Prostate Cancer Survivors

 

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Re: Not a Surgery Candidate

Perhaps my comment was misunderstood. The Urologist said surgery and Brachytherapy were risks from puncture of the wall during the procedure. There is no similar risk to the wall from external radiation. Just to add, I think you discount the value of IMRT. The radiologist I am seeing next week does both IMRT and PBT, I am interested to hear his point of view. The data I have seen to date indicates they are comparable. PBT seems to have milder side effects during treatment.

Re: Not a Surgery Candidate

jww

The following two articles which appeared in Bob Marckini's newsletter may be of interest to you:


"IMRT had greater effect on bowel function than proton therapy.”

That’s the title of an article published last month in Healio–Hematology/Oncology, HemOnc Today. The article refers to a prospective study that compared 1,243 men who underwent proton therapy for prostate cancer to 204 men who were treated with IMRT. All patients in the study completed the Expanded Prostate Cancer Index Composite (EPIC) questionnaire to report their results.

According to the report, after two years most quality of life issues between the two groups were similar with the exception of bowel function, stating: “However, moderate or big problems with rectal urgency (P=.02) and bowel frequency (P=.05) were more common among men in the IMRT cohort.” Further, “Although similar bowel, urinary and sexual scores were observed with IMRT and proton therapy, potential differences in specific functional outcomes, such as bleeding, rectal urgency and bowel frequency, also were observed and may reflect differences in radiation dose distributions between IMRT and proton therapy, differences in patient characteristics, or both.”

Proton Therapy for Prostate Cancer: Long-Term Survival and Quality of Life Report

A five-year study, conducted by the University of Florida Proton Therapy Institute, reports 99 percent of men are living cancer-free and with excellent quality of life. The study was published in the International Journal of Radiation Oncology Biology, Physics.

The study followed 211 patients, all of whom received eight weeks of proton therapy. “Physician-reported data show cancer-free survival rates at five years for low-, intermediate-, and high-risk patients are 99 percent, 99 percent and 76 percent, respectively,” according to the press release.

“These proton therapy results compare very favorably with IMRT results, particularly for intermediate risk-disease, where disease control rates of 70 percent to 85 percent are typical,” according to Dr. Nancy Mendenhall, lead author and medical director of the UF Proton Therapy Institute.

Don O.

Re: Not a Surgery Candidate

JWW,

Brachy needles are inserted in the perineum. They do not go through the rectum. Is the radiation from the seeds going to affect the rectal wall? A normal rectal wall can take it most of the time. Your rectal wall will get some radiation from both procedures. I will defer to your Doc's on this. I would want some odds from both Doc's on this.

Fred

Re: Not a Surgery Candidate

JWW,
Go to a PC support group and talk to men that have had radiation treatment of various kinds. In our group I remember quite a few had complications with rectal issues after 3 to 8 years (I haven't so far). With your history you just don't want any radiation in that area. Radiation damages good cells too. I think most radiation oncologists will be reluctant to treat you. If that happens don't be discouraged because the hormone treatment might still be the best way to go even if you had all the options open to you.
P.S. - I've had the surgery, radiation and hormone treatments and haven't suffered too badly.

Re: Not a Surgery Candidate

Met with the Radiologist. Went into more detail regarding the risks due to the pre-existing condition. The Radiologist feels we have plenty of time to evaluate which path to follow. Will be going in for a pelvic MRI, with and without contrast in an effort to determine the precise location/size of the fistula canal. At this time it appears Proton may be a safer alternative. The MRI should provide support for the discussion with the insurance if necessary. I'm pleased that the group I'm seeing does both Proton and IMRT and has extensive prostate experience. I feel fortunate to live only 10 miles from the CDH Proton Center. Whichever treatment is selected, will most likely start the latter part of April.

Re: Not a Surgery Candidate

Sounds as if you have thoroughly explored your options and you have a few things going in your favor. If you choose protons you may find my ongoing Internet journal helpful; see http://protondon.blogspot.com/
Best wishes. Don

Re: Not a Surgery Candidate

Met with the radiologist today. Did final fitting and scan. He was pleased with the previous image results because they showed some viable routes for treatment. All the material will also be sent to the PBR team and they will also map out their strategy for treatment. They will all meet next week to compare treatment approaches and potential risks . I've got an appointment on 4/21 to hear their conclusions. Hurry up and wait! But it seems their doing their due diligence.

Re: Not a Surgery Candidate

jww:
More progress! Impressive!
All of us will be interested in what you decide and your rationale for the choice you make.
It may be helpful to write a few questions for each team prior to your meetings. Too many times these kinds of appointments develop in unexpected ways and important points get lost in the shuffle.

Best wishes Don O.

Re: Not a Surgery Candidate

Looks like it is PBT pending insurance approval.
Prior to the plans being constructed, alot of scans of the risky area were done and they were able to do pretty precise mapping. Proton is able to map out a treatment that totally avoids that area. I will be doing the 8 week program, and cannot do the 4 because higher dose is a risk for my clinical factors. FYI, I asked about the 30% higher incidence of bowel morbidity for PBT vs IMRT. They told me the base population of Proton participants has a similarly higher number of those that have had prior bowel issues, which might account for the difference.In either case the actual percentage is rather low.I'm comfortable with the process the doctors followed and glad to have a lowest risk option available. However, kind of dimayed to be classified in a higher risk category due to a pre existing condition. All things aside, I'm glad to have reached a decision and greatly appreciate all the support and information from Yana!

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