Important questions to ask your **LARP/RALP/RRP** doc

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gedman
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Date Joined Jan 2013
Total Posts : 1104
   Posted 2/6/2013 4:48 AM (GMT -7)   
Let's compile a list important questions people should ask their LARP/RALP/RRP doc when choosing a treatment approach. (For the Brachy thread, click here.)

Please see updated list (as of 2/16) further down in this thread
41y
Wife + 5 kids
PSA 9
Prostate size 21g
BX 1/17/13
Positive 5 of 12 Cores: G3+4 40%, G3+4 5%, G3+4 10%, G3+4 15%, G3+3 10%
Diagnosed 1/28/13
Latest update (as of 2/12):
CT scan and Bone scan done (negative).
Met Dr. D. Nori (brachy, Weill-Cornell), and consulted with Dr. Michael Zelefsky (brachy, Sloan Kettering). Next comes Dr. Ash Tewari (LARP, Weill-Cornell).

Post Edited (gedman) : 2/18/2013 6:38:30 AM (GMT-7)


IronReb
Regular Member


Date Joined Oct 2012
Total Posts : 172
   Posted 2/6/2013 5:27 AM (GMT -7)   
If my prostate is larger than average, will this pose any problems during surgery and after as far as side effects? (For me, the prostate was large and surgeon indicated this would make incontinence a more likely side effect, however he was wrong)

If I had previous abdominal surgery, will it pose any difficulties and do you have a backup plan? (In my case, there was a potential problem and if there was difficulty he was going to abort the robot and go to the open surgery)

What alterations to the bladder will be necessary and how much bladder capacity do you expect me to loose? (In my case 1/3 bladder capacity lost.)
Age 54 on DX
1st PSA 8.2 Biopsy negative 2010
80cc gland
PSA 11/11 8.7, 3/12 9.1
04/2012 Biopsy: 1 of 12 positive, another 2 suspect
Gleason: 3+3=6
DRE normal
DaVinci: 7/12
Path: G7, Contained, NoMargins, multiple suspicious spots
No incontinence
No ED
PSA 9/12=0.00
me

Big Mac
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Date Joined Jul 2012
Total Posts : 2032
   Posted 2/6/2013 9:01 AM (GMT -7)   
You have some great questions already. I don't see the importance of meeting the entire surgical team before surgery. In my case, they were already in surgery with someone else while I was in Pre-Op getting ready for mine.

How long, on average, does the catheter stay in for your a patients?

With your numbers, surgery looks like a great choice.
Good luck

Bill
Age 62
Feb. 2012 - PSA 18.5 Biopsy 4/27/12
Positive 10 of 12 cores, orginal Gleason 6
DaVinci Surgery 07/17/12 Dr. Vipul Patel, cath removed in 6 days, pos. margins, bladder neck involvement.
Gleason 3+4=7, involving 50% of gland, weight 57 g. Stage pT3a Lymph node involvement: 0/4
1st post op PSA 8/30/12 <0.1
2nd PSA 12/12/12 <0.1

davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 2/6/2013 10:41 AM (GMT -7)   
1 - How many surgeries have you performed?
2 - What do mthink th elearning curve is?
3 - What are your rates of success vis-a-vis typical QOL issues and cure rate?
4 - Can I contact some of your previous patients.
5 - Why do you think I'm a better candidate for surgery versus other forms of treatment including AS.
6 - Would my possibility for a cure and avoiding SEs be just as possible with other forms of treatments?
7 - What role does your staff play in my post op recovery including potential potency rehabilitation requeirements.
8 - Will you be available to me via phone and /or email after the surgery?

