Delay of RALP good, bad or neutral?

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three 5's and a jack
Regular Member


Date Joined Jul 2017
Total Posts : 178
   Posted 9/4/2017 5:07 PM (GMT -7)   
Was diagnosed on 8/4/17 ( see signature below ) finally got to the decision last week, after 2 RO and 2 Surgeon consultations. Decided on the best surgeon in the Pac NW.
Question is................I was offered a date for surgery around the 20th of Oct. I discussed with the surgeon if waiting another 6 weeks would be detrimental to the outcomes. His response was "Not at all, you could (probably) wait until spring, but no guarantees" He suggested 2-3 months was the best idea. That would be between Nov 1st and Dec 1st. I scheduled for the 4th of Dec.
I just wanted enough time to get everything done before winter and the surgery.
Interested in hearing what all of you think as there are many out there much more knowledgeable than myself.

Thanks
Looking for the 4th 5
69yo weight 7/1-283# on 9/1-227# projected 190# for surgery
PSA 6.01 6/17
BX 8/11/17 5/16 cores
L mid/base 4/6 4+3=7 25%
L apex 1/2 3+4=7 30%
RALP on 12/4/2017 DR.Ellis UWMC Seattle

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3109
   Posted 9/4/2017 6:07 PM (GMT -7)   
My diagnosing Uro told me, "you have 6 months to make a decision" (and that was based on 3/12 positive cores at G6. The fact that my post surgery path came back at G7 in all quadrants is of minimal importance.

The fact is that PC is slow growing, and a few months when you're at Low-to-Intermediate risk is awfully common (and should become more so, not less so).
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 635
   Posted 9/4/2017 6:10 PM (GMT -7)   
Your asking, I at your age would go with a radiation therapy.... I had surgery at age 52. I'm doing great, having said that, radiation would be a slam dunk at your age if it were me.... Good luck with surgery and I am sure that it will do you good. I also believe that from what you have shared it will be a walk in the park.
Hero
Father died from complication of metastatic prostate cancer
I was Diagnosed at age 52
10 of 12  cores positive with 4/3 G7, Post-Op Status = T2NoMoG7-(StageII)
Robotic Surgery, Wash-U/Barnes, St.Louis, Mo. Adam Kibel M.D. who is now Chief at Brighams

Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2512
   Posted 9/4/2017 6:29 PM (GMT -7)   
In all likelihood, it's neutral. You were diagnosed in August...how long do you think you had PCa before then? I gotta believe it was at least a year. Let's say it was 2-3 years (I'm guessing I had it at least that long before I was officially diagnosed). If so, an extra couple of months is negligible.

As always, I'm just a hack on the internet...not a doctor. And while that's my (hopefully) commonsense reasoning, I know that TA has some actual data on this and I'm sure he'll weigh in.
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

three 5's and a jack
Regular Member


Date Joined Jul 2017
Total Posts : 178
   Posted 9/4/2017 6:36 PM (GMT -7)   
Hero:
I would have gone with radiation of some type did I live near enough to commute for 8-9 weeks or if my prostate was 30cc instead of over 60cc. about the only RT available to me based on my criteria was SBRT and I just couldn't get my head around that one.
I may be 69 yo but in all respects I am in my 50's and to be totally honest I just don't really give a dam about the ED. I also really want to know what the I have and how aggressive it is.

Halbert......as always right to the point. Thanks
Looking for the 4th 5
69yo weight 7/1-283# on 9/1-227# projected 190# for surgery
PSA 6.01 6/17
BX 8/04/17 DX 8/11/17 5/16 cores
L mid/base 4/6 4+3=7 25%
L apex 1/2 3+4=7 30%
RALP on 12/4/2017 DR.Ellis UWMC Seattle

Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 635
   Posted 9/4/2017 6:57 PM (GMT -7)   
I wish you the best... and I truly believe that you'll do great. BTW regarding my thoughts... its not at all about ED. It is what works best for you!
Keep us posted.
Hero
Father died from complication of metastatic prostate cancer
I was Diagnosed at age 52
10 of 12  cores positive with 4/3 G7, Post-Op Status = T2NoMoG7-(StageII)
Robotic Surgery, Wash-U/Barnes, St.Louis, Mo. Adam Kibel M.D. who is now Chief at Brighams

Nick2017
Regular Member


Date Joined Jun 2017
Total Posts : 90
   Posted 9/4/2017 7:01 PM (GMT -7)   
I had wanted to wait until the end of the summer for my surgery, so I could enjoy it. I had come across studies that there was no difference of outcomes if one waited 90 days from the date of diagnosis. Tall Allen has some of those studies. But I could not understand: How long was the PC in me before there was a diagnosis?

