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My husband was just diagnosed with PC.

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Posted 12/7/2008 6:28 PM (GMT -7)
I am still just gathering all of the information we need to make the right treatment decision. His MD wants to perform the Davinci Surgery. My husband is not so sure he wants to have the surgery. We are still waiting for the bone and Ct scan results. We should know those tomorrow or the next day.
Posted 12/7/2008 8:39 PM (GMT -7)
Hi Tra96 and welcome to the forum. There is a wealth of information here -- so start reading! There's
usually no rush to get treatment started, so take your time studying the options to find a treatment that is best for you both.

If you can provide some more information, such as PSA and Gleason score, we could give some more specific suggestions.
Age 63. Other than cancer, in good health; BMI 20

Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores

7 March 2008, RRP, non nerve sparing

Two nights in hospital; catheter and staples out after 7 days

Continent, no pads needed from the get-go

Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm

6-week and 7-month PSAs: 0

Bimix injections working well 

Posted 12/8/2008 6:43 AM (GMT -7)
Yes, Tra....You can learn a lot on this forum with caring smart people who have been through all of the different options Each man is different though, and how one man does with one type of option, another man, depending on age, general health, skill of doctor, numbers..psa,gleason, etc. may have a very different outcome. Each option has its limitations, and its side effects....I have learned a lot from this forum and the questions to ask the doctors...Keep reading as Piano says......Good luck..Diane
Husband Pete
dx Jan 2001 age 67 gleason 4 + 3 PSA 16.5
seed implant and conformal radiation Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06
Fistula operation 2/07 MSK
Many cystoscopies and ER visits with strictures
catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/07
AUS Operation at MSK Sept 8. Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008

Posted 12/8/2008 8:27 AM (GMT -7)
Hi & welcome; I had the Di Vinci robotic laproscopic prostatectomy surgery 3.5 weeks ago and the healing is going as planned. Depending on your husband's numbers (age, PSA & Gleason score, etc..) the surgery may be the best option. Based on my numbers, my 2 options were the surgery or radiation. Even the radiologist recommended the surgery, and said that's what he'd do. My wife did tons of research and did all the ground work. You sound like that too.

Another big thing to consider is the surgeon. He/she should have many, many operations under the belt. My surgeon has 1500 and is world renowned for it. He teaches the procedure on De Vinci and gives lectures, and does lots of TV spots. I was fortunate in that sense. He also has a site with lots of info and testimonials. Look him up and check it out.

As others have said, this is the place for info and 1st hand experience. I didn't find it until after my op; wish it was before.

Good look to you and your husband. Keep in touch.
Diagnosed:  8/24/08, age-47

Father died of prostate cancer at age 72

PSA 1.5 early 2007, 4.5 mid 2008, all remedies tried & reduced to only 3.2, uh oh.

Biop - 2 positives of 20 samples

Gleason - 3+3

RRP - 11/13/08 via Da Vinci by Dr. David Samadi, Mt. Sinai Hosp. NY

Post op biopsy - 75% of samples positive for cancer, Post op Gleason 3+4

some lymph Nodes tested, all negative

all nerves spared - I'm told

Catheter in for 1 week, using 1 pad a day. 

Posted 12/8/2008 9:47 AM (GMT -7)
Hello and welcome to the Club. I am 3 1/2 week post open RP surgery, and on the mend. With my specs, the doctor said it made more sense to do surgery first, then only if needed, do salvage radiation. He said its a lot harder to have the surgery as salvage after radiation because of scaring and trauma to the area. The open or robotic, popular subject here. I live in an area where there's not much robotic experience, and my dr/surgeon said that had he done mine robotic, due to complications, he would have had to abort it and switch to open. So please research extensively with your options. In hindsight, I feel like I was a little rushed into making a surgical decision, nothing against my doctor. Being my 4th bout of cancer since age 45, I was shocked and horified and wanted it out of me. Good luck in your decision ahead.