There are many more questions, but I'd ask the above.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3562
   Posted 2/6/2013 11:02 AM (GMT -7)   
You will have a hard time getting truthful answers to your last two questions...No surgeon will ever recommend Brachy unless you have some overriding condition that scares him...
Age 70
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5,
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 <0.1 10/'11, <0.1 2/12, <0.1, 4/12 <0.1, 9/12, 0.8

RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1240
   Posted 2/6/2013 11:23 AM (GMT -7)   
I feel it is wise to ask the surgeon about his training on the DaVinci. My doctor did a fellowship, which I felt was pretty good training. I understand some surgeons have less training on the DaVinci. It's good that they did the procedure 500 times, but if they made the same mistake 500 times due to lack of training that's not so good. I would ask the same question for brachy or any other medical procedure.

Also, my incision near the navel herniated after a few months. Not a big problem, but it needed to be repaired. I'd recommend you ask how your incisions will be closed and who will be doing the closures. In my case it was not the doctor running the DaVinci.

Post Edited (RCS) : 2/6/2013 11:27:31 AM (GMT-7)


davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 2/6/2013 11:39 AM (GMT -7)   
good point RCS. My surgeon is actually one of the guys who goes around training other surgeons so that was nice to know.

Another question i'd ask is about putting some sperm in a nice safe place. Not doing so is one of my biggest regrets.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

IronReb
Regular Member


Date Joined Oct 2012
Total Posts : 172
   Posted 2/6/2013 12:18 PM (GMT -7)   
Something else I thought of because it did happen to me. When deciding on a date for surgery, ask the doctor when he is going on vacation. I wanted to do my surgery the week of July 4th. Thought fireworks going off during the operation would be appropriate. Plus it would be during my vacation week and I wouldnt miss that much work. My doctor said he couldn't because he was going on vacation the week after that, and he did not want to be out of town the week after my surgery in case something came up. So I did it the week after he got back. So, make sure your doctor is going to be around after the surgery. You do not want to deal with second stringers if you are having a problem.
Age 54 on DX
1st PSA 8.2 Biopsy negative 2010
80cc gland
PSA 11/11 8.7, 3/12 9.1
04/2012 Biopsy: 1 of 12 positive, another 2 suspect
Gleason: 3+3=6
DRE normal
DaVinci: 7/12
Path: G7, Contained, NoMargins, multiple suspicious spots
No incontinence
No ED
PSA 9/12=0.00
me

Upstate Guy
Regular Member


Date Joined Mar 2012
Total Posts : 165
   Posted 2/6/2013 12:40 PM (GMT -7)   
The morning of my surgery, I asked my surgeon if he had had a good nights rest. :)
Age: 57
Dx: 3rd biopsy 3/3/12; 6 of 7 Right, 70%, Gleason 4+3; 1 of 7 Left, 20%, Gleason 4+4. 2nd Opinion, Gleason 5+4. Extensive perineural invasion on right.
RALP: 4/19/12; Right nerves taken. Left nerves spared; catheter 9 days;
Path rept: Neg Margins on surgical specimen; extraprostatic extension; neg SV; neg LN; Gleason downgraded to 4+3.
PSA: 12.01 pre-op; 8/3/12 <0.02; 11/4/12 <0.02

RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1240
   Posted 2/6/2013 1:37 PM (GMT -7)   
Remembered another one, ask if you can have your surgery the first thing in the morning. I've read stories about the outcomes of medical procedures being better if you are the first one up in the AM.

gams
Regular Member


Date Joined Jul 2011
Total Posts : 115
   Posted 2/15/2013 1:40 PM (GMT -7)   
Greetings,
I would ask if they would use nerve sparing type operation.
Maybe not the best deal if your the first one,in the morning right after a holiday vacation either!
My Dr went to the wrong hospital, postponed surgery,said it was his offices fault. Then remarks after after surgery really made me wonder about his actions,I had researched him and he had extensive expirence but was an ass for bedside ,I ended up having hernia surgery 1 month after,still not knowing the cause but it leaves you wondering wt_.I keep seeing alot of hernia surgerys after ralps but maybe I'm just sensative to it.
I would also ask about the nodes,and what they are planning,looking and removing or what!
57 PSA 5.2 2/12/11 COLO
3+4=7 gleason
larp,bone & ct neg,seminal ,neg
12 Samples 3 pos,1 suspect high grade
57 Gm PT2C ,TUMOR 5%OF each half
Larp 5/31/11
PSA 5.2 2/12/11
Eguinel Hernia surgery 6/25/11
8 wk PSA .01
16 wk PSA .00
24 WK PSA .01,2/09/12
12 Mo PSA .01
ED VIAGRA,VTS,ENCORE
16 mo ED
21 mo>.01 ed
QUAD MIX INJECTIONS 2/7,WORKING

