Oncologists who use color doplar imaging

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tuley
New Member


Date Joined Oct 2010
Total Posts : 2
   Posted 10/8/2010 5:26 PM (GMT -6)   
 
 
   Hi ; I am new to this site and am looking for an oncologist in the Chicago land
  area who use color doplar imaging and TIPs. 
 
  I have just read "invasion of the Prostate snatchers" which I highly recomend.
  I also believe that it is rare that surgery is the best solution to prostate cancer.
 
  Any help in this regard would be very much appreciated.
 
  isg
 
  
 

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 10/8/2010 5:37 PM (GMT -6)   
hello isg:

- every man and every diagnosis is different and I feel it is quite severe for you to say that " ... it is rare that surgery is the best solution to prostate cancer."
- depending on the stats of the person involved ( PSA, free PSA, gleason level, etc) , there are several treatment options - from AS, radiation treatment, and different forms of surgery.
- it is prudent to find out what is the best treatment option, the best hospital and the best doctor ....

- do you know your stats - and what forms of diagnosis have you gone through.

- from what I have heard about the book mentioned - it is one man's journey and not definitively the be-all and end-all of treatment for prostate cancer.

-see previous topic posting ( just bumped it) NEW BOOK - INVASION OF THE PROSTATE SNATCHERS -

-wishing you all the best.
BRONSON

Post Edited (tatt2man) : 10/8/2010 4:55:18 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/8/2010 7:14 PM (GMT -6)   
while that is a new book, and an intersesting read, its not a definitive work on PC. If you haven't, I would highly reccomend you read the classic Surviving Prostate Cancer by Dr. Walsh, Yes, he's a surgeon, buts it is still considered a primer on most things PC.

i agree with bronson above, you are being way too generalized in your remark about a surgical solution.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 10/8/2010 7:34 PM (GMT -6)   
Hello Tuley and welcome to this forum.  I think you will find it full of good information and mostly well meaning folks who will help and support you any way they can.
 
You will also find that most of the guys and gals here are surgery people so don't be surprised at some negative reaction to your comment about surgery...especially from someone just arriving.  The surgery vs. radiation/other treatment debate is an ongoing one here and you might find it interesting to scroll back thru some of the previous discussions on the subject.  In any case, though, you are certainly entitled to your opinion on the subject.
 
I also think "Invasion of the Prostate Snatchers" is an excellent book and I now recommend it along with the more traditional Walsh and Strum books on PCa.  Together I think they provide the reader with a pretty full view of the subject.
 
Pleae keep coming back and let us know some more specifics and how you progress in your decision making.
 
Sorry I can't answer you question re Chicago docs but hopefully someone else can.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643

tuley
New Member


Date Joined Oct 2010
Total Posts : 2
   Posted 10/8/2010 8:38 PM (GMT -6)   
Hi thank you for your quick comments.

Bronson
1. Please read the book before you make any comments.
2. If one has surgery and is not incontinent or impotent this choice was the right one.

David
My next book to read will be Dr Walsh's "Surviving prostate cancer"
I didn't mean to offend anyone who has had surgery and no one book is the answer
to such a difficult choice one has to make

My past experience with 2 urologists was surgery without clearly spelling all of the alternatives
Jim
Thanks for your response after further research I was seriouly looking into seeding
though my sample was small I was able to talk to several people who had seeding,surgery and external beam radiation

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 10/8/2010 9:00 PM (GMT -6)   
Tuley,
the best color doppler Dr in your area is Dr Fred Lee in Rochester MI. It will be well worth the travel to see the "best of the best".
I agree with you that in most cases surgery should not be the 1st option, but there are cases where it should be considered as the 1st option.
1. When there is a high grade large tumor that is confirmed by scans to be fully contained.
2. when the patient has previous urinary issues.
3. When a patient is very young and has a confirmed contained tumor.
4. When a patient has recieved radiation for another cancer.
5. When a patient has an overriding psychological necessity "to get it out now"
6. To be used as a debluking procedure for confirmed advanced PC.
In most other cases radiation will result in similar cure rates with less side affects.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 10/8/2010 9:09 PM (GMT -6)   
tuley - surgery was the right choice for me - it got rid of my stage 3a - gleason 7 cancer - I have had two post op PSA's of 0.05 - my doctor and I are very pleased - my quality of life is great - I AM ALIVE - having issues with incontinence and ED are not the key thing in my life -
- I made the right choice for me -
I hope you get the information you need to make the right choice for you.

-re: reading the book - go to the link on HW that I bumped for you for cross-referencing - and see what others who have read the book think of it -

all the best

BRONSON
Age: 55 -gay with spouse, Steve - live in Peteborough, Ontario, Canada
PSA: 10/06/2009 - 3.86
Biopsy: 10/16/2009- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/2009
Pathology: pT3a- gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
Post Surgery-PSA: April 8, 2010 - 0.05 -I am in the ZERO CLUB
Sept 23, 2010 -0.05 - again -hoorah !

