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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2004Iodine 125 seed implant...and new to group
Hi, all. After two years' study, while PSA rose from 4.7 to 6.2, with Gleason 3+3 and T1c rating...cancer confined to right side or prostate, I finally decided to be treated with the Iodine-125 seeds. Implant was yesterday. I'm feeling pretty good today. Have catheter until Monday. Am 64 years old, about 15 pounds overweight, good physical condition. Supposedly can go back to work (and swing-dancing and stair-walking in my 36 story classroom/office building at the University of Pittsburgh). So...any of you have Iodine 125 treatment? What might I expect in terms of incontinence? I was already the kind of guy who gets up 4 times a night to pee and knows where the next rest area is on the PA Turnpike. Does it last long? If you got active, such as dancing, would you need pads and a diaper? I teach two nights a week, two and a half hours per course. Any danger of just...wetting myself? Would appreciate any feedback....and, just to add to the experiences, will post a report once or twice a month...as to my side-effects. Thanks for any advice, shared experience, tips, whatever. Bruce Dobler > Hi, all. > After two years' study, while PSA rose from 4.7 to 6.2, with Gleason 3+3 [quoted text clipped - 17 lines] > Thanks for any advice, shared experience, tips, whatever. > Bruce Dobler Good luck with your treatment Bruce. I've had high dose rate brachytherapy, a different form of implanted radiation from what you got. In my case the radiation irritated the tissues which caused swelling, which presses on the urethra, making urination difficult. I have read that this is common with radiation. Incontinence (urinating by accident) is relatively rare. In some ways this "over" continence is similar to incontinence. The urine does not leak, but because the bladder is often full, I often have an urge to urinate. When I do, I get a weak stream that does not fully empty the bladder, and then I have to urinate again pretty soon. At its worst, I was getting up 7-8 times per night. I've been given a drug (Flowmax) that seems to help a lot, and I've been told that the inflammation will likely subside within a month after the end of treatment. Anti-inflammatory drugs like aspirin or ibuprofen may also help. Your actual treatment period will be quite long. The half-life of iodine 125 is about 60 days. So if you do the math you see that in 60 days you're still receiving 50% of the radiation you were getting initially, 25% in 120 days, and so on. It would take 398 days to reach 1%. However, as I understand it, the inflammation caused by radiation may not last even though continued radiation is occurring. So hopefully you won't have the symptoms for the entire time of active radiation. And in any case, if your symptoms are bad, there are medications that help quite a bit. Alan > Hi, all. > After two years' study, while PSA rose from 4.7 to 6.2, with Gleason 3+3 [quoted text clipped - 17 lines] > Thanks for any advice, shared experience, tips, whatever. > Bruce Dobler Hi Bruce, You had exactly what I had done on January 7. I also had T1c and Gleeson 6, age 62. I had 90 seeds of I-125 implanted. I had absolutely no pain or even discomfort at any time. Well maybe a little minor soreness on my butt. But at no time did I even think of the pain medication that had been prescribed (and I'm not much into pain!) My catheter was removed before I went home in the afternoon, and I did experience bleeding for about 48 hours, more likely due to the catheter than to the implant itself. Despite the bleeding, I probably would have gone to work the next day had I not been retired! I got up to pee three or four times a night and after about a week and a half the need seemed to increase a bit, but gradually this week it has become less urgent. I'm still getting up three or four times a night and the flow seems slower at night than in the day. There was also an increase in bowel movement for a few days, but that too seems to have gone away. I take Flomax before going to bed each night. As to your specific question, at no time have I experienced any incontinence whatsoever. I guess it could happen later, but from what I know the possibililty of incontinence with this procedure is very small. You just need to go more often! Except for the annoying bleeding for the first two days and a reticence to be too far away from a bathroom at any given time, I have not curtailed any activities. So I really haven't had any major side effects in the past 2 1/2 weeks. The whole thing was easier than I had expected it to be. Bob Stay very quiet for the next couple of days. Your odds of throwing a seed at this point are very high and the best way to prevent that is to stay quiet not matter how good you feel. So stay a couch potato through this weekend. After that you can put your dancing shoes back on. If the doc didn't give you an Rx for Flomax or Hytrin you might want to ask about it. Seems