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Options After Seed Implant Treatment
  1. #1
    rickinFL Guest

    Default Options After Seed Implant Treatment

    Hi All
    This is my first time joining a group of any type, so please bear with
    me if I seem to not be following protocol. I was just last month
    diagnosed with prostate cancer and had my initial treatment options
    discussion with my Dr. One question that I have (And forgot to ask
    him) is in regard to possible treatment if the seed implant treatment
    is not successful. My wife said that she "heard" that prostrate
    removal by surgery was not possible "after" the seed implant
    treatment, should it not be successful. Has anyone heard this? I have
    a very demanding job (I am in India at this moment) that requires
    frequent and unpredictable travel, and I was thinking about the
    easiest treatment to recover from, but I do not want to take any
    chances taht could end in a bad way if you know what I mean.


  2. #2
    Richard Guest

    Default Re: Options After Seed Implant Treatment

    "rickinFL" <[email protected]> wrote in message
    news:[email protected] oups.com...
    > Hi All
    > This is my first time joining a group of any type, so please bear with
    > me if I seem to not be following protocol. I was just last month
    > diagnosed with prostate cancer and had my initial treatment options
    > discussion with my Dr. One question that I have (And forgot to ask
    > him) is in regard to possible treatment if the seed implant treatment
    > is not successful. My wife said that she "heard" that prostrate
    > removal by surgery was not possible "after" the seed implant
    > treatment, should it not be successful. Has anyone heard this? I have
    > a very demanding job (I am in India at this moment) that requires
    > frequent and unpredictable travel, and I was thinking about the
    > easiest treatment to recover from, but I do not want to take any
    > chances taht could end in a bad way if you know what I mean.


    The outcome of a single brachytherapy treatment (seed implants) is usually
    highly effective against cancer if the disease is caught early. This would
    include Gleason score of 3+3, and 3+4. In cases where the cancer returns(or
    high PSA) after brachytherapy treatment, then general radiation might be
    needed (since as you correctly pointed out, surgery is no longer possible
    after seeds because the prostate has been mostly destroyed by the radiation
    in the seeds). Usually the general radiation needs to be administered over a
    period of weeks or months.

    Brachytherapy is considered by some to be the easiest to recover from, but
    there are always exceptions. In terms of efficacy against the cancer,
    brachytherapy and surgery are about equal when the cancer is caught early.
    If the cancer returns (or high PSA returns), then multiple radiation
    treatments may be needed later (but this would take awhile to determine).

    The biggest factors in terms of recovery (and ability to travel) probably
    relate to incontinence, and most people experience less problems with
    brachytherapy that with surgery. Impotence is also a factor, but obviously
    it does not affect your job.



  3. #3
    Steve Jordan Guest

    Default Re: Options After Seed Implant Treatment

    On February 4 rickinFL wrote:

    (snip)

    > I was just last month
    > diagnosed with prostate cancer and had my initial treatment options
    > discussion with my Dr. One question that I have (And forgot to ask
    > him) is in regard to possible treatment if the seed implant treatment
    > is not successful. My wife said that she "heard" that prostrate
    > removal by surgery was not possible "after" the seed implant
    > treatment, should it not be successful. Has anyone heard this?


    Yes, it is common "wisdom" in the prostate cancer (PCa) community.

    But as usual, there is not full agreement. I have seen and heard
    competent radiation oncologists say that that's outdated. But they don't
    deny that it is difficult.

    Failure of brachytherapy to reduce PSA over time (it is not immediate)
    would probably mean that the disease is systemic or even metastacized.
    Surgery or another local tx would not be curative nor even particularly
    helpful, as the PSA is likely from a source other than the gland.

    > I have
    > a very demanding job (I am in India at this moment) that requires
    > frequent and unpredictable travel, and I was thinking about the
    > easiest treatment to recover from, but I do not want to take any
    > chances taht could end in a bad way if you know what I mean.


    The choice is and should be entirely up to the patient and his burden is
    to educate himself so as to make the best treatment (tx) selection *for
    him.*

    There are staging tests beyond the common CT and scan that will help to
    determine the status of the case. and the likelihood of extra-capsular
    extension (ECE). I recommend study of the authoritative and objective
    website of the Prostate Cancer Research Institute (PCRI) at:

    http://prostate-cancer.org/index.html

    Simply search on what is of interest such as brachytherapy. But the best
    beginning would be the section entitled, "Newly Diagnosed." Also see the
    nomograms that can, with proper parameters such as PSA, Gleason, etc.,
    give one a probability of ECE.

    I also recommend the excellent text on PCa, _A Primer on Prostate
    Cancer_ 2nd ed., subtitled "The Empowered Patient's Guide," by medical
    oncologist and PCa specialist Stephen B. Strum, MD and PCa warrior Donna
    Pogliano. It is available via the PCRI site and from the online
    bookstores such as Amazon and Barnes & Noble.

    There is much to do. Study, Learn, Take Charge.

    Regards,

    Steve J

    "Empowerment: taking responsibility for and authority over one's own
    outcomes based on education and knowledge of the consequences and
    contingencies involved in one's own decisions. This focus provides the
    uplifting energy that can sustain in the face of crisis."
    --Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled
    "The Empowered Patient's Guide."




    >


  4. #4
    3Putt from South Carolina Guest

    Default Re: Options After Seed Implant Treatment


    "rickinFL" <[email protected]> wrote in message
    news:[email protected] oups.com...
    > Hi All
    > This is my first time joining a group of any type, so please bear with
    > me if I seem to not be following protocol. I was just last month
    > diagnosed with prostate cancer and had my initial treatment options
    > discussion with my Dr. One question that I have (And forgot to ask
    > him) is in regard to possible treatment if the seed implant treatment
    > is not successful. My wife said that she "heard" that prostrate
    > removal by surgery was not possible "after" the seed implant
    > treatment, should it not be successful. Has anyone heard this? I have
    > a very demanding job (I am in India at this moment) that requires
    > frequent and unpredictable travel, and I was thinking about the
    > easiest treatment to recover from, but I do not want to take any
    > chances taht could end in a bad way if you know what I mean.
    >

    I'm now on day 37 following seed implants. I've had one follow-up visit
    with my urologist to discuss "how" I was doing. Urinating being the main
    discomfort. Then I had a CT with my radiation oncologist to determine the
    spread of the seed, cold spots, etc. Around the 1st of April I will have
    another visit with the urologist having had my fist PSA following seeding.
    And another follow-up with the oncologist. After 37 days I still feel
    discomfort riding and sitting for durations of 30 minutes or more. I feel
    best when I'm up and moving around and playing golf or just long walks. The
    urologist describes this as the continued swelling of the prostate, which
    subsides after six weeks. I certainly hope so. While I don't crave Flomax,
    I use it for 2-3 days at a time now when my frequency of getting up nights
    increases. It really helps. Some nights are good, some nights I'm up 4-5
    times. None of this discomfort would be considered unbearable. But my wife
    says I am a whimp, since she underwent breast cancer surgery last year. So
    I keep my whining to a minimum around her.