I interviewed three urologists, who are surgeons, I was diagnosed a 4+3 but they all saw it as a coin toss with a 4+4 (which it actually turned out to be post surgery biopsy). They all said basically the same thing:

"If I was fortunate, the surgery will get it all, nerve sparing, no evidence of invasion and then my six week PSA would be undetectable. However, how would I FEEL if the results of my surgery showed that it had escaped the prostate capsule? Would I blame myself for having waited?"

From my research, if the TRUS biopsy shows that the cancer is near the edges, which mine was, then it has less distance to travel to escape, so if you're an Intermediate, then you need to move sooner rather than later.

My two cents is to get it over with then hire a reliable, strong, young, local guy who needs the work, will do it cheap, to do all your hard labor such as splitting wood, etc. After all, sooner or later as we get older we need to delegate that hard work, whether we are recovering from surgery or not.

Nick
Age 64, married 34 years, Diagnosed 5/11/17, T1c, PSA 3.5, Originally Gleason 8, reduced by Dr. Epstein to Gleason 4+3, TRUS biopsy: 2 cores at 20%. MRI found PIRADS 4 & 5.

RP Surgery 7/19/17 by Dr. Zagaja at University of Chicago, both nerves spared, Negative Margins, biopsy showed Gleason (4+4), less than 5% of prostate cancerous. Now must test PSA every 6 months. Happy with my decision!

Bohemond
Veteran Member


Date Joined Apr 2012
Total Posts : 846
   Posted 9/4/2017 7:09 PM (GMT -7)   
Three 5s,
I see no problem at all in waiting another 6 weeks or even longer. The few extra weeks until treatment are very, very unlikely to have any effect on your outcome. And for your own peace of mind you should get done now things you aren't likely to do soon after surgery. In my experience I am glad I was able to replace a shower valve that broke two weeks before my surgery. I told my wife to call a plumber but no one wanted such a amall job. If I hadn't fixed it myself a few days before my surgery the upstairs shower would have been out of service for a couple of months.
Age 71
-2002-PSA 9.4, 5 of 10 cores positive - 30-50%.
-RP April 2002. PT3B N0 MX Gleason=7 (3+4), 75% left lobe; small focus rt lobe.
-PSA low of 0.01; slow rise to 0.4 (Aug 2009).
-SRT Jan/Feb 2010. One lymph node targeted. Casodex 3 months during SRT -PSA 0.00 through Apr 2014;
-0.02 Oct 2014; 0.04 Apr 2016; 0.23 Oct 2016; 0.51 Jan 2017; 0.64 Mar 2017, 0.92 Jun 2017

Post Edited (Bohemond) : 9/4/2017 8:12:11 PM (GMT-6)


Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8817
   Posted 9/4/2017 7:15 PM (GMT -7)   
I think he advised you well. If you want some data, here's some data:

onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10666.x/epdf
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

three 5's and a jack
Regular Member


Date Joined Jul 2017
Total Posts : 178
   Posted 9/4/2017 7:23 PM (GMT -7)   
Thank you all
Looking for the 4th 5
69yo weight 7/1-283# on 9/1-227# projected 190# for surgery
PSA 6.01 6/17
BX 8/04/17 DX 8/11/17 5/16 cores
L mid/base 4/6 4+3=7 25%
L apex 1/2 3+4=7 30%
RALP on 12/4/2017 DR.Ellis UWMC Seattle

