Guest guest Posted July 5, 2009 Report Share Posted July 5, 2009 Greetings, I am Stan in Tucson, AZ, USA, age 58. A few weeks ago I got results of a biopsy showing prostate cancer with a Gleason's score of 6 (grades 3+3). In one of 10 specimens, about 1% in 1/2 core of submitted tissue was involved. The analysis was by Dianon Systems. Last week I got a bone scan for background and will get a background CT scan this week. I am sure that consultations and decisions regarding treatment will follow. Another issue is that I have been fighting a prostate infection since last November. The other 9 of the 10 biopsy specimens were listed as having " chronic inflamation, no evidence of malignancy. " It seems that it is resistant to antibiotics that readily penetrate the prostate and is sensitive to ones that do not penetrate. My urologist thinks that the high PSA (around 12.5?) was caused by the infection, and not so much by the malignancy. I take it that with whatever treatment is taken for prostate cancer, future monitoring of PSA is important. I probably will not decide on any treatment until the infection is somehow dealt with. I look forward to being a part of this group. Regards, Stan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 Tom, The radiologist(photon) who we consulted with was also very dismissive. I don't think he was threatened, just very misinformed. He made a statement early on which showed his ignorance of the subject. I had an opportunity to ask the head of radiation oncology at a local, but prestigious hospital about protons. He was not dismissive but was also misinformed. Gregg and I did our own research and spoke with many former proton patients before deciding on proton beam therapy at Loma Medical Center. Gregg is 27 months out from completion of treatment. He was 58 at the time of treatment. PSA 4.9, Gleason 3+3, 2 of 12 cores positive, staged T1c. Today his potency remains unchanged, and he has no urinary issues. He had a few instances of mild rectal bleeding and one incident of trace amounts of blood in his urine. His PSA continues to drop and was at 1 a couple of months ago. Protons have been around a long time. Loma began treating prostate cancer using protons in 1991. They currently use protons to treat over 40 cancerous and noncancerous diseases. It is particularly valuable in the treatment of pediatric cancers. It is FDA approved and has a very good track record with minimal side effects. I urge you to check it out for yourself. You have nothing to lose by doing so. Laurel > > > > > Greetings, I am Stan in Tucson, AZ, > > > USA, age 58. A few weeks ago I got results of a biopsy > > > showing prostate cancer with a Gleason's score of 6 (grades > > > 3+3). In one of 10 specimens, about 1% in 1/2 core of > > > submitted tissue was involved. The analysis was by Dianon > > > Systems. Last week I got a bone scan for background and will > > > get a background CT scan this week. I am sure that > > > consultations and decisions regarding treatment will > > > follow. > > > > > > Another issue is that I have been fighting a prostate > > > infection since last November. The other 9 of the 10 biopsy > > > specimens were listed as having " chronic inflamation, no > > > evidence of malignancy. " It seems that it is resistant to > > > antibiotics that readily penetrate the prostate and is > > > sensitive to ones that do not penetrate. My urologist thinks > > > that the high PSA (around 12.5?) was caused by the > > > infection, and not so much by the malignancy. I take it that > > > with whatever treatment is taken for prostate cancer, future > > > monitoring of PSA is important. I probably will not decide > > > on any treatment until the infection is somehow dealt with. > > > > > > I look forward to being a part of this group. > > > Regards, > > > Stan > > > > Hello Stan, > > > > Reading what you've posted, I am prompted to make a couple of > > comments: > > > > First, it is my understanding that not all prostatitis is caused > > by bacterial infection. In fact, I have read that *most* cases > > are not caused by bacterial infection. " Prostatitis " just means > > " inflammation of the prostate " . It can be caused by bacterial > > infection but often is not. No one knows what all of the > > potential causes are, and no one knows how to treat the cases > > that are not due to bacterial infection. I know that in my own > > case I have suffered from painful prostatitis from time to time > > but a course of antibiotics did me no good at all, and probably > > some harm since I was vaguely nauseous during the entire 28 day > > treatment - presumably because the antibiotic killed off > > beneficial bacteria in my stomach, and perhaps allowed antibiotic > > resistant bacteria to multiply without competition from the > > others. Eventually the prostatitis went away on its own. I did > > try saw palmetto, which may have helped, or may not. It's > > impossible to say. > > > > Secondly, if I were you, I wouldn't rush into treatment for your > > cancer. If 1% of 1/2 of a core of 10 cores was cancerous, that > > means that, as a percentatage of the total samples, you only have > > firm evidence of: > > > > .01 * .5 / 10 = .0005, or 1/20th of one percent showing cancer. > > > > It's entirely possible that you could go another 10 or 20 years > > before this cancer became anything more than microscopic. So you > > have to consider whether you really want to risk impotence, > > incontinence, or other possible side effects of treatment to > > address what may be an inconsequential problem. > > > > Here's a quote from the Wikipedia: > > > > " Autopsy studies of Chinese, German, Israeli, Jamaican, > > Swedish, and Ugandan men who died of other causes have found > > prostate cancer in thirty percent of men in their 50s, and in > > eighty percent of men in their 70s. " > > (http://en.wikipedia.org/wiki/Prostate_cancer) > > > > These are men who never knew they had cancer, and died of > > something else before it could ever become any kind of problem > > for them. > > > > I'm not a doctor and not qualified to give medical advice. But I > > suggest you discuss " active surveillance " with your doctor as one > > of your options. > > > > Also, if I were you, with such a low grade of cancer, I would not > > be anxious to be getting tests that expose significant parts of > > your body to x-rays when they really have a vanishingly small > > chance of detecting cancer. See: > > > > > http://www.prostatevideos.com/prostate-cancer/grading-and-staging-of-prostat > > e-cancer/bone-scan-for-assessing-cancer-spreading-to-the-bones/ > > > > or: http://tinyurl.com/8rlmoa > > > > But, these are all thoughts from an unqualified layman. They're > > just for you to think about. They aren't established truths. > > > > Good luck. > > > > Alan > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 Tom, The radiologist(photon) who we consulted with was also very dismissive. I don't think he was threatened, just very misinformed. He made a statement early on which showed his ignorance of the subject. I had an opportunity to ask the head of radiation oncology at a local, but prestigious hospital about protons. He was not dismissive but was also misinformed. Gregg and I did our own research and spoke with many former proton patients before deciding on proton beam therapy at Loma Medical Center. Gregg is 27 months out from completion of treatment. He was 58 at the time of treatment. PSA 4.9, Gleason 3+3, 2 of 12 cores positive, staged T1c. Today his potency remains unchanged, and he has no urinary issues. He had a few instances of mild rectal bleeding and one incident of trace amounts of blood in his urine. His PSA continues to drop and was at 1 a couple of months ago. Protons have been around a long time. Loma began treating prostate cancer using protons in 1991. They currently use protons to treat over 40 cancerous and noncancerous diseases. It is particularly valuable in the treatment of pediatric cancers. It is FDA approved and has a very good track record with minimal side effects. I urge you to check it out for yourself. You have nothing to lose by doing so. Laurel > > > > > Greetings, I am Stan in Tucson, AZ, > > > USA, age 58. A few weeks ago I got results of a biopsy > > > showing prostate cancer with a Gleason's score of 6 (grades > > > 3+3). In one of 10 specimens, about 1% in 1/2 core of > > > submitted tissue was involved. The analysis was by Dianon > > > Systems. Last week I got a bone scan for background and will > > > get a background CT scan this week. I am sure that > > > consultations and decisions regarding treatment will > > > follow. > > > > > > Another issue is that I have been fighting a prostate > > > infection since last November. The other 9 of the 10 biopsy > > > specimens were listed as having " chronic inflamation, no > > > evidence of malignancy. " It seems that it is resistant to > > > antibiotics that readily penetrate the prostate and is > > > sensitive to ones that do not penetrate. My urologist thinks > > > that the high PSA (around 12.5?) was caused by the > > > infection, and not so much by the malignancy. I take it that > > > with whatever treatment is taken for prostate cancer, future > > > monitoring of PSA is important. I probably will not decide > > > on any treatment until the infection is somehow dealt with. > > > > > > I look forward to being a part of this group. > > > Regards, > > > Stan > > > > Hello Stan, > > > > Reading what you've posted, I am prompted to make a couple of > > comments: > > > > First, it is my understanding that not all prostatitis is caused > > by bacterial infection. In fact, I have read that *most* cases > > are not caused by bacterial infection. " Prostatitis " just means > > " inflammation of the prostate " . It can be caused by bacterial > > infection but often is not. No one knows what all of the > > potential causes are, and no one knows how to treat the cases > > that are not due to bacterial infection. I know that in my own > > case I have suffered from painful prostatitis from time to time > > but a course of antibiotics did me no good at all, and probably > > some harm since I was vaguely nauseous during the entire 28 day > > treatment - presumably because the antibiotic killed off > > beneficial bacteria in my stomach, and perhaps allowed antibiotic > > resistant bacteria to multiply without