gedman
Veteran Member


Date Joined Jan 2013
Total Posts : 1104
   Posted 2/16/2013 8:17 PM (GMT -7)   
My appointment with the Da Vinci surgeon is this coming week (Jan 21st). Here is the list I have thus far. Please help add to this list.

Questions about the doctor:
  • How many procedures have you performed? (I know the answer to this one already... Over 6,000.)
  • How many do you do per day?
  • How many patients have you treated who are my age?
  • Will you personally be operating the console for the entire surgery? What is the role of the other surgeons in the room during the surgery?
Questions about my preparation:
  • What is the purpose of the prostate trans-rectal MRI? How soon can I get that done? (My prostate biopsy was Jan 17th.)
  • Are there other tests that I should have to determine the exact size, location, and aggressiveness of the cancer?
  • What can I be doing TODAY to prepare my body for the surgery and to reduce side effects? (Kegel exercises? How much is too much?)
  • If I decided this week, when would we do the surgery?
Questions about the surgery:
  • Explain the procedure… pre op, op and post op.
  • What may be removed other than the prostate itself (nodes, etc)? How and when will you decide what to remove?
  • Will you attempt to preserve the internal (top)/external (bottom) sphincter urethra muscles?
  • Is the fact that my prostate is relatively small (21g) likely to make the surgery less difficult for you or less difficult for my body?
  • How will you manipulate/remove the prostate using the robotic tools without tearing the capsule (possibly causing cancer cells to be "spilled" inside my body)?
  • What will you do to spare the nerves around the prostate?
  • How is bleeding controlled?
  • How many openings will you need to make for the robotic components?
  • Is the size of the incision above the belly button related to the size of the prostate?
  • How big of an incision should I expect?
  • How will the incision be closed? I have heard of people who have had their incision become herniated after a few months. When will the stitches/staples/etc be removed?
  • How are the loose ends of the vas deferens closed? If there are clips applied, what material are they made of any how do you ensure that they never open?
  • Will the surgery involve changes to my bladder capacity?
Questions about the outcome:
  • What are the outcomes of your patients that are my age (cancer cure, incontinence, ED)?
  • How about these side effects over time, i.e. quality of life 2-3, 5-10, 15+ years out?
  • I have heard reports of penis size reductions that have occurred due to prostatectomy. Is that true, and what will be done to prevent/minimize it?
  • What tests/monitoring will be necessary to track whether the cancer returns (in the prostate or elsewhere nearby)?
  • How soon after the surgery will I get the pathology report?
  • If the cancer returns, what's next?
Questions about recovery:
* How long should I expect to need a catheter?
* What role does your staff play in my post op recovery?
* What rehabilitation strategies will I use after the surgery to minimize incontinence/ED? (Daily 25mg of Viagra? Vacuum pump?)
* How soon can I return to work?
* How soon can I return to my regular daily workout regimen (aerobic/weights/cycling)?
* How soon can I return to sexual activity?
* When would you want to do the first post-surgery PSA test, and what would you expect for results?
* What is your role vs. my urologists' role in my recovery and care: 1) treating side effects from the surgery; 2) long-term monitoring for cancer recurrence;

Other:
* I'm told that if I have radiation as my primary treatment, that surgery is still an option as a salvage therapy. Do you agree?
* Will you be available to me via phone and/or email for the first week or two after the surgery?

