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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2007Options After Seed Implant Treatment
Hi All This is my first time joining a group of any type, so please bear with me if I seem to not be following protocol. I was just last month diagnosed with prostate cancer and had my initial treatment options discussion with my Dr. One question that I have (And forgot to ask him) is in regard to possible treatment if the seed implant treatment is not successful. My wife said that she "heard" that prostrate removal by surgery was not possible "after" the seed implant treatment, should it not be successful. Has anyone heard this? I have a very demanding job (I am in India at this moment) that requires frequent and unpredictable travel, and I was thinking about the easiest treatment to recover from, but I do not want to take any chances taht could end in a bad way if you know what I mean. > Hi All > This is my first time joining a group of any type, so please bear with [quoted text clipped - 9 lines] > easiest treatment to recover from, but I do not want to take any > chances taht could end in a bad way if you know what I mean. The outcome of a single brachytherapy treatment (seed implants) is usually highly effective against cancer if the disease is caught early. This would include Gleason score of 3+3, and 3+4. In cases where the cancer returns(or high PSA) after brachytherapy treatment, then general radiation might be needed (since as you correctly pointed out, surgery is no longer possible after seeds because the prostate has been mostly destroyed by the radiation in the seeds). Usually the general radiation needs to be administered over a period of weeks or months. Brachytherapy is considered by some to be the easiest to recover from, but there are always exceptions. In terms of efficacy against the cancer, brachytherapy and surgery are about equal when the cancer is caught early. If the cancer returns (or high PSA returns), then multiple radiation treatments may be needed later (but this would take awhile to determine). The biggest factors in terms of recovery (and ability to travel) probably relate to incontinence, and most people experience less problems with brachytherapy that with surgery. Impotence is also a factor, but obviously it does not affect your job. > Impotence is also a factor, but obviously > it does not affect your job. Unless he has one HELLUVA job! '-) I.P. (snip) > I was just last month > diagnosed with prostate cancer and had my initial treatment options [quoted text clipped - 3 lines] > removal by surgery was not possible "after" the seed implant > treatment, should it not be successful. Has anyone heard this? Yes, it is common "wisdom" in the prostate cancer (PCa) community. But as usual, there is not full agreement. I have seen and heard competent radiation oncologists say that that's outdated. But they don't deny that it is difficult. Failure of brachytherapy to reduce PSA over time (it is not immediate) would probably mean that the disease is systemic or even metastacized. Surgery or another local tx would not be curative nor even particularly helpful, as the PSA is likely from a source other than the gland. > I have > a very demanding job (I am in India at this moment) that requires > frequent and unpredictable travel, and I was thinking about the > easiest treatment to recover from, but I do not want to take any > chances taht could end in a bad way if you know what I mean. The choice is and should be entirely up to the patient and his burden is to educate himself so as to make the best treatment (tx) selection *for him.* There are staging tests beyond the common CT and scan that will help to determine the status of the case. and the likelihood of extra-capsular extension (ECE). I recommend study of the authoritative and objective website of the Prostate Cancer Research Institute (PCRI) at: http://prostate-cancer.org/index.html Simply search on what is of interest such as brachytherapy. But the best beginning would be the section entitled, "Newly Diagnosed." Also see the nomograms that can, with proper parameters such as PSA, Gleason, etc., give one a probability of ECE. I also recommend the excellent text on PCa, _A Primer on Prostate Cancer_ 2nd ed., subtitled "The Empowered Patient's Guide," by medical oncologist and PCa specialist Stephen B. Strum, MD and PCa warrior Donna Pogliano. It is available via the PCRI site and from the online bookstores such as Amazon and Barnes & Noble. There is much to do. Study, Learn, Take Charge. Regards, Steve J "Empowerment: taking responsibility for and authority over one's own outcomes based on education and knowledge of the consequences and contingencies involved in one's own decisions. This focus provides the uplifting energy that can sustain in the face of crisis." --Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled "The Empowered Patient's Guide." > Hi All > This is my first time joining a group of any type, so please bear with [quoted text clipped - 9 lines] > easiest treatment to recover from, but I do not want to take any > chances taht could end in a bad way if you know what I mean. I'm now on day 37 following seed implants. I've had one follow-up visit with my urologist to discuss "how" I was doing. Urinating being the main discomfort. Then I had a CT with my radiation oncologist to determine the spread of the seed, cold spots, etc. Around the 1st of April I will have another visit with the urologist having had my fist PSA following seeding. And another follow-up with the oncologist. After 37 days I still feel discomfort riding and sitting for durations of 30 minutes or more. I feel best when I'm up and moving around and playing golf or just long walks. The urologist describes this as the continued swelling of the prostate, which subsides after six weeks. I certainly hope so. While I don't crave Flomax, I use it for 2-3 days at a time now when my frequency of getting up nights increases. It really helps. Some nights are good, some nights I'm up 4-5 times. None of this discomfort would be considered unbearable. But my wife says I am a whimp, since she underwent breast cancer surgery last year. So I keep my whining to a minimum around her. > Hi All > This is my first time joining a group of any type, so please bear with [quoted text clipped - 9 lines] > easiest treatment to recover from, but I do not want to take any > chances taht could end in a bad way if you know what I mean. I think you don't fully understand exactly what the seeds do. They actually shrink, kill and eliminate the entire prostate over the course of a year or so. Before I chose my treatment method of surgery, I thought the seeds were only targeting the tumor. Once your prostate is gone, and if your PCA continues, there are still other courses of treatment.  SignatureJK Sinrod www.SinrodStudios.com www.MyConeyIslandMemories.com >> Hi All >> This is my first time joining a group of any type, so please bear with [quoted text clipped - 15 lines] > the seeds were only targeting the tumor. Once your prostate is gone, and > if your PCA continues, there are still other courses of treatment. Is this entirely correct? In all my research on seeding, I don't recall reading that the prostate is eliminated. And, not surprisingly, my urologist did not mention this. I've heard this both ways, even on this newsgroup. The radiation oncologist I spoke with when I was deciding about things said that the goal would be to get my PSA below 1.0 -- I assumed that meant that there would be prostate tissue left. Since I decided to go with the surgery, I never pursued it further. --charlie > I've heard this both ways, even on this newsgroup. The radiation > oncologist I spoke with when I was deciding about things said that the [quoted text clipped - 3 lines] > > --charlie With the seeds there is some prostate tissue left, since placing the seeds everywhere to eliminate all of it would damage the connecting tissues with radiation. But after the seeds have destroyed most all of the prostate, then it is not in one nice piece which can be easily removed via surgery. > Is this entirely correct? In all my research on seeding, I don't recall > reading that the prostate is eliminated. And, not surprisingly, my > urologist did not mention this. Eliminated is probably not exactly the right word, at least not initially. But the seeds do destroy the prostate tissue, which eventually cause the prostate to shrivel up and mostly disappear over time. When this happens, you may still have orgasms, but no ejaculation. Yes, it is strange that urologists don't really explain this, and coupled with newsgroups where many people use cryptic abbreviations and code words, it is hard to understand what is going on unless you have spent a lot time asking questions and researching. Dear JK - I don't think that you realize that you got cancer - that is what the c which comes after the p stands for. That is not like choosing between two dentists, who can see you between your flight schedules. No one in the group knows you or your medical file and thus the debate is very theoretical. In my case I chose RP. I hear from friends as well as in this group that in both cases RP as well as seeding there is a process of healing and recovering and in both cases it take time to come back to "normal" Whatever you choose I wish you success in the procedure RR >>> Hi All >>> This is my first time joining a group of any type, so please bear with [quoted text clipped - 19 lines] >reading that the prostate is eliminated. And, not surprisingly, my >urologist did not mention this. > This is my first time joining a group of any type, so please bear with > me if I seem to not be following protocol. This a prostate cancer support group, not