Gleason 8 Decision Time - DaVinci vs. Radiation + Hormones

DaVinci or Radiation + Hormone Injections
14
DaVinci - 73.7%
5
Radiation + Hormone Injections - 26.3%

 
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JoeBear
New Member


Date Joined Jan 2011
Total Posts : 5
   Posted 1/26/2011 4:12 PM (GMT -6)   
62 Years old
PSA 3.6
Stage T2a
Positive Biopsy Cores 4
Negative Biospy Cores 8
Gleason 8
Pathology -
Benign, Pin3, Benign, Benign
Positive 8 (4+4), Positive 8 (4+4), Benign, Benign
Positive 8 (4+4), Positive 8 (4+4), Benign, Benign
 
Options presented -
 
Radiation + Hormone injections (3 years)
or
DaVinci Radical Prostatectomy
 
Not sure which is the optimal path to go down?
 
Any ideas, thoughts, experiences would truly be appreciated.
 
Thank you in advance.
 

cupcake25
Regular Member


Date Joined Jan 2011
Total Posts : 24
   Posted 1/26/2011 4:35 PM (GMT -6)   
It sounds to me like you would be a good candidate for devinci prosatectomy. Did you have a cat scan of your pelvis and a bone scan to rule out the spread of cancer? My husband just had devinci 2 weeks ago with a gleason 3+3 6 and had clear margins when we got his path report.Just find yourself a good doctor who has done alot of them. Good luck to you.

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 1/26/2011 4:56 PM (GMT -6)   
JoeBear,

- CT Scan and Bone Scan are usually done after biopsy to verify that it hasn't spread. PSA indicates that it probably hasn't, but they usually run these test just to be sure.

- Surgery will tell you definitively if it was contained within the prostate and if microscopically it has spread and to what extent. With this information you can then make an informed decision based on the pathology if any additional therapy is needed (radiation, hormone). (As a G8, you might want to know this info.) The flip side is that surgery, even robotic, is involved and requires weeks of recovery if not months for incontinence issues.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

Post Edited (Jerry L.) : 1/26/2011 2:59:45 PM (GMT-7)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7082
   Posted 1/26/2011 5:00 PM (GMT -6)   
I did DaVinci first, then based on the path report, did IGRT (no HT).
 
Biopsy was 7 cores @ 4+4, 2 @ 4+3, 3 clear. First PSA was 7.4.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3987
   Posted 1/26/2011 5:50 PM (GMT -6)   
honestly, i would (did) go with a combined treatment.
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

mycroft
Regular Member


Date Joined Oct 2010
Total Posts : 54
   Posted 1/26/2011 6:24 PM (GMT -6)   
JoeBear said...
62 Years old

PSA 3.6

Stage T2a

Positive Biopsy Cores 4

Negative Biospy Cores 8

Gleason 8

Pathology -

Benign, Pin3, Benign, Benign

Positive 8 (4+4), Positive 8 (4+4), Benign, Benign

Positive 8 (4+4), Positive 8 (4+4), Benign, Benign

Options presented -

Radiation + Hormone injections (3 years)

or

DaVinci Radical Prostatectomy

Not sure which is the optimal path to go down?

Any ideas, thoughts, experiences would truly be appreciated.


Here is what Stephen B. Strum, MD, one of the best of the best among oncologists, has to say:

“Because the Gleason score is such a critical piece of information, I would want to have an expert pathology opinion. This should be obtained from a prostate cancer pathology expert."

Here is a list:

Bostwick Laboratories [800] 214-6628
Dianon Laboratories [800] 328-2666 (select 5 for client services)
Jon Epstein (Johns Hopkins) [410] 955-5043 or [410] 955-2162
Jon Oppenheimer (Tennessee) [800] 881-0470
Scott Lucia (303)724-3470

In civilized jurisdictions, those specimens are the property of the patient and not the medic nor the neighborhood lab. Sometimes it is necessary to educate them on that point.

It is well to bear in mind that upgrading of cancer status after prostatectomy is not at all infrequent. Your score, 4+4, is IMO high-risk (note that the first score could cover anyting from 50% to 90% of the tissue).