competition from the > > others. Eventually the prostatitis went away on its own. I did > > try saw palmetto, which may have helped, or may not. It's > > impossible to say. > > > > Secondly, if I were you, I wouldn't rush into treatment for your > > cancer. If 1% of 1/2 of a core of 10 cores was cancerous, that > > means that, as a percentatage of the total samples, you only have > > firm evidence of: > > > > .01 * .5 / 10 = .0005, or 1/20th of one percent showing cancer. > > > > It's entirely possible that you could go another 10 or 20 years > > before this cancer became anything more than microscopic. So you > > have to consider whether you really want to risk impotence, > > incontinence, or other possible side effects of treatment to > > address what may be an inconsequential problem. > > > > Here's a quote from the Wikipedia: > > > > " Autopsy studies of Chinese, German, Israeli, Jamaican, > > Swedish, and Ugandan men who died of other causes have found > > prostate cancer in thirty percent of men in their 50s, and in > > eighty percent of men in their 70s. " > > (http://en.wikipedia.org/wiki/Prostate_cancer) > > > > These are men who never knew they had cancer, and died of > > something else before it could ever become any kind of problem > > for them. > > > > I'm not a doctor and not qualified to give medical advice. But I > > suggest you discuss " active surveillance " with your doctor as one > > of your options. > > > > Also, if I were you, with such a low grade of cancer, I would not > > be anxious to be getting tests that expose significant parts of > > your body to x-rays when they really have a vanishingly small > > chance of detecting cancer. See: > > > > > http://www.prostatevideos.com/prostate-cancer/grading-and-staging-of-prostat > > e-cancer/bone-scan-for-assessing-cancer-spreading-to-the-bones/ > > > > or: http://tinyurl.com/8rlmoa > > > > But, these are all thoughts from an unqualified layman. They're > > just for you to think about. They aren't established truths. > > > > Good luck. > > > > Alan > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 > Watchful waiting was discussed but quickly dismissed as the > appropriate solution. I wondered why, and of course the answer > was that I'm relatively young. BUT, I've seen quite a few > posters to this site who are younger than I am, and some of > them have chosen not to be aggressive in treatment. Well, youth is certainly a factor. Cancers that are not threatening for the next ten or fifteen years can become deadly after that, and it can be easier to treat them while they are still small. > Re: Lupron, I was told that it was essential to get my prostate > down to size and ready for brachytherapy. That sounds reasonable too. It can be difficult to treat a really large prostate, and Lupron will shrink it significantly. > ly, I haven't seen much effect. Lupron works by stimulating the production of a hormone that signals the testicles to produce *more* testosterone, not less. For a week or more, the testicles respond and the level of testosterone in your body actually increases. Then the whole system becomes overloaded and the testicles shut down, producing very little testosterone. The effects should be kicking in about now. You will probably soon experience the usual side effects - hot flushes, drop in libido (which might have been elevated during the first couple of weeks), and some reduction in energy. It will be important to keep up a good level of exercise and to avoid over eating since many men experience weight gain. > But what I regret the most was the microwave procedure, given > to prevent urinary retention, and the catheter required > afterwards. I've had the catheter out for five days and I'm > still in pain and urinating every 20 minutes or so (I'm pushing > fluids). The alternative to the microwave presented was the > green laser, and, frankly, I'd hoped to do without either, but > it's a bit late to worry about that. I've been taking an > anti-inflammatory and have been taking Detrol & Flomax for > years, so I assume I'll at least continue with the Flomax. That sounds pretty awful. I hope it gets better soon. I think you should ask the doctor about the scheduling of the brachytherapy procedure. I'm wondering if it should be delayed until the other problem clears up so that you don't have to deal with both at once, and so that the radiation doesn't make an existing problem worse. > How would the group compare brachytherapy to proton beam? The > latter was also dismissed as a solution during my deliberations > with the urologist and radiological oncologist. The theory behind proton beam therapy is that the protons, being massive particles, deposit most of their energy in a narrow band of tissue (see the Wikipedia article on " Bragg Peak " for why that is so), whereas externally beamed x-rays deliver energy to all of the tissue in the path of the beam, including tissue in front of and behind the prostate. Therefore, in theory, proton beam should have about the same effectiveness as external beam x-ray therapy but with reduced side effects on non-cancerous tissue outside the prostate. To the best of my knowledge, no one claims that proton beam