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jbm
New Member


Date Joined Feb 2009
Total Posts : 7
   Posted 2/3/2009 9:46 AM (GMT -6)   
Just got the bad news last week & I'm still trying to "get my brain wrapped" around the idea that "I" have cancer. I woke up the other night and for a second thought my situation was only a dream.  My dad  had PC but he was in his 70's when it was DX.
 
Now, what to do?  I'm going to have it removed asap, but in my research I came across the da'vinci robotic procedure and it sure looks like a better alternative than the open surgery. I called my insurance company and they will cover the procedure. My dilema is that my urologist doesn't do the process, so I'll have to change doctors. I really like my current dr. He's been helping my through some uro issues for the last few years and I know he's a good surgeon, but the da'vinci sure looks like a less invasive, thus quicker, recovery.
I have a follow-up consultation with my dr this Thursday for treatment options and more specfic info about my case. I want to move forward with the process asap.
 
Anybody used a Da'vinci surgeon in Cincinnati? 
 
I'm glad I found this forum and will be reading a lot of posts today.
 
Thanks for any help.
Age: 61
Diagnosed: 1-29-09
Gleason:   6
Stage:     1Tc
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 2/3/2009 9:51 AM (GMT -6)   
jbm, Welcome to HW. Hate you have to be here.... I think the general feeling here is that the experience of the surgeon far outweighs the particular surgical procedure you select. A surgeon who had done two or three thousand open RRP will probably give a better outcome than a guy just learning the Da Vinci with maybe 50 under his belt. And the opposite of course. If you do change doctors to get the Da Vinci, then shop around and get the best, most experienced one available.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/3/2009 9:57 AM (GMT -6)   
Hello and welcome to you, JBM, glad you found us, hope we can be a help to each other. If you have a doctor that you already trust and is very experienced with you as a patient, and assuming he is also very experienced with open surgery, that would be a tough choice. I had an open surgery by choice by a very experienced dr/surgeon. Ultimately, it will be your call, your choice. There are good arguments pro/con for both open and robotic surgery, and we have plenty of men here that have had both. Personally, I am a bit old school, and stuck to a doctor I really trusted. From reading the stories here, the side affects from either type of surgery vary so much from patient to patient. My best to you.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/3/2009 9:57 AM (GMT -6)   
Hi jbm...welcome here to HealingWell. It's tough being told you have cancer and from the looks of your signature you have lots of treatment options available to you. Listen to all the treatment options and I know you want the beast out and surgery is certainly an option...but from the experience here, just look at the options as well before making a final decision if you can. There is only one right treatment...and that is the one that you decide for yourself. I am sure that some of our Ohio folks will chime in for your area so stay tuned for their suggestions.

Again welcome...you have found a great place to bounce your questions and opinions with. Keep us informed with your journey, it helps everyone.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


GarthK
Regular Member


Date Joined Feb 2009
Total Posts : 74
   Posted 2/3/2009 10:05 AM (GMT -6)   
jbm, another welcome to this site. I was diagnosed two months ago and had already made up my mind to do the DaVinci but then I read that you need to find a surgeon that's done at least three hundred to get someone that's qualified at the console. That's not fact, just what I read. I also really like my uro and he preferred tho old fashioned way, especially for my case where the PSA was low but the DRE was a concern. He did both approaches but prefered the open approach so he could better see what he was doing. So, I had RRP done just two weeks ago and am about to get unhooked from the catheter. No complaints. All of the above said, I've never heard any complaints abt the DaVinci and have a friend that went thru it five years ago and is totally satisfied. Recovery time seems to be a lot less than for open style as well.

Anyhow, Good Luck and this is a great place to hang out, ask questions, and read other's experiences.

