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Ger42
Regular Member


Date Joined Apr 2010
Total Posts : 189
   Posted 7/3/2010 9:03 AM (GMT -6)   
Wife and I met with a urologist (doc B) yesterday. I saw him 2 weeks ago on referral from my neighbor who is a doctor. The original urologist (doc A) who did my biopsy was hell bent on surgery and did not want to talk about any alternatives. When I told my neighbor doctor he suggested I go see his friend (doc B). On my initial visit with doc B he was heavily in favor of surgery. He knows my doc A very well but he set me up with a radiologist so I could see if radiation was something I would want to pursue. Met with the radiologist the day after my visit with doc B.
Wife and talked about all the options after yesterdays visit with doc B. My wife had met doc A on and earlier visit after yesterdays meeting with doc B she said she felt better with doc B.
Looking at scheduling robotic surgery for middle of Sept. The only question now is which doc has the most experience. Doc A practices out a hospital less than 10 minutes away and my have done more procedures but doc B who is attached to a hospital further away has been doing robotic surgery 2 years longer.
Doc B says he has been doing 6-8 surgeries a month for 7 years doc A has been doing them for 5 years and doc B thinks doc A has done more in 5 years than he has in 7.
I guess I need to visit with doc A one more time. I think skills are more important than bedside manner. Doc A doesn't know I've been seeing doc B but he did know I was going to get a second opinion. Doc B said if I went with Doc A since he was closer he would understand.
Too many decisions.
I am in south Florida the 2 doctors are Kahn out of Plantation and Masel out of Hollywood. If anyone has had any experience with either one I'd love to hear about it.
Age 68 on 4/30/2010
weight 185
height 6'
Samples taken 4/19/2010
3 out of 12 samples cancer
1) gleason score 3+3 involving 65%
2) gleason score 3+3 involving 65%
3) gleason score 3+3 involving 10%

PSA 3.5 Mar 19
PSA 2.5 Apr 4

Bone scan clean
CT scan clean


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 7/3/2010 9:55 AM (GMT -6)   
This may not help but......

The information you have is quantity of RALP surgeries which of course is very important but I would try and find a prostate cancer support group in your area (should be some in S. Florida) and see if you can get opinions of men who have used the surgeons you are considering. I had three recommendations (two from patients and one from the open surgeon I consulted with-who all recommended the same surgeon). In a nutshell, having two very very satisfied patients make the recommendation for the same surgeon went a long way in helping me make my decision--which I am very very happy with now.

Also, did you get a recommendation from your primary physician?

Good luck!

It is a tough choice, but you seem to be lucky to be able to choose between two qualified surgeons.

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 7/3/2010 10:07 AM (GMT -6)   
I think Dan is correct, you are lucky to be able to choose between two qualified surgeons. I wish you the best and a lifetime of zeros.

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
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 
 
  


Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 7/3/2010 11:43 AM (GMT -6)   
I wish you well with your decision to have surgery but am curious as to why you chose that over radiation or AS?  Your cancer seems early stage with several options available that would promise successful outcomes.  Did the radiologist discuss some of the newer techniques such as IMRT or Cyberknife?  Did you look at proton radiation?  HiFU?  Just interested in the factors that swayed your decision toward surgery when you seem to be somewhat anxious about the experience level of your surgeons. 
 
Best wishes for success.
============================
Age:  59
Dx:  March 2010
PSA @ Dx:  4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason:  3+3=6 (confirmed by second pathologist)
Biopsy:  1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
DRE: Normal
Stage:  T1c
Bone scan and chest x-rays:  Negative
Prostate Volume: 47 cc
PSA Velocity:  0.19 ng/ml/yr
PSA Density:  0.092 ng/ml/ccm
PSA Doubling Time:  > 10 Years
Treatment Decision:  Will have Cyberknife in June 2010
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/3/2010 12:29 PM (GMT -6)   
Sounds like either surgeon would be a good choice, if you choose surgery. It's not just about how many surgeries are done by the dr, its also about the quality of the surgeries themselves, and the doctor's record with quality of life side effects. Sheer number along shouldn't be a deciding factor.

