Seeded by Dr. Michael Dattoli in Tampa - July 14, 1998

Brachytherapy for Prostate Cancer - My Experience

Overall Summery

by

Tom Doherty


[Dattoli] The whole Tampa experience was top notch.
If interested, please read on.

Below are all the very explicit details of my prostate cancer treatment by Dr. Michael Dattoli in Tampa, Florida using conformal 3-D external radiation combined with implantation of Pd-103 radioactive seeds into my prostate and of my recovery.

The photo was taken just 12 hours after the seeding.

WARNING: some descriptions are very explicit.

Sources for the Newly Diagnosed: Prostate Pointers
Guide to Prostate Cancer, SeedPods, Valuable Links
The Medical Procedure, Theragenics Video


Stages of My Seeding Experience:
Diagnosis and Decision, External Radiation (Conformal 3D-EBRT) and Preparation for Seeding,
Brachytherapy (Implanting 82 Palladium-103 Seeds), Post-Seeding EBRT,
Recovery Complications, Medicines and Heart Concerns, My Doctors and Overall Summary

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Overall Summary - July 31, 2006 Update

With my combined treatment of conformal 3D external radiation (EBRT) and seeding (brachytherapy), I am fully confident that my odds of a cure are far better than if I had had a radical prostatectomy (RP). There is no question in my mind that Dattoli's masterful and scientific seeding of my prostate has eradicated all the cancer in the prostate itself. In the unique treatment protocol Dattoli designed for me, he aggressively placed radioactive seeds on the outside part of my prostate and used supplementary 3D-EBRT; both procedures serve to irradiate any cancer that might happen to be in the outlying tissues surrounding my prostate.

Since I still have a functioning prostate, I am still producing prostate specific antogen (PSA), but the value is low (0.1 on 7 Mar 2006). Of at least equal significance is a low prostatic acid phosphatase (PAP) reading of 0.9 (0.0-2.7 scale). Dattoli, et. al. research [Journal of Brachytherapy Int. 13:1], found PAP is a much better predictor of brachytherapy failure than PSA.

Fortunately, I could afford to wait 6 months for a seeding date with Dr. Dattoli by temporarily taking a combination of Casodex and Lupron hormone blockade to essentially eliminate manufacturing testosterone which feeds the cancer; thus I temporarily stopped the growth of my cancer in its tracks.

Dr. Michael Dattoli and his staff are absolutely superb. The seeding went very well, and any side effects are as expected! I played tennis 2 days post-seeding. I never felt any pain from the seeding itself; but I had some initial extreme pain at the tip of my penis while urinating following seeding, because of my unique reaction to the Foley catheter (see details). The urinary pain gradually subsided over a week. There were some minor urinary and/or bowel complications during the first two half-lives (17 days each), but prescribed drugs and dietary restrictions controlled these.

I feel great! The rest of my life is as it was before seeding except that I still continue to take 0.4mg/day Flomax to keep a normal urinary flow, and Viagra (or similar) is required at times. But these are just minor inconveniences. My only future concern is whether the cancer at the time it was originally diagnosed had already extended far beyond the prostate - now an extremely small, but always still possible, scenario.

... and now I join the rest of you men who were treated for prostate cancer and await your next PSA/PAP test results (or whatever test method will be used in the future) to hear, hopefully, that the beast is dead!

Quick Summary: Blood Tests

[PSA = prostate specific antogen; PAP = prostatic acid phosphatase*]

12/2/98: PSA 0.6; PAP 0.4 (0-0.8); CEA 1.0 (Tampa)
6/24/99: PSA 1.1; PAP 0.9 (0-2.7); CEA 0.9 (Wilmington)
11/6/99: PSA 0.8; PAP 0.6 (0-2.7); CEA 1.0 (Wilmington)
12/6/00: PSA 0.7; PAP 0.2 (0-0.8) (Tampa) [CEA no longer needed]
6/1/01: PSA 0.6; PAP 0.6 (0-2.7); testosterone 706 (free 129) (Wilmington)
1/23/02: PSA 0.1; PAP 0.7 (0-2.7); testosterone 720 (free 140) (Wilmington)
12/24/02: PSA 0.1; PAP 1.1 (0-2.7); testosterone** 814 (free 17.5**) (Wilmington)
9/13/04: PSA 0.1; PAP 0.6 (0-2.7); testosterone** 701 (free 13.5**) (Wilmington)
3/7/06: PSA 0.1; PAP 0.9 (0-2.7); testosterone** 598 (Wilmington)


*According to research of Dattoli, et. al. in J. Brachytherapy Int. 13:1 (Oct 1997), an elevated PAP level is a much better predictor of failure for a seed implant than is PSA level. ** Testosterone (serum) ranges (and perhaps test) changed (see below near bottom)

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Summary: Diagnosis to Seeding

I was diagnosed with prostate cancer (T1c; Gleason 3+3=6) via a 2/6/98 biopsy and my urologist recommended radical prostatectomy (RP) surgery as the best option. This is not unusual as it is the recommendation of most all urologists because they have devoted most of their career to RP and it is what they are most familiar with. In his defense, my urologist offered seeding as an alternative procedure; also, my general practitioner (GP) supported my seeding decision.

