2nd opinion- Univ. of Chicago

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wigged-out
Regular Member


Date Joined Dec 2009
Total Posts : 130
   Posted 1/24/2010 3:00 PM (GMT -6)   
Greetings.

My wife and I went for a second opinion with Dr. Gregory Zagaja at Univ. of Chicago Medical Center.

The hospital was a mad-house of activity, and the "suite"/waiting area for the urologist reminded me more of an airline gate than a state of the art medical place.

Maybe just the mood I was in.

We first met with a "fellow" who did the usual question answer stuff, and then a DRE. I sent the wife out for that. DRE concluded prostate enlarged but smooth, no lumps or bumps.

Dr. Zagaja was really a decent guy. He did not really recommend one thing over the other, even though his specialty is robotic surgery, done 1600+ of them.

After reviewing my case, biopsies, etc. his assessment was that though my cancer is in the very low range, I would have a 15-20% chance of dying from Pca in 10 to 15 years. Of coarse this can be translated into a 80-85% chance that I'd still be alive.

In 15 years, I'd be 69 years old. Age works against us in the options. It seems any age.

He suggested that radiation may be a good thing as a back-up in case surgery didn't take, instead of the other way around. At my age, and in the good health that I'm in, he didn't foresee many of the long term complications some have, but offered no guarantees. There will be side affects to anything. Chose your poison, I digress.

And being 54, whatever option I choose, if I chose it reasonably soon, but not rushing, I'd be back to my old self (good or bad) sooner than later.

I am considering AS (active surveillance) for maybe one more biopsy, which would be due next November 2010 (one year from first) or prolong it to May 2011 (18 months), see how the results are and go from there. Somehow I think I'd rather stick my sad p***is in a light socket than to deal with another biopsy, but a guys got to do what a guys gotta do.

And I would absolutely get PSA checked whenever I'm supposed to do that. That's easy. Actually I think I'm due for that in the next month or two.

Radiation scares the crap out of me, but so does surgery. But apparently surgery has a slight edge over radiation as far as cure.
Age: 53- good health, physical anyway. Tinkle alot at night- 4-6x's

DRE 11/08- no lumps, just enlarged prostate

1st PSA, total- 11/08= 6.1

2nd PSA, total- 8/09= 6.6 Referred to Dr. J. Hoeksema @ Rush Univ. Med. Center/Chicago

Needle Biopsy 11/09- 12 samples. 11 OK. Right Lateral Mid- Adenocarcinoma Gleason score 3+3=6 9 involving 5% of specimen. Prescribed Flomax for excessive peeing.
Second opinion scheduled 1/21/10 with Dr. Gregory Zagaja, Univ. of Chicago Med. Center


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/24/2010 3:46 PM (GMT -6)   
Can't tell you what to do, but with what the doctors have told you, and seeing your posted numbers, if appears you could safely do AS for at least a year or more from this point in time. You don't look like you are on an agressive PC path at this point at least.

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% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 1/24/2010 4:17 PM (GMT -6)   
The biggest surprise to me when I discovered I had PCa and was described the options was that surgery after radiation was not an option. I would have guessed the other way around. However, the radiation damages/misshapes the tissue enough that surgery is impossible. You'll hear lots of different opinions about whether surgery or radiation is the better option, but from the perspective of a cure, one thing to keep in mind is that radiation after surgery is an option, not the other way around. Of course, pretty much most of what you would radiate has been removed, so not sure that is a huge advantage. I believe that you are limited to a total amount of radiation in your lifetime, so saving it for later (as a contingency) might also be a benefit.

There are active threads about the whole AS philosophy, and it pretty much comes down to peace of mind and how comfortable you are with waiting and taking the risk. I expect the one thing that everyone will agree on is that YOU need to decide what is best for you. Do your research and deliberation, and then make your decision and don't second-guess your decision afterward.
Peace
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/24/2010 4:55 PM (GMT -6)   
Wigged-out,

I would like to offer two comments:

First, I know several men who had robotic surgery at Univ of Chicago, all with outstanding results. U of C is a teaching hospital where one does get top-of-the-line treatment...although they don't treat you with fresh baked cookies in the waiting area, which I've heard described as one of the very positive attributes of Loma Linda...but I digress.

Second, when I read you comment, "I am considering AS (active surveillance) for maybe one more biopsy...", please do keep the "ACTIVE" part in mind. Without changing your diet, exercise, and other lifestyle changes, you would merely be "passively" waiting for you next biopsy...without any real expectation that things would improve. One can't go into it (AS) without a substantial internal commitment to change...otherwise you would be merely "watchful waiting" which is NOT the same thing as AS.

I wish you well...

wigged-out
Regular Member


Date Joined Dec 2009
Total Posts : 130
   Posted 1/24/2010 6:01 PM (GMT -6)   
Thanks for your comments.

And Casey59,

Your surveillance really hit home. Currently I do 40 minutes on treadmill, 4mph at an incline of 5 degrees. I also walk one mile during my lunch when I can and weather permitting.

Diet? Well, I'm certain I'd be dead by now if I hadn't met my wonderful wife over a decade and a half ago. Yes, she is the voice of reason in our relationship, I the artist, and curmudgeon who makes things that don't go with peoples couches or entertainment centers.

Basically, I'm always aware of what goes in the upper end of my body, and I know what I should (and will) be doing.

Both of us know what we have to do. We just have to do more of it.
Age: 54- good health, physical anyway. Tinkle alot at night- 4-6x's

DRE 11/08- no lumps, just enlarged prostate

1st PSA, total- 11/08= 6.1

2nd PSA, total- 8/09= 6.6 Referred to Dr. J. Hoeksema @ Rush Univ. Med. Center/Chicago

Needle Biopsy 11/09- 12 samples. 11 OK. Right Lateral Mid- Adenocarcinoma Gleason score 3+3=6 9 involving 5% of specimen. Prescribed Flomax for excessive peeing.
Second opinion scheduled 1/21/10 with Dr. Gregory Zagaja, Univ. of Chicago Med. Center


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 1/24/2010 6:26 PM (GMT -6)   
As you can see I am a surgery guy, but my younger brother did AS starting at age 50. At 55 his biopsy was a 6+6 and he chose seeds. Now at 60 he reports PSA at 0.0 and that "Viagra is great" P.S. he also lives in the Chicago area.

This is not to tell you what to do, but to say that you have options. There seem to be very few members here who advocate recreational biopsies. Remember that a biopsy can be done under greater sedation -- so if this is worrying you, talk to your doctor.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day

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