the American Psychological Association. We do not stand on protocol. Welcome to our club! > I was just last month > diagnosed with prostate cancer and had my initial treatment options [quoted text clipped - 3 lines] > removal by surgery was not possible "after" the seed implant > treatment, should it not be successful. They whole idea behind curing prostate cancer is cutting it out, burning it out, or freezing it out. What is left after burning it (radiation) is not suitable for surgery. So, yes, she heard right. For that very reason, many of us (most of us) opt for surgery. However, your age, physical condition, PSA, Stage and Gleason (notice I didn't say job) should all be considered before making the decision for surgery or radiation. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > Hi All > This is my first time joining a group of any type, so please bear with [quoted text clipped - 9 lines] > easiest treatment to recover from, but I do not want to take any > chances taht could end in a bad way if you know what I mean. Every PC treatment has "significant" "chances" of ending in many "bad" ways. The quotes denote words that are very subjective, personal, and/or statistical in nature. One man's "significant", even "devastating", side effect is another man's "who cares?"; one man can encounter practically no SEs while his twin brother is virtually destroyed by a litany of severe ones; and even "bad" is relative, given that a 5-year survival prognosis would overjoy a man with widespread bone metastases but devastate a man with just a Gleason 6 tumor confined to his prostate. This whole field is highly subjective, which is essentially *the* reason most oncologists will not tell us what treatment to accept and *the* reason we must study books and trials outcomes and authoritative websites before choosing initial and follow-up treatments. Many of us spent up to hundreds of hours reading before choosing our treatments, and feel it was justified. Several who didn't do their homework wish the hell they had. (To be honest, of course, some did the research AND got poor results, but at least they know they did all they could do.) And unless the next couple of months of your job is more important to you than the quality and duration of the rest of your life, I strongly urge you to put "easiest to recover from" down around 37th in your list of treatment decision factors. Dude, you *really* picked a weird club to join. Ever think of bird-watching or bridge? ;-) I.P. > <SNIP> > And unless the next couple of months of your job is more important to you [quoted text clipped - 3 lines] ><SNIP> > I.P. I think you are way out of line here. It is well accepted that surgery and brachytherapy (seeds) have similar statistical outcomes with regard to life expectancy when the cancer is discovered and treated early. It is therefore perfectly reasonable for many to make a choice based on how long it takes to recover from the treatment so that one can get on with life. Obviously, the side effects of the treatment (possible incontinence and impotency) are other important considerations for most patients. In any case, I think people should provide factual information on this newsgroup, and keep their opinions of other people's choices to themselves. On Feb 5, 7:10 pm, "James" <nob...@nowhere.com> wrote...snip... > It is well accepted that surgery and brachytherapy (seeds) have similar > statistical outcomes with regard to life expectancy when the cancer is > discovered and treated early. James...Do you have a reference to a study supporting this position?..ron > James...Do you have a reference to a study supporting this > position?..ron Just to repeat what I said, it appears that for early diagnosis and treatment of prostate cancer the general consensus is that brachytherapy and radical prostatectomy yield similar statistical results in terms of longevity of the patient. For more information, please read the complete articles listed below. The question of quality of life (side effects) related to brachytherapy and radical prostatectomy is more problematic, and there are conflicting studies. This is probably because it is easier to find out if a patient dies from prostate cancer, than finding out whether he suffered impotency or incontinence as the result of treatment (not everyone discusses these issues candidly with their doctor, especially years after their treatment). Here are 3 studies, but there are others: 1. "Is brachytherapy comparable with radical prostatectomy and external-beam radiation for clinically localized prostate cancer?" Merrick GS, Butler WM, Lief JH, Dorsey AT. PMID: 11272667 [PubMed - indexed for MEDLINE] CONCLUSIONS: With prostate-specific antigen-based follow-up as long as 10 years, the results of prostate brachytherapy for low-risk patients are as favorable as the most positive radical prostatectomy and external-beam radiation therapy