Stay in touch...
Garth
Vitae:
DOB: Q4'46, HT: 5'9", WT: 180
PC:
Family history of PC
Biopsy: 12/08
Cores: 4 of 12+ positive
PSA: <2.5
DRE: Slight enlargement, one node
Gleason: 3+3
Surgery: 1/21/09
Type: RRP
Catheter: 15 days
Pathology:
Adenocarcinoma occupying 5% of prostatic volume (right posterior aspect)
Gleason: 3+2
No extraprostatic extensions
Perineural invasion within prostate only
No angiolymphatic invasion
No seminal vesicle invasion
Clear margins
AJCC: pT2a


Bluenose
Regular Member


Date Joined May 2008
Total Posts : 260
   Posted 2/3/2009 10:09 AM (GMT -6)   

 

 Hey jbm, welcome to the site, you've found a great island of info and support here. We're all in this together. First things first, read and read some more, then as the questions start coming, yes even more than you already have.......ask away. Lots of very informed people here...good luck brother and again, welcome..


 
  age: 53  Pre-op PSA Feb 08' 5.0, April 08' 4.1
  Biopsy 5.1.08, 5 of 15 cores postive, T2a, Gleason 3+4=7
  DaVinci performed 7.29.08
  Bladder sling installed, umbilical hernia repaired during surgery.
  Path report, "cancer fully contained, margins clear".
  Cath removed 8.8.08, ED therapy begins 8.9.08
  100mg Viagra three times a week, pump for ten minutes daily
  and hold for ten minutes.
  8.16.08 switched to Levitra 20mg, immediate results
  9.15.08 Pad free at night, one thin (light) pad during the day
  9.18.08 1st Post-op PSA Undetectable Zero's....Yes!
  12.22.08 2nd Post-op PSA  Zero's still...
  Pads gone 1.3.09, finally found the courage...Thanks ya'll
          ".....tryin' to reason with hurricane season...."
       


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/3/2009 10:15 AM (GMT -6)   
Welcome,

I agree with those who have suggested the skill of the surgeon using whatever procedure is much more important than the equiptment. The drawback to RRP (DiVinci) is that most surgeons performing it do a short cut procedure leaving vas defrens, seminal vessicles and being unable to actually feel the tissue they excise sometimes also take too little or too great a margin.

My advice is to study all appropriate procedures before settling on one, there is no one perfect procedure you have to tailor the process to your personal situation as much as you can and I think any Dr. who suggests otherwise is more concerned about perfoming operations than the outcomes of those operations.

Best wishes. Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


smilinjack
New Member


Date Joined Jan 2009
Total Posts : 15
   Posted 2/3/2009 1:50 PM (GMT -6)   
Have you considered Proton Beam Therapy? That is what I am going to do.
Check out www.protonbob.com
Jack
age 67
DX 7 Jan. 09
psa 4.1
free psa 17%
Gleason 3+3=6
14 cores 1 had cancer 5%
Going to do Proton Beam Therapy


AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 2/3/2009 3:13 PM (GMT -6)   
jbm,

I'm a recent daVinci patient (1/22/09). I get the pathology (and catheter out) tomorrow morning. I've had no pain or other issues with the surgery and highly recommend it to anyone considering it as an option. As everyone else has intimated, find a doc with lots of experience - in whatever method you choose to win this battle. I got real lucky - I live 30 mins from a world-class cancer research center (Moffitt) and I got the div chief to do my procedure. He's done thousands of these things.

My diagnosis was very similar to yours and the docs told me I could take up to a year to decide a course of action. I spent five months researching this and the doctors available to me. Check with your doc and find out if this is true for you. If so, take your time and find the solution that is "right" for you. Don't make any knee-jerk reaction decisions.

cheers, beers & best of luck,
Chris
Diagnosed on 9/23/2008, age 47
Gleason 6, T1c
da Vinci LRP performed 1/22/2009 at Moffitt Cancer Center
catheter due out on 2/4/2009


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 2/3/2009 3:18 PM (GMT -6)   
Jbm,
Obviously you are getting lots of good advice and you have hard decisions to make. I would tell you that if you decide to do DiVinci (which I am very satisfied with mine) that I would not let doctor location prevent you from pursuing an experienced surgeon. I traveled to Austin from San Antonio for my surgery because the surgeon is one of the most experienced and well respected in the country. I know that he has people come from all parts of the US and foreign countries and local accomodations have been made for those traveling some distance. Ironically, with DiVinci you are normally not at the hospital but overnight, and they may want you to one other night locally in case there are complications, but the stay is minimal. I think you will find this the same with a number of the most prominent DiVinci surgeons.

We wish you the best as you make your way through the trauma of PC. Let me assure you it will be OK. Your diagnosis indicates you have caught it early and you should be fine.