  5. #5
    glassman Guest

    Default Re: Options After Seed Implant Treatment


    "rickinFL" <[email protected]> wrote in message
    news:[email protected] oups.com...
    > Hi All
    > This is my first time joining a group of any type, so please bear with
    > me if I seem to not be following protocol. I was just last month
    > diagnosed with prostate cancer and had my initial treatment options
    > discussion with my Dr. One question that I have (And forgot to ask
    > him) is in regard to possible treatment if the seed implant treatment
    > is not successful. My wife said that she "heard" that prostrate
    > removal by surgery was not possible "after" the seed implant
    > treatment, should it not be successful. Has anyone heard this? I have
    > a very demanding job (I am in India at this moment) that requires
    > frequent and unpredictable travel, and I was thinking about the
    > easiest treatment to recover from, but I do not want to take any
    > chances taht could end in a bad way if you know what I mean.
    >


    I think you don't fully understand exactly what the seeds do. They
    actually shrink, kill and eliminate the entire prostate over the course of a
    year or so. Before I chose my treatment method of surgery, I thought the
    seeds were only targeting the tumor. Once your prostate is gone, and if your
    PCA continues, there are still other courses of treatment.


    --
    JK Sinrod
    www.SinrodStudios.com
    www.MyConeyIslandMemories.com



  6. #6
    3Putt from South Carolina Guest

    Default Re: Options After Seed Implant Treatment


    "glassman" <[email protected]> wrote in message
    news:Q3Gxh.2826$[email protected]..
    >
    > "rickinFL" <[email protected]> wrote in message
    > news:[email protected] oups.com...
    >> Hi All
    >> This is my first time joining a group of any type, so please bear with
    >> me if I seem to not be following protocol. I was just last month
    >> diagnosed with prostate cancer and had my initial treatment options
    >> discussion with my Dr. One question that I have (And forgot to ask
    >> him) is in regard to possible treatment if the seed implant treatment
    >> is not successful. My wife said that she "heard" that prostrate
    >> removal by surgery was not possible "after" the seed implant
    >> treatment, should it not be successful. Has anyone heard this? I have
    >> a very demanding job (I am in India at this moment) that requires
    >> frequent and unpredictable travel, and I was thinking about the
    >> easiest treatment to recover from, but I do not want to take any
    >> chances taht could end in a bad way if you know what I mean.
    >>

    >
    > I think you don't fully understand exactly what the seeds do. They
    > actually shrink, kill and eliminate the entire prostate over the course of
    > a year or so. Before I chose my treatment method of surgery, I thought
    > the seeds were only targeting the tumor. Once your prostate is gone, and
    > if your PCA continues, there are still other courses of treatment.
    >
    >
    > --
    > JK Sinrod



    Is this entirely correct? In all my research on seeding, I don't recall
    reading that the prostate is eliminated. And, not surprisingly, my
    urologist did not mention this.



  7. #7
    chasjac Guest

    Default Re: Options After Seed Implant Treatment

    I've heard this both ways, even on this newsgroup. The radiation
    oncologist I spoke with when I was deciding about things said that the
    goal would be to get my PSA below 1.0 -- I assumed that meant that
    there would be prostate tissue left. Since I decided to go with the
    surgery, I never pursued it further.

    --charlie


  8. #8
    James Guest

    Default Re: Options After Seed Implant Treatment

    "3Putt from South Carolina" <3putt@secoastofsc> wrote in message
    news:45c73c23$0$18925$[email protected]..
    > Is this entirely correct? In all my research on seeding, I don't recall
    > reading that the prostate is eliminated. And, not surprisingly, my
    > urologist did not mention this.


    Eliminated is probably not exactly the right word, at least not initially.
    But the seeds do destroy the prostate tissue, which eventually cause the
    prostate to shrivel up and mostly disappear over time. When this happens,
    you may still have orgasms, but no ejaculation.

    Yes, it is strange that urologists don't really explain this, and coupled
    with newsgroups where many people use cryptic abbreviations and code words,
    it is hard to understand what is going on unless you have spent a lot time
    asking questions and researching.



  9. #9
    James Guest

    Default Re: Options After Seed Implant Treatment

    "chasjac" <[email protected]> wrote in message
    news:[email protected] ps.com...
    > I've heard this both ways, even on this newsgroup. The radiation
    > oncologist I spoke with when I was deciding about things said that the
    > goal would be to get my PSA below 1.0 -- I assumed that meant that
    > there would be prostate tissue left. Since I decided to go with the
    > surgery, I never pursued it further.
    >
    > --charlie


    With the seeds there is some prostate tissue left, since placing the seeds
    everywhere to eliminate all of it would damage the connecting tissues with
    radiation. But after the seeds have destroyed most all of the prostate, then
    it is not in one nice piece which can be easily removed via surgery.



  10. #10
    Steve Kramer Guest

    Default Re: Options After Seed Implant Treatment


    "rickinFL" <[email protected]> wrote in message
    news:[email protected] oups.com...

    > This is my first time joining a group of any type, so please bear with
    > me if I seem to not be following protocol.


    This a prostate cancer support group, not the American Psychological
    Association. We do not stand on protocol. Welcome to our club!

    > I was just last month
    > diagnosed with prostate cancer and had my initial treatment options
    > discussion with my Dr. One question that I have (And forgot to ask
    > him) is in regard to possible treatment if the seed implant treatment
    > is not successful. My wife said that she "heard" that prostrate
    > removal by surgery was not possible "after" the seed implant
    > treatment, should it not be successful.


    They whole idea behind curing prostate cancer is cutting it out, burning it
    out, or freezing it out. What is left after burning it (radiation) is not
    suitable for surgery. So, yes, she heard right.

    For that very reason, many of us (most of us) opt for surgery. However,
    your age, physical condition, PSA, Stage and Gleason (notice I didn't say
    job) should all be considered before making the decision for surgery or
    radiation.


    --
    PSA 16 10/17/2000 @ 46
    Biopsy 11/01/2000 G7 (3+4), T2c
    RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
    PSA .1 .1 .1 .27 .37 .75
    EBRT 05-07/2002 @ 47
    PSA .34 .22 .15 .21 .32
    Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
    2/06, 6/06
    PSA .07 .05 .06 .09 .08 .132 .145
    Casodex added daily 07/06
    PSA <0.04
    Non Illegitimi Carborundum



  11. #11
    I.P. Freely Guest

    Default Re: Options After Seed Implant Treatment

    Richard wrote:
    > Impotence is also a factor, but obviously
    > it does not affect your job.


    Unless he has one HELLUVA job! '-)

    I.P.