With your stats, you still should have sufficient time to really decide what method you want to go with. What advice and methodlocy did the radiation people tell you? How would they handle you if you chose them for primary treatment? Would seem like you would have a good shot at "seeding" with your stats, and that it would be much less invasive for you.

Keep doing your home work, as there is no re-play button once you undergo your primary treatment.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/3/2010 12:37 PM (GMT -6)   
Ger42,

It seems you have a choice between good and good surgeons; a nice choice to have. Like David in SC said, you do have some time to interview some more health care professionals.

Your low concentration of cancer and good Gleason scores make you a fine candidate for surgery and targeted radiation therapy.

From your path report and scans, there is a good chance that the tumor is localized such a skilled surgeon will take all of it.

Wishing you the best on your choice!

Kind regards,

Barry
Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/'07 <0.04; 12/'07 <0.04; 03/'08 <0.04;
06/'08 <0.04; 12/'08 <0.04; 06/'09 =0.06; 09/'09 <0.04; 12/'09 =0.05;
3/'10 <0.04; Latest PSA 6/'10 <0.01


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 7/3/2010 1:00 PM (GMT -6)   

Ger, sounds like you are very interested in surgery.  However, given that you are in South Florida, I would suggest you high-tail it across the state to Sarasota to the Dattoli Cancer Institute.  They will do color doppler staging and give you a highly experienced and professional opinion about the benefits of seeding and/or radiation.  Please take the time to make an educated decision.

Sincerely,

Tudpock (Jim)


Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Ger42
Regular Member


Date Joined Apr 2010
Total Posts : 189
   Posted 7/3/2010 1:22 PM (GMT -6)   
Thanks for all the advise. I ruled out Proton because of the impact on our daly life. Wife works and we have two good sized dogs. Proton would mean I'd be away 4-5 nights a weeks for 8+ weeks. I felt that was too much to ask of my wife who is suffering from Crohn's. The Dattoli center is about 3 hours away that would mean 6 hr drive each day or 2-3 nights away from home each week for 6-8 weeks and then later a few more weeks. The radiologist I saw used the latest equipment with 44 treatments 5 per week.

I just feel getting it out now is less risky that having it treated and the possibility of the cancer not being eliminated.

I will look for a local support group and get some input on local doctors.
My GP sent me to Doc A, they went to medical school together.
This is from the radiologist web site"
"Hollywood Radiation Oncology is proud to announce the availability of Image Guided Radiation Therapy (IGRT) for patient treatment. This new system uses an advanced and highly precise stereotactic radiotherapy (SRT) technology called ExacTrac X-Ray 6D. It enables patients to be treated with a significantly reduced risk of radiation exposure to uninvolved surrounding healthy tissue.Hollywood Radiation Oncology is the first facility in South East Florida to have this state-of-the-art technology."
Age 68 on 4/30/2010
weight 185
height 6'
Samples taken 4/19/2010
3 out of 12 samples cancer
1) gleason score 3+3 involving 65%
2) gleason score 3+3 involving 65%
3) gleason score 3+3 involving 10%

PSA 3.5 Mar 19
PSA 2.5 Apr 4

Bone scan clean
CT scan clean


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/3/2010 5:56 PM (GMT -6)   
Everyone just wants it out and over with and put in jar and forgotten about. PCa doesn't listen all that well and isn't as simplistic as we are lead to believe. Hope it all goes very well for you and that cure becomes your four letter word :-) when talking about PCa. You will be looking very closely at psa tests, especially in the first year or so as a patient (or should be). It gets easier on you if the numbers stay in the safe range...that is the good news. So, I will end it on good news. All avenues of PCa are represented herein as to what could, can, might happen...be it good or not.
Youth is wasted on the Young-(W.C. Fields)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/3/2010 6:46 PM (GMT -6)   
zufus, but as you know, i know and many others know, just getting it out doesn't always end the curse of the PC, not if one's surgery fails, and/if you develop lingering side effects (my case as an example). i tell people to choose wisely, and really think it through.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 7/3/2010 7:01 PM (GMT -6)   
Ger, since you seem intent on "getting it out" this will be my last unsolicited commentary unless you ask me something specific.  Without knowing your prostate size and all of the details of your case I can't know whether brachytherapy alone would be a good choice for you.  But with the stats you have shown it looks like it might be. 
 
