Carbon Fidicial Marker, SPACEOAR Surgery & Proton Therapy

Many thanks for the encouragement. I hope everything goes well for you too.

Hello cdcfbw,

Sorry to hear about your stone and infection. It’s good that you have that behind you now. Sincere writing the original post at the top of this communication chain, asking for feedback on the surgery to place the markers and insert the SpaceOAR gel, I thought I would offer you some feedback on how my procedure went. It was actually a “piece of cake”! I had no pain or discomfort after waking up from the procedure. The first day, I had a very-very slight feeling of “fullness” from the gel, but that disappeared and really was hardly noticeable. So, I thought I would give you my perspective on that process. I worried a great deal in advance of the procedure, but it really was no big deal. So, hang in there! Your healing process has started and will accelerate once you have the markers and the gel. Take care….

I can second @kansascityhusker experience re fiducial marker/spaceoar procedure. Had mine done at Mayo PHX on 10/5/2021. Next step, 28 proton sessions starting 10/18/2021, ending 11/24/2021. My GS is 7 (3+4), Grade Group 2 (favorable intermediate).

Hi gankster,

I started my sessions on Sept 29 and had my 7th treatment today. So far so good — no pain, no discomfort. Pretty amazing technology. Good luck on your journey…. Maybe we’ll bump into each other at Mayo in the Proton area?

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I had the stent removed and the surgery for the gold markers. Also had the Spaceoar inserted at the same time while I was sedated. Everything went well and the only thing I experienced was a little soreness. The next step is to do the consultation and simulation near the end of the month. Many thanks for all your support and encouragement.

I had the procedure yesterday to insert the gold fiducials and the SpaceOAR. This was under twilight anesthesia - I was out cold. No pain afterwards. A slight amount of blood where the needles were inserted in the perineum but this stopped by the time I was discharged to home (about an hour). No blood in the urine. I was told possibly a small amount of blood in semen. If you are experiencing bleeding for more than a day afterwards it could be the result of medication you are taking and you should contact your doctor.

Well, I'm late coming to this conversation, but FWIW:
I had a fusion guided biopsy at Mayo Rochester in November 2019. I was under a general anesthetic. My MRI (multiparametric) with focusing coil had showed an anterior tumor in my prostate. I believe they did 23 cores (samples). I may have been on a short course of antibiotic afterwards (don't remember). Minimal discomfort after the procedure. I opted to return to Mayo Rochester in late January 2020 for PBT (proton beam treatment). I had fiducial markers inserted, I thought they were carbon. I also had SpaceOar inserted. I don't remember any particular discomfort after either procedure (may have been same event; don't remember that for sure).

At Mayo Rochester for some patients (like me) their standard course of PBT is five treatments over two weeks (like M,W,F,M,W). My understanding is that it is the same cumulative dosage as longer courses (~5 day a week/five weeks). I had some irritation to my urethra after my 2nd PBT treatment and was prescribed Flomax- which I still take.

It was recommended that I do a four month course of ADT (Androgen Deprivation Therapy) which I did.
I had erectile dysfunction before my treatments and ADT added to that. About two months past the end of my ADT four month treatment I would say that my erectile 'capacity' returned to about the same level as before PBT and ADT.

I am still able to have an orgasm, but the volume of fluid is reduced - which changes ones 'experience' of orgasm. The change seems consistent to my understanding of the prostate function and impact of PBT.

My PSA was about 8.3 before treatments - but should have been thought of as 2X that (i.e. 16.6) because I was on finasteride for BPH. My PSA levels now are staying at about 0.2.

Anecdotally two men I know who were on ADT told me of emotional mood swings. My one friend said (acknowledging some history of depression) that he found himself sobbing in the corner of his living room. Another man who had a PSA >45 before treatment was on a long course of ADT and said that he had moments of getting extremely irritated. He began to recognize the signs and would remove himself from those situations.

Supposedly men think about sex 19 times a day. I assume that there may some differences between younger men and older men. I took no notes but I think maybe on ADT my thoughts about sex dropped to near zero....

Maybe late to the discussion, but welcome at the table, Jim! Posts like these are so helpful to current and future members. It helps to here from the horses mouth so to speak, someone who's been there.

I looked into the proton, and the MRI guided radiotherapy. I have decided to go with the MRI guided radiotherapy, because the side effects seemed a little less than the Proton as I was told the proton can cause bowel issues. I felt a little more comfortable with the MriDian and it’s ability to stop if my prostate moved at all, which evidently is a common issue, even just lying on the table. I am also in Florida, where Orlando health has both machines so either was an option. It is a hard choice.

Joe, I wonder if you might post links to info that helped you in your decision. Was there any data showing lower side effects from MriDan.

FWIW: Each Mayo center and their doctors make their own decisions. For example, when I got my PBT treatment at Mayo Rochester their standard for my prostate cancer was five treatments spread over two weeks (+advance prep time). At that same time Mayo Phoenix/Scottsdale was doing 5 treatments/week for ~5 weeks. There are other PBT treatment centers that use the 5X5 treatments; whether there are differences in the equipment and delivery systems I don't know.

Also, I'll say that with each PBT treatment I was positioned on the table with my legs and pelvis held in the 'mold' that they had made. I believe an xray was taken and occasionally they came and repositioned me because the xray (looking at the fiducial markers I assume) didn't have me in quite the right position.

One thing about prostate cancer is that there are enough patients that there is ongoing research and investment in evolving technologies as opposed to having a cancer that is so rare that there is little incentive for research and tech investment.
But, that also means that looking at 10 year old data on reoccurrence, long term side effects, long term QOL (Quality of Life) is difficult because the tech has kept moving.

...and I'll repeat that anyone with prostate cancer should think of their treatment choice as "knocking down" the cancer but probably not making it go away for ever. So, I say I'm in remission and hope to stay there the rest of my life (for me maybe another 20 years.

Best of luck!