  12. #12
    RR Guest

    Default Re: Options After Seed Implant Treatment

    Dear JK -

    I don't think that you realize that you got cancer - that is what the
    c which comes after the p stands for.
    That is not like choosing between two dentists, who can see you
    between your flight schedules.
    No one in the group knows you or your medical file and thus
    the debate is very theoretical.
    In my case I chose RP. I hear from friends as well as in this group
    that in both cases RP as well as seeding there is a process of healing
    and recovering and in both cases it take time to come back to "normal"
    Whatever you choose I wish you success in the procedure
    RR




    On Mon, 5 Feb 2007 09:16:08 -0500, "3Putt from South Carolina"
    <3putt@secoastofsc> wrote:

    >
    >"glassman" <[email protected]> wrote in message
    >news:Q3Gxh.2826$[email protected]..
    >>
    >> "rickinFL" <[email protected]> wrote in message
    >> news:1170657004.484229.319[email protected] oups.com...
    >>> Hi All
    >>> This is my first time joining a group of any type, so please bear with
    >>> me if I seem to not be following protocol. I was just last month
    >>> diagnosed with prostate cancer and had my initial treatment options
    >>> discussion with my Dr. One question that I have (And forgot to ask
    >>> him) is in regard to possible treatment if the seed implant treatment
    >>> is not successful. My wife said that she "heard" that prostrate
    >>> removal by surgery was not possible "after" the seed implant
    >>> treatment, should it not be successful. Has anyone heard this? I have
    >>> a very demanding job (I am in India at this moment) that requires
    >>> frequent and unpredictable travel, and I was thinking about the
    >>> easiest treatment to recover from, but I do not want to take any
    >>> chances taht could end in a bad way if you know what I mean.
    >>>

    >>
    >> I think you don't fully understand exactly what the seeds do. They
    >> actually shrink, kill and eliminate the entire prostate over the course of
    >> a year or so. Before I chose my treatment method of surgery, I thought
    >> the seeds were only targeting the tumor. Once your prostate is gone, and
    >> if your PCA continues, there are still other courses of treatment.
    >>
    >>
    >> --
    >> JK Sinrod

    >
    >
    >Is this entirely correct? In all my research on seeding, I don't recall
    >reading that the prostate is eliminated. And, not surprisingly, my
    >urologist did not mention this.
    >


  13. #13
    I.P. Freely Guest

    Default Re: Options After Seed Implant Treatment

    rickinFL wrote:
    > Hi All
    > This is my first time joining a group of any type, so please bear with
    > me if I seem to not be following protocol. I was just last month
    > diagnosed with prostate cancer and had my initial treatment options
    > discussion with my Dr. One question that I have (And forgot to ask
    > him) is in regard to possible treatment if the seed implant treatment
    > is not successful. My wife said that she "heard" that prostrate
    > removal by surgery was not possible "after" the seed implant
    > treatment, should it not be successful. Has anyone heard this? I have
    > a very demanding job (I am in India at this moment) that requires
    > frequent and unpredictable travel, and I was thinking about the
    > easiest treatment to recover from, but I do not want to take any
    > chances taht could end in a bad way if you know what I mean.




    Every PC treatment has "significant" "chances" of ending in many "bad"
    ways. The quotes denote words that are very subjective, personal, and/or
    statistical in nature. One man's "significant", even "devastating", side
    effect is another man's "who cares?"; one man can encounter practically
    no SEs while his twin brother is virtually destroyed by a litany of
    severe ones; and even "bad" is relative, given that a 5-year survival
    prognosis would overjoy a man with widespread bone metastases but
    devastate a man with just a Gleason 6 tumor confined to his prostate.

    This whole field is highly subjective, which is essentially *the* reason
    most oncologists will not tell us what treatment to accept and *the*
    reason we must study books and trials outcomes and authoritative
    websites before choosing initial and follow-up treatments. Many of us
    spent up to hundreds of hours reading before choosing our treatments,
    and feel it was justified. Several who didn't do their homework wish the
    hell they had. (To be honest, of course, some did the research AND got
    poor results, but at least they know they did all they could do.)

    And unless the next couple of months of your job is more important to
    you than the quality and duration of the rest of your life, I strongly
    urge you to put "easiest to recover from" down around 37th in your list
    of treatment decision factors.

    Dude, you *really* picked a weird club to join. Ever think of
    bird-watching or bridge? ;-)

    I.P.

  14. #14
    James Guest

    Default Re: Options After Seed Implant Treatment

    "I.P. Freely" <[email protected]> wrote in message
    news:QZMxh.58$[email protected]..\
    > <SNIP>
    > And unless the next couple of months of your job is more important to you
    > than the quality and duration of the rest of your life, I strongly urge
    > you to put "easiest to recover from" down around 37th in your list of
    > treatment decision factors.
    ><SNIP>
    > I.P.


    I think you are way out of line here.

    It is well accepted that surgery and brachytherapy (seeds) have similar
    statistical outcomes with regard to life expectancy when the cancer is
    discovered and treated early. It is therefore perfectly reasonable for many
    to make a choice based on how long it takes to recover from the treatment so
    that one can get on with life. Obviously, the side effects of the treatment
    (possible incontinence and impotency) are other important considerations for
    most patients.

    In any case, I think people should provide factual information on this
    newsgroup, and keep their opinions of other people's choices to themselves.



  15. #15
    ron Guest

    Default Re: Options After Seed Implant Treatment

    On Feb 5, 7:10 pm, "James" <nob...@nowhere.com> wrote...snip...
    > It is well accepted that surgery and brachytherapy (seeds) have similar
    > statistical outcomes with regard to life expectancy when the cancer is
    > discovered and treated early.


    James...Do you have a reference to a study supporting this
    position?..ron


  16. #16
    I.P. Freely Guest

    Default Re: Options After Seed Implant Treatment

    James wrote:
    > "I.P. Freely" wrote
    >> <SNIP>
    >> And unless the next couple of months of your job is more important to you
    >> than the quality and duration of the rest of your life, I strongly urge
    >> you to put "easiest to recover from" down around 37th in your list of
    >> treatment decision factors.
    >> <SNIP>
    >> I.P.

    >
    > I think you are way out of line here.
    >
    > It is well accepted that surgery and brachytherapy (seeds) have similar
    > statistical outcomes with regard to life expectancy when the cancer is
    > discovered and treated early. It is therefore perfectly reasonable for many
    > to make a choice based on how long it takes to recover from the treatment so
    > that one can get on with life. Obviously, the side effects of the treatment
    > (possible incontinence and impotency) are other important considerations for
    > most patients.


    Anyone who considers the short- and long-term prognosis, benefits, and
    undesirable SEs of PC treatment options of equal or less importance than
    how quickly he can get back to work must have one HELLUVA job, no
    family, and no outside activities he's passionate about. They're
    comparing days or weeks of work impact on the one hand to potentially
    years or decades of heartbeat and QOL on the other.

    > In any case, I think people should provide factual information on this
    > newsgroup, and keep their opinions of other people's choices to themselves.


