WOULD YOU HAVE YOUR PROSTATE REMOVED??

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leeanglo
Regular Member


Date Joined Dec 2010
Total Posts : 191
   Posted 1/12/2011 11:07 AM (GMT -6)   
Good afternoon guys,i need a little help here.I am considering asking my doctor to remove my prostate as i believe that those with advanced pc in nodes and bones seem to do better by removing the tumor.My u doc told me that there was no real point in putting me through a major op when the desease has already got out of the cage but the more i evaluate other peoples life spans after dx the more i am starting to believe that the darn thing is better of in a lab jar than inside my body.I am based in the uk and being treated by our very good national health service but it looks like the USA are supperior in their approach to pc.Do any uk guys know if we have the right to demand the operation to remove a prostate or is it the doctor who gets the last say?.

Galileo
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Date Joined Nov 2008
Total Posts : 697
   Posted 1/12/2011 11:17 AM (GMT -6)   
I'm not in the UK, but I hope you don't mind my comments.
As one who went through prostatectomy and actually came out (in the long run) not so bad in terms of ED and incontinence, if it were me I would not go through the surgery if it had no chance of curing me. I hated the recovery process. Loathed the catheter. The surgery is major, even when done robotically, and has risks, including dying on the table. Although the risk isn't that great for healthy men, it's still there. (There was a guy here, or on CancerForums.net, who coded during surgery and barely survived). The risk of real problems with urinary incontinence cannot be discounted, either. Incontinence can really wreak havoc on quality of life.

I don't think any potential benefit from debulking is worth the risk. Just my two cents.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) Jan-Mar 2007
PSA 9/2007 and thereafter <0.1
pcabefore50.blogspot.com

p_elliott
Regular Member


Date Joined Nov 2010
Total Posts : 143
   Posted 1/12/2011 11:29 AM (GMT -6)   
I'm no expert but the if the doctor say it's not in your best best interest I don't think I would go though with it. You would then have all the problems you have now with the added problems of the side effects of the surgery which you don't want. With probably no health gains. I don't think you have anything to gain and a lot to lose. But talk to some Dr's.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/12/2011 11:30 AM (GMT -6)   
Why have it done for nothing? So, with my lousy stats...I ended up not doing so. I have no regrets and near year 9 now and still doing well thus far, which has exceeded my expectations and some docs predictional forecasting approaches, they were working on eulogies. I went a little differently than likely anyone on this forum, which I had choices to make, one righteous doc Dr. Menon reknown said No surgery for you (only he was not the Soup N_zi type guy-LOL). So went a way different path, even different on using drugs. Does anybody know with certainty which pathway is the best for 'you'...let alone themselves?????

Best to you UK and if it ain't 'bloke' don't fix it.....LOL.....lousy joke???
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

EnglishBob
Regular Member


Date Joined Jan 2011
Total Posts : 126
   Posted 1/12/2011 11:51 AM (GMT -6)   
Hiya, i am in the UK and i too am new in here, i am now 4 weeks post op after prostate removal and i had to apply pressure to get my surgery. The Urologist wanted to monitor me and i insisted on surgery and would not back down so he let me see the surgeon. He too tried to talk me out of surgery so i put this to him ......... Imagine i have just pushed a stick of dynamite up your rectum and lit the fuse and you have no idea if it is a long or short fuse, would you just wait and see.

His comment was, ok lets sort your surgery. It worked for me so maybe you can try it. It is your body, your life and your choices so do not let them over rule you,

Take care, Bob.
Age 58
Prostate problems since early 40s
Ed since early 40s
April 2007 biopsy & all clear
July 2010 prostate swollen more, psa up to 5.6 August 6.7
September Biopsy again
October 7th diagnosed cancer, Gleason grade 6 at 10% mass
December 13th 2010 open radical proctatectomy
Pathology results came back Gleason grade 7 at 12% mass BUT clear margins
Catheter out Jan 5th 2011

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 1/12/2011 11:59 AM (GMT -6)   
Leeanglo -- with all respect to the many caring people on this forum, i would not put much stock in their opinions on a question such as whether debulking surgery for metastatic prostate cancer confers any material benefit. This is not a question for laymen. Indeed, many doctors would not have a well informed view on this question. You really need to talk with an expert on this question. I would discuss it with the best urologists and prostate cancer oncologist you can see. There is some literature dealing with this subject. Here is one short article: http://www.europeanurology.com/article/S0302-2838(06)01579-X/fulltext Best wishes, Medved
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 1/12/2011 12:34 PM (GMT -6)   
How does uro know it has escaped, scan, bone scan, just wondering.