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 10/9/2010 6:22 AM (GMT -6)   
Hi Welcome Tuley,
To make it easier to find the thread if the Bump goes missing the thread is at:
www.healingwell.com/community/default.aspx?f=35&m=1891532
and the link mentioned in that thread is:
well.blogs.nytimes.com/2010/08/30/a-rush-to-operating-rooms-that-alters-mens-lives/?src=me&ref=health

As for how you treat PCa, well I think that all we can be 100% certain about is that there is not a Perfect solution.
I chose surgery, and what matters is that it was the option that looked like it would deliver what I wanted. Yes I have a few unwelcome side-effects etc and my QOL has been affected, but I am getting on with life the way it is.

And, in passing, Dana Jennings blog at the NYTimes was the first thing I read online when I started searching for info about PCa.

The gist of the problem/dilemma we face seems to be that only one in seven cases of PCa are really nasty cancers, but the medical profession has yet to work out a way of telling you if you're one of the "lucky" six.

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 10/9/2010 7:35 AM (GMT -6)   
Tuley........I second JohnTs opinion to travel to see Dr Lee,my husband saw him this summer and as JT says hes the best of the best...........Good Luck, Cooper

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 10/9/2010 3:30 PM (GMT -6)   
I considered all options and chose surgery. It turned out to be a good choice for me, so far. Joined the Zero-Club first PSA test, no complications or side effects (continence + potency) and cured all my prior ills: getting up two, three times at night, very slow urination (several min each time), etc. Many of the people at this forum also has good outcome from surgery.
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Negative margins; Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason grade 4. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 full continent partial potency. Sept PSA: <.1

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 10/9/2010 3:57 PM (GMT -6)   
Yes. I had similar stats and outcome to Newporter, except that I had open surgery, and I am now 16 months out. Never had incontinence, ED is mild and is going away. Urinary obstruction preop totally resolved from the beginning. PSA continues to be <0.04.

I would never advocate surgery for all in this situation, but I'm personally happy I had it. Surgery is very tricky business, but the prostate is also a nasty little piece of horseflesh. For those of us that managed to get it out with everything more or less still functioning, well, whew! glad I had that done!

I agree with most of John T's list. However, I wouldn't say that radiation has similar cure rates, I would phrase it that there is no definitive proof that surgery has a better cure rate than surgery. A number of studies show better survival with surgery, but they aren't randomized and controlled and so can be questioned.

Also, I'm not sure that I agree that radiation has fewer side effects than surgery in the long run. That's certainly true for studies that compare surgery and radiation 3 years after the procedure. However, I've talked to a number of guys that have developed urinary dribbling and ED, 5 or 10 years after radiation. So, it's not entirely clear in my mind if surgery is really worse, or if its just that with surgery you take a hit early on, with some chance of recovery, and with radiation the hit is later, gradual, and slowly progressive. Who knows? The final chapter hasn't been written on that.

The biggest issue in all of this is age. The value of surgery in people over 70 appears to be limited. Controlled trials of surgery for moderate prostate cancer shows no improvement in survival in people over 65 with surgery compared to watchful waiting. On the other hand, if you are in your 40s, there is a lot more time for a slow growing tumor to get you, and getting the most definitive treatment for the cancer is most important.

Jazzman1
Veteran Member


Date Joined Sep 2010
Total Posts : 1160
   Posted 10/9/2010 4:05 PM (GMT -6)   
While I think that saying "it is rare that surgery is the best solution to prostate cancer" is an extreme statement, I also think that any man who doesn't carefully weigh all his treatment options isn't approaching this prudently.

Avoiding all the short term side effects of treatment is important, but so is avoiding long-term side effects. However, those considerations take a distant second place to curing the cancer whenever possible. The main goal is to address the cancer as effectively as possible.

In my view, there are too many possible permutations on one's condition and too many treatment options for quick and easy answers. When new members make blanket statements that exclude mainstream treatment options out of hand, people become somewhat alarmed. Don't take it personally; we all kind of try to look out for one another.

Post Edited (Jazzman1) : 10/9/2010 3:08:28 PM (GMT-6)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 10/9/2010 8:22 PM (GMT -6)   
Postop's backhanded criticism of radiation is misleading.  He mentions that some studies show surgery with better cure rates than radiation.  What he fails to mention is that some studies show radiation with better cure rates than surgery.  The fact that he did get right is that there have been no randomized and controlled studies that show an advantage to either.  But, based on a reading of many, many studies I think it is fair to conclude that JohnT's comment is accurate.
 
Secondly, irrespective of Postop's anecdotal evidence, there are long term studies that exist showing the side effects of radiation as a primary treatment.  The conclusion of these studies is fairly clear....lower incidence of urinary side effects and a lower % of ED.
 
Of course all opinions are welcome here but when you throw out non-fact=based opinions don't be surprised when you are challenged.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 10/9/2010 9:16 PM (GMT -6)   
Didn't mean to be misleading. The facts have their limitations and I wanted to point that out. I wasn't criticizing radiation therapy as a treatment, my criticism is for the evidence for deciding whether radiation or surgery is better. It's full of holes. Swiss cheese.

