This forum is for the discussion of anything to do with Prostate Cancer. There are only four rules:
No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
No harvesting e-mail addresses for Spam;
No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making
Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.
Since this is an International Forum, please specify your location in your post.
A month has slipped by without a posting. As per my recent custom I have reproduced one of my ongoing online journal entries for your review and comment. I have selected the following entry because it illustrates my approach to researching options over the years.
First I consult my trusted advisers who never fail to respond to my requests for their ideas and suggestions. I then attempt to research every option called to my attention in attempt to identify those which show the most promise, i. e., the options with the most effective outcomes and the least harmful side effects; see below:
"A PCa Warrior's Continuing Battle: Part II
I have been researching options for treating my re-currency for nearly two years. Dr. Myers suggested I look for a cure during our final appointment in October of 2016 prior to his retirement.
Failure to do so, he suggested, would result in a slow agonizing death characterized by a system by system shutdown. A summary of my relevant efforts appears below:
I. Cryotherapy* as practiced by Dr. David Miller, University of Michigan Comprehensive Medical Center
--Treatment to be preceded by three months of Lupron therapy
--Cure rate of 50% as indicated by an initial PSA less than 1.00
--100% erectile dysfunction (the procedure destroys the enabling nerve system)
--5% minor (stress related) incontinence
--1% chance of fistula requiring surgery
The outcome data is not particularly attractive to my way of thinking and I have been advised by one of my trusted advisers to avoid this option.
*Cited in an earlier journal entry; repeated here for continuity
II. Pencil Beam Radiation by Dr. Rossi at Scripps Health Center San Diego, California
--Would first require SpaceOar procedure to separate the rectum from the prostate followed by a two week period to allow the swelling to subside
--Four to five weeks of treatment
--Cure rate of 50% with
(A) 10 to 20% chance of fistula requiring surgery
(B) 10 to 20% chance of incontinence
For me and my constant emphasis on quality of life, the cure rate is too low and the complication rate too high. The remote distance and logistics further detract from this option.
I raised the question of chemotherapy with my current MSU oncologist who responded as follows: "Most men with this diagnosis die of something other than PCa. Further attempts to draw him out on this topic were unsuccessful." He concluded our discussion by suggesting, "We do encourage second opinions." Accordingly I consulted another oncologist who I first met when searching for a local to replace Dr. Myers. This practitioner advised me only PCa warriors whose cancers have metastasized and whose scans show a minimum of three lesions one of which involves bone tissue qualify for chemotherapy. He also advised me this treatment does not offer a cure, but typically controls disease progression for three to eight years.
For the record the typical protocol and most common side effects appear below:
-- One or more drugs, e. g., Taxotere by injection and Prednizone orally administered six times every twenty-one days
--Hair loss, mouth sores, loss of appetite, nausea (with some vomiting), diarrhea, easy bruising, fatigue and peripheral neuropathy.
For my purposes at this time it seems reasonable to postpone further consideration of this option until push comes to shove.
IV H D Brachytherapy
I reviewed a variety of online studies on H D Brachy. A summary of one such study by Kollmeier is shown below because it is fairly representative of the other studies and outcomes:
--Cohort of 42 patients
--Biochemical relapse free survival at five years 68%
--Genitourinary Grade 1 and 2 complications 38% and 48% respectively
--Gastrointestinal toxicity 18%
--Severe toxicities were minimal
Kollmeier conducted a ten year study of PSA relapse free survival with the following results:
--Low risk 81%
--Intermediate risk 78%
--High risk 62%
I place myself in the high risk category because of my age, treatment history and the following three interpretations of my one and only biopsy slide: initial lab analysis in 2008 4+3, second reading by UFPTI in 2009 4+3, third reading by Mayo Clinic in 2013 4+4.
Of those listed H D Brachy appears most acceptable to me. Is it preferable to plugging away with various forms of ADP? That my friends is the question of the day. It's a crap shoot, always has been, always will be-- this time with far less favorable odds than when I opted for PBRT at the outset. In any event I intend to let the matter percolate for the time being.
For further detail see: http://protondon.blogspot.com/