series. (excerpt from conclustions) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1 1272667&dopt=Abstract 2. "Comparison of biochemical disease-free survival of patients with localized carcinoma of the prostate undergoing radical prostatectomy, transperineal ultrasound-guided radioactive seed implantation, or definitive external beam irradiation." Stokes SH. PMID: 10758314 [PubMed - indexed for MEDLINE] CONCLUSION: For patients with low or intermediate risk disease, external beam, ultrasound-guided (125)I [brachytherapy], or a radical prostatectomy give comparable long-term biochemical disease-free survival. (excerpt from conclustion) http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=R etrieve&dopt=abstractplus&list_uids=10758314 3. "Ten-year disease free survival after transperineal sonography-guided iodine-125 brachytherapy with or without 45-gray external beam irradiation in the treatment of patients with clinically localized, low to high Gleason grade prostate carcinoma." Ragde H, Elgamal AA, Snow PB, Brandt J, Bartolucci AA, Nadir BS, Korb LJ. PMID: 9731904 [PubMed - indexed for MEDLINE] CONCLUSIONS: Percutaneous prostate brachytherapy is a valid and efficient option for treating patients with clinically organ-confined, low to high Gleason grade, prostate carcinoma. Observed 10-year follow-up documents serum PSA levels superior to those reported in several published external beam irradiation series, and comparable to those published in a number of published radical prostatectomy series. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=R etrieve&dopt=abstractplus&list_uids=9731904 For more information, click on "related articles" James...Thanks for the references. I've inserted some comments / questions by each of them...ron > > James...Do you have a reference to a study supporting this > > position?..ron [quoted text clipped - 23 lines] > favorable as the most positive radical prostatectomy and external-beam > radiation therapy series. (excerpt from conclustions)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&... All I could see was the abstract. The abstract does not state what the median follow-up was (I see that follow-up was as long as 10 years, but what was the median), and what definition(s) of failure (DOF) were used to compare the treatments? > 2. "Comparison of biochemical disease-free survival of patients with > localized carcinoma of the prostate undergoing radical prostatectomy, [quoted text clipped - 7 lines] > give comparable long-term biochemical disease-free survival. (excerpt from > conclustion)http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=p... Here different DOFs were used to compare the approachs 5 years out from treatment. A number of studies have taken a single, treated PCa population and compared the failure rates obtained from this population when using both the ASTRO and PSA>0.2 ng/ml DOFs. Large differences are seen favoring ASTRO, especially with low-risk men and at short (5-6 years) median post-treatment times. Critz's study was a good one on this point (J. Urol., Vol. 167, 1310-1313, 2002; A Standard Definition of Disease Freedom Is Needed For Prostate Cancer: Undectable Prostate Specific Antigen Compared With The ASTRO Consensus Definition). All studies on this point show that there are 15-40% fewer ASTRO failure calls than PSA>0.2 failure calls, the actual number being dependent upon the underlying population and the post- treatment time. So 5 year comparisons using these two different DOFs are flawed and if they claim similar outcomes then they actually suggest that the modality using PSA>0.2 as the DOF actually has a superior outcome. >. "Ten-year disease free survival after transperineal sonography-guided > iodine-125 brachytherapy with or without 45-gray external beam irradiation [quoted text clipped - 9 lines] > beam irradiation series, and comparable to those published in a number of > published radical prostatectomy series.http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=p... Again, I've only read the abstract so I'm not sure what RP series Radge is comparing against. The Johns Hopkins nomogram (http://www.prostate-help.org/download/jhnomo.pdf) is probably the largest, most detailed, published, peer-reviewed RP study and relatively easy to compare against. Radge, et.al. claim a 64% biochemical disease free survival (BDFS) at 10 years (I assume this is a real number, not a statistical projection). In the Hopkins paper, 72% of the men treated had BDFS at 10 years (unprojected), 61% at 15 years. If the 4% with seminal vesicle involvement and the 5% with pelvic lymph node mets were removed from the Hopkins' paper, the Hopkins number would obviously be even higher. If Radge is using the ASTRO DOF (Hopkins uses PSA>0.2) then that will further skew the results in brachy's favor, although at 10 years, the differences are more like 5-10%. > For more