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3745
   Posted 1/12/2011 1:47 PM (GMT -6)   
Rather than surgery consider radiation with both the IMRT and High Dose Brachytherapy. The IMRT can include the area around the gland and lymph nodes. The brachytherapy targets the gland. Strum and other oncologists that specialize in PCa favor killing the cancer at the original sight to lighten the overall load. If you don't, then you have more cancer production to deal with. Surgery would likely find positive margins and require radiation anyway. I suggest you confer with a good radiology oncologist as well as a medical oncologist that specialize in prostate cancer. At this point it is no longer the domain of the urologist-surgeon and you should speak to the other specialists for their treatment opinions.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 1/12/2011 1:57 PM (GMT -6)   
Hi
I'm an English guy, but not resident in UK. My Brother-in-law was diagnosed with PCa that was already outside the gland and they said there was no point in having surgery, but that it was a good idea to reduce the amount of cancer in him, so he had external beam radiation. That was about 6 years ago, he's now 75 and still with us.

Alf

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 1/12/2011 2:26 PM (GMT -6)   
Keep in mind that the surgery itself can kill you.. Then there's the part about picking up a MRSA infection while in the hospital.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7203
   Posted 1/12/2011 2:55 PM (GMT -6)   
As someone said, the opinions of folks in this group has only minimum value.
 
I have read research that seems to imply value in debulking, but I don't remember the source or the details.
 
Maybe it is worth making some telephone calls to some of the top center to see what they think.
 
If it is feasible, call Mayo or MD. Anderson or Sloan Kettering.
 
You need expertise beyond the opinions of those here.
 
Mel

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/12/2011 3:44 PM (GMT -6)   
Montee said:

"How does uro know it has escaped, scan, bone scan, just wondering."

They don't know for a fact where micro mets could lie, in effect it is all best guess, gamble quantitative measurement is the bottom line. No scan exists right now that is definitive enough, no nomogram can predict with complete accuracy for your particular case.

Yeah nobody is an expert and even the experts aren't really 100% experts. Try to get your best assessment and be part of the decision making process is the best idea...only you walk the wallk. I used my own example not for what 'you' would need to choose....but to show people walk many paths in PCa...many paths exist...the no guarantees program is the way it is. It is your next move or let someone else choose it all for you, hope the plan is not:
surgery, srt, ht, chemo....(done)= $500,000 next patient please! That is a common protocol and maybe to common.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 1/12/2011 4:39 PM (GMT -6)   
The reason I asked Leanglo was Harvard Medical at Dana Farber told me mine had escaped, was in seminal ves. and I would have positive margins, no Mets and they would not do surgery, only radiation and HT. Post op path at Emory was no seminal Ves., negative margins and I am >0.05 at 4 years this past Dec. with no further treatment so far. Maybe in the future, but have had 4 years without HT or radiation. I don't regret my decision. I wouldn't dare advise someone to go my route because each case if different. It would help to know his psa and gleason.

leeanglo
Regular Member


Date Joined Dec 2010
Total Posts : 191
   Posted 1/13/2011 3:19 AM (GMT -6)   
Many thanks for your replies gentelmen,very imformative and helpfull in making decisions.The u doc saw mets in my pelvis,spine and 1st & secondry abdominal lymph nodes......T3a n2 m1 gleason 4+3= 7 psa @ dx was 144.Hence his and the radiologist decision to treat with ht (zoladex) only.The radiologist stated that it was dangerous to give radiation treatment in the higher nodes in the abdomen and as this was the furthest point of spread then there was no benefit in treating either the glan or the 1st nodes.They did say that i would be offered radiation treatment for any problems in the spinal area such as bone pain or compression at a time when needed.i believe that hot spots shown on scans( i had isotope & magnetic scan),can reveal areas that are not definetly metasis?can anything other than mets show up in nodes that might look like cancerous activity but could be something else?It seems to me that degree of spread it decided by psa values only, are there any other factors that point to how the desease is progressing if there are no physical signs?
                      Regards Lee..

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/13/2011 7:38 AM (GMT -6)   
leeanglo-UK Dr. Strum mentions in his book, various other tests/markers and further on going testings that can reveal more about progression or what is happening, might be a good reading to check out. (A Primer on PCa-The Empowered Patients Guide)

You are going to likely confront bone issues for possible fracturing or deterioration: look at various drugs like zometa, fosamax, Denosumab, Alendronate, Tormifene maybe you can get some of those over there somehow. The Denosumab, Toremifene and Alendronate look like another new answer for assisting on bone issues if you can get them. Another guy herein had abstract about usinig doxycycline and tetracycline (look into that too). Hope you can do as well as is possible.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

leeanglo
Regular Member


Date Joined Dec 2010
Total Posts : 191
   Posted 1/13/2011 10:37 AM (GMT -6)   
Thank you ZUFUS,doc has suggested that i should have six infusions of zometa after my next psa results and a meeting with him on the 27th jan 2011.
once again many thanks Lee..
p.s i do like the thinking on antibiotics,if it does no good im sure it wont harm......seems like a win win situation to me.
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