I'm a little confused about the "DNA" - do you mean Gleason?  Also,
congratulations on having a uro who's honest - didn't recommend Cyro
(you mean Cryo?) even though it would help him make his next BMW
payment.  As for the treatment you finally opt for, if you ask this
group you're going to get biased opinions on all sides with little
clinical evidence to support one treatment being significantly better
than another.  You just have to look in the archives to find every
argument for all sides - they're all there many times over.  I think
the most useful thing to consider is the possibility that you might
end up with side effects and to decide on which side effects would be
the most tolerable for you.  In my case, I opted for laparoscopic
surgery for two reasons.  First off, I had throat surgery many years
ago that left me with a scar that is numb to this day and I get the
heebie-jeebies anytime I or someone else touches it.  That's just me,
go figure.  I didn't want another running up my belly.  Secondly, a
side effect of radiation is bowel problems up to and including fecal
incontinence, especially since that part of my anatomy is already
delicate to start with - hemorrhoids for instance.  Yeah, I know you
rad types are going to pooh-pooh it (pun intended) because it's so
rare but any possibility greater than zero is more than I wanted since
brown diapers will pretty much preclude any social life except among a
very few closest friends who would deserve a special place in heaven
for their understanding.  As it turned out, I do have urinary
incontinence which isn't a big deal for me and little Willie only
functions marginally even with all the crutches - pills, pumps, shots,
et al.  Best of all though, and really the only thing that counts is
my PSA is still <0.1 at four years, three months post-op.

Good luck with whatever treatment you choose and hopefully you won't
have any side effects at all.  Keep us posted on your progress.
Dave Perry

You will probably get several lengthy responses on the question of
surgery vs. radiation, so I'll keep mine short.  Generally, if one has
surgery first, and it fails (PSA starts rising again) the option of
radiation is still available.  If one chooses radiation first, the
possibility of surgery later (in case the radiation fails) is at least
reduced.  That's because the radiation can affect surrounding tissue
(colon, bladder, etc.) and leave scar tissue that makes surgery
difficult, at best.  I don't know if seeds can cause that sort of
damage, or not.  Someone else will have to address that.

Regarding your earlier question about riding a motorcycle, if you are
riding any kind of fairly comfortable street bike, you'll have no
problems after the surgery heals - if you choose surgery.  Radiation
would cause no problems at all.  If you have incontinence issues, that
might be exacerbated by a motorcycle saddle, though.  But, that's also
manageable.

I also had my gall bladder removed a few years ago.  If you need any
thoughts on that, let me know by email and I'll share my experience
that way - to keep it out of the PCa group.  My body's reduced ability
to handle fat after the removal of the gall bladder does, I think, add
to affects of radiation on my colon, though.  That presents some
interesting and unplesant problems sometimes!

BTW, I grew up in Watkinsville, a small town about 7 miles south of
Athens.  I now live in WA.

Good luck!
Burney

RP in 1995 (age 52)
RT in 2000
ADT (Casodex) 10/06 - 8/07

burney dot huff at mindspring dot com

Hi fatcat,

Sounds like you are well on your way of information gathering and making
your best shot at making a decision regarding your treatment.
I will speak to your concerns of surgery in Atlanta and the side effects of
laparoscopic surgery. Again, these are my personal anecdotal experiences but
they may be similar to your own.

My experience with the robotic lap. radical prostatectomy is such that if
you had a place to stay directly after hospital discharge would be great. I
live 2 hrs away from NYC where the surgery took place. I spent the first
night at my mom's house 40 min away. The town car ride was bumpy and I felt
ok to be out of the hospital. Wasn't quick on my feet but being in a comfort
zone helped. I was walking a few blocks the first day, 1/2 mile the second.
Only stopped when I saw red colored urine in the catheter tube. Freaked me
out, was told that it was no problem. Having some  contacts with simple
questions also was nice.
As far as the side effects with the robotic lap. the effects seem to be
easing a bit. My surgery was only on 10/13 so this is good news for me. My
erectile response is returning nicely except I am concerned that my
experimenting with self arousal may be early. I can achieve a erection and
orgasm but I probably should ease up and wait a bit more. Urinary issues are
easing a bit but more slowly. I am dry all night and when I am standing/
walking I leak more. I go through a few diapers a day supplemented with
sanitary pads. I practice the Kegels and expect there will be a change
towards drier soon.
Hope that my experiences shed a light on the darkness of your predicament.
If my health rebound is any light in the darkness, I feel my experience has
been positive so far and I would do the same path over again.
Good luck,
Peter
I choose the surgery for the reason given that side effect will improve with
time after the surgery, radiation is the opposite in that symptoms could get
worse with time.