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


AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 2/3/2009 3:21 PM (GMT -6)   
gpg said...
The drawback to RRP (DiVinci) is that most surgeons performing it


Scott,

RRP is Radical Retropubic Prostatectomy. The daVinci procedure is a robotic assisted Laparoscopic Radical Prostatectomy (vs standard LRP). I'm sure you already know this, but wanted to clear it up for those new to this game... :)

cheers & beers,
Chris
Diagnosed on 9/23/2008, age 47
Gleason 6, T1c
da Vinci LRP performed 1/22/2009 at Moffitt Cancer Center
catheter due out on 2/4/2009


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4275
   Posted 2/3/2009 3:25 PM (GMT -6)   

Hi jbm:

Dude...slow down a bit.  My recommendation is to research, research, research.  From the limited stats you posted, you most likely have all of the options available to you.  If you do choose surgery, most surgeons want to wait 8 weeks after the biopsy anyway, so that give you time to evaluate all of the options.  You should be talking to EXPERIENCED practitioners (300+ procedures)...and they should include davinci surgeon, radiation oncologist and prostate oncologist. And, smilinjack mentioned proton beam therapy - you should at least call one of the proton centers and have a telephone consult. You have only one chance to get this right, so make sure you listen to multiple experts before making a final decision. 

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


jbm
New Member


Date Joined Feb 2009
Total Posts : 7
   Posted 2/3/2009 3:43 PM (GMT -6)   
Thanks to all who have responded to my shout out this morning. Every respondent has given me much needed info and food for thought. I know it takes a few minutes of your time to read & respond and I really appreciate the suggestions.  Please don't be hesitant to give me your         2 cents...even if it seems redundant. I will defintely have specific questions to ask my urologist and will return to this thread with the new info later this week.  Thanks again to all of you and may God bless you in own situations.    jbm
Age: 61
Diagnosed: 1-29-09
Gleason:   6
Stage:     1Tc
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/3/2009 5:24 PM (GMT -6)   
AstroNerd said...
gpg said...
The drawback to RRP (DiVinci) is that most surgeons performing it


Scott,

RRP is Radical Retropubic Prostatectomy. The daVinci procedure is a robotic assisted Laparoscopic Radical Prostatectomy (vs standard LRP). I'm sure you already know this, but wanted to clear it up for those new to this game... :)

cheers & beers,
Chris

Which is why I added the DiVincci comment,  You are right the acronyms will drive you crazy.
 
In fact the surgery you are referring to is properly called the Anatomical Radical Retropubic Prostatectomy if I am not mistaken.
 
Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney

Post Edited (gpg) : 2/3/2009 3:27:04 PM (GMT-7)


AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 2/3/2009 6:13 PM (GMT -6)   
gpg said...
Which is why I added the DiVincci comment, You are right the acronyms will drive you crazy.

In fact the surgery you are referring to is properly called the Anatomical Radical Retropubic Prostatectomy if I am not mistaken.


It's da Vinci. Like the dude from old...

Actually, you referred to it, and yes, that is the correct name but you did not use that acronym so I tried to avoid further confusion. :-)

cheers & beers,
Chris
Diagnosed on 9/23/2008, age 47
Gleason 6, T1c
da Vinci LRP performed 1/22/2009 at Moffitt Cancer Center
catheter due out on 2/4/2009


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 2/3/2009 6:37 PM (GMT -6)   
welcome Jbm, like the rest of the members have stated I wish you did not have to be here, but since you are get your monies worth. I too faced the same dilema, I had a uro I loved and trusted and he did not do the DaVinci procedure. For me it was a no brainer and I never second guessed it. I went for the RP and glad I did. The Davinci is a great procedure however I think the relationship and trust factor of your doctor has to be taken into consideration. We support you either way my friend.

peace and love
Dale
My PSA at diagnosis was 16.3
age 46 (current)
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
PSA Dec 16th, 2008 is .06
Testosterone keeps rising, the current number is 156, up from 57 in May
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Tobmeister
Regular Member


Date Joined Jan 2009
Total Posts : 41
   Posted 2/3/2009 6:48 PM (GMT -6)   
jbm,

I will reiterate what I've posted previously in another post. No you do not want to rush in to any decisions. But yes you do want to take action sooner than later as the piece of mind was well worth the fast action to me and in my case the cancer was pretty aggressive so you never know.

