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DBB1957
New Member


Date Joined Apr 2011
Total Posts : 4
   Posted 4/13/2011 12:18 PM (GMT -6)   
Hi my name is Doug.
My second biopsy was two weeks ago and the news was not good. My doc has ordered a bone scan and MRI, when the results come in we will talk about options. I have had six months to think about this and I would like to have the prostate removed. My doc tells me that most people are opting for the robotic surgery these days and that it is far superior. Is that true? He is part of the Orange County Urology Associates in CA and he will be recommending a surgeon from this group, on my next visit. Does anyone have experience with doctors in this group? Like everyone, I would like to fine the best surgeon, and if that requires travel, that is okay.
Thanks for your help.
Doug
Age 53
Diagnosed 9/2/10 psa 4.0
1 core <5%, gleason 3+ 3
2nd biopsy 3/31/11 psa 6.5
4 cores max 14%, gleason 3+3 & 3+4

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/13/2011 12:31 PM (GMT -6)   
Your score is low. There are other options to surgery. I thought surgery was best in my case and it seems most men do these days, certainly at your young age ( im 40!).

My only real advice about picking a surgeon is to pick someone you think is really good. You get one chance at this and you want someone who has vast experience in the field. You do not want to be part of the learning curve for a surgeon who is less experienced in the field.

As for robotic surgery itself, I can tell you that most of us were up on our feet within a few days and able to go back to work in 10 days if needed. The surgery itself is a beautiful thing that really uses the best technology to assist surgeons.

I had complete urinary control immediately and do not suffer from ED. People regain these in different intervals typically within a year or two. Some like myself, and there aren't few of us, regain them immediately. Some have long term trouble. I believe our level of fitness, age, sexual potency going into surgery, ability to spare nerve bundles and the skill of our surgeons go a long way in determining our outcome. These are all issues you can discuss with your urologist, the surgeon you might choose to interview and a radiation doc yo might also seek prior to deciding what's best for you.

natural44
Regular Member


Date Joined Dec 2010
Total Posts : 172
   Posted 4/13/2011 12:53 PM (GMT -6)   
I am young also (45) I opted for open surgery only because my surgeon was highly recommended (4 "second" opions from other Dr.s) as the best in the area..and he was! however he has no bedside manner so I fired him 2 days after surgery! The point is...Find someone who is the BEST at whichever procedure you decide on and stick to it! I felt better with the open procedure also because the approach is not blind like the initial introduction of the laproscopic tools to the body, and no air is blown in like in the laproscopic/robotic procedure. I was up in a chair 2 hours after surgery and walking halls within 4. No incontinence issues and ED is making big improvements since the 6 month mark with the help of Trimix. I have a brother in law who had the open procedure done there by the same group you are seeing, however his Dr. retired a year after his procedure was performed and that was 10 years ago, so sorry no help there, but they are a very good group according to him.
age 44 when diagnosed 45 now
RRP 9-28-10
gleason 3+3
pathology report clear
11-1-10 PSA 0.02
3 month 0.00
6 month 0.00
12-1-10 noctural erections, not very strong maybe 20% none prior to Osbon pump use
3-30-11 Trimix 1st injection works GREAT! and more nocturnals and even some spontanious erections plus responding a little bit now to oral meds!!! The trimix really started things going!

diamonds3
Regular Member


Date Joined Jan 2011
Total Posts : 112
   Posted 4/13/2011 1:10 PM (GMT -6)   
Davidg, you said….
“I had complete urinary control immediately”

Yet in another thread you admitted to urinary control problems at 7 weeks.
http://www.healingwell.com/community/default.aspx?f=35&m=2043565

or just google: davidg kegel gym dumbells

"The harmonica motion while getting up while simultaneously lifting and dropping the 45lb dumbells on the last rep provided a little unexpected result. Made note to self to kegel at that very moment for all subsequent reps."

