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What would my doctor/surgeon do? - I asked the question today

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Posted 1/5/2009 9:53 AM (GMT -8)
When I was through with my procedure and appointment today with my doctor/surgeon, and we had shook hands as usual, I asked him point blank, Dr. Smith, if you had my exact pre-surgery specs, what would you do if you had to make a choice of treatment.  He didn't hesitate, he said he would have had surgery, but robotic even though his robotic guy isn't highly experience yet, and he wanted the robotic for the faster recovery time since he is a doctor.  We talked about 2nd guessing and what a cruel game it is on the mind.  He said that with my specs, especially the intense PSA velocity, that any kind of watchful waiting would have been a death wish.  That even allowing the cancer to grow another 6 months to a year might have allowed it to become untreatable in the normal sense.  As a surgeon and urologist, he refuses to do salvage surgery after radiation.  He said it is always a disaster, he knows surgeons that will, and he just forwards the patient to one of them if they insist.  He said if I were 75 years old instead of 56 at dx, he may have told me just to wait and watch, but at my "young" age, lol, he wanted me to have the best chance of living many more years cancer free.  He also said that in my very case, due to the deep and narrow prostate bed, and scarring from previous surgeries, any attempt at robotics would have been aborted and switched to "open" as soon as they saw what was ahead.  He shook my hand again, and was certain, that for me, the choice I agreed to was the best one to be made to hopefully be rid of the cancer and finish my life.  Just thought I would share his opinion.

David in SC

Posted 1/5/2009 10:39 AM (GMT -8)
His and your reasoning is why some many guys here choose surgery. Some may feel that other alternatives would work, but it usually comes down to removing the source for the majority. That a minority of them may have post surgical problems is part of the risk assessment we have to take into consideration.
Posted 1/5/2009 11:37 AM (GMT -8)
I agree with your reply, James. Had I been well in my 70s instead of mid 50s, probably would have never had the biopsies, let alone treatments.

David.
Posted 1/5/2009 2:41 PM (GMT -8)
Hey david. I know what you mean about 2nd guessing driving you insane. If ifs and buts were candy and nuts we would all have a merry Christmas. Wise is he who seeks the counsel of others. Just my two cents.Todd
Posted 1/5/2009 2:59 PM (GMT -8)
As usual, Todd, your opinions are welcomed and just. What I have to accept, and I do most of the time, is that I didn't ask for this PC to happen, it was there anyway, growing its evil self unknownst to me. From the first positive biopsy, based on prior cancer experiences, there was no way for me, that I wanted it left inside me if my specs allowed for surgery. It's kind of brave and cowardly at the same time, I admit that in my case, but if I can help it, I don't like things to linger in my life, more of a fast decision maker, and then stand by my decisions, how I have been most all my working life in the business world. Think through things, act, then stand by the decisions. I hope you are feeling good today, wishing only the best for you.

David
Posted 1/5/2009 5:27 PM (GMT -8)
David, Your surgeon is correct. For Pete, the salvage surgery after radiation has been a horrible disaster that is ongoing. We spent all morning at the hip surgeon's office.....The radiation that Pete had almost seven years ago has been the problem....not the lupron. He also has a UTI, which may cause the surgery to be postponed....Pete calls the radiation oncologist" Dr. Hiroshima.."
We won't know until 8am Friday morning if the hip replacement surgery will go on The oncologist has to deactivate the AUS 800, and then place the catheter in,,,,but must have a clean urine specimen before the operation. He can nix the operation at that point... The Xray of Pete's hip was unbelievably bad. It was entirely worn away by the radiation....We don't even worry about the PSA now... .

.. No one that has not traveled the road of prostate cancer and the side effects....even the smaller ??? side effects can understand the difficulties. That is why this site is invaluable to newcomers and veterans....There are laughs and tears and people that understand., even though we don't know each other by face, we know each other by names and symtoms and WE GET IT.... Di
Posted 1/5/2009 7:33 PM (GMT -8)
Thanks Diane for your post, I'm hoping with all my heart that things go better for Pete then they appear on the surface. My remarks about salvage surgery were not directed against his case, but meant as a general observation and personal opinion. I know a little something about radiation from my past 35 treatments which ended 9 years ago, they were directed from about the level of my nipples to just below my nose. To this day, I have chronic fatique, constant thirst, the inability to drink/eat anything spicy or acidy, i.e. orange juice. On the left side of my neck where the lymph nodes were reeking of cancer, they double zapped me. Had they not made me a special titanium guard for my voice box, I would have lost my voice for life. It took me months afterward to even be able to taste food in the regular sense of the word. I hear some people act as if radiation is no big deal, and perhaps for some its not, but it had a brutal affect on me, after the first 2 weeks, both my ears shrivel up and turned almost lobster red, and my skin burned like the worse kind of sunburn imaginable. I know Pete has been through so much, so I can empathize with him all the way. Please keep me/us posted of his situation and hopefully, good progress.

