On August 28, Charlie wrote:

Of course they do.

There is no way to know. If the PCa (prostate cancer) recurs it is
considered a, well, recurrence, not necessarily a completely new tumor.

The "seeds" would be emplaced throughout the gland. The rad onc should
brief the patient on this. If (s)he fails to do so, shop for a competent
rad onc.

Not that I know of. But periodic followup tests are prudent in order to
determine whether the PCa has recurred.This would likely continue until
something else causes the patient to drop off the twig.

But it is unwise to rely upon the well-intentioned advice of amateurs
such as we on this NG. For authoritative information, go to the website
of the Prostate Cancer Research Institute at:
http://prostate-cancer.org/index.html

We can provide anecdotal war stories that might guide one to lines of
inquiry, but they are unreliable when one is seeking advice on how to
save one's life.

Regards,

Steve J

"If you know the enemy and know yourself, you need not fear the result
of a hundred battles. If you know yourself but not the enemy, for every
victory gained you will also suffer a defeat. If you know neither the
enemy nor yourself, you will succumb in every battle."
-- Sun Tzu, "The Art of War"

Hi Charlie, Sorry to hear you have joined this club.

If the seeds are properly planted you will have no prostate left when they
have finished working on it. That Gleason 7 might make you a poor candidate
for brachytherapy (seeds) - seems to depend on the group doing it. The
Massey Cancer Center, Medical College of Virginia will not do it with a
Gleason 7. You might want to check someplace such as RCOG.
http://www.rcog.com/home.htm

Brachytherapy has been around for a long time but it is only in the last 15
years or so that it has been widely used. (They finally got the technique
down pat.) Our doctor at Massey/MCV has been doing them since 1989 and has
not had a single failure. His stats are not unusual but they have very rigid
guidelines as to who they select for seeding.

Hubby seeded May 2002 after 5 weeks EBRT on IMRT. He's 0.01 - that is
considered undetectable by his radiation-oncologist. He was 56 at the time
with a Gleason 6 (3+3), PSA 4.9, fPSA 8%.

If you want to know more just email me.
Bev

I suggest that you see what Peter Scardino says in "The Prostate Book'.
 He is a world class prostate cancer research scientist, having written
hundreds of papers on the subject.   It is true that he is a surgeon and
may possibly be biased towards surgery, but it seems to me his treatment
in the book is well balanced.

He seems to think that a Gleason 7 tumor should not ordinarily be
treated with seeds, and he gives reasons why.  He suggests using
external beam radiation or surgery in such cases on the basis that
either gives a better chance for long term cancer control.  I believe
there have been some recent studies supporting that conclusion, but I
can't quote them right now.

He does make one other point.  If you have access only to a mediocre
surgeon but to a first class brachytherapist, then it might sense to
choose the latter.  You need to ask each for figures from his practice
on long term, much longer than 10 years in your case, cancer control for
the recommended procedure for men with your specific diagnosis.

I don't know the answer to your question.  But one thing to keep in mind
is that the exact way the procedure is done will determine how much
prostate tissue is left behind.  Some brachytherapists claim to be able
to drive the PSA levels down to undetectable levels, but others are
satisfied with a higher nadir or lowest point.

It would be wise to set up an appt for surgery anyway.  There is one
Dr. Guilloneau at Sloan-Kettering who has a six-month waiting list.

P.S.  I don't understand in-line posting v. other.  If you want your
post to be the last in the thread and viewable by the entire group
where exactly should you write it.  We women are not that technically
inclined.

Leah

Unfortunately, the experts seem to disagree about the answers
to your questions.  I am not an expert myself but, rest assured,
even if I was, you could find other experts that would disagree
with me.

Everyone seems to agree that surgery works if it's properly
done by a very experienced surgeon, and if the cancer has
not yet spread beyond the reach of the surgeon's scalpel.

Many people believe that radiation works equally well, if
properly performed by a very experienced radiation oncologist
and if the cancer has not yet spread beyond the treatment
area (which can include the region a little outside the prostate
itself.)

However some people believe that radiation does not work, or
is not proven for long term suppression of cancer, and should
not be used by men as young as yourself.

My rad onc told me 2.5 years ago that 15 year results were
coming in and that radiation is holding up well.  But longer
term results are not yet available.

