Andy,

I haven't heard of Dr. Terk - he may or may not be a great BT therapist. But I would caution you against using anyone who is not among the top BT ROs in the country. Experience makes a huge difference in BT results, perhaps as big if not bigger than surgery outcomes are reliant on the surgeon's experience.

John Sylvester, an experienced BT RO and part of the renowned Seattle crew, is in Florida with 21st Century Oncology.

- Allen

Post Edited (Tall Allen) : 4/23/2015 7:45:33 PM (GMT-6)

It is the one who does the actual seed implants that counts. The doctor should be a member of the American Brachytherapy Society and ASTRO, and be board-certified by the American Board of Radiology. LDR brachy, like surgery, requires great experience on the treatment end of things. HDR brachy and SBRT requires more expertise on the planning end of things. In fact, for SBRT, my RO was never even in the room during treatment - the computer operates the linac according to his plan and shuts down if parameters are not met. A technician stands by just in case (sometimes to realign fiducials).

I agree with you that you certainly don't need the combo therapy for your low risk PC.

Did you meet with Debra Freeman in Tampa about SBRT? She is excellent by all accounts.

Andy2000 said...
The two local RO's that I met with said they have a URO whom they work with in the seed implants and if any seeds goes in bladder, then the URO takes it out.

An RO, not a Uro, does the seed implants. Seeds sometimes migrate, so maybe what they mean is if a seed migrates out of the prostate into another organ (seeds have been known to migrate as far as the lungs in a couple of cases) they have to use the services of a surgeon to remove it. This kind of thing would be exceedingly rare if they are using stranded seeds.

Andy2000 said...
How long is each session of SBRT/cyber knife? Is there much difference between SBRT and CK?

CK is a brand of SBRT. The brand I had (Truebeam with RapidArc) was a different machine, and each of the 5 treatments took about 5 minutes. I think Dr. Freeman uses the new CK machines where each treatment is about 30 minutes. You'd have to ask her.

Andy2000 said...
I was thinking that since they have to implant gold markers for SBRT, I might as well do the seed implants.

Those are entirely different kinds of things. BT is done under anesthesia and involves placement of 60-100 radioactive seeds by an RO.

The placement of 3 gold fiducials takes about 5 minutes, and it is done by a urologist in his office. The procedure is sort of like a mini-biopsy.

Andy2000 said...
Beside loss of ejaculate, what are long term SE's of SBRT?

Aside from loss of ejaculate, I've had no long term SEs. None. Urination is even better than before treatment (my prostate is half the size it was). No lasting rectal SEs. NO ED whatever (thank God!). If you click on the link in my signature, you can read a full discussion of SBRT SEs. My experience is typical, although there are no guarantees with any treatment.

If you want a guarantee of no SEs, choose active surveillance. The new report on active surveillance that John T just posted is very encouraging.

PS, Andy, Gleason 6 has a great link in his footer of his Brachytherapy journey you may like to read.

Andy,

I live about an hour north of Terk. He has moved his office south towards you. Depending on where you are in Orlando, it might only be. 2 hour drive for you. Terk was recommended to me by the radiologist at MAYO in Jax. Terk was part of a group called FROG and has since moved into his own building and is on his own now. I liked him a lot, but a lot of people find him abrupt. I get a kick out of him and his manner. I also like his nurse Jean. I think she went with him when he moved. When I had my seeds implanted, he was working with Dr. Pruden a urologist at McIver clinic in Jax. I don't know if Terk still works with him. Terk may have someone he works closely with. I'd ask him. But yes, I think is is very good. I would choose him again or Yooper's doctor, Dr Moran. I really liked him a lot when I talked to him and all his patients seem, to do very well.

As for followup, you might be able to use an uro in Orlando as long as everything is going according to plan. I alternated between Terk and the uro to cut down on visits and they coordinated, between themselves.

I'm not a doctor, but you seem to have a very low form of this disease. I would think you have time to check out doctors, get opinions and get every question you can think of answered. Make sure that you are comfortable with your decision as to AS, treatment, doctor...

Your life has been involuntary changed by this disease and will be voluntarily changed by your treatment. As they say, there are no do-overs. Take your time.

Post Edited (Gleason 6) : 5/2/2015 11:00:34 AM (GMT-6)

You're welcome. Let us know how you make out and what you think of him.

Andy,
You have low risk prostate cancer. Seeds + EBRT is certainly overkill, and can only have more SEs. It sounds like a way of hiking up the price with no benefit to you.
- Allen

G6,

I am not into AS, my latest PSA was up by 0.1 from about 6.5 months ago. Hopefully, tumor did not grow.

He did not push the combo therapy , just mentioned it as an option. I would not get either. I also asked him if he knows a good dr in Orlando . He said no one in Orlando, but mentioned Sylvester in Sarasota. He would not recommend the other famous dr there.

My local uro never ordered any Testosterone test for me. Should I get one for baseline?

Thanks.