My wife and I met with Dr. Buskirk at the Mayo yesterday. He was referred by the urologist (Dr. Wehle) I saw a week and a half ago at the Mayo. We really liked him and thought Dr. Buskirk was knowledgeable, took his time with us and presented what he saw as my options clearly.
He did not suggest AS because of my age. He said that surgery or seeds would be his two top choices for me. I documented what the surgeon, Dr. Wehle, had to say in an earlier post Click here for that link
He went on to explain that at the Mayo they do mostly IGRT, which is a nice fit for someone older than me (living in FL can make you feel young sometimes :) even at my age!). He went on to clearly explain IGRT which he said would be his third choice for me.
As far as seeds he suggested that I see Dr. Turk at the FROG (Florida Radiation Oncology Group). He said that he knows Dr. Turk and Dr. Cesaretti very well and both trained with the Mt. Sinai group (under Dr. Stock?) and do hundreds of seed procedures a year. He said that the seed procedure is highly operator dependent as is surgery. I asked about
the fact that Dr. Wehle said that he sees the problems caused by radiation that can not be repaired and Dr. Buskirk said that is why you want someone performing the operation that is highly skilled and has performed many seed procedures. He also said that people come to the Mayo and Dr. Wehle (who he knows well and say is an excellent urologist and surgeon) sees case from all over the county that have had procedures done at facilities that are less than stellar and hope to have them fixed by Dr. Wehle.
He said that they had problems with seeds early on, but have refined the seed procedure over the years and now have a better template for insertion of the seeds. He said that 15 years out surgery has about
an 80% "cure" rate and seeds have a 90% cure rate. If surgery fails I have radiation as a back up. If seeds fail I have HT as a back up (although there other drugs in the pipeline - please excuse my spelling but some of them were Casadax, Kedochomosole, Provenge). When I asked why seeds over IGRT he said because of my age, size of my prostate (33cc), I don't have any urinary flow problems, no flow problems after the biopsy, my PSA <10, Gleason 6 and they can put a higher dose of radiation with seeds than IGRT. He said that leakage is not a problem and does not get worse over time. He said that ED can get worse over time because the radiation constricts the blood vessels over time and is accelerated by aging, but ED drugs usually do help. He said there would be some possible burning and urgency at night for a period.
I asked about
my rapidly rising PSA and he said that I could do another test, so I did. I told him I was concerned about
going from 5.5 to 7.1 in a month. He asked if it was after a DRE and I said yes and he had even stimulated my prostrate to get fluid from it for a test. I'm nervous that the PSA will come back higher that the 7.1, but I would like to know what it is and if the 7.1 is an upward trend or a one time occurrence.
Bottom line is that he thought my chances were very good with either surgery or seeds. I asked him what he would do and he said it would be a tough choice and both would be good with my stats. I came away feeling good about
my choices. Now my next step is to see Dr. Turk at FROG. I am leaning towards seeds at this point because: 1) less invasive (outpatient procedure similar to biopsy), 2) same (or better) "cure" rate over 15 years, 3) no incontinence problems, 4) less initial ED problems, 5) no catheter after procedure, 6) back to work quicker. I will wait to make my decision until I see Dr. Turk. Any suggestions on what I should ask Dr. Turk?
Age 61 Active. No other problems (except small hernia)
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
PSA 6.73 5/18/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6 (3+3)
CT bone scan neg
6/18 areas positive - 2 in left base, 4 left apex. 6/40 cores pos. 33cc.
Met with Dr. Wehle @ Mayo 5/4/11
Met with RO Dr. Buskirk at Mayo 5/17/11
Will Make an appointment with Dr Terk at FROG
Post Edited (Gleason 6) : 5/18/2011 9:45:29 AM (GMT-6)