I'd like to make some comments regarding local vs. distant experts. It could be the difference between good and top-notch.
I did the top-notch thing and had my surgery by one of the acknowledged best surgeons around. That did not guarantee a good pathology and my pathology was lousy. I don't blame the surgeon. In fact, I had a great recovery with no surgical complications. I do have ED. But I recovered very quickly and uneventfully. I healed well. No fatigue. I quickly regained continence.
Ok, the surgery still failed to cure my PC. So now its SRT time. I chose to stay local. The local place is the major cancer center for mid-Michigan. So, no slouches. They also have the latest and greatest equipment (Varian Trilogy RapidArc). My own doctor and another doctor who is a friend both said I can't get any better treatment elsewhere. My other choice was a true world-class facility: Umich. That is 120 miles away. If I went there, I would probably have rented a place. I would have had to stop work (a job I love). It would certainly be inconvenient and HEY WE GOT A GREAT LOCAL PLACE!!
But, let's look at my experience to date. I had some severe bladder burning starting with my 4th session. The radiology-oncologist who was so nice and helpful and seemed so smart during my original consultations when I was trying to decide where to do the SRT was at a loss to explain this. When I arrived at each session they asked if I drank water. Well, I did, but I was just finishing it seconds before I went on the table. I even asked the radiology guy if the timing mattered and he didn't think so. But I soon realized that it takes 20-40 minutes for the water to hit my bladder. Once I did this, the bladder burning diminished greatly (about 95%). It is no longer an issue. But then I started getting very bad rectal burning. I was miserable. Well, locally, they make absolutely no mention about having an empty bowel (it seems they certainly do elsewhere). I brought it up and never got a straight answer. Well, this week I was lucky enough to have a decent bm about 2 hours before the session. This happened on Tuesday and today. Guess what? The burning rectum issue is much better also.
WHY AM I NOT TOLD THESE THINGS. I asked.
Maybe these are some of the subtle differences between good and great. I can only hope that the radiologist's plan is great. But I have to say that I am not pleased. These are little items but somehow I am not experiencing excellence locally.
I can tell you that this only reinforces my plans to consult with 1 and probably 2 top-notch specialists should SRT fail.
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64. Surgery: Dr. Menon @Ford Hospital, 1/26/10. Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- yes.. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13,3/1/11--0.27