the problem is not leakage but just trying to pee! Swelling in the area constricts the urethra and makes it difficult to get the flow started. This tend to last maybe just a few weeks for some men and for my husband forever - okay I'm exaggerating, but it took him months before he could get off the Hytrin. Hubby was implanted May 2002. He had 121 seeds of 125 long-acting Iodine after his 5 weeks of external beam radiation. He was 55 at the time. PSA was 4.9 with a Gleason 6 (3+3). If you have any questions just ask. Bev > Hi, all. > After two years' study, while PSA rose from 4.7 to 6.2, with Gleason 3+3 [quoted text clipped - 17 lines] > Thanks for any advice, shared experience, tips, whatever. > Bruce Dobler Bruce, I'm another brachytherapy recipient. Mine was in October, 1999. Never had an incontinence problem, and was aided by the Flomax in the period after treatment. Had 98 I-125 seeds. Pre-treatment data was: PSA 7.4 Gleason 3 + 3 = 6 Biopsy: six sticks, one with small cancer. My seeds were implanted at M.D. Anderson Cancer Center in Houston, Tx. You might be interested in my psa history, especially after seeding. 4/97 5.2 2/98 9.5 3/98 5.4 6/98 5.5 6/99 7.4 11/99 6.7 1/00 3.3 4/00 1.8 7/00 1.2 9/00 1.1 10/00 1.1 5/01 0.4 1/02 0.2 8/02 0.4 2/03 0.8 5/03 0.7 8/03 0.5 11/03 0.3 Best wishes, John Hanley <><><><><><><><> To send return email: jphanley @ ix. netcom. com ------------------------------------ > Hi, all. > After two years' study, while PSA rose from 4.7 to 6.2, with Gleason 3+3 [quoted text clipped - 17 lines] > Thanks for any advice, shared experience, tips, whatever. > Bruce Dobler > Bruce, I'm another brachytherapy recipient. Mine was in October, 1999. > Never had an incontinence problem, and was aided by the Flomax in the period [quoted text clipped - 28 lines] > > John Hanley John, This is fascinating information. I've never seen anyone post actual four year results like this. I hope more radiation patients will post their PSA histories. Some things that surprised me were: 1. Low point (so far) was achieved 2 years 3 months after treatment. 2. A PSA bounce (fitting the toughest definition I've seen of .5 rise followed by a decline), occurred 3.5 years (!) after treatment. 3. In spite of the bounce, your PSA at last reading was very near it's lowest point. This should give considerable hope to radiation patients who have seen significant PSA numbers and even rises - and worry that their treatment failed. I've just completed radiation and it gives me a very useful picture. Thanks. Alan Allen Meyer wrote "I hope more radiation patients will post their PSA histories". I was diagnosed in Jan 2001 at age 59 (1 of 8 cores pos, stage T1c, Gleason 3+3=6, PSA 4.4). On 5/17/01 I had 111 Pd-103 seeds implanted (Pd103 is an alternative to I-125), catheter removed that day before I left the hospital. My Dr had prescribed Flomax, Cipro, Ranitidine, and Pyridium+ to aid in urination and prevent infection after the implant, and Decadron (a steroid) to reduce inflamation (and thus, pain). All except the Flomax were to be be reduced to nothing 1 week after implant. I was told to take the Flomax untill he told me to stop (6 mos after). I felt great until I stopped the steroid, when I had some discomfort/pain, though nothing major. I resumed a reduced dose of steroid for about 10 days, then stopped it with no problem. From about week 3 to week 6 or 7, I had frequent urgency to urinate, but I have had no incontinence. My PSA history is as follows: 2/14/96 = 1.8 7/22/98 = 4.3 4/05/00 = 4.3 7/18/00 = 3.7 10/31/00 = 4.4 8/02/01 = 0.5 11/15/01 = 0.3 3/15/02 = 0.2 11/19/02 = 0.1 5/15/03 = 0.1 11/06/03 = <0.1 (ND) Paul Ketterer > Allen Meyer wrote "I hope more radiation patients will post their PSA > histories". [quoted text clipped - 25 lines] > 11/06/03 = <0.1 (ND) > Paul Ketterer Thanks Paul. Looks like your experience was totally different from John's. It must have been psychologically easier than John's since you had a straight decline to non-detectable. I'm told by my rad onc that undetectable PSA happens, but is not too common in radiation patients. One difference between yours and John's treatment was the isotope selected. Palladium 103 has a shorter half-life than Iodine 125, so you got your radiation over a shorter, possibly more intense, period. I wonder if that was a factor, or whether it's just the luck of the draw. Alan My Rad Onc said he uses Pd-103 because it is more intense. Maybe that's why he prescribed all the drugs to minimize side effects. He also said about 1/3 of his patients stabilize at PSA of 0.1-0.2, and about 2/3 at <0.1. He only treats patients when he's pretty confident the cancer is contained in the "capsule". "Luck of the draw" may be a factor, but whatever it is, I'll take it and be thankful. Paul > My Rad Onc said he uses Pd-103 because it is more intense. Maybe that's why he > prescribed all the drugs to minimize side effects. He also said about 1/3 of [quoted text clipped - 3 lines] > it and be thankful. > Paul I wanted PD-103...but my docs here