With brachytherapy the visits you are concerned with are minimized dramatically.  Basically you see the doc for analysis/discussion, you have a "volume study" that take an hour or so and is done out-patient, you have the procedure itself which takes less than half a day and is also out-patient.  Then you return in a couple of weeks for a scan for seed placement assurance.
 
There are long term (15+ year) studies that show brachytherapy to be as effective in curing PCa as is surgery.
 
That's the end of my sales pitch except to say if you were my brother or best friend I would advise:
1.  Get your pathology re-read by an expert, e.g. Bostwick or Epstein.
2.  Get color doppler staging.
3.  Carefully read the experiences of the surgery patients on HW so that you know what you are getting yourself into.
4.  Strongly consider brachytherapy for the best balance between cure and low side effects.
 
Tudpock (Jim)
Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

MOM48
New Member


Date Joined Mar 2010
Total Posts : 7
   Posted 7/4/2010 4:24 PM (GMT -6)   
YOU may want to look into Dr. Vipul Patel at Celebration FL - his facility is extremely experienced (3000 or so) and very efficient. They also take many insurances. This was 2 hours from our home, but was chosen for the very experienced robotic team. It was a good choice because the prostaste was over 100 grams, Gleason 7, and I am completely dry at 6 months! This is their speciality and I would recommend them since it is the mid Florida location.
Prostatitis x 2 years with treatment PSA 1.1
8/09 PSA jump to 3.1 biopsy returned with 2 cores positive Pca
12/09 Divinci Dr. Vipul Patel Celebration,FL
100 gm prostate, Gleason 3+4, neg. margins, one side nerves spared
2/09 PSA <.01 One pad a day just in case!
3/09 Leak free and pad free, ED


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3889
   Posted 7/4/2010 4:50 PM (GMT -6)   
Ger42, For what it's worth, I think you are making the right choice..Your Gleason 6, PSA 3.5 cancer puts you in the 80%-90% full cure group. RLRP surgery expertly done is a far cry from the open surgery of just a few years ago.

My own case, PSA 14, Gleason 9 puts me in a different category but I'm still favoring surgery even though future radiation treatments are a high likelihood for me.
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..

Post Edited (Fairwind) : 7/4/2010 5:43:57 PM (GMT-6)


JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 7/4/2010 8:02 PM (GMT -6)   
Ger42,
 
I would like to add my recommendation to Tudpock's that you explore BT before you make a final decision. With a Gleason 6, you are a good candidate for an option that has comparable success rates to surgery with fewer side effects.
 
Whatever you decide,  you will get a lot of support on HW. Best wishes on your journey.
 
Joe

Age -67 PSA - 4.5

Biopsy  (9/4/09) - Positive in 5 of 8 cores. In those 5 cores, 5 of 11 samples were positive. Gleason 3+3=6. Stage – T1C  Ct and Bone scans negative.

 

BT performed on 12/11/09. 84 seeds of Palladium 103. Surgery at 7:30 - Home at 12:30 same day with no catheter. Blood in urine for a week. Side effects as expected -  some burning, frequency, urgency.   Resumed daily  1 ½ mile walk after 3 days. 

 

BT followed with 25 IGRT treatments beginning Feb 15 (4500 Gy's). After third week, experienced some fatigue. Now 2 months from last rad treatment - energy level has returned. Burning gone and urgency is much improved.

 

First post treatment PSA (6/1/10) - 0.1

 


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7082
   Posted 7/4/2010 8:47 PM (GMT -6)   
Ger42,

I was not a valid subject for seeds (7 of 12 biopsy cores at 4+4; 2 at 3+4), but age & stats considered, if I had yours, seeds would have been my choice.

David has a good point - taking the prostate out is not always a perfect solution - I required post-DaVinci IGRT to cover what had escaped.

If only I had found it earlier - I don't regret my treatment choice or my selection of doctors, just my timing - years too late for a PSA -

rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 7/5/2010 9:40 AM (GMT -6)   
It is good that you talked to an oncologist as well as the surgeon. I consulted with both and chose surgery. I am not saying it was the best solution but it was the best solution for me.
 
Age 48 at diagnosis
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue

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