But my advice is to find a multi-disciplinary approach large research setting hospital to consult with for a second opinion. The advantage of this is that you will meet with a surgeon (who most probably will have done hundreds of robotics and should be one of the leaders in his field), a radiologist, and a medical oncologist (from my reading you will probably not require his services as they deal with a more advanced case than what you have but for that reason they will give you a more balanced unbiased opinion). The three of them will knock heads and give you a consensus opinion. If Cincinnati doesn't have one I'm pretty sure Ohio State does.

The literature always stresses that it is the surgeon's competence and experience that matters most, not the type of surgery you have.

I also really like my local urologist and he was very helpful and informative but he did not personally do the Da Vinci. Worry about your future health first and the doctors feelings second.

The recovery process with robot is remarkable. In three weeks tops I was back to normal full work week with no tired feelings at all. At one month my scars are just that - scars only.

I talked with a guy the other night who said he didn't want to deal with the incontinence and impotency issues so he is going with the new cyber knife treatment. But I opted for the "gold standard" which I believe has given me some piece of mind that I did what I could do to rid my body of the cancer.

Good luck!

P.S. The dream thing I'm sure is a very common thing - I went thru it and still do sometimes. But the main thing is to face reality and do what needs to be done and get on with your life. We are all in the same boat.
Tom, age 51
Diagnosed 11/12/2008
PSA 2006 - 2.8, 2007 3.06, 2008 4.6 (remember the rate of increase is as important as the level), PSA free 8.7%
Gleason score 7 (4+3); 6 out of 19 cores sampled positive for cancer; perineural invasion present
Bone scan and CT scan both negative
Prostate mildly enlarged, DRE negative
DaVinci radical prostatectomy 12/30/2008 - Duke Medical Center - left side nerves spared
Catheter removed 1/15/09 - no pain!

Post operative results:
Pathologic stage - T3aN0Mx
Post surgery biopsy - Bladder neck margin negative, lymph nodes negative, specimen confined, extracapsular extension positive, perineural invasion positive, seminal vesicle invasion negative, all margins negative, Gleason 3 + 3 = 6.

1st post op PSA scheduled for 4/16/09

"Pick a good doctor and say your prayers"


vs1vs2
Regular Member


Date Joined Dec 2008
Total Posts : 60
   Posted 2/3/2009 11:01 PM (GMT -6)   
JBM - welcome to HW. I had the robotic in Cleveland Clinic by Dr. Kaouk. Cleveland Clinic is ranked # in the US and they do alot. Best wishes as you ponder it all.
Tim
Age at Dx:48, currently 49
PSA May 08 2.96
referred to uro
PSA June 08 3.44
biopsy 7/25/08-29 core samples
path 7/31/08-8 of 29 PCa/10% involved L/R base and mid
high grade PIN in apex/seminal vesicles clear stage GS 3/3=6 pT2a
10/7/08 robotic at Cleveland Clinic-Dr. Kaouk
10/10/08 path GS 3/3=6 pT2c
cancer contained/neg margins
PSA Jan/09 .03


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 2/3/2009 11:16 PM (GMT -6)   
JBM,
You came to the right place to get answers and suggestions. I agree that the experience of the surgeon is more important than the procedure itself. Having said that, if you have two equally qualified surgeons then the Da Vinci is supposed to be less invasive and provides a quicker recovery. I'm scheduled to have the Da Vinci in 5 days in Austin Texas by Dr. Randy Fagin who has done over 1000 surgeries. There are many qualifies Da Vinci doctors all over the country. Do your research and find one near you.
Age: 67
5ft 10 inches 182 lbs
Married. 4 children; 11 grand children
Retired in 2001 and living in Austin TX.
Scheduled for Robotic surgery on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
12 sections tested 2 with cancer
Left Medial Apex 4.0 mm. Gleason score 9 (4+5)
Left Lateral Apex. 2.0 mm Gleason score 8 (4+4)
Negative CT scan and bone scan done on 1/09
PSA 3.5


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 2/4/2009 12:22 AM (GMT -6)   
Old67
Which in my estimation is not old at all.