Prostatectomy is a gamble as to likelihood of cure. Reason: with such advanced Gleason scores, there is an excellent chance, again IMO, that the cancer has escaped the gland.

You are on the cusp of making a life decision. Please educate yourself and do not permit anyone, including a medic, to panic you into a decision.

I recommend consulting a real cancer expert, a medical oncologist; preferably one who is experienced in treatment of prostate cancer.

I heartily recommend this comprehensive text on PCa: _A Primer on Prostate Cancer_ 2nd ed., subtitled "The Empowered Patient's Guide" by medical oncologist and PCa specialist Stephen B. Strum, MD and PCa warrior Donna Pogliano. It is available from the PCRI* website and the like, as well as Amazon (30+ five-star reviews), Barnes & Noble, and bookstores. A lifesaver, as I very well know.

Objective, encyclopedic and reliable information is available on the website of the Prostate Cancer Research Institute (PCRI) at: http://www.prostate-cancer.org/pcricms/

Regards,

Steve J
Dx 2004 at 67 yoa: Extensive Gleason 9 + Gleason 8.

Uro wanted to do cryotherapy, which I would have declined had I known anything. It failed, except I was rendered totally impotent; the only thing that worked as advertised.

IMRT + Lupron.

Studied PCa extensively.

Fired rad onc, who refused to read Dr. Strum's evaluation of my case.

Hired med onc. Have been on IADT since 2006.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3889
   Posted 1/26/2011 7:52 PM (GMT -6)   
Here is how I looked at it...The surgery might CURE you, thus avoiding the radiation and worse, chemical castration...

But, BUT.....Should you choose surgery and the pathology comes back with some unexpected negative factors, you are going to do radiation and hormones anyway, so speaking with perfect 20-20 hindsight, there is a good chance the surgery will turn out to be a waste of time, as it was in my case, with a history a little worse than yours...

The latest thinking is in high-risk cases, doing all three results in the best outcomes...

But you will never know how your surgery will turn out unless you have the surgery...But don't kid yourself. Gleason 8-9-10 are a whole different ballgame than Gleason 6 men face....
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

JoeBear
New Member


Date Joined Jan 2011
Total Posts : 5
   Posted 1/26/2011 8:01 PM (GMT -6)   
CT & Chest X-Ray were done today. (1/26/11)
Bone Scan is scheduled for Friday. (1/28/11)

All responses are extremely important to me. And I want to thank each one of you who have responded so far. Please don't hesitate to provide additional information if something comes to mind.

I am going to The Urology Center of Colorado.
I have seen a Urologist and have had the needle biposy.
I had a consultation with an Oncology Radiologist today (1/26/11).

I have scheduled a consultation with a surgeon at this center next week, Wednesday (2/2/11).

I will have CT Scan, Chest X-Ray & Bone Scan feedback some time next week.

No one at this center is trying to influence my decision of what path to take, i.e. DaVinci Prostatectomy or Radiation + Hormone. They are making it my decision. To date, I'm leaning towards Radiation + Hormone even though the hormone therapy is a 3 year journey. I'm concerned about doing the Prostatectomy and then having to also do the Radiation + Hormone following that.

I wish it were an easy clear cut decision and I feel unqualified to know what is the right decision. But, if I have to decide, I will. Your feedback has been more helpful than you know and I hope I get more.

rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 1/26/2011 8:22 PM (GMT -6)   
I was a Gleason 7 at biopsy and chose surgery. Gleason was upgraded to Gleason 8 after surgery. I chose surgery because I felt it was the right thing 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

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 1/26/2011 8:41 PM (GMT -6)   
Joe,
As Fairwind mentioned Surgery may not cure you. You can up your odds by getting a color doppler ultrasound or an MRIS to image the extent of the cancer, its location and if it has escaped the capsul. Most surgical failures are do to conditions that good imaging may detect BEFORE going through a radical procedure that may not cure you.
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.

Fairwind
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Date Joined Jul 2010
Total Posts : 3889
   Posted 1/26/2011 10:33 PM (GMT -6)   
Bear, I too began my journey at TUCC. I still have my HT done there..

