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Peet you say Still slogging my way through the dense opaque mysterious world of pc but it seems you have no yet grasped the basic Rule of prostate cancer. THERE ARE NO RULES. No one can give you any firm assurance about any aspect of the disease, the treatments or the outcomes based on good data. It is not possible because the good data – long term studies, independently reviewed – simply do not exist.
Here are my specific responses to your points:.
He did admit that cancer in the apex and base with 8 of 12 positive cores it is more likely for having positive margins that can be addressed with salvage radiation after surgery. That may well be the case. If so, why the proposed surgery? Why not radiation as a primary therapy?
1. He scheduled me for a MRI w/contrast of the pelvic area, which he said would help him map out his strategy. What can they actually see with this type of test? Large tumors may be identified. It is unlikely that small clusters of cells will be. The accuracy of the tests depends on a number of technical issues but studies show fairly high percentages of false negatives and false positives. Having said that, the more relevant test results there are, the better the informed the decision maker. Assess status before determining strategy, as Dr Strum says time and again.
2. Just so I'm clear, with a 50% likelihood that there will be positive margins, which treatment would have less permanent side effects: Surgery and salvage or 6 months hormone with EBRT and seeds, Not sure where you get the 50% likelihood from, but to a large extent that is irrelevant for this question. There is no good long term data to show definitively that either of the two options you mention would have less permanent side effects. The studies to date seem to indicate that the negative consequences of most therapies are likely to be similar.
3. Is effectiveness of both similar? There is no good long term data to show definitively that either of the two options you mention are more effective than the other. The studies to date seem to indicate that the outomes of most therapies are likely to be similar.
4. while my general Urologist initially told me my prostate was small, the results from the biopsy say 64.82 cc. What is a normal size gland in a 56 year old? It is generally accepted that the median size of a normal prostate gland is in the region of 25 cc/gm. 65 cc would not be regarded as a small gland. It is however very difficult to acuratey measure the volume or mas of a prostate gland because of the situation and shape of the gland.
5. What level of urinary problems what exclude one from EBRT and seeds? I have never been able to establish a clear answer to this question. If you do manage to get an answer, perhaps you would share it with us.
Good luck – keep on persevering and you’ll ultimately come to a conclusion as to what is best for YOU.
Aloha Peet,
Terry has covered your questions as best can be answered. Every man reacts differently to primary treatment. You should perhaps evaluate where you are with respect to physical fitness. Even though I was exercising regularly before EBRT/IMRT with ultra sound before each shot, by the 3rd week I was shot, ready to quit, they gave me pain killers & stuff to relax, very bad experience, problems with #1 & #2 waste systems. Looking back it was still my best shot. Presently I have no detectable biopsy cancer, but I don't have a bladder or prostate either.
Joe
Aloha Peet,
My primary treatment was EBRT/IMRT with ultra sound before each shot to verify bladder position. There was no ultra sound treatment. I was also treated with ADT for 1 year. That was in 2007.
The radiation dose was on the high side. It did kill all the PCa, but it damaged the prostatic urethra & bladder which were removed this past July. The rectum & anus were also damaged, but I'm able to live with that.
My starting PCa conditions were very poor, EBRT/IMRT was the only choice.
Joe
Joe,
Was your cancer already in the bladder and they wide dosed you, or was that collateral damage from a localized EBRT treatment of just the prostate?
Aloha Peet,
All 12/12 Prostate biopsy cores were positive (4 to 70%). Scans did not show PCa anywhere else. First 20 shots were pelvic cavity, remaining 19 shots target Prostate. Bladder & Prostatic Urethra were radiation damaged beyond ability to recover. No cancer detected in Bladder/Prostate biopsy after surgery.
Joe
Aloha,
I sent Peet an e-mail with answers to the above questions which I will share with anyone who wants to know. Just let me know you want to know.
Joe
Aloha Peet,
My e-mail to you was rejected - here is my reply to your last questions:
Aloha Peet,
No problem.
#Joe,
#Don't want to keep harping on this, but I am considering radiation, so if #you don't mind answering a few more questions about your treatment.
#How long ago was this? and how old were you at the time
I was 65 July 2007
Casodex 2 weeks April 2007
Lupron Depot 1 year start April 2007
EBRT/IMRT Sept 2 to Oct 30, 2007
#Why were the first 20 the entire pelvic region and not specifically #targeting the prostate?
With all 12 of 12 biopsy cores showing PCa, it was thought that the PCa had grown beyond the prostate even though it could not be detected. Specifically targeting the prostate would not kill the PCa that had to be outside the prostate.
#What was the experience level of the radiologist?
Don't know specific dates or how long this person had been practicing. The Center had been in existence for about 20 + years. My friend who got bladder cancer from EBRT at this Center 18 years ago was treated by the radiologist oncologist that started the Center and was semi retired. My rad-onc had been there for several years and the Center had just gotten a bunch of new "toys". Before the treatment we had discussions about why/how much/schedule which centered around the research data at the time. It seemed that University Research Centers were reporting better long term results with higher doses from this EBRT machine/procedure.
#Sounds like to first broad doses might have caused the collateral damage,or #the mapping and targeting was off(or both)
This will probably never be known. It is obvious now that the dose was too high due to the collateral damage inflected. The PCa was not detectable in the removed organs. Whether or not the PCa had indeed left the prostate and whether or not it will spread & grow and whether or not it will show up in the future is yet to be known. I was told that I had agressive PCa and my survival outlook was poor, even with treatment. I am a member of a large HMO which has been collecting data for many years and seems to have docs that are at the cutting edge of technology. The Radiation Center was a contracting agent to the HMO. I live on the Big Island of Hawaii. This was the only reasonable treatment/location choice that we had. The uro-onc-surg that removed my bladder/prostate was during my stay at the HMO hospital (in Honolulu) was also doing work at the other hospital in Honolulu that has the highest ranking by medicare. In other words these two hospitals had the lowest problem rates and the best outcomes in Hawaii.
#Just need to know if you think this was professional administered or you #fell into that small percentage that fail?
At this point only the future knows. Is failure determined by whether or not the PCa returns or how much damage was inflected by the EBRT? If the PCa is actually gone, then I would not consider the experience/problems to be a failure, only an unfortunate side affect.
If you have more questions or want me to call you (if possible) please ask,
Joe