On Nov 6, 10:11 am, fatcat <d127geng...@embarqmail.com>
wrote...snip...

fatcat...There are now (at least) 5 peer-reviewed papers that have
been published and suggest that surgery has an edge over radiation in
terms of outcome in the treatment of PCa; in 4 of the 5 studies at
least one of the authors is an established PCa researcher and the
publication occurs in a major journal.

The following long-term studies compare RP, RT and WW:
Urology. 2006 Dec;68(6):1268-74; Long-term survival probability in men
with clinically localized prostate cancer treated either
conservatively or with definitive treatment (radiotherapy or radical
prostatectomy); Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M.
J Urol. 2007 Mar;177(3):911-5; Long-term survival in men with high
grade prostate cancer: a comparison between conservative treatment,
radiation therapy and radical prostatectomy--a propensity scoring
approach; Tewari A, Divine G, Chang P, Shemtov MM, Milowsky M, Nanus
D, Menon M.
J Urol. 2007 Mar;177(3):932-6; 13-year outcomes following treatment
for clinically localized prostate cancer in a population based cohort;
Albertsen PC, Hanley JA, Penson DF, Barrows G, Fine J.
Arch Intern Med. 2007 Oct;8;167(18):1944-50; Short- and Long-term
Mortality With Localized Prostate Cancer; Merglen A, Schmidlin F,
Fioretta G, Verkooijen HM, Rapiti E, Zanetti R, Miralbell R, Bouchardy
C.

The following reference just compares RP and RT:
J Clin Oncol. 2003 Jun 1;21(11):2163-72; Cancer-specific mortality
after surgery or radiation for patients with clinically localized
prostate cancer managed during the prostate-specific antigen era;
D'Amico AV, Moul J, Carroll PR, Sun L, Lubeck D, Chen MH

That said, if your GS is valid and with only 1 stick out of 13
positive, I doubt that you will see much of a difference between RT
and RP in your case.  Consider the following points in making your
decision:
1. Select a treatment based on the best doctor available to you.
2. Compare the long-term side effects (SEs) likely to occur from each
treatment and select a treatment based on your sensitivities.  Note
that RT SEs may take up to 6 years to show up.  The following
references may be useful:
http://www.medscape.com/viewarticle/548683_print
J Clin Oncol. 2005 Apr 20;23(12):2772-80; Long-Term Outcomes Among
Localized Prostate Cancer Survivors: Health-Related Quality-of-Life
Changes After Radical Prostatectomy, External Radiation, and
Brachytherapy; Miller DC, Sanda MG, Dunn RL, Montie JE, Pimentel H,
Sandler HM, McLaughlin WP, Wei JT.
3.  The length of the membranous urethra, as determined by endorectal
MRI, appears to correlate with post-RP return to continence (J Urol.
2002 Sep;168(3):1032-5; Urinary continence after radical retropubic
prostatectomy: relationship with membranous urethral length on
preoperative endorectal magnetic resonance imaging; Coakley FV,
Eberhardt S, Kattan MW, Wei DC, Scardino PT, Hricak H.); if yours is
short, well, just something else to consider in advance, if possible.
4.  If RT is your choice, then a) have your AUA score measured [it's a
written test], if it is high, RT will only make your urinary symptoms
worse; b) RT is contra-indicated for any small vessel disease such as
diabetes mellitus (there is a higher liklihood of RT SEs with
diabetics than non-diabetics) and c) discuss the likelihood of
seconday cancers with your rad onc, while the risk appears to be a few
percent ten years out from treatment, it is real and should be
understood going in.
5.  If you consider AS, a color doppler ultrasound or endorectal MRI
would be an excellent test to help you confirm that AS is applicable
in your case, and also it will be useful as a long-term tracking tool.

...Best wishes and good health, ron

I understand your Gleason is 3+3 and your PSA is 4.9. Since you're a
little overweight, 59, concerned about side effects, if I were you, I
would avoid both surgery and radiation, i.e. opt for "observation". Look
at the September 2005 NCCN guidelines and you'll see that that is a very
responsible decision. Don't let hysterical people scare you that you
should "get rid of the beast inside". When there is no compelling reason
for treatment, why would you take the considerable risk of side effects?