While their treatment did not cure me, they never said it would, always encouraged me to get second opinions and were always very careful and professional. Their best surgeon Dr. M.J. operated on me, he is a davinci expert and I don't fault him for the failure of my surgery..I presented him with a pretty tough case. Dr. R.W, their radiation oncologist, is no slouch either and I would have been happy having him treat me except TUCC does not have up to date equipment in my opinion. I found a more aggressive doctor with access to a state-of-the-art machine and I chose that path...Should you decide on surgery, I would try to avoid Swedish hospital. As a complication of my surgery, I suffered through a hospital acquired staph infection, abscessed lymphocetes, back in the hospital for 6 days,
abdominal drain for a month, not fun..The surgery left me 100% continent and 100% impotent even though the nerves were spared..

In Denver, what disappointed me a little. there are no really good brachytherapy doctors, at least I could not find any..Nobody at TUCC does it..I feel that the combined IMRT / Brachy treatment has a lot to offer, especially for us high-risk guys..In any case, I was not a candidate because my prostate was too large...If your insurance will cover treatment at the CU Medical Center at Anschutz, that's another option to investigate..At least for a second opinion...

Always keep in mind that fighting cancer is BIG BUSINESS and doctors and hospitals (treatment centers) will try very hard to secure YOUR business..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 1/26/2011 10:52 PM (GMT -6)   
My 2 cents worth...
 
I was a Gleason 8 who chose davinci surgery.  It so far, has been a success.  I have not required any follow up treatment. 
 
Avoid follow up radiation and hormone treatment if at all possible.  Avoid hormone treatment as an initial treatment unless your cancer has advanced to that level.
 
Simply put, if surgery looks like it will work then do that first. 
PSA July 2006 4.7 , Nodule found
biopsy 10/06 very agressive gleason4+4=8 identified
DaVinci surgery, January 2007
Post Ob confirms, gleason 4+4=8 with no extension or invasion
no long term continence problems
post surgery PSA continues to be undetectable at 4 years
ED problems continue, using bimix
born 1941

fulltlt
Regular Member


Date Joined Nov 2010
Total Posts : 264
   Posted 1/27/2011 12:08 AM (GMT -6)   
Welcome JoeBear,

All good replies.

The only thing I would add is find a support group and attend it.

Good luck.
age 57 2/2010
PSA Feb 8.2
biopsy 2/2010 - 2 of 8 left & 2 of 8 right positive, Gleason 3+4=7
attended support group - advised to get a second opinion
second opinion on pathology from Johns Hopkins 4+4=8
PSA 15 4/2010
5 weeks IMRT 4/2010-6/2010 at Copley Hospital in Aurora, IL
91 palladium 103 seeds 7/2010 at Chicago Prostate Center, Westmont, IL
PSA Oct 3.97, Dec 2.78
no ED or incontinence

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 1/27/2011 12:31 AM (GMT -6)   
I'm hesitant to encourage anyone to go a certain way but I'll outline my thinking and post up a full sig so you can get an idea of where I was coming from. I'm a fellow G-8 with Tertiary 5 by the way.

My Dr explained that while she hoped I was a T-2 she strongly suspected due to the lag in diagnosis that I'd be T-3. She explained all treatment options and encouraged me to talk to other surgeons and a radiation oncologist. After doing a lot of research I opted for her to do an open RP, there are no robots near by and by researching her online I felt comfortable she and her partner from Denver could do a good job.

Our plan was to de-bulk the tumor at a minimum with an eye to a cure and do followup radiation if necessary, she estimated a 20% chance of a "cure" from surgery. So far at a 11 months out I'm a happy camper, undetectable PSA and good recovery. Hormones for her are a last result.

The skill of the surgeon/radiation tech is key to any treatment, do your homework and don't be rushed into anything. From what I've seen success rates and side effects are all over the map with all treatments. Take your time and find a treatment and a doctor that you are comfortable with.
Best of luck to you
Dave in Durango CO

___________________________________________________

Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04....... 06-07-10 PSA <0.04..... 08-03-10 <0.04...... 10-26-10 <0.04...... 1-25-11 <0.04
05-03-10 1 week without pads
06-28-10 Success!!