David in SC
Posted 1/5/2009 7:40 PM (GMT -8)
Mikey, sure you will make a good choice for you in the end. To me, the only thing worse then agonizing over the treatment choices and their respective side affects, is having a cancer just growing away inside your body. Your specs, and I am no arm chair doctor, look promising for a cure at this point. By the time you finish with your process of elimination, I am certain you will settle into what is best for you. I am not saying its the only way, but the mainline thinking with containable PC is surgery first line, radiation as back up if you have a biological reaccurance. But everyman here has to make those choices. Sometimes it comes back to the classic, do you want to get shot with a gun or stabbed with a knive.
David in SC
Posted 1/6/2009 2:15 PM (GMT -8)

Hi David,

Well, the hits just keep on coming don't they.  Maybe the doc is finally on the right course and Friday will be the end to all the ills.  I certainly hope so.  I think you are quickly becoming the leading authority of the different varieties of cath. equipment.  If I have any questions in the next couple of weeks you're the guy I'm going to call on.  Hope your Mother is doing well.  All the best,

Bob

Posted 1/6/2009 2:48 PM (GMT -8)
Hello Bob,

Not sure I want to be the expert on the fine manly art of catheter fashion, but at the rate I am accumulating time on one, perhaps by default I will, lol. I am confident my doctor will have a solution sooner now rather then later, still waiting to confirm the Friday procedure. May or may not happen this week.

Update on my mother. She had her stroke on Dec 26th, spent 4 days in the local hospital, and ten days at the rehab center, and I just found out they are letting her return to her house tommorow afternoon. Not bad for a woman going on 82 years of age. She's a tough old bird, that's for sure.

David
Posted 1/6/2009 5:09 PM (GMT -8)
Oh David, you made me laugh!! Your mother is a tough old bird....!!! She gave birth to another tough young bird...)I was going to say cock, but decided against it..........! ) The radiation problem is definitely a strong probability, and one that the urologists and radiologists don't like to talk about. You should have seen the urologist today when Pete called the former Radiology Oncologist..."Dr. Hiroshima"...He stared.....blankly..... Pete's hip surgery is due to the radiation he had for the prostate cancer in 2002. And the cancer is coming on strong again, despite salvage surgery of the prostate in 2006....Who knows what is going to be.....Di.
Posted 1/6/2009 6:41 PM (GMT -8)
Di, you would have to meet my mother, she is 4'11" tall, and claims she was taller then either of her parents, she is British, born and raised in London, went through all the WW2 bombings there while in high school.

When I had radiation that time, I will never forget what the radiation doctor asked me first. He said are you real sensitive to the sun and sunburn real easy? I told him yes, been that way all my life, and would often get what they called in the old days "sun sickness". After that, he said that I would have a very difficult time when they radiated me. I started having back side affects by about the 4th treatment. By the end of the 2nd week, I felt like I was sun sick and very sun burned, yet despite that pain, had to make myself go back 5 days a week, and somehow, at that time, I still managed to work full time. I would plan my zapping late in the afternoon and then go home somehow and crash all evening. It upset my wife so much at the time, that she would cry and beg me to stop the treatments. It was tempting, but I knew it was my best chance for survival at the time. This is exactly why I told my urologist/surgeon after my dx, that I was more afraid of having radiation then having any type of surgery.

Only my best to you and Pete, a very tough situation but you two seem to have such a good attitude about everything, it is inspiring to say the least.

The term "cock" would have made me laugh, it would have been ok to use, but right now, this one feels neutered, or at least in a deep, coma somewhere, lol.

David in SC
Posted 1/7/2009 6:15 PM (GMT -8)
Thank you so much, David... I would have loved to meet your mother. I probably would have gotten on very well with her. !! I am sorry for what you had to endure with the radiation. It helps get the cancer , but it also can damage good tissue at the same time. ...My best to your wife. She is amazing and I understand what she is living with. Your catheter issues are enormous....and we had the same thing. Pete had the catheter in for One Year....So I know what you are dealing with....Good luck to you in getting the "devil's tail", (as Pete called it) out..... Diane
Posted 1/7/2009 7:36 PM (GMT -8)
Hello DI, I had read of Pete's one year ordeal, was that one year continuous? And why for that long? Not that I have changed my mind, but the longer it is in me now, the less it bother's me. It funny how us mere humans can adapt to unplesant things over time.

My mother is spending her first evening back in her own home, my brother took her out of the rehab place against medical advice. As her power of attorney, he had the right to do so. My wife, the nurse, and I , feel its a big, big mistake, but that's how the law works here in such family matters. I have to be in her town tommorow afternoon (about 6 miles) and plan to at least check on her in person.

I am still waiting to see if I will have another procedure this Friday, but the dr office has failed once again to follow through on the doctor's orders and call me. So in the morning, I will have to forgo my passive ways and get ugly on the phone.

Can I assume that Pete's surgery is on hold too, because of his UTI?
Posted 1/8/2009 5:13 AM (GMT -8)
David, first I'd like to say I'm glad that your mother is recovering from her stroke. my best wishes to her.

When Jeff was diagnosed, he asked his doctor what he would do, and the doctor's reply was "I had prostate cancer last year and had surgery." that along with the fact that Jeff just wanted the cancer out of his body as soon as possible helped Jeff make his decision to have surgery. he hasn't second guessed it since. whenever we get down about the lack of erections or dribbles, we remind ourselves that it's better than having cancer.

keep up the good fight!! kat
Posted 1/8/2009 6:38 AM (GMT -8)
I agree with you Kat, the ordeal of the surgery and the recovery, learning to live and adapt with the side effects, to my wife and I, are must less of a strain then worrying about an agressive and mean cancer inside me. From reading Jeff's stats, he's doing real well and appears to be cancer free at 2 years, I hope I am in that same position at that point in time. My best to the both of you.

David in SC
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