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Editorial (I am not a medical doctor):

I am extremely glad that I did not listen to the advice of my urologist who recommended a radical prostatectomy (RP). Instead, I announced my condition to all my friends and acquaintances (as well as to my students in a class I was teaching at the Academy of Lifelong Learning), joined a support group and did my own research. that is how I learned about the Medicare-approved brachytherapy procedure.

For reasons discussed herein, brachytherapy is rapidly replacing RP as the treatment of choice in the manner of a typical technological substitution process with the providers of the old technology (RP) reacting in an expected defensive manner. The reason the RP to brachytherapy technology substitution has been rather slow is because most GPs will refer their patients to a urologist, and urologists traditionally treat this disease with a time-honored, "gold standard" surgical procedure. But even "gold standard" technologies eventually outlive their usefulness and are replaced with improved technologies.

Dr. Patrick Walsh, arguably the world's leading RP practitioner, is a particularly obnoxious brachytherapy opponent. Walsh used unscientific arguments on his web site [no longer available] to try to debunk brachytherapy research. His most flagrant obfuscation is when he supports RP by comparing post-operative PSA readings. If the cancer was originally confined to the prostate, a successful RP would result in an "undetectable" PSA reading as there is no prostate; whereas, successful brachytherapy would result in an detectable PSA reading, because in most cases there is still a functioning prostate generating PSA. Perhaps he realized this when he had his page debunking brachytherapy removed. His new website is at Dr. Patrick Walsh and his colleagues.

While a radical prostatectomy was considered the treatment of choice only a few years ago, it should now be considered barbaric. There is no level of prostate cancer where RP is a better treatment than seeding/EBRT, especially if the cancer may have penetrated the wall of the prostate. In addition, there is some concern that if any cancer is in the outlying tissues of the prostate, the surgical procedure to remove the prostate may actually act to spread the disease. I would expect that by 2010, RP will only be used in very small niche markets, if at all. There appears to be no advantage to an RP.

Brachytherapy has a much more rapid recovery, a much lower (almost infinitesimal) risk of incontinence, a similar risk of impotence and leaves a functioning prostate. To me, the choice was obvious.
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After a few, long, one-on-one telephone conversations with Dr. Michael Dattoli, I chose him to do my brachytherapy. Since his first seeding date was not until July, he put me on Casodex from Mar 19 to Jul 13 and monthly Lupron injections Mar 26 to Jun 15 to minimize (essentially eliminate) testosterone production and reduce the size of the prostate to improve seeding efficiency.

On Jul 14 in Tampa, Dr. Michael Dattoli implanted 82 radioactive Pd-103 seeds using 26 hollow needles into my 19cc gland and in the tissue outside the prostate gland. Even though it was not mandatory, I also opted for 15 treatments of 3D conformal external beam radiation from Jul 2 to Jul 21 at 180 rads each.


The seeding was uneventful for me as I was sedated with a spinal, but the catheter pain was real as was the pain while urinating over the 2 days following seeding. The external radiation plus the "aggressive seeding" delivered slightly more than 3000 rads to the tissues surrounding the prostate, an amount sufficient to eradicate any cancer that may have been there.

Summary of Seeding Aftermath

While I played tennis less than 2 days after seeding, I had a variety of side effects, the worst being an irregular heartbeat (keeping me leery of tennis) and a 20 lb weight gain that I eventually lost, and then some. I have had no bowel problems (initially taking daily Metamucil), but had a slightly increased hemorrhoid irritation for which I digitally applied ointment for relief. In the first month after seeding I had several bowel movements per day but am now about back to normal. Within a couple of months, I had added most all potentially bowel irritating foods (e.g. broccoli, apple and potato skins, red pepper, raison bread, non-citrus fruits) back into my diet and had reduced Metamucil to every 3rd day. My urinary flow was much slower, and urge somewhat more intense than before SI, as expected, but Flomax and initially supplemental benzylidine have kept the problem in check; and I have never had to resort to diapers. Initially my stamina was extremely low, getting very fatigued after running only a mile, but with a change in heart medication (see below), I am now back to normal.

I can sleep through the night without having to get up to pee and have no diet restricitons. A very minor tingling irritation during urination continued for a few months after seeding. Sexually, everything seems to function OK, with even a very small amount of ejaculate, albeit discolored. This reduced sexuality was expected after 4 months of Casodex/Lupron hormone blockade before SI and the irrradiation of the prostate. Heck, that's a lot of trauma for an organ to recover from. There is still the chance that it will return to the milky white substance it once was, but that is still a few years away.

The Irregular Heartbeat Problem - Summary

Before I was diagnosed with prostate cancer, I had a minor exercised-induced arrhythmia, an irregular heartbeat after extended exercise in high heat and humidity. This was controlled with Verapamil which I discontinued in June because a published finding said it might interfere with the lowering of PSA.