(Oddly, it is only possible to have 4 bulleted lists in a post, and after that it stops working.)
41y
Wife + 5 kids
PSA 9
Prostate size 21g
BX 1/17/13
Positive 5 of 12 Cores: G3+4 40%, G3+4 5%, G3+4 10%, G3+4 15%, G3+3 10%
Diagnosed 1/28/13
Latest update (as of 2/12):
CT scan and Bone scan done (negative).
Met Dr. D. Nori (brachy, Weill-Cornell), and consulted with Dr. Michael Zelefsky (brachy, Sloan Kettering). Next comes Dr. Ash Tewari (LARP, Weill-Cornell).

Post Edited (gedman) : 2/20/2013 6:03:23 AM (GMT-7)


davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 2/16/2013 10:44 PM (GMT -7)   
that's an extensive list. Let us know his answers.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 2/16/2013 11:02 PM (GMT -7)   
Do you mean LARP or RALP?

Dr. Ash Tewari is a recognized robotic surgeon. That's RALP. Or robotic assisted laparoscopic prostatectomy.

Tony
Advanced Prostate Cancer at age 44 (I am 50 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

gedman
Veteran Member


Date Joined Jan 2013
Total Posts : 1104
   Posted 2/17/2013 7:21 AM (GMT -7)   
The "official" HW PCa acronyms post has these two entries:
LARP – laproscopic robotic prostatectomy
RALP – robot-assisted laparoscopic prostatectomy (similar to LRP but with “robotic” assistance)

Can someone explain the difference to me?

-Gedman
41y
Wife + 5 kids
PSA 9
Prostate size 21g
BX 1/17/13
Positive 5 of 12 Cores: G3+4 40%, G3+4 5%, G3+4 10%, G3+4 15%, G3+3 10%
Diagnosed 1/28/13
Latest update (as of 2/12):
CT scan and Bone scan done (negative).
Met Dr. D. Nori (brachy, Weill-Cornell), and consulted with Dr. Michael Zelefsky (brachy, Sloan Kettering). Next comes Dr. Ash Tewari (LARP, Weill-Cornell).

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 2/17/2013 7:31 AM (GMT -7)   
Gedman - since potential ED issues is a realistic possibility, you could also ask him about that and what his practice offers in terms of rehab services. Many surgeons have in-house teams that assist you with the process, some even have formal arrangements with specialists. This could be an important issue so I'd ask.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

DonaldJ
Regular Member


Date Joined Feb 2013
Total Posts : 451
   Posted 2/17/2013 8:28 AM (GMT -7)   
These are some great questions, thank's for sharing. I have an appointment this week with a surgeon.
Age : 48 Biopsy 01/21/2013
4 of 13 cores involved/ localized
Gleason Score : 3+3=6
PSA: 6.6 Orig. (12/03/12)
PSA (12-26-12) 3.1
% Free PSA : 20
T1c
Possible Robotic Surgery

gedman
Veteran Member


Date Joined Jan 2013
Total Posts : 1104
   Posted 2/17/2013 11:59 AM (GMT -7)   
Added two more questions to the full list above:

* When are the stitches/staples from the abdominal incision removed?
* What may be removed other than the prostate itself (nodes, etc)? How and when will you decide what to remove?

-Gedman
41y
Wife + 5 kids
PSA 9
Prostate size 21g
BX 1/17/13
Positive 5 of 12 Cores: G3+4 40%, G3+4 5%, G3+4 10%, G3+4 15%, G3+3 10%
Diagnosed 1/28/13
Latest update (as of 2/12):
CT scan and Bone scan done (negative).
Met Dr. D. Nori (brachy, Weill-Cornell), and consulted with Dr. Michael Zelefsky (brachy, Sloan Kettering). Next comes Dr. Ash Tewari (LARP, Weill-Cornell).

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 2/17/2013 12:11 PM (GMT -7)   
Do most people get stitches or staples? I got glue that required no follow up and worked wonderfully.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6760
   Posted 2/17/2013 12:52 PM (GMT -7)   
I had both stitches and the "super glue". The stitches were not taken out. They dissolved over time.
 