And in other threads you admitted to taking cialis for that “extra pop”, something you did or did not do pre-surgery?
DOB: 01/61
PSA: 01/10 2.8
PSA: 11/10 4.2
DRE: 12/10 Normal
PSA: 01/11 4.1
Biopsy: 01/21/11 7 out of 12 cores + Gleason: 6(3+3) Stage: T1C
da Vinci 03/04/11 Penn Hospital
Catheter Removed 03/11/11
Prostate Size: 22 g Gleason: 7(3 + 4)
Grade: T2C 10% of Tumor involved
Extraprostatic Extension: None
Perineural Invasion: None
Seminal Vesicle/Lymph Nodes: Clear
Margins: +, invasive apical, posterior

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/13/2011 1:17 PM (GMT -6)   
when I had a severe cold ( about 3-4 weeks after surgery ) and was doing flys at the gym with heavy dumbells I would spritz a tiny drop here and there. Went away right after my cold went.

I never wore a pad. IN fact, I bought months supply of pads and diapers pre surgery which I threw out.

First few weeks after surgery I had concerns because I would feel urgency after an hour or so. I drive into NYC which can take anywhere from 50 min to 3 hours depending on accidents. That went away rather quickly as my bladder seemed to adapt and progressively be able to hold urine for longer periods. I can go hours now and I don't even worry about it mentally anymore. I believe this is common.

I get erections with cialis and without. I'm 100% with Cialis and range from 70% to perhaps 95% now without. I defintiely prefer the extra "pop" I get with Cialis. I've been very clear about this. The natural ones are getting stronger by the week as I believe is the case for most people.

What's with the investigation? God knows there are enough amateur investigators here.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 4/13/2011 1:17 PM (GMT -6)   
Surgical results depend on the SKILL of the surgeon, NOT the type of surgery...Robotic or open, they both have their advantages and disadvantages..Consult with a radiation oncologist and medical oncologist before you make your decision..Make sure your insurance supports your choice....

Read Dr, Pat Walsh's book, "Guide to surviving Prostate Cancer" and learn the fine points of what you are facing...

Best of luck to you..
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd 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. 2-15-'11 PSA 0.0

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6078
   Posted 4/13/2011 1:26 PM (GMT -6)   
Hey Doug, I had open surgery. I checked into the hospital @ 6 am on a monday and checked out at noon the following wed. with 1 4" scar, and a tiny scar where they put a drain to remove excess fluid from the surgery. I wanted the tactile feel the surgeon would have, that is missing from Leo. They both have pros and con's. The key is with out a doubt, imo, the surgeon's skill in either case. Imo this skill play' s heavy , on cancer control/eradication continence,and ED in both robotic and open. I was on the eliptical as soon has catheter came out, was walkiing 3mile daily with in that 1st week post op with catheter. I've stayed fit my whole life which really helped. But even with that post op recovery has its setbacks. Check with your surgeon on post op exercize, DO NOT overdue it. I was right on the cusp there, but managed to stay ahead of the power curve. Quite frankly and this may sound strange, my experience, was darn right mystical, I will never forget the positives from it. Good luck, you'll be fine.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/13/2011 1:32 PM (GMT -6)   
it's not strange. It was an amazing experience/process.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6078
   Posted 4/13/2011 1:39 PM (GMT -6)   
I agree diamonds 3, No one imo is 100% continent, but we don't need to be called on it, embellishment is a universal constant. My wife will tell you there is less urine on the floor and skivvys now than presurgery due to shake it dont break it before. As to ED theres enough enough nits to pick without going there. Didn,t really get the point of your post.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/13/2011 1:44 PM (GMT -6)   
davidg - its your own words that choke you sometimes, not what others say.

you either have ED or you don't. You brag all the time about being 40 (very sad actually for someone that young to have PC, a rare thing, not common), so does this mean you needed ED drugs before you had PC, or you are using them after your surgery. If you didn't have any ED, before or after, then why are you using ED drugs at all?

in my own journey (and the dr's still call it the chance in a million) i literally had no ED. either before PC, or after PC, i have never used a pump, never used any ED drug (not even a sample), and have never had any ED related injections. And that's coming from someone that had a non-nerve sparing operation, that due to surgical difficulties because of something weird in my anatomy, my surgeon left the right side nerves "as is", noting that on my surgical report as "damaged". Why I didn't or don't have ED is still a mystery, but I am thankful.

