Welcome to the site.
Dr Strum who write "The primer on Prostate cancer" is fond of saying that you need to fully understand your status before working out your treatment strategy. Questions like "Is my cancer really 4+4?" and "What is the likelihood that the cancer is still in my prostate?" will help define your status and this in turn will help work out what the strategy should be.
Can I suggest that the very first thing you do is get an expert to review your biopsy slides. All pathologists are not equal. There are probably a handful in the US that are experts - Bostwick Laboratories and also Epstein are two of the experts. It is possible that your cancer is either more serious or less serious than you and your doctor think and this is the way to know is to get an expert to review your slides. If you are in Australia then Dr Cohen from Western Australia or Dr Delprado from Sydney are also two such experts.
There are a variety of tools such as the Partin tables or the MSK nomograms (google msk nomograms) that would help you work out what the chance is that the cancer is organ confined. If there is a low percent chance of the cancer being in the prostate a radical prostetectomy may not be a good idea - seeds or other treatments may have a better chance of success. The reason I say this is that a radical prostetectomy is not minor surgery, it has many potential side effects like incontinance or erectile dysfunction so you really do not want to do it unless you are confident it has a good chance of fixing the problem.
Also, given your high risk 4+4 cancer, I would definately get a second opinion (and maybe a third) from experienced urologists, and also an oncologist. If you continue with the surgery route it worries me that your surgeon has done only 150 Da Vincis - this is just about
the most complicated surgeries there is and surgeons hit their stride when they do about
500. If you cannot find a surgeon who has done 500 Da Vincis it probably is better to go for an
open procedure with someone who has done more than 500
open procedures. You don't really want a surgeon with training wheels on for a surgery that could leave you incontinent. If you are concerned about
the nerve sparing issue, bring it up with the second and third urologists - now is the time to ask.
Rescheduling your surgery until you have answers to some of these questions could be a good idea. You only have one shot at this very complicated surgery and there are many examples of people on this forum for whom the surgery did not go well due to inexperienced surgeons and hasty decisions made about treatment paths without a good understanding of their status.
All the best, I am sure this is a very scary time for you and if you continue to visit this site you will find many people to support you through whatever decisions you decide to make.
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01
Post Edited (An38) : 1/16/2011 3:13:11 AM (GMT-7)