My story started September 5, 2014, when I visited a new doctor for the first time. A few years ago I joined Kaiser Permanente in California because it was the most affordable in my area. I had trouble finding a doctor I liked at Kaiser. I haven't had many health problems; however, when I did need to visit doctor I was not happy with the care my doctor(s) provided. So this year I decided I would try one more doctor during "open enrollment" and if unhappy, switch to another health plan.
On September 5, I had an annual physical. My new doctor had me do the usual lab work, but this year he said he wanted me to have a PSA test. I am 57 and had no PSA ordered for me before. Last year I was diagnosed with "Benign Prostatic Hyperplasia" after seeing my old doctor for urinary problems. The doctor told me I could have a PSA test if I wanted one but he did not recommend it. He explained the test often produced false positives which could lead to further unnecessary testing. I did not know what a PSA test was and took my doctor recommendation to have no test.
A few days after the lab work my doctor called me at home and told me my PSA lab results were a little high at 4.8. He had me wait one month and have another PSA test done, so I did. Another doctor call and I learned my PSA had risen to 5.5. This time the doctor referred me to an Urologist. The same day I received a call from the Urologist who told me I needed a biopsy.
The biopsy was not bad. The worst part was the enema prep, and having people poking around my bum during the procedure. It was a little uncomfortable, but I did not find it as painful as some trips to the dentist. For me the tough part was after my procedure, more specifically, the shock of seeing clotting blood shooting out when I urinated and red or very dark brownish color in my ejaculate.
My biopsy results came with yet another call at home from my Urologist. He called while I was watching game 7 of the World Series, October 29, 2014. I am a Giants fan and I know it was a great game, but I don't remember much after he told me I have Prostate Cancer (PC). My numbers: 4 out of 12 core samples positive. Three (3) had a Gleason score (GS) of 3+3=6 and one core is 3+4=7 (20 & 25% of the core sample).
The following week my wife and I met with the Urologist. He told us my PC was located on both sides of my prostate and he considered it "moderately advanced". He said I needed treatment (as opposed to watching it) and recommended robotic surgery to remove it, which he described as the "gold standard" for PC treatment. Before I met with him I had a few days, so I had time to research PC a little. Therefore, I asked my Urologist about Brachytherapy or other radiation treatment. He said it was my decision to make about my treatment and referred me to a Brachytherapy Department for a "Brachy class".
On November 19th my wife and I attended the Brachy class which was conducted by a Radiation Oncologist and program supervisor. The class was great and discussed all the treatment options offered by Kaiser and there risks and side effects. They also provided resource information, such as nutrition information and support groups.
Following the Brachy class I was very confused. My Urologist recommended surgery. He informed me he was experienced with the robotic radical prostatectomy procedure, stated he performed more than 350, and maintained one of the best surgical margins in Northern California (Kaiser). He also claimed about 60% of surgery patient's maintained urinary continence. During the Brachy class I was told if I selected Brachytherapy (seeds) I had similar odds of recovery as those with surgery and with fewer side effects (at least initially).
I spent the next couple weeks reading everything I could about PC. I read Dr. Patrick Walsh's book, "Surviving Prostate Cancer" and emailed my Urologist with a few questions which led me leaning towards surgery. I even told my Urologist I chose surgery. He told me a surgery scheduler would call me to select a date. A few days went by and I did not hear from the scheduler. Also, my Urologist was out of the office for the week.
The same week I attended a PC support group, 11 men who had been through it all and between them had about every type of PC treatment possible. It seemed to me some of them, who had surgery, still questioned if they should have done seeds instead, but those who had the seeds were happy they had done so. One of the group recommended I read a book by Jay S. Cohen, MD, "Prostate Cancer Breakthroughs (2014)". I read the book and some other information I found on-line and then found myself feeling stronger about Brachy seeds. I emailed the Radiation Oncologist with a few questions and scheduled a "volume study" exam with Radiation Oncologist to see if I was a good candidate for seeds.
During the volume study doctors obtained my complete medical history and performed a new ultrasound of my prostate. The doctor also provided individual consultation with me (and my wife) and answered all our questions. When we left the appointment we both felt Brachytherapy (seeds) was a good treatment option. I went home and slept on it, then made a final decision to go with the seeds. The Brachytherapy Department scheduled my seeds procedure for December 18.