You can't have it both ways, just like with incontinence, you either are or you aren't. No big deal to me ,don't think any investigation is going on, but people again are remembering to what you wrote, and commenting on it.

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 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/13/2011 1:55 PM (GMT -6)   
Welcome, Doug, very sorry you need to be here, but glad you found us.

You are smart to check all options.

I had open surgery. My surgeon was very experienced with them, and at the time in my area, only 15 robotics had been done. I was in the hospital for 4 1/2 days, which I didn't mind.

Some of the negatives against open aren't always true. In the old days, excessive bleeding was an issue, they banked 2 units of blood for me, and none of it was needed. They claim magnification is better in Robotic, in many ways it is, but with alternative magnification means, my surgeon (whose practice does both now) says that's not an issue. The tactile issue is strongly in favor of open surgery, nothing replaces a skilled doctor's touch on what he is feeling. An RP is a complex operation, robotic or open.

As a general rule, men seem to bounce back quicker with the Robotic, but we have guys here that were in the hospital 48 hrs or less with an open, and a week after robotic. Depends on the patient too, and what other issues are going on, i.e. complications or other medical conditions, or infection.

I have had 8 operations, all related to PC in the past 2 plus years, and I have never been in a rush to get out of the hospital, pain meds can be better administered there, etc. If one has good insurance, I don't consider that much of an issue.

Had I chosen robotics at the time, the op would have had to been switched to open anyhow, as they encountered a deep and narrow prostate bed, than even with open surgery, the surgeon had extreme difficulty finishing. The robotic arms/fingers would have never reached what the doctor couldn't reach with his fingers, etc.

The skill of the surgeon is paramont if your decision is for surgery, not a doubt about that.

Good luck, and please keep us well posted. We care about you.

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 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

DBB1957
New Member


Date Joined Apr 2011
Total Posts : 4
   Posted 4/13/2011 2:05 PM (GMT -6)   
Thanks for all the replies. I guess they are really trying to sell the robotic surgery here at Orange County Urology, it sounds like they don't have any surgeons that do the open procedure any more. After reading Dr Walsh's book I was leaning towards the open procedure but his book was written in 2007 and things may have changed, so I am a little confused. I would like to go for a second opinion for open surgery, but I'm not sure who the best surgeons are in my area. When I google pc all I get is a lot of robotic hype.

Doug
Age 53
Diagnosed 9/2/10 psa 4.0
1 core <5%, gleason 3+ 3
2nd biopsy 3/31/11 psa 6.5
4 cores max 14%, gleason 3+3 & 3+4

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/13/2011 2:11 PM (GMT -6)   
logoslidat said...
I agree diamonds 3, No one imo is 100% continent, but we don't need to be called on it, embellishment is a universal constant. My wife will tell you there is less urine on the floor and skivvys now than presurgery due to shake it dont break it before. As to ED theres enough enough nits to pick without going there. Didn,t really get the point of your post.


I consider myself 100% continent. What definition do you go by? Whenever I need to pee I go to the urinal at work or bathroom at home. I go all night without peeing. No pads. The few times I had very limited drops was some 2 months ago while doing "heavy" weights while having a severe cold and doing a specific exercise. That too was controlled by kegals.

Maybe it is a lose definition. Many women after giving birth naturally complain of drops here and there. I don't consider them incontinent.

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 4/13/2011 2:18 PM (GMT -6)   
DBB1957 said...
Hi my name is Doug.
My second biopsy was two weeks ago and the news was not good. My doc has ordered a bone scan and MRI, when the results come in we will talk about options. I have had six months to think about this and I would like to have the prostate removed. My doc tells me that most people are opting for the robotic surgery these days and that it is far superior. Is that true? He is part of the Orange County Urology Associates in CA and he will be recommending a surgeon from this group, on my next visit. Does anyone have experience with doctors in this group? Like everyone, I would like to fine the best surgeon, and if that requires travel, that is okay.
Thanks for your help.
Doug


Doug,
I did lots of research on this before I decided on open surgery, I could find NO report that substantiated better long term outcomes with robotic, smaller incisions, shorter recovery times, and less pain yes, but as far as the part I was interested in, i.e. lack of recurrence and urinary and sexual function what I found was open had a slight edge.