information, click on "related articles" So where I come out is that it is unclear if two modalities have similar or different outcomes when different DOFs are used in the comparison...ron > Again, I've only read the abstract so I'm not sure what RP series > Radge is comparing against. The Johns Hopkins nomogram [quoted text clipped - 14 lines] > similar or different outcomes when different DOFs are used in the > comparison...ron You have raised some good points. Unfortunately, a lot of these studies are probably flawed in some way. One of the authors of the study you referenced in the your link above is very famous for performing radical prostatectomy surgery (Walsh). He is also famous for cherry picking his patients, and he does not operate on anyone who is past the very early stages of prostate cancer. Some doctors think that his own success rate is highly skewed because of this. > You have raised some good points. Unfortunately, a lot of these studies are > probably flawed in some way. I was specific about the flaws in these studies: 1) Making comparisons using different DOFs 2) Applying the ASTRO DOF to studies with short median post-treatment times >One of the authors of the study you referenced > in the your link above is very famous for performing radical prostatectomy > surgery (Walsh). He is also famous for cherry picking his patients, and he > does not operate on anyone who is past the very early stages of prostate > cancer. Some doctors think that his own success rate is highly skewed > because of this. This is said repeatedly about Walsh on various lists. I don't know what type of patients he is treating today, but his publications spell out, in detail, the patients he treated between 1982 and 1999, the consecutive 2,000 plus men that form the basis of his studies. I've reproduced the Table describing these men below... TABLE 1. Clinical stage, preoperative PSA, Gleason score and pathological stage in 2,091 men who underwent anatomic radical retropubic prostatectomy for T1c or T2 disease with Gleason score 5 or greater No. Men (%) TNM stage: T1c 845 (40) T2a 771 (37) T2b/c 475 (23) Total 2,091 (100) Serum PSA (ng./ml.): 0-4 452 (24) 4.1-10 1,021 (55) 10.1-20 319 (17) Greater than 20 80 (4) Total 1,872 (100) Gleason score: 5 241 (12) 6 1,020 (49) 7 693 (33) 8-10 137 (6) Total 2,091 (100) Pathological stage: Organ confined 1,050 (50) Extraprostatic extension, Gleason score less than 7, neg. surgical margins 310 (15) Extraprostatic extension, Gleason score less than 7, pos. surgical margins 96 (5) Extraprostatic extension, Gleason score 7 or greater, neg. surgical margins 306 (15) Extraprostatic extension, Gleason score 7 or greater, pos. surgical margins 119 (6) Seminal vesicle involvement, neg. lymph nodes 98 (4) Micrometastases to pelvic lymph nodes 112 (5) Total 2,091 (100) Half of the men weren't organ confined, 60% were T2a/b/c and 39% had GS>6. That doesn't sound like he was cherry-picking back then. These are the men used to generate the Hopkins RP success / failure rate. If anything, I would suspect the large number of men with SV involvement, lymph node mets, EPE or non-organ confined cancers would "skew" the data quite differently than you insinuated...ron > This is said repeatedly about Walsh on various lists. I don't know > what type of patients he is treating today, but his publications spell [quoted text clipped - 50 lines] > involvement, lymph node mets, EPE or non-organ confined cancers would > "skew" the data quite differently than you insinuated...ron As I mentioned, some doctors have told me that Walsh cherry picks his patients (at least in recent years). That includes my own urologist/surgeon who thinks Walsh's statistical outcomes are skewed because of that. Perhaps he originally treated all patients who came to him, but once Walsh became "famous" then maybe he started cherry picking at that time. I personally don't know. > As I mentioned, some doctors have told me that Walsh cherry picks his > patients (at least in recent years). That includes my own urologist/surgeon > who thinks Walsh's statistical outcomes are skewed because of that. Perhaps > he originally treated all patients who came to him, but once Walsh became > "famous" then maybe he started cherry picking at that time. I personally > don't know. Another interpretation - as Dr. Walsh gained more understanding of the disease, he declined to treat patients who had a high probability of failure. This is good medicine in that, if the staging, PSA, images, and so on, indicate that failure is very likely because the disease has already extended beyond the prostate, beyond the adjacent ducts, how could he honestly subject the patient to the stress of surgery? This is a trade off that we all face. If he recommends treatment, there's a 90, 75, 50, 30, 10 percent probability of success and a 10, 30, 50, 75, 90 percent probability of THESE side effects. In addition, the patient is guaranteed the stress and cost of the treatment. As the odds shift against treatment success and toward a bad outcome, a good doctor is compelled to step back. Figure, 1990, 1995, that timeframe, imaging is crude compared to today, no Prostascint, no PET-scan, and the database of success/ failure is sparse. In that timeframe, sure, whip that thing out-a there. 