therapy is more effective than x-ray therapy, only that side effects are less. Of course in theory, theory and practice are the same. In practice, well ... X-ray therapy has gotten quite refined. I have not myself seen any evidence that the side effects from proton beam therapy are less than those from x-rays. Furthermore, brachytherapy, if done properly, also delivers very little energy to tissues in front of or behind the prostate because the radiation doesn't come from outside. It comes from inside the prostate itself, and is " cool " enough that it typically only ionizes tissue within a couple of millimeters of each individual seed. That's why they plant 75 - 100 seeds or so instead of just one. I am not an expert in radiation oncology and you shouldn't take my views on this to be authoritative. However I personally am not aware of any real world, practical advantage of proton beams that justifies the extra cost. I have not seen any study that proves that effectiveness is greater or side effects are less. I am aware of advantages and disadvantages of external beam vs. brachytherapy. External beam is more appropriate if and when it is suspected that the cancer extends to tissue around the prostate because brachytherapy is less likely to treat that area. However, for Gleason 6, PSA < 10 cancer, it is my understanding that the cancer is very likely to be fully contained in the prostate and that brachytherapy and external beam therapies (including proton beam therapy) have about the same (quite high) cure rates. Brachytherapy has the advantage over external beam that only one procedure is needed. You go into the hospital, get it done, and you're usually out the next day. That's it. External beam requires about 40+ days of treatment, though it does not require any surgical procedures as brachytherapy does. That's my inexpert 2 cents on the subject. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 > Watchful waiting was discussed but quickly dismissed as the > appropriate solution. I wondered why, and of course the answer > was that I'm relatively young. BUT, I've seen quite a few > posters to this site who are younger than I am, and some of > them have chosen not to be aggressive in treatment. Well, youth is certainly a factor. Cancers that are not threatening for the next ten or fifteen years can become deadly after that, and it can be easier to treat them while they are still small. > Re: Lupron, I was told that it was essential to get my prostate > down to size and ready for brachytherapy. That sounds reasonable too. It can be difficult to treat a really large prostate, and Lupron will shrink it significantly. > ly, I haven't seen much effect. Lupron works by stimulating the production of a hormone that signals the testicles to produce *more* testosterone, not less. For a week or more, the testicles respond and the level of testosterone in your body actually increases. Then the whole system becomes overloaded and the testicles shut down, producing very little testosterone. The effects should be kicking in about now. You will probably soon experience the usual side effects - hot flushes, drop in libido (which might have been elevated during the first couple of weeks), and some reduction in energy. It will be important to keep up a good level of exercise and to avoid over eating since many men experience weight gain. > But what I regret the most was the microwave procedure, given > to prevent urinary retention, and the catheter required > afterwards. I've had the catheter out for five days and I'm > still in pain and urinating every 20 minutes or so (I'm pushing > fluids). The alternative to the microwave presented was the > green laser, and, frankly, I'd hoped to do without either, but > it's a bit late to worry about that. I've been taking an > anti-inflammatory and have been taking Detrol & Flomax for > years, so I assume I'll at least continue with the Flomax. That sounds pretty awful. I hope it gets better soon. I think you should ask the doctor about the scheduling of the brachytherapy procedure. I'm wondering if it should be delayed until the other problem clears up so that you don't have to deal with both at once, and so that the radiation doesn't make an existing problem worse. > How would the group compare brachytherapy to proton beam? The > latter was also dismissed as a solution during my deliberations > with the urologist and radiological oncologist. The theory behind proton beam therapy is that the protons, being massive particles, deposit most of their energy in a narrow band of tissue (see the Wikipedia article on " Bragg Peak " for why that is so), whereas externally beamed x-rays deliver energy to all of the tissue in the path of the beam, including tissue in front of and behind the prostate. Therefore, in theory, proton beam should have about the same effectiveness as external beam x-ray therapy but with reduced side effects on non-cancerous tissue outside the prostate. To the best of my knowledge, no one claims that proton beam therapy is more effective than x-ray therapy, only that side effects are less. Of course in theory, theory and practice are the same. In practice, well ... X-ray therapy