As you will note by my info below I was a Fagin patient. I was somewhere around #1400 so I am sure by now he has done more than 1500. Regardless of the high number he was sincerely interested and personable in his interaction with me. I just want to encourage you that you are doing the right thing in going to him. You will find the hospital and all associated professional, nice, and under the circumstances an otherwise remarkable efficient predictable experience. Dr. Fagin and these folks genuinely know what they are doing and have found their calling and I continue to be most grateful they are there to help us.

Let us know about things on the other side of surgery.

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


Dirtmover
Regular Member


Date Joined Apr 2008
Total Posts : 158
   Posted 2/4/2009 1:15 PM (GMT -6)   
you will know when you find the right doc ,i did ,and i dont like or trust docs , im a firm beleiver you have to be your own advocate, im thoroghly impressed with the doc that did mine , he is  THE BEST hes done over 2100 proceedures and teaches the divinci to other docs we met other  patients of his when there  whom were from other countries good luck my brother , one more thing ,if i had it to do again ,,,,,,,i wouldnt change a thing.............dirt

Diagnosed November 2007   (43 years old )
PSA 3.9 / Gleason 6 / TC1 6 cores 1 shows 25%
Sugery scheduled 5/29/08 - City of Hope - Dr. Mark Kawachi
 "First show of the day"
 and now for the new ive been waiting for
 FINAL PATH REPORT:gleason upgraded to 3+4 T2c bilateral disease,tumor involvment 5%
extra prostatic extention:absent
seminal vesical invasion :absent
pathological staging:pTNM pT2 ORGAN CONFINED
margins free of carcinoma
usable erections ;6-6-08 with little blue pill
continence; 1 pad a day, dry at night
continence a non issue at 10weeks


strawberry man
Regular Member


Date Joined Dec 2008
Total Posts : 23
   Posted 2/4/2009 2:36 PM (GMT -6)   
Sorry you had to join our club! I went with DaVinci, there are pros and cons of every option.
I am doing fine 8 months after surgery.

take care

Dx 4/21/08 psa 9.7  Age 58 OMG

Biopsy results  3 areas of  3+3=6 gleason

Di Vinci surgery 6/3/08

Post op 3 months and 6 months -  all clear

0 psa TYG  (thank you God)


jbm
New Member


Date Joined Feb 2009
Total Posts : 7
   Posted 2/5/2009 8:15 PM (GMT -6)   

Update!  Visited my uro today for more specific info about my diagnosis.  See my updated profile.

I had pretty much decided that I was going  the Surgery route, not sure which one tho. After talking to the Uro, he told me that with my relatively low grade, TC1, early detection cancer, that seed implant would/ should give me just as good a result as surgery...statistically speaking. He didn't say which procedure he would chose, but it was pretty obvious he thought the seeding would be just as effective and a lot less traumatic, etc.

Any thoughts from you guys? Seeding or surgery?   would especially like to hear from guys that had the seeding done.

Also, I got notice today that the company I retired from a couple of years ago (Delphi) is canceling all salaried retirees health care and life insurance effective 4-1-09.... IF the bankruptcy court allows it.....which it probably will.  Makes a guy wonder why he went to school, worked hard for 35 years, saved his money, etc.   I feel like taking what's left of my retirement account (down 50% last 14 months) and blowing it all and going on welfare / medicaid.

Been a BAAAAAD week for me.  Let me hear from you.



Age: 61
Diagnosed: 1-29-09
Gleason:   6  3+3
Stage:     1Tc  
biopsy: 16 cores    4positive   both lobes affected
PSA:    at biopsy  4.47    up from a 3.6 one year earlier
Prostate size:   20 grams (small)

Post Edited (jbm) : 2/5/2009 6:18:56 PM (GMT-7)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4275
   Posted 2/5/2009 10:31 PM (GMT -6)   

Dear jbm

I'm the token seed guy on this forum, and I'm glad to help with brachytherapy issues and questions if I can.  Shown below in italics is a "copy and paste" from one of my other posts to someone who was considering seeds (I apologize to the regs and vets who have read this before).  At two months out I am VERY happy with my choice.  Actually sometimes I even feel a little guilty reading about all of the problems the surgery guys have with catheters, diapers, surgical recovery, ED, etc. as I've gone about my normal life since right after the procedure.  Having said this, sure I know that there MAY be some issues down the road.  But I also know that the cure rate for my choice, in my case, is as high as for the surgical procedure I did not choose and I'm confident I went the right way...as most of the surgery guys are confident in their choices.

