Talk Cancer

Question:

After much research into all this, I was led to radiation.  But I no longer believe it is the best treatment, only one of the best treatments, with surgery being another.

There is no "best" treatment.  They all have pros and cons depending on such variables as the stage of the disease, whether it’s confined, gleason score, age of the patient, the patient’s personal preferences and values, etc. What is "best" is completely subjective for each particular patient in consultation with his physicians – and there should be more than one of the latter.  Each patient should get at least two opinions, one from a surgeon and one from a radiation oncologist experienced with both external radiation and seeds. As I understand IMRT, it is a step above traditional EBRT in that the side effects are minimized and the prognosis for long term cure (greater than 10 years is good). As far as the age of the patient is concerned, relative youth (below age 60) is a double edge sword.  The conventional wisdom is that a younger man should opt for surgery because it has the best track record for long term cure, and a younger man can withstand surgery better than an older one.  But the younger man will have to live with the inevitable side effects of diminished sexual capacity and threat of incontinence for a longer period of time, not to mention "losing out" a decade of healthy response in both areas. I am 53, a year and a half post IMRT treatment, and have regained most of my pre treatment health.  No incontinence, sleeping through the night before having to urinate, good erectile function, fair to middlin’ orgasm sensation (see "dry orgasm thread), falling PSA (nadir not reached yet), maybe a little lacking in physical endurance, but pretty much the same guy. I am completely happy with my choice of treatment and have no second thoughts. Nor should anybody.  You do the research, you listen to your doctors, you talk to your family,  you search your soul, you make your decision.  Then you don’t look back.

Response:

For the new members of the PC group, don’t let the surgery guys drown out the wonderful option of Intensified Modulated Radiation Therepy (IMRT). I am 6 months post IMRT and have better erections than before PC with only temporary irritation of the bowel and frequent urination during the last week of treatment and for 2 months thereafter. My PSA went from 7.7 to 2.6 at 3 months and 1.9 at 6 months. CDS in TX

Response:

Sounds great…..5 years ago I was not going to trust a small town Dr. with a big Rad machine……. I went on.  I am 5 years post op, oh, and do have a great manly blossom, when need be…….Hu Hum. Glad you are fine. John Loomis – Hide quoted text — Show quoted text – For the new members of the PC group, don’t let the surgery guys drown out the wonderful option of Intensified Modulated Radiation Therepy (IMRT). I am 6 months post IMRT and have better erections than before PC with only temporary irritation of the bowel and frequent urination during the last week of treatment and for 2 months thereafter. My PSA went from 7.7 to 2.6 at 3 months and 1.9 at 6 months. CDS in TX

Response:

… Intensified Modulated Radiation Therepy (IMRT). …

Glad you’re doing well. By the way, that should be "Intensity Modulated Radiation Therapy". The machine has metal shields that are inserted into the beam inside the projector head under computer control.  The metal shields block radiation at specific points, as directed by the computer.  When done properly, this can slightly decrease the total radiation to parts you don’t want radiated, allowing a corresponding increase in the total radiation administered, and the total delievered to the cancer, for the same damage to healthy tissue. I agree that this is a valuable option.  It’s highly recommended for men who are older and less likely to recover well from surgery. Its use in younger men is still debated.  However, although younger myself (57 at time of treatment), I opted for radiation too.  So far (knocking furiously on wood), I’m very pleased with the outcome. Please note, your mileage may vary on side effects.  The statistics on potency after radiation seem to be about the same as for surgery.  Lucky guys come out in great shape. Unlucky guys don’t.  One big advantage on side effects is that incontinence is rare with radiation, and of course the surgical complications like blood clots, tearing, pain, and scarring which affect a minority of surgery patients don’t occur because there is no surgery. After much research into all this, I was led to radiation.  But I no longer believe it is the best treatment, only one of the best treatments, with surgery being another.     Alan

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