I'd urge you to get multiple opinions from a few different specialists and make an informed decision. It sounds like you have caught it early and have a few options at your disposal.

Also be advised, sadly forums can be a platform for people to promote their "experience" which may or may not be factual hence some of the comments in this thread.
Dave in Durango CO

07-06 PSA 2.5
01-08 PSA 5.5 (Dr never told me)
09-09 PSA 6.5
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 1-25-11 <0.04

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 4/13/2011 2:34 PM (GMT -6)   
Another thing to keep in mind on forums is that some people celebrate success in anyone while some do not seem to be happy about good news from others and automatically regard it dubious. That's a real pity because good honest and optimistic news is exactly what many people who just find out they have cancer need to hear about in my opinion. At least that is what Yana did for me. I read hundreds of those testimonials and they prepared me to head into the process. That's the advantage of a site like Yana where people just post their stories over forums which include all different kind of personalities and motives which unfortunately invade the story itself.

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 4/13/2011 2:56 PM (GMT -6)   
daveshan said...
I'd urge you to get multiple opinions from a few different specialists and make an informed decision. It sounds like you have caught it early and have a few options at your disposal.

Also be advised, sadly forums can be a platform for people to promote their "experience" which may or may not be factual hence some of the comments in this thread.


Doug I endorse the post above. Please discount the misinformation of "most" being able to go back to work in 10 days if needed. That is not typical of either open or robotic surgery. Both which are major surgeries.

Post Edited (Ziggy9) : 4/13/2011 1:59:31 PM (GMT-6)


axle
Regular Member


Date Joined Feb 2011
Total Posts : 35
   Posted 4/13/2011 3:07 PM (GMT -6)   
DBB1957,

Following my personal research on how to treat my PC, I decided upon the da Vinci robotic assisted method. As part of my investigation, I met with 4 different urologists and read the Dr. Walsh book (which was given to me by one of the Urologists). I also considered and researched radiation therapy. But even now at 11 weeks post-Op I am still learning details of how the different treatments are applied. I probably did not learn enough details regarding the radiation options before eliminating that as one of my choices. But, I am satisfied with the decision I made.

My Urologist that did my biopsy told me that my biopsy results revealed too much cancer to consider Brachytherapy as an option. I still am not totally sure what the cutoff point is regarding eliminating seeds as an option but I trusted the statement.

Both Uro-surgeons that I consulted with performed open prostatectomies before converting to the robot assisted method. And both said they would convert back to the open in the middle of a da Vinci procedure if needed. My main concerns in selecting a treatment were to acheive a cure with the most minimal of side effects (imagine that).

Yesterday was a milestone for me. At 11 weeks out I had my first full day without a pad. Also, things are improving in the ED area. Things just seem to be getting better and better. Even at 11 weeks out, for me, I can still feel healing is not completely finished. But I can feel that I am healing well.

By the way, when my first Doc gave me Dr. Walsh's book he said that the book was biased to the open surgery method. And I also thought it interesting that that particular Doc was 50/50 regarding robotic surgery versus radiation therapy. He said he knew two RT oncologists that he could refer me to but I never did meet with them.
Age 58; da Vinci on 1/26/2011
PSA History: 10/2005 = 1.7; 10/2007 = 2.8; 10/2009 = 3.6; 10/2010 = 4.9
Abnormal DRE in 2009; Increasingly abnormal DRE in 2010
Thank you POPs!
Biopsy on 11/23/2010: GS = 3+4 (right side) with 4 of 6 cores positive @ 40%.
Post-OP pathology: GS=3+4; tumor = 35%; pT3b; R. seminal vesicle invasion; Extraprostatic extension into the R. bladder neck; margins uninvolve

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/13/2011 3:16 PM (GMT -6)   
DBB1957 said...
Hi my name is Doug.
My second biopsy was two weeks ago and the news was not good. My doc has ordered a bone scan and MRI, when the results come in we will talk about options. I have had six months to think about this and I would like to have the prostate removed. My doc tells me that most people are opting for the robotic surgery these days and that it is far superior. Is that true? He is part of the Orange County Urology Associates in CA and he will be recommending a surgeon from this group, on my next visit. Does anyone have experience with doctors in this group? Like everyone, I would like to fine the best surgeon, and if that requires travel, that is okay.
Thanks for your help.
Doug
 
Hi Doug, and welcome.
 