So, it's individual to you and I can't tell you what to do, but am happy to share my journey or answer any questions you may have.  After this post, I'll be off the computer 'til Sunday night, but will come back then to see if you have any follow up.

Good luck.

Tudpock

 

Hi and welcome.  I have observed that most of the guys on this site have elected surgery and you will get plenty of advice from them.  My stats were not far from yours and I looked at all options, narrowed them down to da vinci and brachy, and ultimately chose bracytherapy.  My procedure was recent (8 weeks ago) and, if you are interested, you can check my thread "Tudpock's Brachaytherapy Journey" on this site to see my thought process re my choice -- plus you'll see my post-op situation which is remarkably good, i.e. my life is normal and all equipment is functioning great.

 

Having said that, I wouldn't necessarily recommend seeds for you, I just know it was right for me.  I'm sure you have examined both options carefully and know the stats and SE's backward and forwards so I won't go into those except to say that, with your cancer stats as I read them, the cure rate for both options is basically the same.  There are a few other things to consider, however, that may not necessarily be in all of the books, so I'll throw them in for whatever help they can be:

 

1.  There is a personal psychological issue that only you can answer.  That is, how important is "getting it out" to you?  You'll read a lot of posts on this site from men for whom that was a really big deal.  They wanted the cancer out of their bodies, wanted to see an immediate pathology report and that was that.  For me, that wasn't a big deal at all...the important thing was to do lots of research and make an informed decision as to the right cure and the quality of life issues, then move on.  There are no sure things with either choice...

 

2.  The other issue many men bring up is that "surgery after radiation" is not really a good option but that "radiation after surgery" is possible. That is true (though some docs do surgery after radiation but it is a very difficult procedure).  There are other options after seeds that are available but you should probably assume that surgery is not among them.  If this issue is important to you, then brachy may not be your best choice.

 

3.  The immediate side effects from surgery are well known...and you can read them in spades on this site.  Re brachy, the immediate urinary side effects are generally frequency and urgency and may last a couple of months.  However, IF you don't have much of an issue with this pre-procedure, you probably won't post-procedure.  My urologist gave me a test (can't remember what it is called) that scored me on such things as number of times I had to go urgently now, number of times I get up in the night, weak stream, etc.  My score was low (that's good), meaning that I did not have issues on those functions pre-procedure.  My radiation oncologist and my urologist both predicted that my post-procedure issues would be minor or non-existent with Flomax treatment and, so far, they have been correct.  Now, remember I'm only 8 weeks out, so I may yet have some of these issues but, so far - so good.

 

4.  ED issues occur in brachy patients at a slightly lower rate than in surgery patients -- but there are varying reports on this.  However, the ED with surgery occurs immediately after the surgery and generally gets better (with pills) over time.  The ED with brachy, if it occurs, comes later, i.e. 2 years++.  And, as in the case of urinary effects, if your equipment is working well before the procedure, the chances are better that it will work after the procedure.  Also, if ED does occur, the same little pills that surgery patients take work with brachy patients.  For me, sex started 2 weeks after the seeding, and junior responded well with no pill assistance needed.  I'm looking forward to 2 good years and then, if we need a little help, I'll pop the pills at that time.

 

5.  There are a small % of brachy patients who have bowel issues...but it's a larger % than surgery patients.  Experience of your radiation oncologist is key here as the issues seem to vary with seed placement and dosage.

 

I hope this helps a bit.  It's a BIG decision and I wish you the best.  Please come back and let us know what you decide.

 

Tudpock

 

 


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


AstroNerd
Regular Member


Date Joined Sep 2008
Total Posts : 56
   Posted 2/6/2009 2:04 AM (GMT -6)   
I had a 16 core biopsy and was graded T1a. After surgery they ran it through pathology and it was re-graded to T2c. That's a significant difference in my book...
cheers & beers,
Chris

Diagnosed on 9.23.08, age 47
Gleason 6, T1c
da Vinci LRP performed 1.22.09 at Moffitt Cancer Center by Dr. Pow-Sang
Catheter out on 2.4.09!!!!
Pathology: Gleason 7 (3+4), T2c. Tumor 15%, fully contained, margins clear, lymph clear.

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