Prostate cnacer treatment options

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Brasil
New Member


Date Joined Jul 2009
Total Posts : 4
   Posted 7/14/2009 7:35 PM (GMT -6)   
I would be most grateful for any insights on robotic surgery as an option.  I was just diagnosed with cancer.  Though the PSA was 2.47 (only), the Gleason score was 3+4, and it is T2a, and moderately aggressive.
 
I am talking to Dr Ash Tewari at Cornell and Dr Vip Patel in Florida.
 
Any advice?
 

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2009 7:57 PM (GMT -6)   
You are talking to two of the best out there. Tewari and Patel are very well known and we have had many of their patients come through here. Before any advice, How old are you? In your biopsy how much was positive for cancer?

Welcome to HealingWell. This is a great site for support for anyone around the world. If I am reading you screen name to mean anything, you are from the very deep South...lol. Stay with us and we are glad to have you here...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 7/14/2009 7:57 PM (GMT -6)   
Brasil,
Welcome to healingwell, sorry you have to be here.  Ask away, you will find a lot of help here. 
Everyone's cancer is different and eveyone's treatment has different successes and side effects. Please keep reading as much as you can.  The best thing you can do is to make an informed decision.  Consider getting another opinion from another treatment plan. One item that keeps recurring is that whatever treatment you decide on to get the best experienced doc available. 
 
It was davinci for me and I am happy with my decision.  The final pathology was a higher grade and more involved than the biopsy showed. 
 
Get yourself in as good of physical shape as you can before any treatment.  It will help in the recovery stage. 
I know the mental state is difficult to keep on track right now. Don't panic! You do need to be thinking clearly right now.  Do you have someone close that can help you in this part of your journey? 
Whatever your decision is, I wish you only the best and a future of 0 psa.
Dan
PSA 01/07 1.2, PSA 01/08 1.9, PSA 01/09 2.5
BIOPSY 02/24/09  PCa DX age 52
Right: 3+3=6, 3/6 cores 10% involved,PNI-Y
Left:  3+3=6, 1/7 cores <5% involved,PNI-N
LARP 04/09/09 nerve sparing. Final pathology:
GS 3+4=7, Margins uninvolved, 2 lymph nodes negative
Catheter out 04/17,1st no-pad day 05/03
25 mg Viagra nightly;100 mg:not ready for prime time
Followup PSA 05/28/09 <0.1
 
 


Brasil
New Member


Date Joined Jul 2009
Total Posts : 4
   Posted 7/14/2009 8:35 PM (GMT -6)   
Thank you Tony, and thank you for the welcome. I already feel warmly welcomed.

I am 59 years. The clinical stage is T2a, 7 cores positive 7 cores negative out of the 14 core biopsies.

Thank you again.

TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 7/14/2009 9:16 PM (GMT -6)   

Brasil,

The first thing that you must do is get informed about the options. Go to the book store and buy one of several good books about PCa and treatment options. You will find your situation (statistically speaking) and what the professionals say about treatment options, risks, and benefits. Then you will be an informed decision maker. Refer to some of the sources available at the top of the welcome screen, I used the book written by Johns-Hopkins surgeon Dr. Patrick Walsh which is good and there are others.

best wishes,

Ted


Background:
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.
Stats:
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/14/2009 9:31 PM (GMT -6)   
Brasil,

You are getting good advice here. Don't forget to look at the links at the top of this forum. The internet is a marvelous resource.

You have 2 or 3 major options, external beam radiation, brachytherapy, and surgery. Actually you have fourth with your realtively low PSA and moderate Gleason score, qnd that is waiting to see how fast and agressive your cancer is.

Most of us on this forum chose our option after some research, and went with that treatment. Some on this forum felt they were told by their doctor what they should do, and have never felt good about the choice, becausee it wasn't theirs.

Whatever you choose, it is you who has to live with the side effects, and results. My advice is to make sure it is your decision, and then never look back. Incontinence and Erectile Disfunction are major side effects of surgery immediately. They may also occur later after radiation. Be sure you understand what that really means. Inability to hold your urine in, wearing pads, etc. is a shock to some. They thought maybe they would dribble or drip. Not having sex with your partner is a fairly major thing for men.

There are solutions for almost every problem however, but it won't be the same as it was most likely.

