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NewspaperLover
Regular Member


Date Joined Sep 2009
Total Posts : 311
   Posted 9/27/2009 1:46 PM (GMT -6)   
Got the pathology this week; two of 13 snips positive for adenocarcinoma; two other snips suspicious and "consistent" with cancer.  Gleasons were 3/4 = 7; and 4/3 = 7.  Surgery recommended as only real option.  I have appointments with two surgeons the week of October 4th.  In our upstate New York area, one surgeon is probably the leading experienced doctor for radical open prostatectomy.  He works out of our teaching medical center and has done this surgery in the thousands for 20 + years.  A friend had surgery with this doctor 12 years ago (at age 48) and my friend is still here. 
 
The second surgeon is the most expereinced practitioner in the area with the DaVinci -- but that means probably on the order of 300 - 400 surgeries completed as that has only been done around here for a few years. 
 
All my sorces of inormation indicate that both surgeons are highly competent within their technicque sets, so I am wondering if any data are available regarding the relative efficacy and short term outcomes of the two approaches?  In the immediate term I am most concerened about: margins and continence.  Lymph either is or isn't. 
 
Thanks for any input.  Best to all...  NewsPaper Lover

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/27/2009 2:31 PM (GMT -6)   
Welcome to the club, officially. You definitely have PC, the 2 of 13 cores is better, but both are noted as Gleason 7. Who told you surgery was the only option? And yes, I am an open surgery guy. Some might feel it would be worth at least talking to a radiation oncologist to see if RT might be a good fit for you. Being a Gleason 7 myself, sitting around watching it get worse wouldn't have been an option for me.

Perhaps if you could post some of your other stats, it might help to understand your situation a bit better. I.E. staging, psa history, psa velocity, prostate size, family history, etc.

Good luck as you seek the best solution for you.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, mapping on 9/21/9, 9/24 - mtg & procedure? with uro/surg, IMRT starts 10/5/9


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 9/27/2009 5:00 PM (GMT -6)   
Daivd hit it right on the head.

If you have seen my posts, you know I just completed my surgery 10 days ago. That makes me a newbie here, experienced, but newbie still the same.

Take a little time, take a deep breath and research the hell out your options.

All of us make our decisions on which way to go when we have talked to Dr.s from the different disciplines. We reason it out and consult with our loved ones and move forward with confidence and comfort in our decisions.

It's not a race for you from what I see from your info. Be thorough. Search it out and you will know when you find the right fit for you.

Good luck in your search down this muddy path. We will keep you and your family in our prayers,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 9/27/2009 5:30 PM (GMT -6)   

Good evening,

Look at the resources available for studying various treatments. There are many good books describing almost every treatment options. You cannot really decide w/o studying and there are many variables to consider.

I studied Patrick Walsh's book which was very helpful.

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....
 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 9/27/2009 7:08 PM (GMT -6)   
Hi NewspaperLover. As I started my career, in the world of making money as a reporter, (even managed to write once for Time Magazine) I love your alias.

Sorry to hear you've been confirmed as a member of this club. While you may well decide on surgery, be assured it is not your only reasonable option, at least best I can tell from the stats you've given, and remember us former reporters don't necessarily get our facts right. That said, you do have some reading and research ahead of you. In the end you'll find you've got trade offs that only you can decide on.

The guys and gals here are a fantastic resource. Don't hesitate to ask.

Sheldon AKA Sleepless
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
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 9/28/2009 9:41 PM (GMT -6)   

Hi NewspaperLover,

Research your treatment options, decide on your treatment, have the treatment, move forward with your life.  Decide your treatment based on what is best for you and do it with a doc that you are both confident in and comfortable with. 

Many posts here speak of the need for lots of experience.  At my followup visit last month I was a bit surprised to hear that my Uro has now done 40 - 50 DaVincis.  That would put me at around #25 or so if he does 1 per week.  I was completely trusting of him  and am satisfied with the results.  I believe that he had the skill necessary for a successful surgery.  Or, maybe I just got lucky with the way everything happened.   

Best wishes for a successful treatment for you,

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, 08/20/09 <0.1
 
 


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 9/29/2009 3:58 PM (GMT -6)   

Greetings, Newspaperlover.  First thing I would say is to agree with my brothers here.  Do your research and make sure you choose the treatment option that is right for you.  There are lots of options and they all have their place.  You have to choose what is right for you.  You are going through that process just by asking the questions you are. 

Now for your specific questions.  I'll tell you what my surgeon said.  He is in probably the largest group of urologists in our area.  They have a very good reputation and docs with lots of experience.  My doc came highly recommended and I was very impressed with him from the start.  He only does open surgery and does lots and lots of them.  He began his practice here in 1985 after a one year fellowship at the Mayo Clinic.  He does 3 surgery's on Monday and 3 on Wednesday most weeks.  That is somewhere around 250 surgeries a year.  He does other surgery besides prostatectomies but most are prostate surgeries.  My doc says that robotic surgery is the wave of the future.  In fact, at some point he may switch over.  But for now he does open and thinks it is the better choice for many men.  He likes to get in and both look and feel around.  He believes you can do a better job of sparing the nerves with the open.  The day will come when nearly all prostatectomies will be done with the robot, but not quite yet.  He did say that if I decided I wanted robotic he could not disagree with me and he would refer me to one of his partners who does robotic.  I had great confidence in him and decided to let him do the open.  I have had great results so far - go back for my 90 day PSA on Thursday and then the next one will be 2 years post surgery and we plan to move to every 6 months instead of every 90 days. 

Please let me know if I can provide more details or further informatin.  Best wishes on your treatment.  David
Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


NewspaperLover
Regular Member


Date Joined Sep 2009
Total Posts : 311
   Posted 9/29/2009 6:54 PM (GMT -6)   
Thanks for the detailed and thoughtful replies.  Have a consult with the surgeon tomorrow  -- decision time getting close.  Thanks...
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