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joe2011
New Member


Date Joined May 2011
Total Posts : 11
   Posted 5/15/2011 4:15 PM (GMT -6)   
I was diagnosed April 28, 2011.  I am going for a second opinion with Dr. Pow-Sang at Moffitt in Tampa on May 19, and with Dr Patel in Celebration, Fla on June 1.  I have read Dr. Walsh`s book, and a few others.  Asking for general input.  I am favoring robotic. I live in Clearwater, Fl.
Joe2011

AGE at time of diagnosis 63

PSA 3.9   (last year 3.5)

Biopsy:

2 of twelve cores

Left mid   Gleason               4+3=7  10% of core

Right Lateral Mid   Gleason 3+3=6   5% of core

No Perineural Invasion Identified

T1c

Thanks!


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7204
   Posted 5/15/2011 4:42 PM (GMT -6)   
Not sure what input you want. I looked at surgery and radiation and met with experts in each area. I chose surgery because if it failed I could then still do radiation. The reverse is not true, although I understand if radiation fails there might be some salvage procedure. Also surgery would give me an exact pathology so I would absolutely get an accurate staging of my situation. Also, the SE of surgery are right there and should get better in time (usually). Radiation's SE can continue and in fact show up months and years later.
 
Once I chose surgery, I researched it. The best advice at this point is to find the best surgeon you can. The best one I found is considered among the very top in the country. He is a robotic surgeon; had he specialized in open surgery I still would have gone with him. I also liked the fact that he utilized a SP catheter which is much better than the traditional Foley catheter.
 
Anyway, that was my reasoning. I'm sure others will come along and give you some good arguments for radiation or maybe something else.
 
Hope this helps
 
Mel

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 5/15/2011 4:45 PM (GMT -6)   
Not sure what you are asking for, but I will say a few things: first, you did a smart thing by reading the Walsh book; second, this website is a very useful place to get information, input, support - so coming here is a second smart thing you did; third, you are seeing two VERY experienced and well-regarded docs. So personally I don't have much to add. If I had to make one suggestion, it might be to also consult with a radiation oncologist -- you could at least consider the option of radiation before signing up for surgery, and it is hard to consider the radiation option in any serious way without talking to a radiation oncologist.
Best wishes, Medved

joe2011
New Member


Date Joined May 2011
Total Posts : 11
   Posted 5/15/2011 4:50 PM (GMT -6)   
Thank you, Mel.
SP Catheter is a good suggestion.
I have heard that both the surgeons I am considering are very good,w hich is the most important criteria.
I have spoken to pations who had sucess with both.
Just steering my way through this, with some very great support
Joe
Joe2011
AGE at time of diagnosis 63
PSA 3.9 (last year 3.5)
Biopsy:
2 of twelve cores
Left mid Gleason 4+3=7 10% of core
Right Lateral Mid Gleason 3+3=6 5% of core
No Perineural Invasion Identified
T1c

joe2011
New Member


Date Joined May 2011
Total Posts : 11
   Posted 5/15/2011 4:57 PM (GMT -6)   
Thanks, Medved
I will research the radiation oncologist!
I have had some great support, both from many who have had surgery, and now with all my new supporters on HW. I have been reading posts for weeks, and found them very helpful.  I have spoke to patients of both surgeons I am considering, and both spoke highly of the.  So, encouragement and support is what we all need in a case like this
Joe
Joe2011
AGE at time of diagnosis 63
PSA 3.9 (last year 3.5)
Biopsy:
2 of twelve cores
Left mid Gleason 4+3=7 10% of core
Right Lateral Mid Gleason 3+3=6 5% of core
No Perineural Invasion Identified
T1c

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4155
   Posted 5/15/2011 5:42 PM (GMT -6)   
Hi Joe and welcome to HW.  Sorry you have to be here.
 
Given your location and that you are looking at providers in different Florida cities, I would strongly suggest that you consult with the Dattoli Cancer Center in Sarasota.  This place is world class and you will get a non-surgical option to consider that might provide you with better long term quality of life.  You can Google Dattoli and easily get to their web site for more info.  I don't get a commission - LOL - but still think it's a good idea!
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 5/15/2011 5:56 PM (GMT -6)   
Hi Joe,

This is a stressful time for you, and like most of us at the time of diagnosis you must feel that there is a clock ticking and you need to make quick decisions about what to do next. This is true for many cancers but becuase prostate cancer is typically a slow growing cancer, a smart thing to do is simply to gather all the information to can and then make a considered decision. You have probably had this cancer for well over seven years so waiting a few months is not going to change much.