Good luck to you, and stay on this forum. You will learn a lot, and can help others as well.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 7/14/2009 9:31 PM (GMT -6)   
Brasil,
1st, welcome to the site. A gleason 6 with a 2.9 psa doesn't sound like a moderately agressive cancer, but more like a low grade cancer. Is there something the doctor's told you that makes them believe it's agressive? Do you have a nodule that can be felt by a DRE?
Getting a 2nd opinion and educatating yourself is the best thing you can do right now before making any decision. You have gobs of time.
The Prostate Cancer Research Institute's recommended treatment for a G6, psa less than 10 and no nodule is "no immediate Treatment". go to their web site and you can get alot of info on treatment options and the best way to make a decision.
To get the best results:
Know the biology of your individual cancer.
Choose the treatment that best fits your biology.
Pick the best expert in that treatment.
Most patients fail to go through the first two steps.
Good luck, get informed and get 2nd opinions.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 7/14/2009 9:34 PM (GMT -6)   
Brasil,
Sorry, I mis read your post. A G7 is moderatly agressive and needs to be treated. There are still a lot of treatment options available and surgery is a good choice.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2009 10:18 PM (GMT -6)   
You are welcome, Brasil,
At your age with half your cores positive, plus the 3+4=7, I would think you are on the right track. I have seen many guys do very well with these numbers, so as my motto says ~ stay positive!. A good positive attitude goes a long way in the cancer world. So does good medicine, and for you there are many options. I chose surgery with half my core positive and a Gleason 7, and even though we found that my cancer had already begun to move around, I am doing very well. Again, stay with us, and I am sure you can gain a lot from this great group of people.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/14/2009 10:23 PM (GMT -6)   
Brasil,

Can't answer you about the robotic part, as my operation was an open one. But many here have had them with great sucess. The method isn't as important as the skill and experience of your surgeon. I think most would agree with that statement.

Since you are a Gleason 7 now, and there is always an outside chance it could be upgraded after surgery when they have more to look at, I feel that surgery would be your best shot at a primary treatment.

Sorry you need to be here, but glad to have you among us. Please keep us posted.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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 capsule, one post. margin, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, they want to start radiation, 70 gray, I am still considering all options and opinions
 
 


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 7/14/2009 10:37 PM (GMT -6)   
Brasil, I'll provide insight on the da vinci robot as you requested. That said, all of the comments and advice above are good. Learn as much as you can about the options available to you. There are no do-overs on this. One more thing I think everyone will agree on is to work with the most experienced doctor you can.

If you search the internet, you can find good information about prostatectomy using the da vinci robot. My experience was close to those descriptions. My surgery was at about 7:00 am. By about 8:00 pm that evening, I was able to walk the halls of the hospital while holding on to my wife. I sat in a chair for about 30 minutes after my walk then returned to bed. I felt like I was very bloated. Enough so that I was very uncomfortable. I did not get relief for about 48 hours. I was discharged from the hospital about 36 hours after the surgery. The ride home was difficult. I felt like my wife hit every bump and hole she could. Pain was not bad. I did not need pain medication to control pain. I began to walk around the house the next day and then walked outside by the second day home. Third day home I walked about 1/2 mile. I continued to walk more each day. I had a cath for six days. It was a blessing to get rid of the cath. I have an office job. I took 4 weeks off work but could have returned after two weeks. I don't know what else to say, so I'll stop before I begin to ramble.
Age 51
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
Mild ED. Levitra works well for me
Post Op PSA 0.00


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/14/2009 11:51 PM (GMT -6)   
Hey Brasil,

Sorry for the reason you're here, but welcome!

You do have some time to weigh your treatment options.

Since you asked, I will tell you that I had robotic surgery here in Boise, Idaho. I was fortunate that my surgeon had performed many successful procedures with the equipment.

Robotic surgery is really guided by the surgeon (not a computer) and allows the surgeon to see great detail through electronic lenses in a laparasocopic (low invasive) surgery. There should be links to videos of the procedure in the "frozen" Prostate Cancer Forum topics above. If not, let us know and we'll send you links.

Personally, my robotic surgery was a piece of cake. It was much easier than my two hernia surgeries. I could not believe how well I felt the afternoon of surgery day. I went home 36 hours after surgery.

Results and pain will vary from person to person, but I was happy with the procedure.

Having said all this, surgery in any form does not guarantee specific survival results. Yet surgery will provide you with definitive pathology regarding your cancer. This is because the entire prostate and some surrounding tissue is removed and thoroughly examined. You'll know exactly what kind of cancer you had, the statistical probability of the cancer escaping the prostate, and how much cancer (volume) that you're dealing with. With Nomograms that are available on the Internet, you'll be able use the pathology information to predict your survival rate post surgery.

Now... surgery is not for everyone and there are other good options, including various forms of radiation and hormone therapy. I am no expert in any of these things and even less knowledgeable about all the radiation therapies. Other members will chime in on your request.

Keep as cool as possible as you weigh your various treatment options. The folks on this forum are here to lend support as you get advice from various health care professionals.

I wish you the best,

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1

Post Edited (IdahoSurvivor) : 7/14/2009 10:54:04 PM (GMT-6)


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/15/2009 1:01 AM (GMT -6)   
Hi Brasil, it's never fun to see a new member show up as I remember how stressed I was when I first got 'the call.' But, I agree with all the others above who say this is a great supportive spot.