As your doctor pointed out, robotic radical prostatectomy (RP) procedures are more common in the US than open surgeries...they crossed over in the year 2007 and today more than 80% of RPs are robotic.
 
The skill of the surgeon is more important than the technique.  Dr Eric Klein at Cleveland Clinic says it this way: 
"The most important factor in ensuring the best chance for cure and good functional outcomes after radical prostatectomy is the experience of the surgeon and not what approach is used. My best advice is to find the most experienced surgeon you can and let him choose the surgical tools that work best in his hands."
Most of the highly balanced assessments of outcomes for robotic vs open (in the hands of a skilled surgeon in both cases) is that they are essentially the same.  You will have a faster recovery from robotic (thus the name "minimally invasive surgery").
 
best wishes...
 

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6078
   Posted 4/14/2011 9:55 PM (GMT -6)   
DavidG, It wasn't a slam, but 100% is 100%, any leakage for whatever reason, is rounded down to 99% in my system so as to avoid, the whole nano thang! As an aside, we aren't having a p---ing contest are we? Cause I want to play angel in the snow next, lol.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/14/2011 10:46 PM (GMT -6)   
Doug -
 
Welcome to HW.  I think you will find your time here worthwhile.
 
I hope you will not be put off by the debate in this thread concerning whether David was, or was not, 100% continent -- or whether he said some inconsistent things in various posts.  I find that whole discussion to be totally ridiculous, and not the least bit helpful to anyone in their quest for good health.
 
In any event, you asked about docs.  If you want to talk with another doc, who is not that far from Orange County, CA, and has a very good reputation, here's one suggestion:  http://www.cityofhope.org/directory/people/wilson-timothy/Pages/default.aspx
 
I don't know the  guy personally, but he has a very good reputation.  You really do want to get an excellent, super-experienced surgeon, if you are going to have surgery.
 
Best wishes,
Medved

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/15/2011 12:42 AM (GMT -6)   
Doug,
Take your time and learn as much as possible before proceeding. It is very important that you know the therapies and their pros and cons. i used to line in the OC for 23 years and have a lot of family down there. This helped me when I chose my primary therapy which was robotic surgery at the City of Hope where strong surgeons can be found. But I concur with Casey that the decision if it is surgery should be predicated on the physicians experience and reputation and not the procedure. It's isn't unheard of to miss a week then get back to work, but likely won't be recommended. Typically I hear three weeks is better.

Also, if you look into radiation the same rules apply. The center, the radiation oncologist, and their experience matters.

Also I would make another recommendation ~ because your disease moved relatively quickly as your biopsy and rising PSA indicate, you should also talk with whatever professional you are speaking to about adjuvant therapies. Additionally what would the plan be if you did not get desired results with your first therapy. I was a G7 (3+4) and it was very apparent after surgery that there would likely be a need for follow up or adjuvant therapy. I am four years in remission now even though I had a very adverse post operative pathology report (4+3=7 and stage 3B)...Just something to add to your questions.

Peace and welcome to HealingWell. You are very welcome...

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3886
   Posted 4/15/2011 5:22 AM (GMT -6)   
In my opinion the urologist that said you have too much cancer to use radiation should not be listened to. It is well accepted and studies prove that surgery and radiation (brachytherapy plus IMRT) are equal at 10 and 15 years in treatment success for low risk cancers. Intermediate and high risk (more cancer) cancers actually do better at these stages with radiation versus surgey.

My statistics show I had far more cancer than you. My urologist said I had too much cancer for surgey to be successful and should pursure radiation, which I did.