has gotten quite refined. I have not myself seen any evidence that the side effects from proton beam therapy are less than those from x-rays. Furthermore, brachytherapy, if done properly, also delivers very little energy to tissues in front of or behind the prostate because the radiation doesn't come from outside. It comes from inside the prostate itself, and is " cool " enough that it typically only ionizes tissue within a couple of millimeters of each individual seed. That's why they plant 75 - 100 seeds or so instead of just one. I am not an expert in radiation oncology and you shouldn't take my views on this to be authoritative. However I personally am not aware of any real world, practical advantage of proton beams that justifies the extra cost. I have not seen any study that proves that effectiveness is greater or side effects are less. I am aware of advantages and disadvantages of external beam vs. brachytherapy. External beam is more appropriate if and when it is suspected that the cancer extends to tissue around the prostate because brachytherapy is less likely to treat that area. However, for Gleason 6, PSA < 10 cancer, it is my understanding that the cancer is very likely to be fully contained in the prostate and that brachytherapy and external beam therapies (including proton beam therapy) have about the same (quite high) cure rates. Brachytherapy has the advantage over external beam that only one procedure is needed. You go into the hospital, get it done, and you're usually out the next day. That's it. External beam requires about 40+ days of treatment, though it does not require any surgical procedures as brachytherapy does. That's my inexpert 2 cents on the subject. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 Very helpful, Alan. Thanks very much. You mention timing and cost. Whatever I do, I'll do after I go on Medicare, in December. Is Medicare more likely to cover none procedure as opposed to another, i.e. will proton beam therapy cost me more than, say, brachytherapy? Tom Lauterback 2820 Edgewater Drive Elgin, IL 60124 (cell) From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer Sent: Tuesday, July 07, 2009 2:53 PM To: ProstateCancerSupport Subject: RE: Re: New member introduction On Tue, 7/7/09, Tom Lauterback wrote: > Watchful waiting was discussed but quickly dismissed as the > appropriate solution. I wondered why, and of course the answer > was that I'm relatively young. BUT, I've seen quite a few > posters to this site who are younger than I am, and some of > them have chosen not to be aggressive in treatment. Well, youth is certainly a factor. Cancers that are not threatening for the next ten or fifteen years can become deadly after that, and it can be easier to treat them while they are still small. > Re: Lupron, I was told that it was essential to get my prostate > down to size and ready for brachytherapy. That sounds reasonable too. It can be difficult to treat a really large prostate, and Lupron will shrink it significantly. > ly, I haven't seen much effect. Lupron works by stimulating the production of a hormone that signals the testicles to produce *more* testosterone, not less. For a week or more, the testicles respond and the level of testosterone in your body actually increases. Then the whole system becomes overloaded and the testicles shut down, producing very little testosterone. The effects should be kicking in about now. You will probably soon experience the usual side effects - hot flushes, drop in libido (which might have been elevated during the first couple of weeks), and some reduction in energy. It will be important to keep up a good level of exercise and to avoid over eating since many men experience weight gain. > But what I regret the most was the microwave procedure, given > to prevent urinary retention, and the catheter required > afterwards. I've had the catheter out for five days and I'm > still in pain and urinating every 20 minutes or so (I'm pushing > fluids). The alternative to the microwave presented was the > green laser, and, frankly, I'd hoped to do without either, but > it's a bit late to worry about that. I've been taking an > anti-inflammatory and have been taking Detrol & Flomax for > years, so I assume I'll at least continue with the Flomax. That sounds pretty awful. I hope it gets better soon. I think you should ask the doctor about the scheduling of the brachytherapy procedure. I'm wondering if it should be delayed until the other problem clears up so that you don't have to deal with both at once, and so that the radiation doesn't make an existing problem worse. > How would the group compare brachytherapy to proton beam? The > latter was also dismissed as a solution during my deliberations > with the urologist and radiological oncologist. The theory behind proton beam therapy is that the protons, being massive particles, deposit most of their energy in a narrow band of tissue (see the Wikipedia article on " Bragg Peak " for why that is so), whereas externally beamed x-rays deliver energy to all of the tissue in the path of the beam, including tissue in front of and behind the prostate. Therefore, in theory, proton beam should have about the