LARP – laproscopic robotic prostatectomy
RALP – robot-assisted laparoscopic prostatectomy (similar to LRP but with “robotic” assistance)

Can someone explain the difference to me?

RALP is basically LARP surgery with the DaVinci robot offering an interface to the surgeon which helps him control the laparoscopic arms.  I've rarely heard mention of it (LARP) being done in the past few years.
 
 
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12;Prolia 6-mo inj 12/12

Steve N.
Regular Member


Date Joined Jan 2013
Total Posts : 95
   Posted 2/18/2013 3:52 AM (GMT -7)   
I also see RRP (Robotic Radical Prostatectomy) used here in place of RALP. 
 
I think it's confusing to include the term "robotic" in LARP.  My understanding is that there's Laparoscopic (surgeon has hands on the minimally invasive tools at operating-tableside) and Robotic (which is minimally invasive as well, but surgeon is at a console feet away from the table).
 
From what I've seen, most minimally invasive surgeries are the later, using the DaVinci.  But, Johns Hopkins still lists both as viable options in their literature.
 
--Steve N.
1/2012 PC Diagnosed
PSA 4.8
2 of 12 biopsies pos: 3+3=6 and 3+4=7
Struggling with a treament decision. Leaning toward robotic RP.

gedman
Veteran Member


Date Joined Jan 2013
Total Posts : 1104
   Posted 2/18/2013 6:38 AM (GMT -7)   
I changed the subject to include LARP/RALP/RRP, even if the thread is not exactly applicable to all.

-Gedman
41y
Wife + 5 kids
PSA 9
Prostate size 21g
BX 1/17/13
Positive 5 of 12 Cores: G3+4 40%, G3+4 5%, G3+4 10%, G3+4 15%, G3+3 10%
Diagnosed 1/28/13
Latest update (as of 2/12):
CT scan and Bone scan done (negative).
Met Dr. D. Nori (brachy, Weill-Cornell), and consulted with Dr. Michael Zelefsky (brachy, Sloan Kettering). Next comes Dr. Ash Tewari (LARP, Weill-Cornell).

Post Edited (gedman) : 2/18/2013 6:41:03 AM (GMT-7)


gedman
Veteran Member


Date Joined Jan 2013
Total Posts : 1104
   Posted 2/19/2013 5:46 PM (GMT -7)   
New one:

* How will you manipulate/remove the prostate using the robotic tools without tearing the capsule (possibly causing cancer cells to be "spilled" inside my body)?
41y
Wife + 5 kids
PSA 9
Prostate size 21g
BX 1/17/13
Positive 5 of 12 Cores: G3+4 40%, G3+4 5%, G3+4 10%, G3+4 15%, G3+3 10%
Diagnosed 1/28/13
Latest update (as of 2/12):
CT scan and Bone scan done (negative).
Met Dr. D. Nori (brachy, Weill-Cornell), and consulted with Dr. Michael Zelefsky (brachy, Sloan Kettering). Next comes Dr. Ash Tewari (LARP, Weill-Cornell).

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 2/19/2013 6:04 PM (GMT -7)   
i could be wrong, but didn't I read that that, along with getting cancer to spread through a biopsy, are myths?
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

gedman
Veteran Member


Date Joined Jan 2013
Total Posts : 1104
   Posted 2/19/2013 6:46 PM (GMT -7)   
If my question is based on a false assumption, then I'll gladly let the Doc tell me so.

-Gedaliah
41y
Wife + 5 kids
PSA 9
Prostate size 21g
BX 1/17/13
Positive 5 of 12 Cores: G3+4 40%, G3+4 5%, G3+4 10%, G3+4 15%, G3+3 10%
Diagnosed 1/28/13
Latest update (as of 2/12):
CT scan and Bone scan done (negative).
Met Dr. D. Nori (brachy, Weill-Cornell), and consulted with Dr. Michael Zelefsky (brachy, Sloan Kettering). Next comes Dr. Ash Tewari (LARP, Weill-Cornell).
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