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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2004

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Brachytherapy and update

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ray - 18 Feb 2004 22:45 GMT
UPDATE:  I posted a little while ago under guidance and info needed.  My
father has a PSA 10, Gleason 6, T1c and two cancer samples found 1 -1mm and
1-3mm.
The specialist surgeon gave my father no indication which way to treat
rather said it was up to him and come back in a week after reading up.  Week
later father returns and says he wants it removed as others had and are now
fine.  The specialist informed him that many thought they have had the full
removal (big procedure)but were confused and most, more than likely had
merely received blockages.  He told father to go on his intended holiday and
told him to consider other options as the cancer found was so small again
without giving preferred option.   My father now totally confused and upset
told specialist he wwas seeing his GP that day and asked to have results
sent to him.
At the meeting with the gp, the Gp was great and showed my father all the
results and info. that had been sent and Bingo on the the letter the
specialist wrote this patient would make an ideal candidate for
Brachytherapy.  Why he didn't tell him this i don't know.  The GP also said
that seeing the specialist was more inclined towards surgery then this
recommendation sounds good.
My father will now getting a second opinion from a specialist March 4,at the
Peter Maccallum which is the number one cancer hospital  in Australia. They
have a multi discipline team there. He is currently leaning towards
Brachytherapy. My concern is if he goes ths way then he cannot have the
prostate removed later on.  I read that Brachytherapy has advanced so much,
but i also read with interest from this goup that results are supposedly
better when coupled with external radiation depending on PSA etc.  which
category do you think my father into and waht are your opinions ??
Alan Meyer - 19 Feb 2004 00:03 GMT
> UPDATE:  I posted a little while ago under guidance and info needed.  My
> father has a PSA 10, Gleason 6, T1c and two cancer samples found 1 -1mm and
[quoted text clipped - 23 lines]
> better when coupled with external radiation depending on PSA etc.  which
> category do you think my father into and waht are your opinions ??

Ray,

There have been quite a few studies of low dose brachytherapy
(seed implants) with and without external beam radiation.  If you search
Pubmed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) using terms like
(prostate cancer brachytherapy external beam radiation) you'll find lots
of them.

It looks to me, from reading this literature, that brachytherapy by itself
is pretty good for "low risk" cancers, i.e., Gleason <= 6, but should be
supplemented by external beam for higher risk Gleason >= 7.  PSA
of 10 is also thought to be a cutoff point between low and intermediate
risk so, even with G=6 your father might be at intermediate risk.

One of the problems with Gleason scores is that they are frequently
under-evaluated by pathologists who are not experts at prostate
cancer.  Mine was reported as 3+3, but got revised by later pathologists
to 4+3, a significantly higher risk cancer.  So get a second opinion on
the pathology slides from someone who is recommended as good
for that.

External beam is easy to take but will add additional side effects to your
father's treatment.  If he's young enough to live more than say 10 years,
that might be a factor arguing for the more aggressive treatment too.

That's my non-expert, layman's 2 cents.

Good luck.

   Alan
Steve Kramer - 19 Feb 2004 00:16 GMT
Keep plugging away, Ray.  I don't understand why a urologist wouldn't give
your father some direction.  There is nothing complicated about his case.

Signature

Prostate Cancer Survivor (so far), not a doctor
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000
PSA  .1  .1  .1  .3  .4  .8
EBRT 05-07/2002 @ 47
PSA  .3 .2  .2  .2 .3
Erection 05/12/2003 @ 48
HTbegins 07/21/2003 @ 48
PSA  .1
Lupron 7/03, 8/03, 12/03

> UPDATE:  I posted a little while ago under guidance and info needed.  My
> father has a PSA 10, Gleason 6, T1c and two cancer samples found 1 -1mm and
[quoted text clipped - 23 lines]
> better when coupled with external radiation depending on PSA etc.  which
> category do you think my father into and waht are your opinions ??
ron - 19 Feb 2004 03:03 GMT
Hi Ray...I think you said your dad was 67.  What's the expected
lifetime for men in your family?  If 75 is old for men in your family,
then watchful waiting - active surveillance becomes an option if your
dad is T1c, PSA less than or equal 10 and GS=6.  The GS=6 needs
further verification, especially with PSA=10 and 2/6 cores positive.
The GS is an important parameter in terms of staging the disease and
Gleason scores are notoriously easy to misread.  There are a dozen or
so expert pathology labs that you can resend the tissue samples to for
a second reading.  As the GS moves above 6, seeds + XBRT become
increasingly more effective in controlling the disease than seeds
alone...Best wishes and good health, Ron

> UPDATE:  I posted a little while ago under guidance and info needed.  My
> father has a PSA 10, Gleason 6, T1c and two cancer samples found 1 -1mm and
[quoted text clipped - 25 lines]
>
> --
Hi Ho Silver - 19 Feb 2004 03:16 GMT
Strictly my opinion, but your father's age would be an important factor.
Also applaud getting 2nd opinion because the first one didn't sound very
confident or helpful.  All things equal, younger men seem to opt for surgery
to maximize the many years ahead.  I think people here could help more if
you could tell us his age.

John Hanley
Brachytherapy: October, 1999
98 I-125 Seeds
Age at treatment: 62
Pretreatment PSA:  7.5
Gleason: 3+3 = 6
Most recent PSA: 0.3

--------------------

> UPDATE:  I posted a little while ago under guidance and info needed.  My
> father has a PSA 10, Gleason 6, T1c and two cancer samples found 1 -1mm and
[quoted text clipped - 23 lines]
> better when coupled with external radiation depending on PSA etc.  which
> category do you think my father into and waht are your opinions ??
ray - 19 Feb 2004 23:23 GMT
I am sorry about the age - he is 67 years old and fit.  Plays golf always
working or off fishing.  In relation to age expectancy his brother and
father both passed away around mid 60's.  Though, I'm not sure that is
relevant.
The specialist believes the cancer is very small and most likely all
confined in the prostate.  Perhaps this is why he leans at Brachy rather
than full removal.  i would like to think that if it is as small as he
thinks that it may be curative.
> UPDATE:  I posted a little while ago under guidance and info needed.  My
> father has a PSA 10, Gleason 6, T1c and two cancer samples found 1 -1mm and
[quoted text clipped - 23 lines]
> better when coupled with external radiation depending on PSA etc.  which
> category do you think my father into and waht are your opinions ??
Alan Meyer - 20 Feb 2004 00:19 GMT
>  The specialist believes the cancer is very small and most likely all
> confined in the prostate.  Perhaps this is why he leans at Brachy rather
> than full removal.  i would like to think that if it is as small as he
> thinks that it may be curative.

Ray,

If brachytherapy is well done, and the cancer is of the lower risk kind,
it should indeed be curative.

Is it as curative as RP?  I don't know.  Johns Hopkins reports
phenomenal results with RP, 97.8 % disease free after 7 years,
higher than what any other institution reports to my knowledge,
and better than brachytherapy (79%).  See:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9
609622&dopt=Abstract


However, Hopkins is perhaps the best place in the world to get
RP.  I haven't seen any other center claim that kind of results.  Other
studies have shown comparable results from the two kinds of
treatment.

Personally, I chose high dose rate brachytherapy + EBRT.  If
Dr. Walsh were offering to do my surgery, I might have chosen
RP.

  Alan
 
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