't worth much in that area.

Knocking furiously on wood, I'd have to say that my
results were good.  Two and a half years later, my PSA
is .25, which is considered good for radiation patients.
My potency wasn't great going in to the procedure, but
it came out pretty much intact.  I think it's a little less
than it was, but I'm getting older too.  In any case, I can
still have sex.

The side effects I experienced were:

Aggravation of a pre-existing hemmorhoid, cleared
up about 4 weeks after the end of treatment.

Aggravation of pre-existing prostatitis.  That was an
off and on thing before treatment and continued as
an off and on thing after.  It's been off for about a year
now and I'm hoping it will stay that way.  (Surgery
would presumably have cured the prostatitis.)

Blood in semen.  Cleared up 2-3 weeks or so after
treatment.

Urinary urgency, requiring Flowmax.  At its worst I
was getting up almost every hour all night long.  The
worst of it lasted about 4-6 weeks.  However it took
about 5 months to return to normal.

Other effects: the radiation burned off pubic hair - which
grew back shortly after, and I had radiation burns, like
sunburn, on the skin where the beams hit it.  Like
sunburn, that cleared up in about a week.

I watched on the screen as my rad onc did a proctoscopy
one year after radiation.  I could see that the rectal
walls were scarred from the radiation.  The beams are
invisible, but like a surgeon's knife, they do violence to
the body.

I had my two HDR brachytherapies on Thursdays,
taking those Thursdays and Fridays off from work.
Other than that, I never missed a day of work and
never stopped physical exercise during the whole
process.  I could walk, drive, work, even jog, during
and after the treatment (with a few days off exercise
after the brachy procedures.)

I don't know anything about the docs you're seeing in
Georgia, but I like the plan of putting in seeds, using
them to assist targeting of external beam (the seeds
should show up clearly on xrays), and using IMRT.
Most docs use a simpler 3DCRT when using brachy-
therapy (mine used 3DCRT) which requires less
computer simulation and setup time than IMRT, but
delivers slightly more radiation to sensitive areas
that it would be good to miss.

I also like that these guys are specialists doing 1,000
cases a year.  Everything I've read says that every
procedure, whether surgery or radiation, has a higher
success rate when done by specialists than when
done by generalists (e.g., surgeons or rad oncs who
only do occasional prostate treatment.)

There are no guarantees.  With radiation you can get
incontinence (relatively rare but not unknown) or
impotence (less rare, some think the rates are about
the same as for surgery).  You could have permanent,
accidental damage to bladder or rectum.  You could
have more radiation induced genetic damage that
could result in secondary cancer 10-20 years down
the road.  You could fail treatment and still have
prostate cancer at the end.

But s**t can happen with surgery too.  Either way,
it requires great skill by the doctor and maybe some
plain old fashioned luck.

It sounds to me like the RCOG doctors are minimizing
the dangers as much as they can.  It looks to me like
a very reasonable treatment choice.

I'm content with the choice I made, and would do it
again.

Best of luck to you.

   Alan

Here's the link to RCOG

http://www.rcog.com/home.htm

Bev

I just want to put in a good word for Dr. Patel. He performed my
robotic surgery a year ago and I went home after catheter removal on
the sixth day totally dry. I also had an outstanding experience with
the James Cancer Hospital at Ohio State University. Dr. Patel's
followup has been excellent and I especially value the high priority he
places on recovery of erectile function and the experience of the staff
who works with him on this issue. He is a very sensitive and caring
physician, but I really appreciated his thorough assessment of risks in
determining whether I was a viable candidate for robotic surgery. He
will be an excellent resource for you in evaluating your options.