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Urology (Expert Forum)
Making the decision
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
Questions in the Urology forum are answered by Dr. Stephen Liroff, affiliated with the Henry Ford Hospital. Topics covered include benign prostate disease, penis curvature, cystisis, kidney stones, pediatric urology, prostate, sexual dysfunction, urinary tract infections (UTI), and urological cancers.
Making the decision
by mdinfo, Aug 03, 2003 12:00AM
Biopsi, I have 45% in one lobe, 9 % in the other . My Gleason is 3+3 on both sides. 2 of 4 cores extent of cancer 9mm and 7 mm on one side and 2mm on the other.
I am 60 years od in good health
Free PSA 5 once and 6 another time
digital exam smooth but firmer on one side
Every Doctor I talk to gives me the same percentages.
80% chance of encapsulation
50% chance of impotence
2% chance of incontinance problems
Long term cure rates seem to be the same for seeds, beam and surgery
Clearly Seeds are the easiest treatment.
What are the long term problems with the seeds? If I were to have future problems in the area colon, bladder?
Some Dr. suggest a combination seeds and beam. any issue with this?
If I had surgery what are the issues if it is not encapsulated? Do I than have beam radiation? Is this the same as beam radiation while prostate is in place?
What would you do? I am very confused I would appriciate your opinion. I am assuming watchful waiting is not a good option.
I am 60 years od in good health
Free PSA 5 once and 6 another time
digital exam smooth but firmer on one side
Every Doctor I talk to gives me the same percentages.
80% chance of encapsulation
50% chance of impotence
2% chance of incontinance problems
Long term cure rates seem to be the same for seeds, beam and surgery
Clearly Seeds are the easiest treatment.
What are the long term problems with the seeds? If I were to have future problems in the area colon, bladder?
Some Dr. suggest a combination seeds and beam. any issue with this?
If I had surgery what are the issues if it is not encapsulated? Do I than have beam radiation? Is this the same as beam radiation while prostate is in place?
What would you do? I am very confused I would appriciate your opinion. I am assuming watchful waiting is not a good option.
Doctor's Answer
by Kevin Pho, MD, Aug 09, 2003 12:00AM
, Aug 09, 2003 12:00AM
I cannot make any recommendations as to treatment without examining you. That is a decision that must be made in conjunction with your urologist and oncologist.
However, I can give you information about the long term problems with seeds (brachytherapy). The following is taken from UptoDate, and comments on some of the factors affecting the decision:
"Men who undergo brachytherapy may experience acute inflammation and swelling of the prostate gland, which can lead to retention of urine. Thus, men with large or enlarged prostate glands are not good candidates for this treatment. In addition, damage to nearby tissue can cause bowel urgency and frequency, rectal bleeding, and the development of rectal ulcers; these symptoms tend to improve over time.
The risk of urinary incontinence and sexual impotence may be less with brachytherapy than with EBRT, but health-related quality of life is similar following brachytherapy, EBRT, and surgery.
A rare complication of prostate brachytherapy is migration of the seeds to the lung. This usually does not cause symptoms, and the clinical significance is unclear.
For men with early stage prostate cancer, current practice suggests that surgery and radiation therapy produce similar outcomes except for men with aggressive tumors, who may do better with surgery. The "cost" of better tumor control with surgery is a higher frequency of urinary and sexual side effects. Watchful waiting is considered appropriate only for older men with a small tumors, a low Gleason score, and a life expectancy of 15 years or less.
Often, the decision between radiation and surgery is a matter of patient preference. Younger men may be better served by surgery because they are more likely to survive beyond ten years. Older men may prefer radiation therapy to avoid the risks associated with anesthesia and the recovery period associated with major surgery. Although brachytherapy offers some advantages over external beam radiotherapy, there is not enough long-term follow-up data to recommend this approach as a first option, especially in younger men with long life expectancies." (1)
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
1) Klein. Patient information: Treatment for early prostate cancer. UptoDate, 2003.
However, I can give you information about the long term problems with seeds (brachytherapy). The following is taken from UptoDate, and comments on some of the factors affecting the decision:
"Men who undergo brachytherapy may experience acute inflammation and swelling of the prostate gland, which can lead to retention of urine. Thus, men with large or enlarged prostate glands are not good candidates for this treatment. In addition, damage to nearby tissue can cause bowel urgency and frequency, rectal bleeding, and the development of rectal ulcers; these symptoms tend to improve over time.
The risk of urinary incontinence and sexual impotence may be less with brachytherapy than with EBRT, but health-related quality of life is similar following brachytherapy, EBRT, and surgery.
A rare complication of prostate brachytherapy is migration of the seeds to the lung. This usually does not cause symptoms, and the clinical significance is unclear.
For men with early stage prostate cancer, current practice suggests that surgery and radiation therapy produce similar outcomes except for men with aggressive tumors, who may do better with surgery. The "cost" of better tumor control with surgery is a higher frequency of urinary and sexual side effects. Watchful waiting is considered appropriate only for older men with a small tumors, a low Gleason score, and a life expectancy of 15 years or less.
Often, the decision between radiation and surgery is a matter of patient preference. Younger men may be better served by surgery because they are more likely to survive beyond ten years. Older men may prefer radiation therapy to avoid the risks associated with anesthesia and the recovery period associated with major surgery. Although brachytherapy offers some advantages over external beam radiotherapy, there is not enough long-term follow-up data to recommend this approach as a first option, especially in younger men with long life expectancies." (1)
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Thanks,
Kevin, M.D.
Bibliography:
1) Klein. Patient information: Treatment for early prostate cancer. UptoDate, 2003.
Member Comments (1)
by kevinmd, Aug 05, 2003 12:00AM
To: Prostate Cancer
0