    I generally agree we have little right to volunteer uninvited treatment
    advice on others' well-researched choices, but Rick specifically
    requested our advice and his posts demonstrate that he has not
    researched PC and its treatments the least bit thoroughly yet. But
    realize I'm a maverick here; several people here have expressed strong
    opinions that our only purpose is emotional support, as in "You'll be
    fine" and "May your PSA remain undetectable for 30 years", that facts --
    especially if unsettling -- do not belong here. Thank you for putting me
    back in the middle of the road. ;-)

    I.P.

  17. #17
    James Guest

    Default Re: Options After Seed Implant Treatment

    "I.P. Freely" <[email protected]> wrote in message
    news:0ZSxh.115$[email protected]..
    > Anyone who considers the short- and long-term prognosis, benefits, and
    > undesirable SEs of PC treatment options of equal or less importance than
    > how quickly he can get back to work must have one HELLUVA job, no family,
    > and no outside activities he's passionate about. They're comparing days or
    > weeks of work impact on the one hand to potentially years or decades of
    > heartbeat and QOL on the other.


    If the expected outcome of two treatment choices (surgery vs. brachytherapy)
    have been shown to be about the same statistically for life expectancy (for
    early treatment of prostate cancer), then it is perfectly reasonably to
    focus on the other factors, such as side effects and recovery time when
    deciding between the two.

    > I generally agree we have little right to volunteer uninvited treatment
    > advice on others' well-researched choices, but Rick specifically requested
    > our advice and his posts demonstrate that he has not researched PC and its
    > treatments the least bit thoroughly yet. But realize I'm a maverick here;
    > several people here have expressed strong opinions that our only purpose
    > is emotional support, as in "You'll be fine" and "May your PSA remain
    > undetectable for 30 years", that facts --
    > especially if unsettling -- do not belong here. Thank you for putting me
    > back in the middle of the road. ;-)
    >
    > I.P.


    I am not one of those who would like to see this newsgroup be primarily for
    emotional support, although given the name of the newsgroup, I suppose it is
    not improper to offer it.

    I would like to think this newsgroup is primarily a source of factual
    information, including anecdotal information from patients who can relay
    their experiences with the disease and the various treatments they have
    received, most of which have significant side effects. If you want to give
    your opinions about prostate cancer treatments, that is fine, but I don't
    think it is proper to make judgments about what other consider to be most
    important things in their lives.



  18. #18
    I.P. Freely Guest

    Default Re: Options After Seed Implant Treatment

    James wrote:

    > If the expected outcome of two treatment choices (surgery vs. brachytherapy)
    > have been shown to be about the same statistically for life expectancy (for
    > early treatment of prostate cancer), then it is perfectly reasonably to
    > focus on the other factors, such as side effects and recovery time when
    > deciding between the two.


    Of course. Now . . . which is more important to most PC pts, the speed
    bump of recovery or a (possibly shortened) lifetime of SEs?

    > I would like to think this newsgroup is primarily a source of factual
    > information, including anecdotal information from patients who can relay
    > their experiences with the disease and the various treatments they have
    > received, most of which have significant side effects. If you want to give
    > your opinions about prostate cancer treatments, that is fine, but I don't
    > think it is proper to make judgments about what other consider to be most
    > important things in their lives.


    So Rick has no right to request advice?

    I.P.

  19. #19
    James Guest

    Default Re: Options After Seed Implant Treatment

    "ron" <[email protected]> wrote in message
    news:[email protected] oups.com...
    > James...Do you have a reference to a study supporting this
    > position?..ron


    Just to repeat what I said, it appears that for early diagnosis and
    treatment of prostate cancer the general consensus is that brachytherapy and
    radical prostatectomy yield similar statistical results in terms of
    longevity of the patient. For more information, please read the complete
    articles listed below.

    The question of quality of life (side effects) related to brachytherapy and
    radical prostatectomy is more problematic, and there are conflicting
    studies. This is probably because it is easier to find out if a patient dies
    from prostate cancer, than finding out whether he suffered impotency or
    incontinence as the result of treatment (not everyone discusses these issues
    candidly with their doctor, especially years after their treatment).

    Here are 3 studies, but there are others:

    1. "Is brachytherapy comparable with radical prostatectomy and external-beam
    radiation for clinically localized prostate cancer?"
    Merrick GS, Butler WM, Lief JH, Dorsey AT.
    PMID: 11272667 [PubMed - indexed for MEDLINE]

    CONCLUSIONS: With prostate-specific antigen-based follow-up as long as 10
    years, the results of prostate brachytherapy for low-risk patients are as
    favorable as the most positive radical prostatectomy and external-beam
    radiation therapy series. (excerpt from conclustions)
    http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract


    2. "Comparison of biochemical disease-free survival of patients with
    localized carcinoma of the prostate undergoing radical prostatectomy,
    transperineal ultrasound-guided radioactive seed implantation, or definitive
    external beam irradiation."
    Stokes SH.
    PMID: 10758314 [PubMed - indexed for MEDLINE]

    CONCLUSION: For patients with low or intermediate risk disease, external
    beam, ultrasound-guided (125)I [brachytherapy], or a radical prostatectomy
    give comparable long-term biochemical disease-free survival. (excerpt from
    conclustion)
    http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10758314

    3. "Ten-year disease free survival after transperineal sonography-guided
    iodine-125 brachytherapy with or without 45-gray external beam irradiation
    in the treatment of patients with clinically localized, low to high Gleason
    grade prostate carcinoma."
    Ragde H, Elgamal AA, Snow PB, Brandt J, Bartolucci AA, Nadir BS, Korb LJ.
    PMID: 9731904 [PubMed - indexed for MEDLINE]

    CONCLUSIONS: Percutaneous prostate brachytherapy is a valid and efficient
    option for treating patients with clinically organ-confined, low to high
    Gleason grade, prostate carcinoma. Observed 10-year follow-up documents
    serum PSA levels superior to those reported in several published external
    beam irradiation series, and comparable to those published in a number of
    published radical prostatectomy series.
    http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=9731904

    For more information, click on "related articles"



  20. #20
    James Guest

    Default Re: Options After Seed Implant Treatment

    "I.P. Freely" <[email protected]> wrote in message
    news:SgUxh.122$[email protected]..
    > So Rick has no right to request advice?
    >
    > I.P.


    He can request advice, and you can give it. But I was not aware that he
    requested advice on what was most important in his life.



  21. #21
    kh Guest

    Default Re: Options After Seed Implant Treatment

    On Feb 5, 1:30 am, "rickinFL" <Rick_Swa...@Jabil.com> wrote:
    > Hi All
    > This is my first time joining a group of any type, so please bear with
    > me if I seem to not be following protocol. I was just last month
    > diagnosed with prostate cancer and had my initial treatment options
    > discussion with my Dr. One question that I have (And forgot to ask
    > him) is in regard to possible treatment if the seed implant treatment
    > is not successful. My wife said that she "heard" that prostrate
    > removal by surgery was not possible "after" the seed implant
    > treatment, should it not be successful. Has anyone heard this? I have
    > a very demanding job (I am in India at this moment) that requires
    > frequent and unpredictable travel, and I was thinking about the
    > easiest treatment to recover from, but I do not want to take any
    > chances taht could end in a bad way if you know what I mean.


