Surgery or Radiation? Trying to decide.

You should see if there is an SBRT (cyber knife) there. That's only a 5 day radiation course and might be a good option for you. Maybe TA knows a center there that does it. Most guy who go the SBRT route report few SEs and an easy treatment.

Honestly, with your numbers any of the treatments would work fine.

The other question is: how far are you willing to travel for treatment? If you're able to spend a week away from home for treatment, and can afford an airplane ticket, hotel, etc, then anything within reach of an airport is a possibility. I've heard of folks doing that. Not for everyone, just a possibility. If it was an option, then your choices are greatly expanded.

Just some random thoughts.

Andrew

Investigate brachytherapy both permanent seed and High Dose Rate. For you it would likely be one procedure. If you are looking fir convenience, this is it.

Hey guys thanks for all the input I hope to get more.
I don't mind the travel as shown by me going to Seattle 300 miles one way. I would also fly and stay some where else if I felt that was what was needed. Actually I have relatives who live 30 miles from Mayo/Rochester. That said the reports on the Seattle Cancer Alliance with UofW and Fred Hutchinson is so highly rated I felt that would be a good place if I can get the treatment I decide on and the Dr. and I get along. Once I decide what and where and who there will be no looking back for me with the "what if". I will follow the Dr and march to his/her music.
Yes the Brachytherapy is DEFINITELY on my play list at the moment. I have been told that it might be a bit dicey as my prostate is just north of 60cc.
Hey Halbert and John_Tx: Thx for the two opinions on the RALP. Even though I am 69 I am in really good shape. Lots of muscle well developed. All of the markers are great BP, Chol, A1C and weight, everything except the PC.
I would hope that if I go the RALP or other surgical route that I might fair better than most my age. Age and living alone on 40 acres in the mountains, 7 miles from town and something they call a hospital that I call a vetenarian clinic, are the main reasons I am really interested in a short duration Radiation treatment.
I meet with a RO at the UofW on this coming Monday.

JNF thanks for the referral.Great site I have book marked it and will be reading in depth.

I believe I have already sent you info on Dr Hsi (see) who specializes in LDR, Brachy Thearapy. As stated earlier I had this procedure done in July of 2014 from Dr. Hsi's mentor, the late Dr. Peter Grimm. Out of the procedure before noon, up and walking, the same day. Went home (about the same miles you are from Seattle)walked a lot at each stop on the way home. Have no side effects today outside of reduced ejaculate.

three 5's and a jack said...
I believe I would prefer radiation when it comes to the SE's although I am not particularly worried about ED.

So far I have met with a surgeon, he only does open, and with a RO who only does what she called "Standard IMRT" These two Doctors both from Spokane,wa.

I have appointments for the U of W Med Center which is in alliance with the Fred Hutchinson Cancer Center in Seattle coming up next week. One for Surgeon and one for RO. I will be able to discuss all options with them.

Now to the question so I can get some info, get better informed so to be able to ask better questions of the RO.
I live 300 miles from Seattle and due to personal situation could not live there for 9 weeks. So what Radiation treatments are there that might fit my situation DX and can be done over a few days time. Of, course still with a good percentage on the outcome?

Also any info on Robotic surgery would be helpful.

Thanks

May I ask: what do you men by "I am not particularly worried about ED."? Do you mean you do not care if you have partial or even total ED, and don't care if you have ED ( partial or likely total) for a few months if lucky or permanent if unlucky? If you don't care, then you sound like a particularly good candidate for surgery. For me the surgery or recovery was not bad, only the after effects. Although, there are several other potential, even perhaps some what likely, nasty problems that you might object to more so than ED. Bent penis, shortened penis, urination while trying to have sex, loss or orgasmic pleasure or even pain. But, if you don't care about ED you probably also would not be overly concerned about any of those. The only concern left would be incontinence, for a few weeks to a year or two or even permanent, requiring more surgery to probably fix it. But I'm thinking the big majority of us don't have long lasting significant problems with that, though some for sure will.

As far as I can tell by responses here and elsewhere, the RT- especially if no HT required, will result in a much lower chance of any of he above nasties. Although it has it's on list of very unpleasant results, still I think with much lower likelihood of severe problems. Assuming all goes right, with either surgery or RT.

I don't know if you would qualify, but Active Surveillance has zero side effects, assuming you don't advance. Even if you do, I think there are no significantly worse outcomes, no increased chance of death. Something to look into anyway. Good luck on your research!

Hey guys really thanks alot for the info.
The next three days are big time for finish up on study and prep questions for the RO on Monday.

What I meant about not being concerned with ED is that other SE's, most notably urinary, are higher on the list. I know there are no 100% positives here but for the sake of clarity in discussion just say.

If I found a treatment that was statistically 100% cure but also 100% ED and there was another Treatment that was 95% cure and 25% ED I would take the 100%. I am 69, I am single, I am sexually active, I like sex but sex is not a driving force in my life. There are many other things of greater importance to me. Spirituality, understanding of self and furthering my journey towards enlightenment to list a few. If the cost of another 10-15 years of good quality living is the loss of erections, it ain't even a close race.
As far as the other things mentioned, bent and shortened penis, they don't really count much at this time either.

AS is really not an option, I don't think given my numbers and considering I could expect another 20 years given my health, fitness and family history. Many family members, both sides, 80's and 90' and a smattering of 100's.

May we all be well.

I have had eight years since diagnosis, of pondering the question of treatments, and have spent a LOT of time searching the internet and asking everyone I meet.

Luckily, I seem to have an indolent case of PCa, but I am still avidly searching the discussions.

IF i had to have treatment, it would either be SBRT or HDR brachytherapy. Sorry to say, and this is anecdotal, but I have read far too many stories about the "quality of life" issues after surgery to consider it.

<<<IF i had to have treatment, it would either be SBRT or HDR brachytherapy. Sorry to say, and this is anecdotal, but I have read far too many stories about the "quality of life" issues after surgery to consider it.>>>

I mostly agree with your choice for treatment, ASA, but......

As you know probably better than me, SBRT and HDR Brachytherapy are relatively new treatments, with a lot less long term data available, either scientific or anecdotal. Both are most promising however.

Also, many of the negative reports about surgery come from the small percent of those who have issues. They, IMHO, are over represented on forums, because they are searching for help. Also the population of surgery patients dwarfs SBRT and HDR Brachy folks....so the people reporting surgery issues is much higher.

Like most everything about PCa....clear as mud.

Post Edited (garyi) : 8/18/2017 10:11:27 AM (GMT-6)

You raised a big red flag, you mentioned you "live alone". If you choose surgery it is a real PITA to recover from surgery without help in the house. I started a thread on this a few weeks ago. You should get a live in helper for the first few days:

https://www.healingwell.com/community/default.aspx?f=35&m=3889239

It's hard to move much. I am 64 in excellent shape.

Good luck,

Nick

<<<three 5's and a jack said...
If I do surgery I will have an old army buddy pick me up and take me to his house where I will stay until the cath comes out>>>

Very wise, and a great friend.

The worst part for me, when I had my catheter in, was having my wife insist on showering with me to "help", and unlike before surgery....no happy ending. ;-)

Your friend was misinformed. The only kind of radiation precluded by large prostates is LDR brachytherapy, not HDR nor SBRT. Outcomes with larger prostates are worse, even with surgery.