insist that: 1. it's for a higher grade cancer than I had (and that you had) (so I let them talk me out of it!) 2. That since I already had some problems with urinary frequency and urgency, that even though side effects with PD 103 are over sooner...that they might be much more intense and difficult in my case. Amazing the different advice you get. I spent nearly two years checking things out. Surgeon, of course, told me surgery was THE way to go. So I got second opinion from Radiation Oncologist. He told that External Beam Radiation (HIS specialty) was actually the really smart way to go. Then a friend at NIH told me about Palladium 103...I read up...told the doc I went to for third opinion...and he, and my fourth opinion guy...both talked me into the Iodine 125. I will say that after a bad, bad night of frequent, difficult and painfully burning urination, the told me: 1. Only drink when you are thirsty 2. Take a double dose of Flomax at night. Problem immediately went away (though I am still somewhat frequent. Did, however, manage to sit through an hour and a half class without asking my students to take a break). Still....I really wish I had just insisted on Palladium 103 -- although, one person in the field told me you don't want it from a doctor who is not really used to doing it...needs about 200 cases ahead of you to feel comfortable. One thing's clear...when it comes to prostate...we do, to a great degree, have to manage our choices and sort through the counter-claims and try to figure out for ourselves what works. But I sure do appreciate this group -- wish that I'd started a year ago...asking questions right in this group! Any, anybody ever tells me they're going through the choices, I'll send them here right off! Bruce Dobler > Still....I really wish I had just insisted on Palladium 103 -- although, > one person in the field told me you don't want it from a doctor who is > not really used to doing it...needs about 200 cases ahead of you to feel > comfortable. Bruce, I know it's very painful to acquiesce in something like this when your gut feeling tells you to do otherwise, but the difference between Palladium and Iodine may not be significant and your treatment may be just as effective. I did a search on the words "palladium iodine compare prostate cancer" on PubMed and got this hit at the top: Int J Radiat Oncol Biol Phys. 2003 Dec 1;57(5):1297-303. 125I versus 103Pd for low-risk prostate cancer: preliminary PSA outcomes from a prospective randomized multicenter trial. Wallner K, Merrick G, True L, Sutlief S, Cavanagh W, Butler W. The conclusion was: "CONCLUSIONS: The 3-year actuarial biochemical control rates for low early-stage prostate cancer are similar after (125)I and (103)Pd." Alan Alan, thanks for the encouragement (and facts). What I hadn't counted on was having my IBs (irritable bowel syndrome) kick in so badly that I spend 4 or more hours a day on the "throne." Along with truly painful, burning urination. I'm almost thinking I'd like the catheter back! Colostomy, though...could be. Seriously messed up health on this. Bruce >>Still....I really wish I had just insisted on Palladium 103 -- although, >>one person in the field told me you don't want it from a doctor who is [quoted text clipped - 24 lines] > > Alan At 6 mos after implants my hubby's PSA had dropped to 0.4 and at 18 months it was 0.17 and still falling. The doc said he was way ahead of the curve. I think John Brockhouse's numbers are running about the same as my hubby's. BTW, where is John? Bev > Bruce, I'm another brachytherapy recipient. Mine was in October, 1999. > Never had an incontinence problem, and was aided by the Flomax in the period [quoted text clipped - 64 lines] > > Thanks for any advice, shared experience, tips, whatever. > > Bruce Dobler I'm just...stunned, amazed, at the warm, generous, honest SUPPORT, advice, help I've gotten from so many people in regards to my question on incontinence. Thanks Alan Meyer and Bob Oaks, Paket41 and Hi Ho Silver, and Beverly! Had my catheter out today...but, thanks to all of you...got rid of my worries right away! What a great group this is! To borrow a slogan from Mickey D's....I'm lovin' it! Bruce Dobler > At 6 mos after implants my hubby's PSA had dropped to 0.4 and at 18 months > it was 0.17 and still falling. The doc said he was way ahead of the curve. I [quoted text clipped - 74 lines] > > > Thanks for any advice, shared experience, tips, whatever. > > > Bruce Dobler Man, this was soooooo useful. Going to print it out as a reminder that psa takes a while to change. You had same treatment I had...almost exactly the same PSA (mine was 7.2) and precisely the same Gleason score (3+3). I'm feeling a whole lot calmer! Thanks, Bruce > Bruce, I'm another brachytherapy recipient. Mine was in October, 1999. > Never had an incontinence problem, and was aided by the Flomax in the period [quoted text clipped - 76 lines] >>Thanks for any advice, shared experience, tips, whatever. >>Bruce Dobler |
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