I think you have done all the right things in researching PCa through Walsh's book and then coming here.
One bit of input that I can provide is having an expert review of your pathology done. Very often the picture changes in some way once this expert review is done. In my husband's case he went from having no cancer to having cancer. In other cases people go from having cancer of lower aggressiveness to having cancer of higher aggressiveness. Or vice versa.

The reason why an expert review makes sense is that reading biopsy slides is a bit of an art. Very few people are good at it and the more you look at what these pathologists do, the more you realise that there are so many shades of gray in prostate cancer diagnosis and so many conditions that mimic prostate cancer that your average pathologist (who deals with hundreds and thousands of different conditions) just simply isn't experienced enough to see.

The process for doing this is quite simple. Experienced pathologists include Bostwick, Epstien and Dr Helmut Bonkhoff in Germany. Google them, contact them, get the forms and speak to your urologist who will organise for the slides to be sent across.

Having good data on what kind of prostate cancer resides in you will help you make good decisions.

Wishing you all the best,

Regards,
An
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|Feb11 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01|Feb11 – 0.01|Apr11 – 0.01

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/15/2011 7:01 PM (GMT -6)   
With your numbers, I would think you would be suitable for Seed Radiation, Robotic, or open Surgery. With the prescence of some Gleason 7, I wouldn't be inclined to do AS. Just my take

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 margin
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, 4/11 3.81
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

FLBeachgal
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 5/15/2011 7:20 PM (GMT -6)   
My husband also consulted with Dr. Pow-Sang at Moffitt and with Dr. Patel in Celebration.  In addition, he also consulted with a radiation oncologist locally. 
 
As you probably know already, your biopsy slides will be re-reviewed at Moffitt Cancer Center as part of your consultation, so you will have a second opinion done by the experts there.  We had a very positive experience at Moffitt - Dr. Pow-Sang reviewed all options with us, including robotic surgery, radiation, brachytherapy, active surveillance, etc.
 
Hubby chose to have robotic surgery done by Dr. Patel in Celebration.  He had a foley catheter for less than a week and was totally continent within 3 weeks, so no problems there.  He recovered very quickly and was totally satisfied with Dr. Patel and FL Hospital Celebration.
 
Feel free to email me if you have any specific questions about your upcoming appointments. 
 
Margie

joe2011
New Member


Date Joined May 2011
Total Posts : 11
   Posted 5/16/2011 3:34 PM (GMT -6)   
Thanks
Tudpock (Jim)
 An
 Margie
 and David in SC.
Good stuff from all of you!  I appreciate the support.
Joe
Joe2011
AGE at time of diagnosis 63
PSA 3.9 (last year 3.5)
Biopsy:
2 of twelve cores
Left mid Gleason 4+3=7 10% of core
Right Lateral Mid Gleason 3+3=6 5% of core
No Perineural Invasion Identified
T1c

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5818
   Posted 5/17/2011 3:51 PM (GMT -6)   
Looks real promising, consider open also, Tactile feel is good for nerve sparing, and deciding the cuts. Hospital 48 hours 1 4" scar, plus little puka, { hole} fm pratt drain. But its all good, this will be the proverbial bump in the road for you, so stay positive. The mid tumor placing is real good news for a contained cancer.
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

joe2011
New Member


Date Joined May 2011
Total Posts : 11
   Posted 5/17/2011 4:06 PM (GMT -6)   
Thanks, logoslidat
Always good to hear "real promising" when one really doesn`t know that much and is learning.. I will incorporate you suggestion into my questions for tomorro`s consultation with Dr. Pow-Sang. He has been doing surgery for years, including open,, so he should appreciate your points. Moffitt also has a good reputation and I have spoken to people who swear by them as well. Still doing my research.
Joe
Joe2011
AGE at time of diagnosis 63
PSA 3.9 (last year 3.5)
Biopsy:
2 of twelve cores
Left mid Gleason 4+3=7 10% of core
Right Lateral Mid Gleason 3+3=6 5% of core
No Perineural Invasion Identified
T1c
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