2000, 2005, 2007, Tomo, MRI, seeds showing a 90% success rate, color doppler ultrasound, the Trilogy just down the hall, a surgeon has to hesitate, begin to limit his work. -kh deal with it guys, make your best, informed decision and go with it. >> <SNIP> >> And unless the next couple of months of your job is more important to you [quoted text clipped - 13 lines] > (possible incontinence and impotency) are other important considerations for > most patients. Anyone who considers the short- and long-term prognosis, benefits, and undesirable SEs of PC treatment options of equal or less importance than how quickly he can get back to work must have one HELLUVA job, no family, and no outside activities he's passionate about. They're comparing days or weeks of work impact on the one hand to potentially years or decades of heartbeat and QOL on the other. > In any case, I think people should provide factual information on this > newsgroup, and keep their opinions of other people's choices to themselves. I generally agree we have little right to volunteer uninvited treatment advice on others' well-researched choices, but Rick specifically requested our advice and his posts demonstrate that he has not researched PC and its treatments the least bit thoroughly yet. But realize I'm a maverick here; several people here have expressed strong opinions that our only purpose is emotional support, as in "You'll be fine" and "May your PSA remain undetectable for 30 years", that facts -- especially if unsettling -- do not belong here. Thank you for putting me back in the middle of the road. ;-) I.P. > Anyone who considers the short- and long-term prognosis, benefits, and > undesirable SEs of PC treatment options of equal or less importance than > how quickly he can get back to work must have one HELLUVA job, no family, > and no outside activities he's passionate about. They're comparing days or > weeks of work impact on the one hand to potentially years or decades of > heartbeat and QOL on the other. If the expected outcome of two treatment choices (surgery vs. brachytherapy) have been shown to be about the same statistically for life expectancy (for early treatment of prostate cancer), then it is perfectly reasonably to focus on the other factors, such as side effects and recovery time when deciding between the two. > I generally agree we have little right to volunteer uninvited treatment > advice on others' well-researched choices, but Rick specifically requested [quoted text clipped - 7 lines] > > I.P. I am not one of those who would like to see this newsgroup be primarily for emotional support, although given the name of the newsgroup, I suppose it is not improper to offer it. I would like to think this newsgroup is primarily a source of factual information, including anecdotal information from patients who can relay their experiences with the disease and the various treatments they have received, most of which have significant side effects. If you want to give your opinions about prostate cancer treatments, that is fine, but I don't think it is proper to make judgments about what other consider to be most important things in their lives. > If the expected outcome of two treatment choices (surgery vs. brachytherapy) > have been shown to be about the same statistically for life expectancy (for > early treatment of prostate cancer), then it is perfectly reasonably to > focus on the other factors, such as side effects and recovery time when > deciding between the two. Of course. Now . . . which is more important to most PC pts, the speed bump of recovery or a (possibly shortened) lifetime of SEs? > I would like to think this newsgroup is primarily a source of factual > information, including anecdotal information from patients who can relay [quoted text clipped - 3 lines] > think it is proper to make judgments about what other consider to be most > important things in their lives. So Rick has no right to request advice? I.P. > So Rick has no right to request advice? > > I.P. He can request advice, and you can give it. But I was not aware that he requested advice on what was most important in his life. >> So Rick has no right to request advice? >> >> I.P. > > He can request advice, and you can give it. But I was not aware that he > requested advice on what was most important in his life. Well, right or wrong, I made one (it's been made before, here and in the literature, in an attempt to get new patients to consider the whole forest). Picture a matrix with the half-dozen