I've spoken to surgeons and a radiation oncologist, and have read studies and the Walsh book. I've succeeded thoroughly confusing myself.
Has anyone been down a similar path and can suggest how you decided on one treatment over another? Or is it just a case of "picking my poison" as suggested by the RO.
Thanks for any feedback.
Here are questions to ask yourself:
pcnrv.blogspot.com/2017/12/...
Walsh's book is out of date (all books are)- toss it.
Oncological outcomes are the same with your risk factors- side effects are different:
pcnrv.blogspot.com/2020/02/...
Who are the 3 doctors?
Dr. Tewari at Mt. Sinai and Laudone at MSK for surgery. Dr. Shasha at MSK for RT.
Tewari is great. I don't know Shaska at MSK, only Zelefsky. Does Shaska do either brachy or SBRT? (Zelefsky does) I assume you mean LDR brachy?
Dr. Shasha does both.
On our first phone consultation 3 weeks ago, he recommended 1 treatment of HDR Brachytherapy and 5 sessions of MSK Precise (SBRT). On a followup call last week, he said he would do Brachytherapy seeds. No explanation for the switch and I didn't grasp the change until I went back through the material he first sent to me. Maybe the newly taken MRI suggested a different course of action.
Contacting the office to ask about it.
Combining brachy and EBRT should only be done for unfavorable risk patients. For a favorable intermediate risk patient like you it only magnifies side effects without providing any extra oncological benefit. There is no evidence that favorable risk patients do any better than with a monotherapy.
Did you ask for his experience with HDR, LDR or SBRT? There is a steep learning curve for brachy, which is why it's hard to find good practitioners. Here are questions that you should feel have been answered:
pcnrv.blogspot.com/2017/12/...
pcnrv.blogspot.com/2017/12/...
pcnrv.blogspot.com/2017/12/...
Thanks. He says he has done thousands of Brachy placements.
I will use the links on your blog to fill in the blanks.
Thanks for all of the things you've done for all of us.
I used laudone for surgery in 2014 and he is great. Spent 4 hours on nerve saving and was great on follow up. You can't do better.
SpecialName....interesting handle!!!
Started learning about my newly discovered gift the day I was dx’ed!! After the testing period, and my shock that “I had to decide” what my treatment would be (never expected that) I verified the urgency (or not so) of my decision and took a long breath!!!
Chose RT because I understood either option offered similar results and with a simple change in my daily schedule and cooperation from my Oncl., I could continue work.
My options (as laid out for me) both included RT (only greatly reduced if I had RP) and ADT. Now in hindsight, I would have modified the ADT SUBSTANTIALLY!!!
Best of luck with your decision and God Speed in your journey.
Jim C
Hi JimC, what do you mean modified ADT?
I would want to look at the standard of care for a particular Dx. Although clinical trials exist for many situations, it doesn't mean that the SOC wouldn't be the best course of action.
Some of us will be biased (I certainly am) based on our experience and outcome(s).
I went with RT and ADT, because I didn't have the choice of surgery. My results to date (I have 3 years in 'the game') have been good.
I'd also point out that it is hard to predict how a patient will respond - assuming that we are starting from the beginning of the treatment process after a Dx.
One thing that has caught my attention over time is this -> how often I read about 'something that got missed' during surgery that grows into a more complex or serious condition. I'm guessing, but it seems that that percentage is greater than 10%. That pattern may be reduced, seeing as we are looking at 'older practices and techniques' - maybe modern surgery is less prone to 'error'.
The 'brachy' therapy that is offered today (maybe combined with ADT) appears to be very promising.
I don't have all the numbers from your situation to make a more informed commentary
(maybe your history is posted and I missed it) but I would suggest further reading on YOUR particular circumstances to see if you can research the best treatment options for you.
We wish you well on your journey ....
Many have faced a similar choice. Each MD sells their own wares. You don’t state your numbers or disease status. Mine is in my profile. I had a MP MRI targeted to a single lesion in the right lobe. 3+4 on one side with no extracapsular penetration. Chose SBRT because of efficacy and side effects of RP. No ADT. 15 months out, would make the same call with same data. I was limited by insurance to a certain geography for treatment. If not, I probably would have chosen to travel to one of the larger centers mentioned in theses strings by others. Read, read read and if the provider is not forthcoming or disses other options, find another one. I don’t know your numbers but you should take the tome to pick the best option for you.
The decision drove me nuts. After learning my G6 went to G7 in Oct 2019I scheduled RALP for late Jan 2020, then spent 2 months researching and calling ROs and RTs to see if I might be better off with RT. I constructed a spreadsheet with all known SEs, treatment and recovery details - it’s the way I learn! In the end I chose surgery because I wanted to know the pathology, my walnut was 90 grams, and I am very active, young, and have had the experience of a couple of surgeries. I’m glad I did - everything works 3 mos later and I’m back to golf, surf, hiking in the jungle, and maintains our multi acre property.
Having said that, if my prostate had been within limits I would have done brachytherapy when I was G6 as I have numerous friends that had excellent long term results. I tried to shrink it with proscar and did another drug to reduce testosterone for over a year, made Rick Simpson CBD oil, but no reduction in size.
When my Uro said I should something in 6 months time - when it went to G7, I scheduled the surgery first for 3 months out. I’m glad I did the surgery when I did because the Covid 19 scare came 3 weeks post.... and my incorrect clinical diagnosis would have resulted in a delay if I had delayed. I learned my true grade group was 3- it was diagnosed clinically as a 1.
Everyone has their own clinical data, other background, and fears to evaluate and consider. SBRT and HDRT show similar life expectancy outcomes and possibly better SEs. I chose immediate side effects and they have resolved sufficiently - no urinary SEs after 2 months and enjoying sex again with some good wine and following post surgery protocols. Even better - a post RALP PSA of <.01.
Good luck in your journey.
Proton radiation
How old and general level of health?
Sorry. I see the info in your bio. I was similar about a year ago. I chose surgery without a second thought. I have a lot of years ahead and didn’t want to have lingering concerns of a formerly cancerous gland in my body. Glad I went that route. 7 months out things are getting back to normal and I don’t worry about cancer.
SBRT v. Brachytherapy for Favorable Intermediate Risk 
UCLA/UCSF Doctors for initial treatment – SBRT or Surgery
Stanford or USCF for HDR brachytherapy
Brachytherapy
Surgery or Radiation? 