ddyss
Regular Member


Date Joined Apr 2017
Total Posts : 128
   Posted 9/4/2017 7:25 PM (GMT -7)   
I was in your situation and I decided to get it done within 5 weeks of Dx and I would suggest you take the october date ... at the end of the day statistics is what it is ... you have those 4s in there and I would take those out sooner than later
DX@ 48 Yrs PSA 03/15 4.45 DRE: Firm Right Base
04/18 Biopsy Right: Base 4+3, Middle 3+4, Apex: HPIN
Left 6 cores : -ve
5/20 MRI: Pirads 5, ECE:+ve
RALP 05/26 Mt. Sinai Miami - Dr. A. Bhandari
Path:
Gleason downgraded to 3+4 !! Stage T2C
Prostrate Size: 49grams Tumor:20%
LN/SV/ECE: -ve PNI: +ve
Cath Removed : 6/1
Full continence: 7/4
PSA: 7/7 <0.1

BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 2600
   Posted 9/5/2017 1:15 PM (GMT -7)   
three 5's and a jack said...
Hero:
I would have gone with radiation of some type did I live near enough to commute for 8-9 weeks or if my prostate was 30cc instead of over 60cc. about the only RT available to me based on my criteria was SBRT and I just couldn't get my head around that one.
I may be 69 yo but in all respects I am in my 50's and to be totally honest I just don't really give a dam about the ED. I also really want to know what the I have and how aggressive it is.

Halbert......as always right to the point. Thanks


I may have said this before, but if so I repeat: going by what you said from above, I'd say if there was ever a good candidate for surgery, it is you! Also, I don't think a few months 1 way or another is going to make a big difference. You may have had this cancer slowly growing for years.

Also, whatever amount of time you decide to delay, it will give you more time to get in shape for surgery, and if interested to check into various lifestyle changes that may- or may not- help with your pC condition prior to surgery. In my case, whether actually helpful I have no way to say, I managed to drop my PSA 25%(first drop in my history) during the 2 months after my biopsy and before surgery. I always like to tell myself that was a worthwhile drop, makes me feel better. ;)
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17

Post Edited (BillyBob@388) : 9/5/2017 2:20:21 PM (GMT-6)


john4803
New Member


Date Joined Sep 2017
Total Posts : 2
   Posted 9/13/2017 9:47 PM (GMT -7)   
Tall Allen said...
I think he advised you well. If you want some data, here's some data:

onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10666.x/epdf


TA, I couldn't get your link to work. I'm a newbie so probably don't know what I am doing?
69 yr. old DOB 4/7/48 Troy MO-just W of St. Louis
PSA 3.2 7/08 Slightly enlarged
No PSA DONE w/labs. 2013 due to 0 symptoms-MISTAKE
PSA 51.2 (7/11/17), 0 symptoms
DRE hard on left, 31g size (normal 25g) 7/24
Biopsy 8/11 No PNI GS 4-8s, 4-7s out of 12
NUC Whole Body Scan/CT Urogram 8/29. BOTH CLEAR
Prolaris result 9/11 T2b, 3.8/10, 10yr Mort Risk: 23.5%, Metast Risk: 29.6%.
Consult 9/11 Recom RT or RALP
Consult for RALP 10/12

Post Edited (john4803) : 9/14/2017 9:26:50 AM (GMT-6)


Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8817
   Posted 9/13/2017 10:14 PM (GMT -7)   
Hmm. Try this link instead, and click on the red "pdf" button on the upper left to view the full text:

onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10666.x/abstract
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

john4803
New Member


Date Joined Sep 2017
Total Posts : 2
   Posted 9/14/2017 8:25 AM (GMT -7)   
TA, I put it into Google and came up with the following link:

onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10666.x/full

Thanks!
69 yr. old DOB 4/7/48 Troy MO-just W of St. Louis
PSA 3.2 7/08 Slightly enlarged
No PSA DONE w/labs. 2013 due to 0 symptoms-MISTAKE
PSA 51.2 (7/11/17), 0 symptoms
DRE hard on left, 31g size (normal 25g) 7/24
Biopsy 8/11 No PNI GS 4-8s, 4-7s out of 12
NUC Whole Body Scan/CT Urogram 8/29. BOTH CLEAR
Prolaris result 9/11 T2b, 3.8/10, 10yr Mort Risk: 23.5%, Metast Risk: 29.6%.
Consult 9/11 Recom RT or RALP
Consult for RALP 10/12
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