    According to my radiation doc, if seeds fail, it's because the disease
    had already metastasized beyond the prostate. In that circumstance,
    surgery would fail too.

    No one knows, of course but the stats speak to that. There's about a
    10% failure rate from both surgery and seeds.

    IMRT, Tomo, 3DCRT, Trilogy, the external beam radiation techniques,
    seems to be a different treatment philosophy, where the radiation
    field is lower intensity but covers a wider area.

    There are some circumstances where the cancer is just beyond the reach
    of the surgery and seeds but still local. In those cases, external
    radiation might clean it up. No one knows when this is the case.

    -kh There isn't a simple answer to your question, sorry.


  22. #22
    cmdrdata Guest

    Default Re: Options After Seed Implant Treatment

    On Feb 6, 5:26 am, "kh" <tch...@yahoo.com> wrote:
    > On Feb 5, 1:30 am, "rickinFL" <Rick_Swa...@Jabil.com> wrote:
    >
    > > Hi All
    > > This is my first time joining a group of any type, so please bear with
    > > me if I seem to not be following protocol. I was just last month
    > > diagnosed with prostate cancer and had my initial treatment options
    > > discussion with my Dr. One question that I have (And forgot to ask
    > > him) is in regard to possible treatment if the seed implant treatment
    > > is not successful. My wife said that she "heard" that prostrate
    > > removal by surgery was not possible "after" the seed implant
    > > treatment, should it not be successful. Has anyone heard this? I have
    > > a very demanding job (I am in India at this moment) that requires
    > > frequent and unpredictable travel, and I was thinking about the
    > > easiest treatment to recover from, but I do not want to take any
    > > chances taht could end in a bad way if you know what I mean.


    Going back to the original question about surgery after radiation, I
    too
    was in a quest to find the answer. If you are in the US and have cable
    TV,
    you may have come accross a program called "Dr G, Medical Examiner".
    I sent an email to her and she kindly reported the next day with this:
    "The prostate seems smaller and harder from the radiation. You get
    fibrosis (scar tissue) and atrophy of glands. Prostatectomy after
    surgery
    is difficult because of the fibrosis but sometimes can be done.
    There are a lot more perioperative complications." The Florida Orange
    County ME Office oversees thousands of deaths, so I tend to believe
    that Dr. Garavaglia's opinion to be more correct than heresays that
    have
    been reported here. Her answer makes sense, since you are then still
    able to pee, since the urethra still exist (which wouldn't be if the
    prostate
    is gone/dissapear) after radiation takes its effect.


  23. #23
    Alan Meyer Guest

    Default Re: Options After Seed Implant Treatment

    On Feb 6, 6:26 am, "kh" <tch...@yahoo.com> wrote:
    > ...
    > There are some circumstances where the cancer is just beyond the reach
    > of the surgery and seeds but still local. In those cases, external
    > radiation might clean it up. No one knows when this is the case.
    > ...


    I think that's right in the absolute sense. No one knows whether
    cancer is beyond the range of the seeds in most cases. But
    we do have nomograms that show the likelihood of it given
    different initial conditions of PSA and Gleason.

    The radiation oncologists that I consulted recommended
    brachytherapy as a mono-therapy only for "low risk" disease
    (PSA < 10, Gleason < 7). Above that they wanted
    adjuvant external beam therapy on the grounds that
    the probabilities of extra-prostatic extensions began
    to get significant. As you say, they didn't know if the
    external beam was required, but they wanted to use it
    just in case it was.

    Alan


  24. #24
    ron Guest

    Default Re: Options After Seed Implant Treatment

    James...Thanks for the references. I've inserted some comments /
    questions by each of them...ron

    On Feb 5, 10:49 pm, "James" <nob...@nowhere.com> wrote:
    > "ron" <oit...@yahoo.com> wrote in message
    >
    > news:[email protected] oups.com...
    >
    > > James...Do you have a reference to a study supporting this
    > > position?..ron

    >
    > Just to repeat what I said, it appears that for early diagnosis and
    > treatment of prostate cancer the general consensus is that brachytherapy and
    > radical prostatectomy yield similar statistical results in terms of
    > longevity of the patient. For more information, please read the complete
    > articles listed below.
    >
    > The question of quality of life (side effects) related to brachytherapy and
    > radical prostatectomy is more problematic, and there are conflicting
    > studies. This is probably because it is easier to find out if a patient dies
    > from prostate cancer, than finding out whether he suffered impotency or
    > incontinence as the result of treatment (not everyone discusses these issues
    > candidly with their doctor, especially years after their treatment).
    >
    > Here are 3 studies, but there are others:
    >
    > 1. "Is brachytherapy comparable with radical prostatectomy and external-beam
    > radiation for clinically localized prostate cancer?"
    > Merrick GS, Butler WM, Lief JH, Dorsey AT.
    > PMID: 11272667 [PubMed - indexed for MEDLINE]
    >
    > CONCLUSIONS: With prostate-specific antigen-based follow-up as long as 10
    > years, the results of prostate brachytherapy for low-risk patients are as
    > favorable as the most positive radical prostatectomy and external-beam
    > radiation therapy series. (excerpt from conclustions)http://www.ncbi.nlm.nih.gov/entrez/q...eve&db=PubMed&...


    All I could see was the abstract. The abstract does not state what
    the median follow-up was (I see that follow-up was as long as 10
    years, but what was the median), and what definition(s) of failure
    (DOF) were used to compare the treatments?


    > 2. "Comparison of biochemical disease-free survival of patients with
    > localized carcinoma of the prostate undergoing radical prostatectomy,
    > transperineal ultrasound-guided radioactive seed implantation, or definitive
    > external beam irradiation."
    > Stokes SH.
    > PMID: 10758314 [PubMed - indexed for MEDLINE]
    >
    > CONCLUSION: For patients with low or intermediate risk disease, external
    > beam, ultrasound-guided (125)I [brachytherapy], or a radical prostatectomy
    > give comparable long-term biochemical disease-free survival. (excerpt from
    > conclustion)http://www.ncbi.nlm.nih.gov/entrez/q...tractplus&db=p...


    Here different DOFs were used to compare the approachs 5 years out
    from treatment. A number of studies have taken a single, treated PCa
    population and compared the failure rates obtained from this
    population when using both the ASTRO and PSA>0.2 ng/ml DOFs. Large
    differences are seen favoring ASTRO, especially with low-risk men and
    at short (5-6 years) median post-treatment times. Critz's study was a
    good one on this point (J. Urol., Vol. 167, 1310-1313, 2002; A
    Standard Definition of Disease Freedom Is Needed For Prostate Cancer:
    Undectable Prostate Specific Antigen Compared With The ASTRO Consensus
    Definition). All studies on this point show that there are 15-40%
    fewer ASTRO failure calls than PSA>0.2 failure calls, the actual
    number being dependent upon the underlying population and the post-
    treatment time. So 5 year comparisons using these two different DOFs
    are flawed and if they claim similar outcomes then they actually
    suggest that the modality using PSA>0.2 as the DOF actually has a
    superior outcome.