My only thoughts are you are doing really well in your decision-making
process.  I have nothing otherwise to add with regard to surgery vs.
radiation.

SRK

Here's a few questions to ask your rad-onc.

How many brachytherapies has he done?
Does he do them on high PSA's (over 10) and on high Gleason's (7 or more)?
How long has he been doing them?
What is his success rate?
Number of patients with ED, bowel problems, urinary problems?
Define ED! (Some figure if they use Viagra and are successful then they
don't consider it ED)
How many years does he follow-up with his patients?

Our brachy doc has been doing them since 1989. He does between 5 to 10 per
week. (He's at a huge teaching hospital and at a large Veteran's facility.)
He can count the number of ED patients on less than ten fingers. (He
considers anything less than natural spontaneous erections as being ED) No
bowel problems and the number patients with long-term urinary problems are
under 20. (The common urinary problem is difficulty starting the stream and
for most men the problem vanishes as the prostrate is destroyed. It is
correctable with meds and only a few have a problem after about 18-20
months) He does not do anyone over a PSA of 10 or a Gleason higher then 6.
He follows them as long as they are alive. His average patient gets 121 of
Iodine-125 seeds. He has not had a single failure in all those years! He
admits he's waiting for the shoe to drop, but says he's not alone as there
are plenty of doc with the same statistics.

One of the big objections to brachytherapy is the concept that it if doesn't
work you have no further recourse.  5 weeks of EBRT followed by
brachytherapy is equivalent to a RP with salvage radiation. If that doesn't
get it then the RP with salvage radiation wasn't going to get it either!

Brachy can be done without the added EBRT, and the EBRT will still be an
option later if required.

My husband had a combination of EBRT on the IMRT and brachytherapy (Gleason
6 (3+3) PSA 4.9 and  fPSA 8.9% , he was 56 when the treatment was started.)
Five years later, my  husband was a postmortem organ donor and they
purposely searched looking for cancer cells related to his PSA. He did not
have a single cancer cell to be found in his body.

Brachytherapy does work! My husband missed almost nothing in the way of time
from work. He went each morning before work for his EBRT and then missed the
day (Friday) they inserted his seeds (brachytherapy). He came home and
unwillingly played couch potato as he felt just fine. He did admit it was
fun being spoiled. You are supposed to stay very quiet after brachy for
about 3 days so that you don't lose a seed.

The other myth that needs de-bunking is the concept that you will be
radioactive for a while. Apparently you can set off the metal detectors at
an airport, etc. and I've heard others say they have asked the doctor for a
note if they travel, etc.. But you are not going to damage your wife or
child/grandchild with radioactivity. The seeds "reach" only a quarter of an
inch with true radioactivity. You could slap a radiation badge on your
wife's pelvis and sleep snuggled and she will never register on the badge.

Some docs will cover their a.s and tell a patient to not hold a baby for the
first 6 weeks. Our doc was a nuclear physicist before he got is MD in '89.
He was part of the govt's nuclear regulatory panel and he swears it is
perfectly safe. He says if you don't feel comfortable then don't do it. I
know they load the seeds by hand and all of the docs and their residents
wear "a ring" on their finger to detect radioactive exposure. They have
direct exposure to the seeds all the time and they've never had a problem.

As with any PC treatment if you still were entertaining the idea of more
children then you should consider banking your sperm before treatment.
Brachy will eliminate ejaculate as most of the fluid produced is made in the
prostrate. Unlike RP where the vas are cut, during brachy they do remain
somewhat intact so it seems as if it would be possible to pass sperm.

Some men complain about dry orgasms both after RP or RT. It's different. My
husband never complained, but he did admit it was an odd sensation. Although
he said it was still satisfying.

RCOG is in Georgia and somebody out here had brachy done by a doc trained at
RCOG but had left to start is own practice. Wish I could remember who it
was. Maybe Steve might know.

If you are a Vietnam vet you are instantly covered through the VA system.
The trick is to apply for the coverage. (yes, they pay you money and they
will pay for the treatment. If you need help with that let me know as I
still have that information.

Please contact me if you have any questions!
Bev