or so treatments across the top and their 20-30 potential effects, good and bad, with likelihoods, down the side. Even leaving such irrelevant blocks as LRP vs diabetes or WW vs heartbeat extension blank, the matrix still contains several dozen blocks more important than a couple of weeks of virtually any job on the planet by virtually anyone's perspective, and should open anyone's eyes so they can better evaluate their importance relevant to a two-week vacation. I wouldn't make that suggestion to the old hands here; they've been there, done that, in one way or another . . . or in some cases regretted not having done so. In particular, consider two rows in that matrix: time lost from work due to treatment (<100 hours) and time lost from work due to dying early of curable PC (potentially > 100 months). I'm making the suggestion. He can define his priorities any way he wants. I.P. > > Hi All > > This is my first time joining a group of any type, so please bear with [quoted text clipped - 37 lines] > > I.P. Sorry I.P. Guess I didn't realize that this was a "club". I was only asking a question and obviously should not have added anything more (i. e. My job) But the fact is that if I live and lose my job, then my family's lifestyle changes.....If i die it isn't a heck of a lot different for them except they will at least be able to maintain their lifestyle.......birdwatching may be more comforting that using one of these damn discussion (Or Clubs as you put it) groups to ask a question......I guess there are going to be folks like you with noting else to do except sit on your PC and write smart a.s remarks. Good bye On February 8, rickinFL replied to IP (Mike) Freely: > Sorry I.P. > Guess I didn't realize that this was a "club". I was only asking a [quoted text clipped - 6 lines] > question......I guess there are going to be folks like you with noting > else to do except sit on your PC and write smart a.s remarks. Good bye Please don't be driven away by obnoxious and callous remarks by this fellow. He is far from typical. There is much help to be gained here if one is careful not to make treatment decisions based upon someone else's experience. What helps me might harm you -- and vice versa. Regards, Steve J > I.P. wrote >> (Snip the helpful stuff) >> Dude, you *really* picked a weird club to join. Ever think of >> bird-watching or bridge? ;-) [quoted text clipped - 5 lines] > question and obviously should not have added anything more (i. e. My > job) After others have said "Welcome to our club!" and "Welcome to the club nobody want to join", and despite the Smiley with my club comment, and after we offered advice relevant to his request for same, we get . . . *this*? It really puzzled me until I read . . . > if I live and lose my job, then my family's lifestyle changes..... > If i die it isn't a heck of a lot different for them except they > will at least be able to maintain their lifestyle Wow; I'm very sorry to hear that, Rick, but it probably helps explain your angry response to a well-intended response. That ranks up there among the sadder situations I've seen on the internet, even approaching some of our advanced cancer cases. I commend you on maintaining your dedication to that family's lifestyle. I'm afraid that if my family felt that way about me, I'd blow 'em off and try to salvage a few good years in a loving relationship somewhere and in a job that allowed me to take a week or two off to save my life. You're a tougher man than I, Gunga Din! Hang in there; it will help you through what will probably dictate a significant change in your life. I hope that change is only temporary and doesn't cost you your beloved career. And congratulations on finding or creating a career more important than life and family; if I had ever heard of and were qualified for a career that genuinely precious, maybe I'd still be working. > .......birdwatching may be more comforting that using one of > these damn discussion (Or Clubs as you put it) groups to ask a > question......I guess there are going to be folks like you with noting > else to do except sit on your PC and write smart a.s remarks. Good bye Rick, ";-)" is one of hundreds of punctuation-based symbols known as emoticons, or clever little shorthand symbols for various emotions. Most of them, including this one, are viewed with your face rotated 90 degrees to your left, facing the screen. This one depicts a winking Smiley face, and indicates that the comment preceding it is a joke (but with no guarantee it is funny). Welcome to the internet. And here's an uninvited but totally vital tip to anyone new to the net: *LIGHTEN UP*. Thin skin, or worse yet a chip on one's shoulder, are incompatible with internet discussion groups. I.P. > Hi All > This is my first time joining a group of any type, so please bear with [quoted text clipped - 9 lines] > easiest treatment to recover from, but I do not