same effectiveness as external beam x-ray therapy but with reduced side effects on non-cancerous tissue outside the prostate. To the best of my knowledge, no one claims that proton beam therapy is more effective than x-ray therapy, only that side effects are less. Of course in theory, theory and practice are the same. In practice, well ... X-ray therapy has gotten quite refined. I have not myself seen any evidence that the side effects from proton beam therapy are less than those from x-rays. Furthermore, brachytherapy, if done properly, also delivers very little energy to tissues in front of or behind the prostate because the radiation doesn't come from outside. It comes from inside the prostate itself, and is " cool " enough that it typically only ionizes tissue within a couple of millimeters of each individual seed. That's why they plant 75 - 100 seeds or so instead of just one. I am not an expert in radiation oncology and you shouldn't take my views on this to be authoritative. However I personally am not aware of any real world, practical advantage of proton beams that justifies the extra cost. I have not seen any study that proves that effectiveness is greater or side effects are less. I am aware of advantages and disadvantages of external beam vs. brachytherapy. External beam is more appropriate if and when it is suspected that the cancer extends to tissue around the prostate because brachytherapy is less likely to treat that area. However, for Gleason 6, PSA < 10 cancer, it is my understanding that the cancer is very likely to be fully contained in the prostate and that brachytherapy and external beam therapies (including proton beam therapy) have about the same (quite high) cure rates. Brachytherapy has the advantage over external beam that only one procedure is needed. You go into the hospital, get it done, and you're usually out the next day. That's it. External beam requires about 40+ days of treatment, though it does not require any surgical procedures as brachytherapy does. That's my inexpert 2 cents on the subject. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 Very helpful, Alan. Thanks very much. You mention timing and cost. Whatever I do, I'll do after I go on Medicare, in December. Is Medicare more likely to cover none procedure as opposed to another, i.e. will proton beam therapy cost me more than, say, brachytherapy? Tom Lauterback 2820 Edgewater Drive Elgin, IL 60124 (cell) From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer Sent: Tuesday, July 07, 2009 2:53 PM To: ProstateCancerSupport Subject: RE: Re: New member introduction On Tue, 7/7/09, Tom Lauterback wrote: > Watchful waiting was discussed but quickly dismissed as the > appropriate solution. I wondered why, and of course the answer > was that I'm relatively young. BUT, I've seen quite a few > posters to this site who are younger than I am, and some of > them have chosen not to be aggressive in treatment. Well, youth is certainly a factor. Cancers that are not threatening for the next ten or fifteen years can become deadly after that, and it can be easier to treat them while they are still small. > Re: Lupron, I was told that it was essential to get my prostate > down to size and ready for brachytherapy. That sounds reasonable too. It can be difficult to treat a really large prostate, and Lupron will shrink it significantly. > ly, I haven't seen much effect. Lupron works by stimulating the production of a hormone that signals the testicles to produce *more* testosterone, not less. For a week or more, the testicles respond and the level of testosterone in your body actually increases. Then the whole system becomes overloaded and the testicles shut down, producing very little testosterone. The effects should be kicking in about now. You will probably soon experience the usual side effects - hot flushes, drop in libido (which might have been elevated during the first couple of weeks), and some reduction in energy. It will be important to keep up a good level of exercise and to avoid over eating since many men experience weight gain. > But what I regret the most was the microwave procedure, given > to prevent urinary retention, and the catheter required > afterwards. I've had the catheter out for five days and I'm > still in pain and urinating every 20 minutes or so (I'm pushing > fluids). The alternative to the microwave presented was the > green laser, and, frankly, I'd hoped to do without either, but > it's a bit late to worry about that. I've been taking an > anti-inflammatory and have been taking Detrol & Flomax for > years, so I assume I'll at least continue with the Flomax. That sounds pretty awful. I hope it gets better soon. I think you should ask the doctor about the scheduling of the brachytherapy procedure. I'm wondering if it should be delayed until the other problem clears up so that you don't have to deal with both at once, and so that the radiation doesn't make an existing problem worse. > How would the group compare brachytherapy to proton beam? The > latter was also dismissed as a solution during my deliberations > with the urologist and radiological oncologist. The theory behind proton beam therapy is that the