David in SC
Age 56, 56 at DX

PSA 2007 5.8

PSA 9-2008 14.9

3rd Biopsy 9-2008 Positive

7 of 7 cores positive, ranging from 40 - 90%

2 tumours noted, Gleason 4+3 and 3+4

Open RP surgery completed on Friday, November 14, 2008 at

St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon,

Non-nerving sparing, 4 days in hospital, staples removed 11/24/8

Post-surgery Pathlogy Report:

Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer

Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes. Left lobe: infiltrating tumor miscroscopically appears to extend to marked left posterior margin

Posted 12/8/2008 3:49 PM (GMT -7)
TRA 96
Before you make any decisions I would get a 2nd opinion from a prostate oncologist. Prostate Cancer Research Institute has a list of recommended doctors specializing in prostate cancer. I was about to have surgery after being diagnosed and the 2nd opinion I got was the cancer found was insignificant and didn't need to be treated at all. The doc was concerned about My high PSA history and ordered more tests and found a tumor that 13 biopsies missed. Surgery would not have been effective because of the tumor location. It is very important to have the prostate cancer properly staged before deciding on any treatment options. There are two types of prostate cancer, slow growing and very slow growing, so you have plenty of time to get a 2nd opinion from an oncologist who specialized in prostate cancer.
John T
Diagnosed 10-08 at 63 with PSA of 33

PSA was 4.4 in 1999 and has risen steadily.

Had 13 biopsies and an endorectal MRI, all negative until 10-08. Two cores out of 25 with a gleason 6

2nd opinion with an oncologist said cancer found was insignificant, but suspected larger tumor somewhere.

Doppler ultrasound with target biopsy indicate a large tumor in the transition zone, gleason 7.

Bone and CT scans negative.

PSA3= 43; high normal is 35

Currently evaluating treatment options, surgery is not an option as a high probability of positive margin exists.

John T

Posted 12/8/2008 7:06 PM (GMT -7)
Thanks everyone. I am still waiting to get a copy of his PSA level and pathology reports. I was hoping they would be in the mailbox when I got home but no such luck. I am the one doing the research and will help him make a decision as to what the best treatment will be. He can't handle it right now. I hate waiting for results. I just want to know what we are dealing with. We are still waiting the results of his CT scan and bone scan. Hopefully, the Dr will call with those results tomorrow. I will definitely continue to post and read here.
Posted 12/8/2008 9:26 PM (GMT -7)
So i just accidently ignored someone and dont know how to unignore...just joined today...
Posted 12/8/2008 10:38 PM (GMT -7)
Tra96,
Welcome to the best site on the web for caring and compassionate support. I have found that the people here do really care.

Your husband's PSA and pathology numbers matter when making a treatment decision so get them as soon as possible. This is a very important decision so I highly recommend that you review all local treatment modalities. You cannot un-ring this bell so whatever is decided now is where you will have to make the next decision upon later if necessary.

It is good you are researching for your husband. da Vinci is a good option, as is open RRP. What matters most in surgery is the surgeon, not the method. So make sure your doctor has extensive experience, it will likely make a difference. Do the same if you consider radiation, cryotherapy, or whatever as a primary treatment.

We're sorry to have you here. But glad you are here.

Peace

Tony
Age 46 (44 when Dx)

Pre-op PSA was 19.8

Surgery on Feb 16, 2007 @ The City of Hope

Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)

Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx

HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)

IMRT radiation for 38 Treatments ending August 3, '07

Current PSA (September 17 '08): <0.1 ~ Undetectable!

You can visit my Journey at:

Tony's Blog

Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!

Posted 12/9/2008 8:08 AM (GMT -7)
Hi Tony, thanks for the reply...
we have the numbers so far they are
Gleeson 3+4
9 out of 12 cores positive
6 of 6 on left side but they said 30%
3 of 6 on right side 13 %
psa 7.71

at least a t2

we dont have davinci as he is veteran and so we will have to do at va lajolla sandiego....only open is available...or bracy therapy in seattle...
any help or comments are appreciated
Posted 12/9/2008 8:26 AM (GMT -7)
hi again, the hardest part is that steve just had open heart surgery 3 months ago...that is how we found out about the cancer...
Posted 12/9/2008 9:20 AM (GMT -7)
Chinito,

With those specs you posted, pretty similar to what I started with. My dr. would not reccomend waiting and watching for long, I had the open surgery less then 4 weeks ago, and I am doing as well as expected. I don't have any opinion or experience with the "seed" radiation, other then my doctor doesnt feel like its very effective with most candidates.

I know you will make the right choice when it all settles down, good luck ahead.

David in SC
Age 56, 56 at DX

PSA 2007 5.8

PSA 9-2008 14.9

3rd Biopsy 9-2008 Positive

7 of 7 cores positive, ranging from 40 - 90%

2 tumours noted, Gleason 4+3 and 3+4

Open RP surgery completed on Friday, November 14, 2008 at

St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon,

Non-nerving sparing, 4 days in hospital, staples removed 11/24/8

Post-surgery Pathlogy Report:

Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer

Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes. Left lobe: infiltrating tumor miscroscopically appears to extend to marked left posterior margin

Posted 12/9/2008 9:35 AM (GMT -7)
chinto, to unignore someone, click the Control Panel on left above, then Edit Ignored Users to remove people from your ignore list.
James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.