want to take any > chances taht could end in a bad way if you know what I mean. According to my radiation doc, if seeds fail, it's because the disease had already metastasized beyond the prostate. In that circumstance, surgery would fail too. No one knows, of course but the stats speak to that. There's about a 10% failure rate from both surgery and seeds. IMRT, Tomo, 3DCRT, Trilogy, the external beam radiation techniques, seems to be a different treatment philosophy, where the radiation field is lower intensity but covers a wider area. There are some circumstances where the cancer is just beyond the reach of the surgery and seeds but still local. In those cases, external radiation might clean it up. No one knows when this is the case. -kh There isn't a simple answer to your question, sorry. > > Hi All > > This is my first time joining a group of any type, so please bear with [quoted text clipped - 9 lines] > > easiest treatment to recover from, but I do not want to take any > > chances taht could end in a bad way if you know what I mean. Going back to the original question about surgery after radiation, I too was in a quest to find the answer. If you are in the US and have cable TV, you may have come accross a program called "Dr G, Medical Examiner". I sent an email to her and she kindly reported the next day with this: "The prostate seems smaller and harder from the radiation. You get fibrosis (scar tissue) and atrophy of glands. Prostatectomy after surgery is difficult because of the fibrosis but sometimes can be done. There are a lot more perioperative complications." The Florida Orange County ME Office oversees thousands of deaths, so I tend to believe that Dr. Garavaglia's opinion to be more correct than heresays that have been reported here. Her answer makes sense, since you are then still able to pee, since the urethra still exist (which wouldn't be if the prostate is gone/dissapear) after radiation takes its effect. > "The prostate seems smaller and harder from the radiation. You get > fibrosis (scar tissue) and atrophy of glands. Prostatectomy after > surgery > is difficult because of the fibrosis but sometimes can be done. The literature is even less optimistic. But even more fundamental IMO is the clear implication of the original statement: "My wife said that she "heard" that prostrate removal by surgery was not possible "after" the seed implant treatment, should it not be successful. Has anyone heard this?" Is says two things: 1. Their research has baaarrrely begun (i.e., they don't know enough to choose a treatment, which most oncs want the patient to do.) 2. It has begun (i.e., they're on their way towards making an informed choice.) I.P. > ... > There are some circumstances where the cancer is just beyond the reach > of the surgery and seeds but still local. In those cases, external > radiation might clean it up. No one knows when this is the case. > ... I think that's right in the absolute sense. No one knows whether cancer is beyond the range of the seeds in most cases. But we do have nomograms that show the likelihood of it given different initial conditions of PSA and Gleason. The radiation oncologists that I consulted recommended brachytherapy as a mono-therapy only for "low risk" disease (PSA < 10, Gleason < 7). Above that they wanted adjuvant external beam therapy on the grounds that the probabilities of extra-prostatic extensions began to get significant. As you say, they didn't know if the external beam was required, but they wanted to use it just in case it was. Alan Hello, Rick: Welcome to the club no one wants to join. I know how you feel. I love my job, and people depend upon me showing up and doing it -- I am not easy to replace here. I chose to have a laparoscopic radical prostatectomy, and was back teaching two weeks after the surgery last November. But that's just my experience. You'll hear people in this newsgroup and elsewhere who have had terrible experiences recovering from surgery. You'll hear people who have had both great and awful experiences recovering from radiation. Our stories can give a human face to the statistics you need to wade through, but those stories cannot replace a dispassionate weighing of the probabilities involved. In any case, Rick, I would suggest that whatever treatment you choose, prepare yourself and those with whom you work for an absence. Treating this disease aggressively and decisively should be paramount. And be happy if you recover more quickly than expected. As far as surgery after radiation ... as others have said, if the radiation doesn't work, the most likely reason is that the cancer has spread, so surgery would be pointless in that case. But that's getting ahead of yourself. Choose the best treatment for what you know about now. And please let us know how it all turns out. Good luck. All the best, Charlie |
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