I looked a little more and found a 6 year study on later effects of radiation. This shows some deterioration in sexual and urinary function after brachytherapy, but that overall quality of life wasn't affected:

http://www.ncbi.nlm.nih.gov/pubmed/20097486
Int J Radiat Oncol Biol Phys. 2010 Mar 15;76(4):1054-60. Epub 2010 Jan 25.
Health-related quality of life up to six years after (125)I brachytherapy for early-stage prostate cancer.
Roeloffzen EM, Lips IM, van Gellekom MP, van Roermund J, Frank SJ, Battermann JJ, van Vulpen M.

There is evidence for existence of urinary and erectile problems years after radiation; what I couldn't find are long term studies comparing surgery and radiation urinary and erectile problems years after treatment. There is a real good study doing this comparison for the first 24 months after surgery (you can get the whole article free on line):

http://www.nejm.org/doi/full/10.1056/NEJMoa074311
N Engl J Med. 2008 Mar 20;358(12):1250-61.
Quality of life and satisfaction with outcome among prostate-cancer survivors.
Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT.

There is no question that radiation has fewer side effects that surgery, short term. I couldn't find good long term studies. If you can find a study that shows a lower LONG TERM incidence of urinary and ED side effects with radiation, well, bring it on...

As for effectiveness for cancer control, there was a thread about this some time ago. There are some studies that show better outcomes for surgery:

http://archinte.ama-assn.org/cgi/content/abstract/167/18/1944
Short- and Long-term Mortality With Localized Prostate Cancer
Arnaud Merglen, MD; Franz Schmidlin, MD; Gerald Fioretta, BSc; Helena M. Verkooijen, MD, PhD; Elisabetta Rapiti, MD, MPH; Roberto Zanetti, MD; Raymond Miralbell, MD; Christine Bouchardy, MD, MPH
Arch Intern Med. 2007;167(18):1944-1950.

This one is a Swiss study. These studies have limitations, but this one is a large population based study. You can get the whole article for free at that website. If you know of similar studies showing that radiation has a better outcome that surgery, well, er, bring it on...

It's human nature to think that we absolutely made the best decision about treatment. I chose surgery, but I'm actually not sure that I made the best choice. I think the evidence guiding treatment choices is really c****y. Prostate cancer and the effects of treatment roll out slowly over the years, and it's incredibly difficult and time consuming to do definitive clinical trials to get level 1 evidence (another thread from several weeks ago).

The reality is that no one really knows whether radiation or surgery is better. That's not backhanded.

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 10/9/2010 11:29 PM (GMT -6)   
Sorry, that was a lot to lay down in a post. I totally understand why many people choose radiation over surgery. I get frustrated because when you try to investigate which treatment to get, there are so many poor studies in the medical literature, and so many unanswered questions. It seems that if you are letting someone cut open your belly, or shoot rads up your butt, there should be better answers to some of these questions. I tend to come out of the woodwork when I think someone's overstated the case for a particular treatment. Time to go back into the woodwork.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 10/10/2010 2:15 PM (GMT -6)   
Postop,
I have to agree with your conclusion that the studies are all over the map and that they are all retrospective and not controlled. There is a wide variation of cure rates depending on institutions ect.
I do think that the vast majority of studies have showed that radiation does in general have fewer short and long term side affects than surgery. This is it's biggest advantage over surgery. Both techniques have improved over the last 10 years, but the improvements in radiation have far out shadowed the improvements in surgery, especially when it comes to side affects. The latest studies indicate that the effects of the newer radiations peak within about two years and that effects beyond this are rare.
The older ERBT did cause longer term affects. As accurracy improved, side affects diminished.
Since most men treated with radiation are in their 60s or 70s one would expect some deteriation of sexual and urinary functions as a normal course of aging. The major issue with radiation is a 2% incidence of bowel issues that can be very severe, and does not occurr with brachy. The incidence of incontinence is very rare. ED rates are lower and respond better to meds than ED resulting from surgery. One thing I have recently learned is that patients that have a tendency to scar easily have a high probability of strictures when undergoing surgery. I'm on several radiation sites and the rate of posts regarding side affects doesn't come close to the discussions of surgical side affects on this site. 50% of all posts on this forum relate to postop problems. This too is unscientific, but indicates that something is going on that can't be ignored.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 10/11/2010 11:39 PM (GMT -6)   
There is no such thing as one size fits all in prostate cancer treatment and we all lived with our own choices. The benefit of this forum is it allows us to share our experiences and biases, good or bad, so those that follows our footsteps can learn from us and select their own treatment options.

For the surgery option, what I learned here was that the outcome, especially side effects depended very much on the skill of the "artist" (surgeon), it paid to find the best.
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Negative margins; Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason grade 4. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 full continent partial potency. Sept PSA: <.1
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