    >. "Ten-year disease free survival after transperineal sonography-guided
    > iodine-125 brachytherapy with or without 45-gray external beam irradiation
    > in the treatment of patients with clinically localized, low to high Gleason
    > grade prostate carcinoma."
    > Ragde H, Elgamal AA, Snow PB, Brandt J, Bartolucci AA, Nadir BS, Korb LJ.
    > PMID: 9731904 [PubMed - indexed for MEDLINE]
    >
    > CONCLUSIONS: Percutaneous prostate brachytherapy is a valid and efficient
    > option for treating patients with clinically organ-confined, low to high
    > Gleason grade, prostate carcinoma. Observed 10-year follow-up documents
    > serum PSA levels superior to those reported in several published external
    > beam irradiation series, and comparable to those published in a number of
    > published radical prostatectomy series.http://www.ncbi.nlm.nih.gov/entrez/q...tractplus&db=p...


    Again, I've only read the abstract so I'm not sure what RP series
    Radge is comparing against. The Johns Hopkins nomogram
    (http://www.prostate-help.org/download/jhnomo.pdf)
    is probably the largest, most detailed, published, peer-reviewed RP
    study and relatively easy to compare against. Radge, et.al. claim a
    64% biochemical disease free survival (BDFS) at 10 years (I assume
    this is a real number, not a statistical projection). In the Hopkins
    paper, 72% of the men treated had BDFS at 10 years (unprojected), 61%
    at 15 years. If the 4% with seminal vesicle involvement and the 5%
    with pelvic lymph node mets were removed from the Hopkins' paper, the
    Hopkins number would obviously be even higher. If Radge is using the
    ASTRO DOF (Hopkins uses PSA>0.2) then that will further skew the
    results in brachy's favor, although at 10 years, the differences are
    more like 5-10%.

    > For more information, click on "related articles"


    So where I come out is that it is unclear if two modalities have
    similar or different outcomes when different DOFs are used in the
    comparison...ron



  25. #25
    I.P. Freely Guest

    Default Re: Options After Seed Implant Treatment

    James wrote:
    > "I.P. Freely" <[email protected]> wrote in message
    > news:SgUxh.122$[email protected]..
    >> So Rick has no right to request advice?
    >>
    >> I.P.

    >
    > He can request advice, and you can give it. But I was not aware that he
    > requested advice on what was most important in his life.
    >
    >

    Well, right or wrong, I made one (it's been made before, here and in the
    literature, in an attempt to get new patients to consider the whole
    forest).

    Picture a matrix with the half-dozen or so treatments across the top and
    their 20-30 potential effects, good and bad, with likelihoods, down the
    side. Even leaving such irrelevant blocks as LRP vs diabetes or WW vs
    heartbeat extension blank, the matrix still contains several dozen
    blocks more important than a couple of weeks of virtually any job on the
    planet by virtually anyone's perspective, and should open anyone's eyes
    so they can better evaluate their importance relevant to a two-week
    vacation. I wouldn't make that suggestion to the old hands here; they've
    been there, done that, in one way or another . . . or in some cases
    regretted not having done so.

    In particular, consider two rows in that matrix: time lost from work due
    to treatment (<100 hours) and time lost from work due to dying early of
    curable PC (potentially > 100 months).

    I'm making the suggestion. He can define his priorities any way he wants.

    I.P.


  26. #26
    I.P. Freely Guest

    Default Re: Options After Seed Implant Treatment

    cmdrdata wrote:

    > "The prostate seems smaller and harder from the radiation. You get
    > fibrosis (scar tissue) and atrophy of glands. Prostatectomy after
    > surgery
    > is difficult because of the fibrosis but sometimes can be done.


    The literature is even less optimistic.

    But even more fundamental IMO is the clear implication of the original
    statement: "My wife said that she "heard" that prostrate removal by
    surgery was not possible "after" the seed implant treatment, should it
    not be successful. Has anyone heard this?"

    Is says two things:
    1. Their research has baaarrrely begun (i.e., they don't know enough to
    choose a treatment, which most oncs want the patient to do.)
    2. It has begun (i.e., they're on their way towards making an informed
    choice.)

    I.P.

  27. #27
    James Guest

    Default Re: Options After Seed Implant Treatment

    "ron" <[email protected]> wrote in message
    news:[email protected] ups.com...
    > Again, I've only read the abstract so I'm not sure what RP series
    > Radge is comparing against. The Johns Hopkins nomogram
    > (http://www.prostate-help.org/download/jhnomo.pdf)
    > is probably the largest, most detailed, published, peer-reviewed RP
    > study and relatively easy to compare against. Radge, et.al. claim a
    > 64% biochemical disease free survival (BDFS) at 10 years (I assume
    > this is a real number, not a statistical projection). In the Hopkins
    > paper, 72% of the men treated had BDFS at 10 years (unprojected), 61%
    > at 15 years. If the 4% with seminal vesicle involvement and the 5%
    > with pelvic lymph node mets were removed from the Hopkins' paper, the
    > Hopkins number would obviously be even higher. If Radge is using the
    > ASTRO DOF (Hopkins uses PSA>0.2) then that will further skew the
    > results in brachy's favor, although at 10 years, the differences are
    > more like 5-10%.
    >
    > So where I come out is that it is unclear if two modalities have
    > similar or different outcomes when different DOFs are used in the
    > comparison...ron


    You have raised some good points. Unfortunately, a lot of these studies are
    probably flawed in some way. One of the authors of the study you referenced
    in the your link above is very famous for performing radical prostatectomy
    surgery (Walsh). He is also famous for cherry picking his patients, and he
    does not operate on anyone who is past the very early stages of prostate
    cancer. Some doctors think that his own success rate is highly skewed
    because of this.



  28. #28
    ron Guest

    Default Re: Options After Seed Implant Treatment

    On Feb 6, 6:31 pm, "James" <nob...@nowhere.com> wrote:
    > You have raised some good points. Unfortunately, a lot of these studies are
    > probably flawed in some way.


    I was specific about the flaws in these studies:
    1) Making comparisons using different DOFs
    2) Applying the ASTRO DOF to studies with short median post-treatment
    times

    >One of the authors of the study you referenced
    > in the your link above is very famous for performing radical prostatectomy
    > surgery (Walsh). He is also famous for cherry picking his patients, and he
    > does not operate on anyone who is past the very early stages of prostate
    > cancer. Some doctors think that his own success rate is highly skewed
    > because of this.