My numbers (3 plus 4 in the most pessimistic read) and PSA, 1.5, are not too different from your situation, although at 67 I have a couple of years on you.

15 days ago I danced with daVinci and I couldn't be more pleased. I looked at other options and chose surgery for all the pathology reasons Barry sets out so well above. Good, or bad, I wanted to know exactly where I stood so I could deal with it. My nature isn't of the watch and wait type. My surgeon said he had two sets of patients who always wanted the surgery to get the pathology: businessmen and engineers. I'm a businessman, although with the way the economy is beating us up these days I sometimes wonder.

I chose the daVinci route because A) it had outcomes as good as open surgery with a much easier recovery, providing the guy flying the robot is experienced. and B) I was accepted by a surgeon who had 500 laparoscopic prostatectomies plus near 200 daVinci ones under his belt before I lay down on his table. I went for surgery totally calm, and convinced I was doing the right thing, the right way, in the right place, with the right OR team. Getting to that mind set wasn't easy. Learning about PCa wasn't what I wanted to do, and I was an emotional basket case as I worked my way through all the options. I was lucky to have a friend who is a GP doctor who helped. Not by telling me what to do but for an hour or two on the phone night after night challenging my thinking, making me ask myself the tough questions about what I really wanted, and challenging the information I had which led me to go back, and back again, to the various practitioners of the PCa options to ask further questions, to seek further clairifications. The eight weeks were far far worse than the surgery, but well worth the mental agony.

I was discharged by my doctor 30 hours after I arrived at the hospital. He was pleased with himself as he said he didn't think I'd lost but an ounce of blood in the whole surgery. That means I wasn't anemic when I was rolled out of the OR suite and was up walking up and down the ward that afternoon. The next morning, after a shower, I went down to the hospital cafeteria for coffee with my wife.

It's not all a bed of roses. The rubber tail for 10 days (otherwise known as a catheter) wasn't great, but it wasn't a big deal either, and I was able to sleep the night through without heading to the bathroom for the first time in years! And, now that it's gone, I find the whole pad business a bit of getting used to. But, bottom line, I've had only a fraction of the pain and discomfort I expected to have and I can go out and walk a mile a couple of times a day, have dinner out with friends, which I did this evening, and hit the shopping centers, which I did the day after I was discharged.

I wish you well, and I hope this helps,

Sleepless (it's 1 a.m. CDST) AKA Sheldon
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good  


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/15/2009 8:14 AM (GMT -6)   
Hey chas,

For those leakage problems, I wonder if you ever had pelvic floor therapy?

One year post-surgery, I obtained a referral from my doc to a physical therapist who employed bio-feedback for pelvic floor training and the results were very good. The therapy is essentially a 30 to 90 day patient specific training for gradually bringing you into shape by doing Kegels the right way for you. And no, the standard literature on Kegels won't help. The literature tells you to do either too few or too many Kegels and you don't know how they're really affecting your specific situation when you perform them.

Using the bio-feedback sensor, a trained therapist can assess where you are in your current pelvic floor strength and know fairly accurately how to bring you up to the point you need to be to keep you there. The problem therapists see is that most men don't have the patience for it, while women do. The men that stick with the training program and continue the minor post-therapy exercises have good results.

After you get your pelvic floor in shape, there are supplemental medications that can help as well. I was prescribed "Vesicare" (you can see it advertised on TV), but there are several others that help with patient-specific needs.

This may be of help.

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 7/15/2009 2:32 PM (GMT -6)   
As with many here, I had DiVinci Robotic from a very experienced surgeon. The surgery experience itself was relatively easy, and the healing process fairly quick. Continence took some time, and even after a year I have some minor occasional dribble. ED is a reality, and the alternatives, pills, pumps, and shots work to a lesser degree than before and are inconvenient.

All that being said, I wanted the cancer out of me (hoping it would all be removed), and feeling like I took the best possible long-term approach. I cannot say I have wondered if my long term ED would have been better if I had gone radiation, but I believe I would have had greater anxiousness about cancer return had I not had it removed. That was the #1 goal. So - I would still do the same thing again. I hope you find comfort in your decision.

RB
Age 62
Original data - pre-operation PSA: 5.2, T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 3+4 in 1 core (40%), 7 cores Gleason 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) 5/19/2008, Post operative pathology - pT2c NX MX
Gleason 3+4, Margins - negative, Extraprostatic extension - negative,
seminal vesicle invasion - uninvolved.   PSA's 7/12/2008, 10/30/2008, 4/03/2009, 7/6/2009 - all undetectable 

 


Brasil
New Member


Date Joined Jul 2009
Total Posts : 4
   Posted 7/16/2009 6:22 AM (GMT -6)   
Thanks for this wonderful group of people who share their thoughts and support so freely!