You are in california and I strongly advise you to see Dr. D. Jeffrey Demanes at UCLA med center. He heads up their radiology and is the pioneer in High Dose radiation brachytherapy. In this method the radiation is inserted and withdrwn so nothing left in the body (nom permanent seeds). Check his website at www.cetmc.com and also look for his information on the UCLA med center website. There are some excellent videos explaining the process.

I used HDR and IMRT and have done very well.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/15/2011 7:02 AM (GMT -6)   
Dr. Samadi http://www.youtube.com/watch?v=Wr8EEhQrN10IO  for news video info. rolleyes

More seriously get your pathology reviewed if you like the idea of more precision and second opinions on pathology slides on your huge decision. (recommended Dr. Bostwick, Oppenheimer, Grignon, Bonkhoff, Epstein) You would be amazed at what specialized testings Dr. Bonkhoff and Bostwick and maybe others can offer.

When is it dumb to get second (various) opinions from different therapy options, especially if you go out on your own, not the referral good ol' boy network (collaboration sale to make concept).

Hey Dr. Samadi might be great (you decide), so are others yeah ...best to you. Your changes in pathology in 1 year or so were interesting to note. I am not endorsing anyone or any particular therapy just probably have a case of Samadi syndrome hopefully it can be cured, many roads lead to Rome in PCa, plenty of things for you to consider as to overall effects.

Post Edited (zufus) : 4/15/2011 6:11:24 AM (GMT-6)


diamonds3
Regular Member


Date Joined Jan 2011
Total Posts : 112
   Posted 4/15/2011 9:15 AM (GMT -6)   
Zufus, Good work by you!
What an excellent post vis-à-vis my pointless and ridiculous posts thus far.
DOB: 01/61
PSA: 01/10 2.8
PSA: 11/10 4.2
DRE: 12/10 Normal
PSA: 01/11 4.1
Biopsy: 01/21/11 7 out of 12 cores + Gleason: 6(3+3) Stage: T1C
da Vinci 03/04/11 Penn Hospital
Catheter Removed 03/11/11
Prostate Size: 22 g Gleason: 7(3 + 4)
Grade: T2C 10% of Tumor involved
Extraprostatic Extension: None
Perineural Invasion: None
Seminal Vesicle/Lymph Nodes: Clear
Margins: +, invasive apical, posterior

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 4/15/2011 9:47 AM (GMT -6)   
Welcome Doug,

You've had examples already of the range of advice and opinion here. So you know why the wise folk here suggest taking time to absorb as much info as possible.

Surgery is clearly not the only option. Surgeons are however reluctant to perform a prostaectomy on someone who has alreadty ahve RT should tghe RT not work! Whereas if like me and others the surgery does not work then having RT is not extra complicated.

Hard as it may be to deal with this fact it has to be pointed out that info from biopsies does not paint a completley accurate picture of what is going on in every part of your prostate. There are many ehre including myself who found out after surgery that things were worse that originally measured with the biopspy.

Being back at work 10 days after surgery is an exceptionally good recovery, not the rule. For starters ability to return to work depends on your work. Guys here with office jobs not far from home (and desks not far from bathrooms) may be back at their desks a lot sooner than those with a physically strenous jobs or one that involves a lot of traveling.

ED means the system does not work all by itself. If you need any pills, pumps or injections to get an erection, then you have ED.

Continent means having a bladder function similar to a healthy person that has had no treatment etc. Thus if you leak occasionally say when you cough sneeze, lift or laugh, then you are not fully continent, this is stress incontinece. If you have to dash to the bathroom every 45 minutes, as I do, rather than every three hours like the person sitting next to me then you are not fully continent, you have simply found a way to manage it.
I have not heard of a single guy here whose bladder control after surgery is as good as it was before.

And rememebr that we are not medically qualified to give the definitive answers.

All the best
Alf
Age dx 48
Apr 09 PSA 8.6
DRE neg
Biop 2/12 pos
Gleason 3+3
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
Nov 09 PSA 0.1
Mar 10 PSA 0.4 sent to RT
13 Apr CT
RT 66Gy ends 11 Jun 10
Tired + weird BMs
Sep 10 PSA <0.1
Jan 11 PSA <0.1
Apr 11 PSA <0.1
Erection OK
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