    This is said repeatedly about Walsh on various lists. I don't know
    what type of patients he is treating today, but his publications spell
    out, in detail, the patients he treated between 1982 and 1999, the
    consecutive 2,000 plus men that form the basis of his studies. I've
    reproduced the Table describing these men below...

    TABLE 1. Clinical stage, preoperative PSA, Gleason score and
    pathological stage in 2,091 men who underwent anatomic radical
    retropubic prostatectomy for T1c or T2 disease with Gleason score 5 or
    greater
    No. Men (%)
    TNM stage:
    T1c 845 (40)
    T2a 771 (37)
    T2b/c 475 (23)
    Total 2,091 (100)
    Serum PSA (ng./ml.):
    0-4 452 (24)
    4.1-10 1,021 (55)
    10.1-20 319 (17)
    Greater than 20 80 (4)
    Total 1,872 (100)
    Gleason score:
    5 241 (12)
    6 1,020 (49)
    7 693 (33)
    8-10 137 (6)
    Total 2,091 (100)
    Pathological stage:
    Organ confined 1,050 (50)
    Extraprostatic extension, Gleason score less than 7, neg. surgical
    margins
    310 (15)
    Extraprostatic extension, Gleason score less than 7, pos. surgical
    margins
    96 (5)
    Extraprostatic extension, Gleason score 7 or greater, neg. surgical
    margins
    306 (15)
    Extraprostatic extension, Gleason score 7 or greater, pos. surgical
    margins
    119 (6)
    Seminal vesicle involvement, neg. lymph nodes
    98 (4)
    Micrometastases to pelvic lymph nodes
    112 (5)
    Total 2,091 (100)

    Half of the men weren't organ confined, 60% were T2a/b/c and 39% had
    GS>6. That doesn't sound like he was cherry-picking back then. These
    are the men used to generate the Hopkins RP success / failure rate.
    If anything, I would suspect the large number of men with SV
    involvement, lymph node mets, EPE or non-organ confined cancers would
    "skew" the data quite differently than you insinuated...ron



  29. #29
    James Guest

    Default Re: Options After Seed Implant Treatment

    "ron" <[email protected]> wrote in message
    news:[email protected] oups.com...
    > This is said repeatedly about Walsh on various lists. I don't know
    > what type of patients he is treating today, but his publications spell
    > out, in detail, the patients he treated between 1982 and 1999, the
    > consecutive 2,000 plus men that form the basis of his studies. I've
    > reproduced the Table describing these men below...
    >
    > TABLE 1. Clinical stage, preoperative PSA, Gleason score and
    > pathological stage in 2,091 men who underwent anatomic radical
    > retropubic prostatectomy for T1c or T2 disease with Gleason score 5 or
    > greater
    > No. Men (%)
    > TNM stage:
    > T1c 845 (40)
    > T2a 771 (37)
    > T2b/c 475 (23)
    > Total 2,091 (100)
    > Serum PSA (ng./ml.):
    > 0-4 452 (24)
    > 4.1-10 1,021 (55)
    > 10.1-20 319 (17)
    > Greater than 20 80 (4)
    > Total 1,872 (100)
    > Gleason score:
    > 5 241 (12)
    > 6 1,020 (49)
    > 7 693 (33)
    > 8-10 137 (6)
    > Total 2,091 (100)
    > Pathological stage:
    > Organ confined 1,050 (50)
    > Extraprostatic extension, Gleason score less than 7, neg. surgical
    > margins
    > 310 (15)
    > Extraprostatic extension, Gleason score less than 7, pos. surgical
    > margins
    > 96 (5)
    > Extraprostatic extension, Gleason score 7 or greater, neg. surgical
    > margins
    > 306 (15)
    > Extraprostatic extension, Gleason score 7 or greater, pos. surgical
    > margins
    > 119 (6)
    > Seminal vesicle involvement, neg. lymph nodes
    > 98 (4)
    > Micrometastases to pelvic lymph nodes
    > 112 (5)
    > Total 2,091 (100)
    >
    > Half of the men weren't organ confined, 60% were T2a/b/c and 39% had
    > GS>6. That doesn't sound like he was cherry-picking back then. These
    > are the men used to generate the Hopkins RP success / failure rate.
    > If anything, I would suspect the large number of men with SV
    > involvement, lymph node mets, EPE or non-organ confined cancers would
    > "skew" the data quite differently than you insinuated...ron


    As I mentioned, some doctors have told me that Walsh cherry picks his
    patients (at least in recent years). That includes my own urologist/surgeon
    who thinks Walsh's statistical outcomes are skewed because of that. Perhaps
    he originally treated all patients who came to him, but once Walsh became
    "famous" then maybe he started cherry picking at that time. I personally
    don't know.



  30. #30
    kh Guest

    Default Re: Options After Seed Implant Treatment

    On Feb 7, 12:20 am, "James" <nob...@nowhere.com> wrote:

    > As I mentioned, some doctors have told me that Walsh cherry picks his
    > patients (at least in recent years). That includes my own urologist/surgeon
    > who thinks Walsh's statistical outcomes are skewed because of that. Perhaps
    > he originally treated all patients who came to him, but once Walsh became
    > "famous" then maybe he started cherry picking at that time. I personally
    > don't know.


    Another interpretation - as Dr. Walsh gained more understanding of the
    disease, he declined to treat patients who had a high probability of
    failure. This is good medicine in that, if the staging, PSA, images,
    and so on, indicate that failure is very likely because the disease
    has already extended beyond the prostate, beyond the adjacent ducts,
    how could he honestly subject the patient to the stress of surgery?

    This is a trade off that we all face.

    If he recommends treatment, there's a 90, 75, 50, 30, 10 percent
    probability of success and a 10, 30, 50, 75, 90 percent probability of
    THESE side effects. In addition, the patient is guaranteed the
    stress and cost of the treatment.

    As the odds shift against treatment success and toward a bad outcome,
    a good doctor is compelled to step back.

    Figure, 1990, 1995, that timeframe, imaging is crude compared to
    today, no Prostascint, no PET-scan, and the database of success/
    failure is sparse. In that timeframe, sure, whip that thing out-a
    there.

    2000, 2005, 2007, Tomo, MRI, seeds showing a 90% success rate, color
    doppler ultrasound, the Trilogy just down the hall, a surgeon has to
    hesitate, begin to limit his work.

    -kh deal with it guys, make your best, informed decision and go with
    it.


  31. #31
    chasjac Guest

    Default Re: Options After Seed Implant Treatment

    Hello, Rick:

    Welcome to the club no one wants to join.

    I know how you feel. I love my job, and people depend upon me showing
    up and doing it -- I am not easy to replace here. I chose to have a
    laparoscopic radical prostatectomy, and was back teaching two weeks
    after the surgery last November.

    But that's just my experience. You'll hear people in this newsgroup
    and elsewhere who have had terrible experiences recovering from
    surgery. You'll hear people who have had both great and awful
    experiences recovering from radiation. Our stories can give a human
    face to the statistics you need to wade through, but those stories
    cannot replace a dispassionate weighing of the probabilities
    involved.