Radiation techniques have changed pretty dramatically in
the last 10-15 years.  Doses have gone up, beam aiming has
become more precise, and the ability to work around
sensitive structures has improved.  So the data from 15
and 20 years ago is not representative of what can now
be achieved.  That further complicates the problem of trying
to evaluate the long term effectiveness of any of the
current radiation techniques.  There are also new surgical
and non-surgical techniques for which long term data are
not yet available.

Unfortunately, although you are not an expert on prostate cancer
and have no previous experience with it, you are now forced
to make your own judgement about which experts to believe.
We have all been there and done that, with each of us coming
to his own conclusions.

I personally chose radiation for a Gleason 7 (4+3) tumor with
PSA of 8.7.  However two different radiation oncologists that
I consulted told me (and my reading appeared to confirm) that
brachytherapy alone (without external beam radiation) is less
effective than either surgery or other radiation techniques for
"intermediate risk" cancers - which includes all cancers with
Gleason 7.  I was 57 at the time.

I had two doses of "high-dose rate" brachytherapy plus 25
doses of external beam.  Two and a half years later
(knocking on wood), my cancer seems not yet to have
recurred.

Whatever you do, I am convinced that experience counts.  Get
a doctor, either a surgeon or a rad onc, who does lots and lots
of prostate cancer treatment, and whom you judge to be a
careful and competent person.  I believe that you can improve
your odds of success more by choosing the right person than
the right treatment modality (at least between surgery and
external beam or external beam plus seeds modalities.)

Best of luck.

   Alan

Hi Charlie,
Few questions.. how do you know it's 1.2 cm? Can it be felt on rectal
exam?
or was it "seen" on ultrasound (rather unreliable IMO)? Is it 3+4 or
4+3
Regardless, any 7 is a significant cancer, especially in a 51yo that
can be
expected to most likely harm you early in your lifetime. I'd opt for
definitive
local therapy.. which kills the cancer. That's radiation or surgery.

For both, make sure you go to someone who does a high-volume of seeds
or surgery. I'm biased, but I'm concerned about seeds in higher grade
cancers,
and the growing trend towards "spackling" with supplemental beam. Also,

consider that prostate cancer is starting to evolve much like breast
with multi-
modal therapies. As a front-line treatment, radiation failures will
typically end
up on hormones/chemo. Few will even suggest surgery to you following
radiation, due to radiation-effects on tissues and poor healing. Almost
all men
who undergo "salvage" prostatectomy surgery following radiation are
totally
incontinent and impotent. Conversely, assuming you regain continence
and
some erectile function after prostatectomy, if your PSA recurs and
suggests
local residual cancer, adjuvant external beam is fairly well tolerated
with
preservation of continence and, to varying degrees, potency.

There's a lot to think about and learn. Given your young age and
health, I'd
advise an aggressive approach.  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.
===

More like ALL of us, Charlie.

You're still a might young for radiation treatment.  However, studies have
shown that there is no appreciable difference between surgery and radiation
as far as the cancer is concerned.  You seem to have a pretty good chance at
a cure either way.  Most prostate cancer patients would prefer a Gleason 6
and a PSA of 4 (or better), but you're close on both counts.

As far as our experiences, I could probably give you a statistical analysis
of 600+ that have stopped by here in the last few years, but check out
"Partin Tables" in prostate books or on the web.  You'll need to know if
your Gleason of 7 is represented as 3+4=7 or 4+3=7.  You'll also have to
have your Stage.  Your doc should have told you these.  And, let us know,
please.

That is the problem with seeds or other radiation.  A man of 51 that is
cured of PCa through radiation has to worry about becoming a man of 71 with
serious side effects from radiation (cancer, tubes and bags handling your
waste function(s), etc.).  Of course, there are side effects of surgery that
effect the man at 51 (temporary incontinence, temporary impotence, etc.).

There is no good way to get through this.  But, you really need to research
it.  Dr. Patrick Walsh's Guide to Surviving Prostate Cancer and Dr. Peter
Scardino's Prostate Book are two of the best.  Websites include
www.phoenix5.org.  There is only one absolute in this disease.  You must
research, research and then research and THEN make YOUR decision.

The best treatments have come about in the late 1990s.  It's tough getting
15-year and 20-year results.