(No Subject)

Steve, welcome but sorry you have to be here.

I'm pretty new to this myself but if you can give folks some of your specifics you might get a few ideas you haven't considered. In any case, welcome & good luck.

Steve,
Here is a cut and paste of the last signture you used. Thought it would be faster to this than to walk you through fixing why it's not showing up (likely you didn't check, "include signature" when you did the post).

DOB - 12/1949 Age 65 at DX
Family history
Annual PSA check - jump from 1.44 to 2.20 in 12/14
3/15 - 2.09 18% free.
Uro 5/15 felt asymmetry. PSA 2.90 25% free.
MRI 6/29/15 - 7mm nodule mid left lateral periph
7/9/15 - MRI/TRUS BX
7/13/15 - DX PCa
4 of 16 cores 60-40-20-10% - G7 (3+4)
2nd opinion from Epstein- 2 cores G6, 2 cores G7 (3+4) - 20% @ grade 4
7/29/15 - negative bone & CAT scans

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Andrew

Steve, here's the thing that will drive you crazy: with your numbers almost any treatment mode will work just fine. There are trade offs that only you can really decide about. Some times it just comes down to intuition or personal preference. Some guys just want it out and go for surgery. Some guys hate the idea of being cut open and go for RT.

However, we've been hearing a lot of good things about SBRT so if I were you, I'd hold off on a decision until you talk to that RO.

I am not a doc, just some random guy on the internet, but I encourage you to look into the SBRT. Could be just the thing for you.

Hang in there, it isn't easy, but you'll get through,
Andrew

Posting here can take a little getting use to, but you'll figure it out.

Lots of the folks here will jump in soon with suggestions for you.

which may help, or may overwhelm more.

If you've got any specific questions about a treatment plan or something docs said, let us know. Lots very knowledge folks around here.
Andrew

Here's an option for you - set up an appointment at MD Anderson. You will get to have an opportunity to chat with different specialists that aren't promoting a particular treatment. Surgery? Yup, my Doc has performed over 2,000 da Vinci procedures. Seeds? Yup, they have one of the best in the country. IMRT? That also. Everything is on one campus with an attached hotel.

Steve-
The problem with books like Walsh's is that they're out of date by the time they go to print. That's why I never recommend them. I think his last edition was published in 2012, and a lot has been learned since then. To me, much better sources are recent articles written in peer-reviewed journals. But I know that not everyone is a research junkie like I am.

The longest running (7 years), largest(n=477), single-institution study (Katz) on SBRT for low/intermediate risk guys like yourself is the one you can access by clicking the link in my signature. He did a separate one on side effects:
Quality of Life and Toxicity after SBRT for Organ-Confined Prostate Cancer, a 7-Year Study

Coincidentally, someone in my PC support group asked the same question you did about how to decide between them all. After all, at your risk level, all the treatments have about the same chance of giving you a lasting cure. So then it all comes down to you. I think the patient has to make a frank assessment about what is most important to him. Some guys want the assurance (if they get it) of an A+ pathology report and undetectable PSAs after surgery. Some guys want treatment with a long history. For me, the critical factor was preservation of sexual potency - SBRT and HDR brachy had the best stats on that dimension. I also wanted to avoid an operation or anything intrusive if I could, so SBRT became my choice. Also, it was totally covered by my insurance, was very quick, and the pioneer RO was only 10 minutes away. But I also recognize that these aren't the factors that are most important to everyone.

I did find, as you are probably finding, that many doctors have an opinion about about all the other treatments. I learned to take those with a grain of salt. The only thing I can count on a doctor to really know a lot about is his own specialty. And if you go to any of the top specialists, you can't go far wrong. Be careful of community doctors.

How to choose which treatment? That's one of the toughest things to decide since the "best" choice varies depending on what's important to us, and also because for most of us with PC, *any* treatment has the potential to cure us.

I do think that after you've investigated your choices, most guys find a treatment that "speaks" to them. If you haven't got there yet, you likely will. I think it's also likely you'll find a practitioner that you're the most comfortable with.

And if it helps take the pressure off of you, it's very unlikely you have to worry about not being cured with your stats. I do think your concern about SEs is a valid one since all treatments have them--I think trying to dig into the potential SEs of your various treatment options makes a ton of sense.

Last thing I'll add. I agonized over my choice. But once I made my decision I felt instantly better and never looked back. And nowadays if I wasn't on HW, I probably wouldn't even remember that I had cancer.

You must be Mr Suz, then.

SBRT is a kind of external beam radiation therapy. Like IMRT, it uses X-rays (not from radioactive elements). It's done in just 5 treatments rather than 40+ treatments the way IGRT/IMRT is. So it's very concentrated. It turns out that prostate cancer is killed more effectively by fewer more intense treatments than by more less intense treatments. Because of the intensity, it has to be done with sub-millimeter precision that isn't necessary with IMRT. To accomplish that, it tracks the motion of the prostate throughout each treatment (called intrafractional motion) in addition to between treatments (called interfractional motion). At the same time, it is so efficient in cancer-cell killing that less than half the total amount of radiation is required, so it spares healthy tissue very well.

As far as the patient is concerned, he gets the fiducials or transponders placed (like a mini-biopsy), gets a CT/MRI for planning purposes afterwards, and a few days later starts treatment. The whole thing is automated according to the computer plan - only a technician hangs around during the treatments. The patient lies on a special bench that adjusts microscopically to align the fiducials with the plan, he gets his treatment (he feels nothing during the treatment), he gets up, and goes home. He does that every other day, and does it 5 times. That's all there is to it. The cancer cells die off over time and the PSA goes down over the next few years.

Kevin Stephans has been treating prostate cancer with SBRT (probably using the CyberKnife machine) there for several years, which is probably more than enough experience. Unlike surgery or seed brachytherapy, there is not a steep learning curve. All the work goes into the computer planning end and not into the actual execution of the plan. Let us know what you think of him after you've met with him.

- Allen

Steve, in a situation like yours where no matter which treatment you choose,there is an equally high chance of success, it's tough. Each treatment comes with its own side effects and risks.
So at the end of the day, it seems like the best answer is make sure you've done your due dilligence, and in the absence of science that shows one treatment being better than others, go with what your gut says.

Maybe do the old, pros and cons list. Create one for each treatment, compare,than ask yourself which makes me more comfortable ? (Or less uncomfortable.

No easy way for sure.