Posted 12/9/2008 3:40 PM (GMT -7)
Hi Tra96. I'm sure many others can add more, but I've just gone through the same decision making process (I'm 6wks post RALP - robotic surgery) and know how confusing it is.

If I say anything wrong or misleading, please others, correct it. This is just my personal best understanding.

First, you will be looking for some clear decision criteria between the various possible treatments -- at least based on outcomes, there really isn't one. It's pick your poison. Being in the med-science field, I know something about how to read the scientific literature, and of course read lots of them for PC lately. There are no direct comparison studies of outcomes between radiation and surgery (at least not double-blind randomized trials which is the gold standard for such a study). There is some evidence that suggests that surgery may have up to a 5 to 9% better 15 year survival rate than the various radiation treatments. But, and I want to stress this, this may just be numerology. The 'true' relative probabilities may be the same or radiation could even be better -- one would need to properly run gold standard trial to say for sure. Nevertheless, for me I figured that even if it might not be 'true', better to go with the numbers that are out there than go against them.

15 year recurrence rate (the longest time period for which they have data) for surgery builds up linearly to about 9%.

Having said that, perhaps one of the biggest deciding factors may be age and general health. I'm an otherwise healthy 50 yo. Surgery seemed the best option for me. I'm now arguing with my 76 yo father who recently got a high PSA and is in denial. But I think at that age, he may do better with the seed implants.

OK, after survival, how do the treatments compare for side effects?
The studies I looked at (can dig out reference if wanted) read to me as follows in summary:

Incontinence - better for radiation than surgery -- but probably only for the short term (first 2 years). After that 'most' surgery related incontinence is well controlled (jury still out in my personal case)

Bowel function - better for surgery than radiation. You radiate the surrounding tissues, they get hurt. Surgery can almost always avoid this.

ED - not much difference between the two treatments. All approaches result in 'dry' orgasms. All of them damage the nerves (via different mechanisms). (jury very much still out in my personal case. I have lots of blind hope and faith)

So in recap, there's no clear cut winner. It turns on smaller considerations of your personal case, what the rest of your husband's medical history is like, and what you're willing to tolerate.

Hope this helps.

Post Edited (Rolerbe) : 12/9/2008 3:43:39 PM (GMT-7)

Posted 12/9/2008 4:32 PM (GMT -7)
As one who had DiVinci but strongly considered radiation, I know that the clinic that is considered the very best for seeds is located in Seattle (as you mentioned Seattle). I would suggest you check everything out. I am not saying this because I am unhappy with my DiVinci - I would do the same thing again, but every situation is different and is an individual choice. However, if I was faced with having an inexperienced open surgeon vs. a very reknowned radiation clinic, I might consider going the other way. Bless you as you check everything out and make tough decisions - ultimately it will likely come out well either way.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008

Posted 12/13/2008 2:35 PM (GMT -7)
Hi Chinto,

I just read your posts. My husband had the robotic 3.5 weeks ago, you might have read his post here...glabers. How old is your husband? Are you the patient? Got a little confused, are you and Tra96 related? Anyway, I read the part about you (or your husband) being a veteran. First off I'd like to say Thank Your for you service! Secondly, I would still get in touch with a robotic surgeron, even if he is not on your plan. Dr. David Samadi is the surgeon that we used. He told us when we went that if we had any problems with our insurance to let him know. I don't know what you're financial siutation is, but maybe you can (a) go on some sort of payment plan or (b) who knows, if he hears your story he might do the surgery at no cost to you. Like someone else said, I would not chance having open surgery with a surgeon that is not well known. We did A LOT of research, we actually had an appointment with another surgeon and surgery scheduled before I found Dr. Samadi. If I can be of any help with whatever information I found don't hesitate to ask. Good luck to you and God Bless!
Posted 12/13/2008 2:43 PM (GMT -7)
Here's a good recent study published in New England Journal of Medicine that gives a good survey of quality of life outcomes for various treatments (e.g. surgery, radiation, etc.) that may help with decision making (or be even more confusing as there is no clear-cut winner).

http://content.nejm.org/cgi/content/short/358/12/1250 -- Quality of Life and Satisfaction with Outcomeamong Prostate-Cancer Survivors (2008)
50 YO

PSA at Dx: 8.2

DaVinci RALP: 10/31/08

Negative margins, no extra-capsular involvement

One nerve spared

No follow-up PSA yet (next week).