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 1/27/2011 3:58 AM (GMT -6)   
I was a Gleason 9 before RRP, later downgraded to Gleason 8. Surgically I had a good outcome, apparently organ confined and negative margins. No incontinence, but ED of course.

My PSA remained undetectable for almost a year, but now is on a steady upwards march. Doctors have ruled out radiation (the horse has bolted) so ADT is in my future, at a point to be decided.

Knowing what I know now, would I do the same again? Probably yes. The Radiation/HT option was never offered to me, but if it had been, I would have been faced with the same difficult decision you have now.

All you can do is weigh up the probability of a cure for each option and contrast with the side-effects as they will affect you. It's a personal choice for us all -- good luck with whatever you decide.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but now 0.4, doubling time 7 months
No radiation but ADT coming unless I can slow down the rise...

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/27/2011 11:19 AM (GMT -6)   
Zufus- the Gorilla in the room (you might not like hearing the total truth)

Jerry L. (not picking on you, but showing why you might want to slightly change your wording to be more precise in correctness, not because I know more than you..but because of the real facts about PCa) You mentioned above:

- Surgery will tell you definitively if it was contained within the prostate and if microscopically it has spread and to what extent-

That is not totally truthful and I can support that premise and so can John T and some others. Fact on our forum we have some patients whom have all clear margins and clear everything from their doctors diagnosis post surgery....and yet some have BCR or failed to be cured (clear does guarantee clear in PCa). Thus they cannot tell you with total definity your outcome, many docs have egg on their faces for things they said or promised. The failed patients are out there whom can tell you this directly, also and after the facts.
 
 Fact, scannings are in effect wasteful and lack big time as to how definitive they are...and do not pickup on 'micro mets' (coined term by Dr. Barken et al)...John T could elaborate to the 10 th degree on scannings and even went to Holland to get Combidex which is the only scan that found PCa that his righteous Dr. Scholz knew existed (his other numerous docs all said it wasn't PCa), and was missed by biopsies, and tons of various USA scans. We could quote Dr. Strum, Scholz, Barken and others...I think you see the point.

Question everything in PCa maybe you will see more than might want to.
 
Hey I didn't vote, it was against my religion (lol), best to you in choosing and don't limit yourself to two choices so early. cool

Post Edited (zufus) : 1/27/2011 9:44:07 AM (GMT-7)


BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 1/27/2011 12:01 PM (GMT -6)   
Joe, my stats were very similar to your, except that at biopsy I was given a G7 (3+4). My PSA was 3.4. Based on this I had surgery. Pathology report indicated sucessful surgery with tumor contained within the prostate and no evidence that any PCa escaped. Only problem was that gleason was upgraded to G8.

One year after surgery I had a BCR, and have since had SRT and HT, I am currently 8 months into 1 year of ADT3. Hindsight is 20-20. I often wonder if I should have gone the Brach, IMRT and HT route. I know some men that have been successful with that treatment, but also some with successful surgery.

I don't have an answer for you. It is a difficult question with no clear answers. I agree that you need to get all the information that you can on your desease, but unfortunately with a G8 time is of the I believe that time is of the essense.

Best of luck. BB
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 1/27/2011 6:30 PM (GMT -6)   
Zufus,

How about this?:

- Surgery will tell you more information about containment and if it hasn't been contained to the prostate - to what degree it may have spread.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3987
   Posted 1/27/2011 6:37 PM (GMT -6)   
Jerry -- pathology after surgery is of course more accurate than biopsies and scans but zufus' point is the cancer could have spread even if there is no sign that it has.
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 1/27/2011 7:10 PM (GMT -6)   
I'll add my 2 cents. I was diagnosed with Gleason 8 in 2 out of 12 cores. I had Robotic surgery in Feb 09. The cancer had broken thru the capsul but I  had negative margins. So far 2 years after surgery, I have had <.01 PSA. Will I have BCR later? That is the question that I hope I never have to answwer.

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 1/27/2011 7:13 PM (GMT -6)   
Joe I assume you're in Colorado. I recommend Dr Crawford he's the best in the region and has a national reputation for a second opinion.