I had a nagging thought. I have been taking propecia (finasterida) 1 mg for 7 years for hair loss (it worked). Could this have brought about my problem or hidden it? I read that this could suppress PSA readings. And even cause an aggressive form of the disease, although it is also used by some in higher dose (5 mg) to prevent the disease...

Brasil

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/16/2009 8:35 AM (GMT -6)   
Studies have shown that Finestaride can actually delay the onset of prostate cancer. But there has been some debate that when prostate cancer occurs while on it, that it is more aggressive when it occurs. Not study has been complete to prove it is the case, but discussions exist. As far as suppressing the PSA that to is in the investigational stage, but it isn't looking like there will be mech support for it.

For now it's water under the bridge, and a moot point. I think we all have looked back in our lives to see what we could have done wrong that gave us this cancer. I really don't spend much time with such thoughts. Instead, there is plenty of living ahead...That is a much better thought...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 7/16/2009 8:36 AM (GMT -6)   
My advice:  Good care starts with a good primary physician . . . from whom you should receive situation management, referrals to varied competent specialists, etc.  I underwent the da Vinci procedure 10 months ago and believe it was the right choice for me.  But I'm not you and we don't share the same medical history.  If you ultimately select the da Vinci procedure don't be swayed too far when chosing a surgeon by a large number of procedures undertake by that person.  Some minimal number of surgeries is wise to look for, though.  But as I started with, if you don't already have a good primary care physician get one and work through the options with him/her.  Best wishes for a good end-result.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0

 


Brasil
New Member


Date Joined Jul 2009
Total Posts : 4
   Posted 7/16/2009 8:12 PM (GMT -6)   
Thank you all wonderful people, wish I could advise you on something! Brasil

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/16/2009 9:26 PM (GMT -6)   
Brasil,
All the folks here do is share their stories. When you do that for someone who needs it, it's a true blessing...:-)

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/16/2009 9:34 PM (GMT -6)   
On surgeon experience, see:

http://www.ncbi.nlm.nih.gov/pubmed/19342300?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Numbers aren't everything--some surgeons don't learn from their mistakes. But a tyro will have more problems than an old hand.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 0.006


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 7/16/2009 9:39 PM (GMT -6)   
Brasil,  Stay with us on this forum and you will have plenty of opportunity to advise
someone.  You will have your own unique perspective on your treatment plan.  Whatever your journey is, I wish you the best.
Dan

Dirtmover
Regular Member


Date Joined Apr 2008
Total Posts : 158
   Posted 7/17/2009 1:31 PM (GMT -6)   
BRAZIL YOUR IN THE RIGHT PLACE , I STRONGLY AM AN ADVOCATE OF ROBOTIC , IF YOUR A YOUNG GUY ITS EVEN MORE IMPORTANT , YOUR SPEAKING TO TWO HIGHLY COMPETENT SURGEONS , IF YOU CHOOSE SURGERY AT LEAST YOU KNOW WHAT YOU HAVE  WHEN ALL IS SAID AND DONE , MY OPINION ONLY , FOR ME THE BIOPSY WAS WORSE THAN THE SURGERY , SO THREYA  GO . I WISH YOU WELL AND HOPE YOU STAY WITH US IN HOPES WE CAN ANSWER YOUR EVERY QUESTION ,   ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,DIRT   cool
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
 1 year p.s.a. undetectable


ttrapski
New Member


Date Joined Jul 2009
Total Posts : 16
   Posted 7/18/2009 10:31 AM (GMT -6)   
Hello all,

I , like Brasil have just been diagnosed and am struggling to make the right decision on treatment options. Although I am leaning towards surgery The DaVinci Robotic technique is not available in Kelowna B.C. Canada , so it is old school with the 8" incision and longer recovery time . I enjoy reading the posts and the encouraging words. Hang in there Brasil !!!

ttrapski

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/18/2009 10:44 AM (GMT -6)   
ttrapski,

Having an open isn't so bad, I had one, several others here have as well. It's more important that the surgeon you use is very experienced, that is far more important than the method. Some surgeons feel an advantage with an open surgery, since they can feel with their fingertips what is going on inside. In the old days, an open surgery was a major bleeding risk procedure, nowadays, it's not as much an issue. They had 3 units of blood on the side in case it was needed on mine, and none was needed, zero. And my surgery turned complicated, and still no bleeding issues.

Both methods are invasive, and both are major adombial surgeries, and both require time to heal properly, more than the surgeons like to advertise.

If you have access to a good open surgeon in your neck of the wood, he/she should be able to do a good job for you. I could have come home in 2 days after my open, but insurance paid for 4, and my dr. and I decided not to rush things, so I stayed the entire 4.

Just my take.

David in S. Carolina
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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 capsule, one post. margin, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, they want to start radiation, 70 gray, I am still considering all options and opinions
 
 

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