protons, being massive particles, deposit most of their energy in a narrow band of tissue (see the Wikipedia article on " Bragg Peak " for why that is so), whereas externally beamed x-rays deliver energy to all of the tissue in the path of the beam, including tissue in front of and behind the prostate. Therefore, in theory, proton beam should have about the same effectiveness as external beam x-ray therapy but with reduced side effects on non-cancerous tissue outside the prostate. To the best of my knowledge, no one claims that proton beam therapy is more effective than x-ray therapy, only that side effects are less. Of course in theory, theory and practice are the same. In practice, well ... X-ray therapy has gotten quite refined. I have not myself seen any evidence that the side effects from proton beam therapy are less than those from x-rays. Furthermore, brachytherapy, if done properly, also delivers very little energy to tissues in front of or behind the prostate because the radiation doesn't come from outside. It comes from inside the prostate itself, and is " cool " enough that it typically only ionizes tissue within a couple of millimeters of each individual seed. That's why they plant 75 - 100 seeds or so instead of just one. I am not an expert in radiation oncology and you shouldn't take my views on this to be authoritative. However I personally am not aware of any real world, practical advantage of proton beams that justifies the extra cost. I have not seen any study that proves that effectiveness is greater or side effects are less. I am aware of advantages and disadvantages of external beam vs. brachytherapy. External beam is more appropriate if and when it is suspected that the cancer extends to tissue around the prostate because brachytherapy is less likely to treat that area. However, for Gleason 6, PSA < 10 cancer, it is my understanding that the cancer is very likely to be fully contained in the prostate and that brachytherapy and external beam therapies (including proton beam therapy) have about the same (quite high) cure rates. Brachytherapy has the advantage over external beam that only one procedure is needed. You go into the hospital, get it done, and you're usually out the next day. That's it. External beam requires about 40+ days of treatment, though it does not require any surgical procedures as brachytherapy does. That's my inexpert 2 cents on the subject. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 > Very helpful, Alan. Thanks very much. You mention timing and > cost. Whatever I do, I'll do after I go on Medicare, in > December. Is Medicare more likely to cover one procedure as > opposed to another, i.e. will proton beam therapy cost me more > than, say, brachytherapy? Hmmm. If you're going on Medicare in December, you are probably not quite as " youthful " as I thought when I made the comment that young men should seek treatment more than older men. Incidentally, as long as you are on hormone therapy, it's likely that your cancer is being suppressed. So there is no incentive to get immediate treatment. Waiting until December shouldn't hurt you, though it will subject you to hormone therapy side effects for a longer time than would be necessary just to shrink the prostate. As for Medicare coverage, I don't know. A good way to find out would be to call the clinics that you are considering and ask them if Medicare covers their treatments. I don't know if the answers are uniform from place to place, but the clinics will know for sure if they are receiving payment from Medicare. If you're paying out of pocket, I believe that proton therapy is one of the most expensive options. But again, a call to each clinic can get you more precise answers. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2009 Report Share Posted July 7, 2009 > Very helpful, Alan. Thanks very much. You mention timing and > cost. Whatever I do, I'll do after I go on Medicare, in > December. Is Medicare more likely to cover one procedure as > opposed to another, i.e. will proton beam therapy cost me more > than, say, brachytherapy? Hmmm. If you're going on Medicare in December, you are probably not quite as " youthful " as I thought when I made the comment that young men should seek treatment more than older men. Incidentally, as long as you are on hormone therapy, it's likely that your cancer is being suppressed. So there is no incentive to get immediate treatment. Waiting until December shouldn't hurt you, though it will subject you to hormone therapy side effects for a longer time than would be necessary just to shrink the prostate. As for Medicare coverage, I don't know. A good way to find out would be to call the clinics that you are considering and ask them if Medicare covers their treatments. I don't know if the answers are uniform from place to place, but the clinics will know for sure if they are receiving payment from Medicare. If you're paying out of pocket, I believe that proton therapy is one of the most expensive options. But again, a call to each clinic can get you more precise answers. Alan Quote Link to comment Share on other sites More sharing options...
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