E. David Crawford is Professor of Surgery, Professor of Radiation Oncology, at the University of Colorado Medicial Center at Anshultz Cancer center. He accepts most insurances.

I first went to TUCC as did Fairwind. I heartily recommend you check out the alternative that the CU Med Ctr offers to it.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy

2/16/10 12 of 12 Negative Biopsy

Post Edited (Ziggy9) : 1/27/2011 5:16:56 PM (GMT-7)


JoeBear
New Member


Date Joined Jan 2011
Total Posts : 5
   Posted 1/28/2011 1:28 PM (GMT -6)   
Well, my head has been swimming with everything I've been reading, trying to find my optimal path for successful outcome while minimizing side effects.
 
I'm leaning towards Radiation + Hormones at this time.  I've seen and heard about what seems to be plenty of guys that have done the Radical Prostatectomy only to later end up doing Radiation + Hormones anyway.
 
The radiologist at TUCC, Eric Gross, said that they would include / target things on the G8 cancer outside of my prostate, e.g. seminal vesicles.  Maybe these things would be removed with the surgery as well.  I have an appointment with Dr. Montoya (DaVinci surgeon) at TUCC next wednesday to see what he presents and to ask questions of.
 
I have read from 1 poster above to avoid HT & Radiation, if possible.
 
I have read at CU Med Centers website that seminal vesicles & lymph nodes should be biopsied prior to Radical Prostatectomy.  Sounds painful, but makes sense, if I read this correctly.  I would be much more inclined to do the surgery if I was more certain that it would be the be all end all of this cancer. 
 
I would rather do one procedure -
Radical Prostatectomy vs. two -
HT + Radiation and worst case three
Radical Prostatectomy + Radiation + HT.
 
Second best option seems to be doing 2 procedures -
HT + Radiation avoiding Radical Prostatectomy and it's side effects prior to having to do HT + Radiation anyway, if it's not completely eliminated with the surgery.  Being weakened and possibly experiencing incontinence and having to do the HT + Radiation looks pretty rough.
 
Without knowing more beforehand about the likelyhood of Radical Prostatectomy's success, i.e. being able to biposy seminal vesicles & lymph nodes it seems like a real gamble.
 
Bone scan this afternoon.
 
Results from chest x-ray, catscan & bone scan + surgeon meeting next week.
 
Trying hard to stay positive and make best decision.
 
Thank you for your support & good health to each one of you.
 

62 Years old

PSA 3.6 - low

Stage T2a - confined

Positive Biopsy Cores 4

Negative Biospy Cores 8

Gleason 8 - Aggressive

Pathology -

Benign, Pin3, Benign, Benign

Positive 8 (4+4), Positive 8 (4+4), Benign, Benign

Positive 8 (4+4), Positive 8 (4+4), Benign, Benign

 

rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 1/28/2011 4:41 PM (GMT -6)   
I wanted surgery after I was diagnosed and my surgeon told me he was biased toward surgery and required me to meet with an oncologist before making my final decision. I met with the oncologist and he told me "have the surgery because you may need to come back for clean-up later and need radiation". I chose surgery over 2.5 years ago. My brother was diagnosed with cancer and chose the seed implants and he is doing fine too.
 
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

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 1/28/2011 4:51 PM (GMT -6)   
Bear:

Second opinions, absolutely. I assume your physical health is good with no issues, particularly of the Gastro- intestinal kind, colon in good shape, colonoscopy current. If all this is true you may consider radiation. Second opinion on Gleason is critical as that is what drives all decisions.
Good Luck!

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3889
   Posted 1/28/2011 7:23 PM (GMT -6)   
By now, you have had several DRE's...How did they turn out??

Ask your surgeon (Montoya, a good man) whether or not he will recommend adjunct radiation treatment after your surgery regardless of what your first post surgery PSA result is...

He might say something like: "I don't know, can't be sure yet, I'll know more after the surgery".. If he says something like that, that should give you a strong clue that adjunct radiation (and hormones) is a distinct possibility..

Also, it would be wise to check with your insurance company and get "pre-approval" for any treatments, especially the radiation which can be very expensive...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW
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