However, on the 12th day after seeding while I was on the alpha-blocker Cardura (to improve urine flow), I became extremely fatigued with an irregular heartbeat (missed beats and extra beats) after only playing about 40 min. of tennis. Since Cardura generally has more heart problems associated with it than the other alpha-blockers, Dattoli switched me to Flomax.

However, the irregular heartbeat continued so on day 36 my cardiologist switched me from Verapamil to a much stronger Pacerone (amiodarone). My heartbeat was still somewhat irregular after only a 12 minute run, but nothing that seemed to worry my cardiologist - many rapid beats together would be worrisome. One year later after an extended exercise program to get back into shape, my heart problem was (and still is) well under control - and I have lost 25 pounds from the bloated 185 pound maximum that I had reached right after seeding.

Chronology

I am athletic and in excellent health. I live in Wilmington DE. I was born 10/18/40 (age 57 at seeding).

10/94: PSA = 4.0

12/97: PSA = 5.0 led to -->sextant biopsy 2/6/98 found

2/6/98 biopsy (prostate size = 37.6cc; both DRE & ultrasound are neg) results:

* right side not cancerous, but prostate cancer found on left side
* left side base 21% cancerous, mid 47%, apex "suspicious"
* Gleason = 6 (3+3) for left base and left mid; Stage = T1c

3/98: PAP=2.1 (ref=0-2.5);

3/19/98: began daily Casodex for 3 months(3/27/98+)

3/27/98: began Lupron/mo for 3 months

4/2/98: endorectal MRI (U. of Penn) = no extracapsular spread (size=28cc)

4/24/98: PSA = 1.4 [PSA by Hybritech]

6/9/98: PSA = 0.2 [PSA by Hybritech]; testosterone = <15; liver function normal

6/12/98: discontinued Verapamil due to PSA-related news

7/2-7/21/98: conformal 3D EBRT (with Dattoli in Tampa)

7/14/98: 82 Pd-103 TheraSeeds implanted by Dattoli

7/14/98: Post-seeding medicine prescribed (start 7/14/98):

* Anti-inflammatory: Decadron (urinary) to 7/25 (4mg3x to 2mg1x); then 400mg Motrin
* 100mg Trovan (antibiotic), Pepcid AC (to lower acidity)

7/16/98: begin daily Metamucil/Crangrape and "Anusol" suppositories option

7/20/98: begin biweekly Cortenema enema (anti-inflammatory )

7/19 to 8/2/98: daily (for urine flow) 1mg Cardura + 10mg dibenzyline (as needed) 1-2/day

7/27/98: begin 0.4 Flomax 2x/day (for urine flow)

8/5/98: due to irregular heartbeat: restarted daily 180mg Verapamil

8/19/98: for heart switched to 800mg Amiodarone (for 10 days), then 200mg

12/2/98: PSA 0.6; PAP 0.4 (0-0.8); CEA 1.0 (Tampa)

6/24/99: PSA 1.1; PAP 0.9 (0-2.7); CEA 0.9 (Wilmington)

11/6/99: PSA 0.8; PAP 0.6 (0-2.7); CEA 1.0 (Wilmington)

8-9/00: cut 0.4mg Flomax & 200mg Motrin from twice/day to once/day before bedtime

11/00: discontinued daily 200mg Motrin

12/6/00: checkup with Dattoli in Tampa

* Color doppler ultrasound detected no cancer
* PSA 0.7; PAP 0.2 (0-0.8) (Tampa)

12/20/00: began daily 5mg/day Proscar to reduce my prostate size from

31cc on 6 Dec 2000 back to the 19cc it was at my 14 Jul 1998 seeding
to improve urinary flow and reduce need for Flomax
Blood flow to right side of penis normal, left slightly reduced.
Viagra may improve with regular use.

6/1/01: PSA 0.6; PAP 0.6 (0-2.7); testosterone 706 (free 129) (Wilmington)

1/23/02: PSA 0.1; PAP 0.7 (0-2.7); testosterone 720 (free 140) (Wilmington)

3/6/02: cystoscopy because of some bleeding after a few urinations

revealed stone blockage in urethra near sphincter; discontinued Proscar

12/24/02: PSA 0.1; PAP 1.1 (0-2.7); testosterone 814 (241-827), free 17.5 (6.6-18.1) (Wilmington)

9/13/04: PSA 0.1; PAP 0.6 (0-2.7); testosterone 701 (241-827), free 13.5 (6.6-18.1) (Wilmington)

3/7/06: PSA 0.1; PAP 0.9 (0-2.7); testosterone 598 (241-827) (Wilmington)

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For additional details see
Stages of My Seeding Experience:
Diagnosis and Decision, < External Radiation (Conformal 3D-EBRT) and Preparation for Seeding,
Brachytherapy (Implanting 82 Palladium-103 Seeds), Post-Seeding EBRT,
Recovery Complications, Medicines and Heart Concerns, My Doctors and Overall Summary



Visit the SeedPods web site at http://www.prostatepointers.org/seedpods
to learn even more, and to ask your own questions.

You can also download Aubrey Pilgrim's Book at http://www.prostatepointers.org/prostate/lay/apilgrim



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© Thomas P. Doherty, July 31, 2006 - comments to: tdoherty@magpage.com