Decision making process: The more I read the more confused I became about which treatments was best (best chance of successfully curing the PC). I read an equal amount of information which sent me in opposite directions, nothing seemed definitive. My age (57) also complicated things. Some information clearly indicated that at my age I should have surgery, but other sources (generally newer information) indicated my age did not matter. So it came down to his; When I originally decided I would go with surgery I immediately began to regret my decision; however, when I considered Brachy seeds I felt much better about doing so. I decided to go with the seeds because it was easier for me to live with the decision. Am I taking a bigger risk – I don't know, but so far I am happy with my decision.
After a pre-operative physical, lab work, and a pre-operative class, I was ready for the seed implant procedure. Then I had to prepare my body for the procedure which required a liquid diet, fasting, drinking magnesium citrate and using an enema to clean me out before the procedure. I was knocked out for the procedure and waked up pain free. I was tired from the anesthesia and procedure and a little tender when sitting on a hard surface for a few days. I experienced a little blood in the urine and a dark brown color in my first ejaculate, but this experience was not as bad as the biopsy (for me).
It has been about 12 days since my seed implant, and so far I have no side effects other than occasionally getting up to pee while sleeping. Now the next part of my PC care starts, monitoring my PSA levels to see if my seed implant was successful.
My PSA History
09/09/2014: 4.8 (This was my 1st PSA test).
12/12/2014: 7.9 (Possibly elevated because of biopsy – but I don't know).
12/18/2014: Brachytherapy (90 seeds implanted).
03/18/2015: 2.9 (1st Post implant PSA test). Dr. said it "looks good".
My experience so far since my seed implant has not been bad at all. For me the first experience was very similar to my biopsy.
My Radiation Oncologist prescribed "Flomax" (Tamsulosin .04mg), which I took daily starting about 1 week before my seed implant. I continued taking it for about 2 months and did not notice any problems when I stopped. I believe I might urinate more frequently now (compared to before the seed implant), but it is not much of a problem. If I drink a lot of fluid during the end of the day I will have to get up 1 or 2 times during the night. After I have my 2 cups of coffee in the morning I will take a few trips to the bathroom. This seems to be slightly more frequent then before the procedure.
After having a biopsy in October and then the seed implant in December I was not very interested in sexual activity. At first I mistook my disinterest as impotence. I discussed my concern with my doctor and he prescribed "Viagra" (Sildenafil 20mg). My doctor suggested taking 3 (60mg). I utilized the Viagra once then reduced the dose to 40mg the second use. The Viagra helped but I also realized I did not actually need the medication, so I discontinued using it. I think I just feared attempting sexual activity, but after making the commitment to do so, and taking the Viagra, I got over the mental block which was holding me back. All is as it was before the seed implant for me now.
My first PSA post seed implant was March 18th. My score dropped to 2.9. I didn't really know what to expect, but my doctor said it "looks good", so I guess I am progressing like I should.
Six month PSA only dropped to 2.5 (from 2.9). My doctor was not concerned at all, but I am a little disappointed it was not lower.
My next PSA was not scheduled for another 6 months; however, I was a little concerned my numbers were not lower after my last test, so I asked my doctor for a test in 3 months. On September 18th my PSA was tested (9 months after my procedure). I am glad I requested the test because my PSA dropped to 1.1, which sounds much better to me than 2.5.
At this point I have no symptoms. I feel at least as good as I did a year ago, before I was diagnosed with PC. I sleep through the night without having to urinate most nights and sex life is similar to how it was. No side effects to report. It's about 1 year now since I was diagnosed with PC and I am feeling great.
PSA update: After 1 year & 3 months, my PSA has dropped to 0.05, I could not be happier. No side effects and I have taken no medication since shortly after my procedure was performed.
Since my last report I have been feeling and doing great. I had a small rise in my PSA in September to 1.2; however, in December it was back down to 0.6. My doctor informed me tiny rises were not uncommon for younger patients. It's nice to be considered "young"! My next PSA is due in a few weeks.
PSA dropped to 0.4.
Scott's e-mail address is: scottmoe AT comcast.net (replace "AT" with "@")