    In any case, Rick, I would suggest that whatever treatment you choose,
    prepare yourself and those with whom you work for an absence. Treating
    this disease aggressively and decisively should be paramount. And be
    happy if you recover more quickly than expected.

    As far as surgery after radiation ... as others have said, if the
    radiation doesn't work, the most likely reason is that the cancer has
    spread, so surgery would be pointless in that case. But that's
    getting ahead of yourself. Choose the best treatment for what you
    know about now.

    And please let us know how it all turns out. Good luck.

    All the best,

    Charlie


  32. #32
    rickinFL Guest

    Default Re: Options After Seed Implant Treatment

    On Feb 5, 4:10 pm, "I.P. Freely" <fuhgheddabou...@noway.nohow> wrote:
    > rickinFL wrote:
    > > Hi All
    > > This is my first time joining a group of any type, so please bear with
    > > me if I seem to not be following protocol. I was just last month
    > > diagnosed with prostate cancer and had my initial treatment options
    > > discussion with my Dr. One question that I have (And forgot to ask
    > > him) is in regard to possible treatment if the seed implant treatment
    > > is not successful. My wife said that she "heard" that prostrate
    > > removal by surgery was not possible "after" the seed implant
    > > treatment, should it not be successful. Has anyone heard this? I have
    > > a very demanding job (I am in India at this moment) that requires
    > > frequent and unpredictable travel, and I was thinking about the
    > > easiest treatment to recover from, but I do not want to take any
    > > chances taht could end in a bad way if you know what I mean.

    >
    > Every PC treatment has "significant" "chances" of ending in many "bad"
    > ways. The quotes denote words that are very subjective, personal, and/or
    > statistical in nature. One man's "significant", even "devastating", side
    > effect is another man's "who cares?"; one man can encounter practically
    > no SEs while his twin brother is virtually destroyed by a litany of
    > severe ones; and even "bad" is relative, given that a 5-year survival
    > prognosis would overjoy a man with widespread bone metastases but
    > devastate a man with just a Gleason 6 tumor confined to his prostate.
    >
    > This whole field is highly subjective, which is essentially *the* reason
    > most oncologists will not tell us what treatment to accept and *the*
    > reason we must study books and trials outcomes and authoritative
    > websites before choosing initial and follow-up treatments. Many of us
    > spent up to hundreds of hours reading before choosing our treatments,
    > and feel it was justified. Several who didn't do their homework wish the
    > hell they had. (To be honest, of course, some did the research AND got
    > poor results, but at least they know they did all they could do.)
    >
    > And unless the next couple of months of your job is more important to
    > you than the quality and duration of the rest of your life, I strongly
    > urge you to put "easiest to recover from" down around 37th in your list
    > of treatment decision factors.
    >
    > Dude, you *really* picked a weird club to join. Ever think of
    > bird-watching or bridge? ;-)
    >
    > I.P.


    Sorry I.P.
    Guess I didn't realize that this was a "club". I was only asking a
    question and obviously should not have added anything more (i. e. My
    job) But the fact is that if I live and lose my job, then my family's
    lifestyle changes.....If i die it isn't a heck of a lot different for
    them except they will at least be able to maintain their
    lifestyle.......birdwatching may be more comforting that using one of
    these damn discussion (Or Clubs as you put it) groups to ask a
    question......I guess there are going to be folks like you with noting
    else to do except sit on your PC and write smart ass remarks. Good bye


  33. #33
    Steve Jordan Guest

    Default Re: Options After Seed Implant Treatment

    On February 8, rickinFL replied to IP (Mike) Freely:

    > Sorry I.P.
    > Guess I didn't realize that this was a "club". I was only asking a
    > question and obviously should not have added anything more (i. e. My
    > job) But the fact is that if I live and lose my job, then my family's
    > lifestyle changes.....If i die it isn't a heck of a lot different for
    > them except they will at least be able to maintain their
    > lifestyle.......birdwatching may be more comforting that using one of
    > these damn discussion (Or Clubs as you put it) groups to ask a
    > question......I guess there are going to be folks like you with noting
    > else to do except sit on your PC and write smart ass remarks. Good bye


    Please don't be driven away by obnoxious and callous remarks by this
    fellow. He is far from typical.

    There is much help to be gained here if one is careful not to make
    treatment decisions based upon someone else's experience. What helps me
    might harm you -- and vice versa.

    Regards,

    Steve J

  34. #34
    I.P. Freely Guest

    Default Re: Options After Seed Implant Treatment

    rickinFL wrote:
    > I.P. wrote
    >> (Snip the helpful stuff)


    >> Dude, you *really* picked a weird club to join. Ever think of
    >> bird-watching or bridge? ;-)
    >>
    >> I.P.

    >
    > Sorry I.P.
    > Guess I didn't realize that this was a "club". I was only asking a
    > question and obviously should not have added anything more (i. e. My
    > job)


    After others have said "Welcome to our club!" and "Welcome to the club
    nobody want to join", and despite the Smiley with my club comment, and
    after we offered advice relevant to his request for same, we get . . .
    *this*? It really puzzled me until I read . . .

    > if I live and lose my job, then my family's lifestyle changes.....
    > If i die it isn't a heck of a lot different for them except they
    > will at least be able to maintain their lifestyle


    Wow; I'm very sorry to hear that, Rick, but it probably helps explain
    your angry response to a well-intended response. That ranks up there
    among the sadder situations I've seen on the internet, even approaching
    some of our advanced cancer cases. I commend you on maintaining your
    dedication to that family's lifestyle. I'm afraid that if my family felt
    that way about me, I'd blow 'em off and try to salvage a few good years
    in a loving relationship somewhere and in a job that allowed me to take
    a week or two off to save my life. You're a tougher man than I, Gunga
    Din! Hang in there; it will help you through what will probably dictate
    a significant change in your life. I hope that change is only temporary
    and doesn't cost you your beloved career. And congratulations on finding
    or creating a career more important than life and family; if I had ever
    heard of and were qualified for a career that genuinely precious, maybe
    I'd still be working.

    > .......birdwatching may be more comforting that using one of
    > these damn discussion (Or Clubs as you put it) groups to ask a
    > question......I guess there are going to be folks like you with noting
    > else to do except sit on your PC and write smart ass remarks. Good bye


    Rick, ";-)" is one of hundreds of punctuation-based symbols known as
    emoticons, or clever little shorthand symbols for various emotions. Most
    of them, including this one, are viewed with your face rotated 90
    degrees to your left, facing the screen. This one depicts a winking
    Smiley face, and indicates that the comment preceding it is a joke (but
    with no guarantee it is funny).

    Welcome to the internet.

    And here's an uninvited but totally vital tip to anyone new to the net:
    *LIGHTEN UP*. Thin skin, or worse yet a chip on one's shoulder, are
    incompatible with internet discussion groups.

    I.P.

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