Posted 12/14/2008 6:27 AM (GMT -7)
hi all, thanks for your answers. we found a surgeon, Dr Liao at Palo Alto VA that is with Stanford. they do the davinci and will do my husband if he is released by his cardiologist due to having open heart in august...the dr talked to us at length and he has done alone 50 davinci..he is the chief of urgology there...he has assisted in many more plus to in the 100s of open...they say if my husbnad started having complications while under due to heart they would switch to open...i was told that anything above 25 da vinci surgeries was a good number as far as experience...as far as finances we have none...we are missionaries and our needs are provided for but not something like that...we do have an insurance plan but is 80/20...where is Dr samadi from?
Posted 12/14/2008 7:37 AM (GMT -7)

Dear Chinito:

Re your last post, I would not suggest da vinci surgery with a surgeon who has only 50 procedures under his belt.  That is still considered "inexperienced" in that field, regardless of the number of open surgeries performed.  For some stats on experience in general, please refer to my recent post under a thread by pws1 called "experience ?".  The topic is still on page 1 of the forum as of this morning.  I seriously considered da vinci and would have definitely gone to a more experienced guy.

Depending on the specific man and his specific stats, the cure rates for the basic treatment options may be the same.  For my particular situation, that was true.  Then it becomes a choice based on consideration of side effects as well as intangibles such as the need to "get it out".  In any case, I would strongly recommend that you take a good look at different options such as seeds and other radiation before making a final decision.  You should see a radiation oncologist as well as an experienced surgeon. This decision is a BIG DEAL and I needed the peace of mind that came with extensive research and exploration of all options.

The quality of life link given by Rolerbe is to an excellent article that I personally found very helpful.  Unfortunately the link goes only to the abstract and that summary wasn't great.  To get the article one needs to purchase it ($15 I think), but I found it well worth it to pour over these quality of life stats very carefully. 

Age 62

Gleason 4 +3 = 7

T1C

PSA 4.2

27cc

Brachytheraply volume study done on 11/14/08

Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort. 

Posted 12/14/2008 7:56 AM (GMT -7)
no sure how to go to pws1 thread
Posted 12/14/2008 8:07 AM (GMT -7)
chinito, I just bumped it to the top of the main thread page.  Go back to the page that shows all the current threads and look for it, the senders name pws1 will show in the starters name column, the subject is experience ?


James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
Present- 1 year: ED- Viagra, pump continues, no response- Trimix ..35ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.

Posted 12/14/2008 7:16 PM (GMT -7)

Tudpock18 said...

The quality of life link given by Rolerbe is to an excellent article that I personally found very helpful.  Unfortunately the link goes only to the abstract and that summary wasn't great.  To get the article one needs to purchase it ($15 I think), but I found it well worth it to pour over these quality of life stats very carefully. 

The full text is available for free at http://content.nejm.org/cgi/content/full/358/12/1250. There is a "full text" link on Rolerbe's abstract page.

Age 63. Other than cancer, in good health; BMI 20

Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores

7 March 2008, RRP, non nerve sparing

Two nights in hospital; catheter and staples out after 7 days

Continent, no pads needed from the get-go

Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm

6-week and 7-month PSAs: 0

Bimix injections working well 

Posted 12/15/2008 4:52 AM (GMT -7)
I wanted to personally welcome you to the club Chinto, looks like you already have some prety sound advice. The only thing I would like to ad is to be sure to take care of yourself emotionally and spiritually. HEaring those words "you have cancer" can be a drain emotionally for the fighter and caregiver so be sure to nurture yourself, take a deep breath, read a good book, anything just to keep your mind fresh to face the decisions that will be coming up. The good news hear is that PCa caught early is very treatable. Please ask all the questions you want and many people from this wonderful site will jump at the opportunity to help. Keep us posted.

peace and love
Dale
My PSA at diagnosis was 16.3

age 46 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8

I had 44 IMRT's

Casodex

Currently on Lupron

I go to The Cancer Treatment Center of America

Married with two kids

latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04

cancer in 4 of 6 cores

92%

80%

37%

28%

Posted 12/16/2008 11:21 AM (GMT -7)
Tra96,

You've come to a great place to share experiences. I'm almost 24 months post-op (DaVinci Robotic LRP). If I can answer any of your questions with regard to my personal experience, please don't hesitate to ask. We are all here to help you cope with your situation.

Post Edited (Gunny) : 12/16/2008 11:24:34 AM (GMT-7)

Posted 12/16/2008 11:42 AM (GMT -7)
Tra96,

Any word yet on the biopsy results?

Post Edited (Gunny) : 12/16/2008 11:46:56 AM (GMT-7)

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