Folks, I'm blown away by how helpful everyone's comments have been. This is truly a great resource and I am deeply thankful to everyone for sharing your very insightful thoughts. I was particularly encouraged to see that Ben Stiller went through the same thing as we all did....
Very interesting comments on RALP. Dr. Catalona provided me a packet of materials disparaging robotic (Da Vinci) surgery. I suppose that since he is a strong believer in open surgery by very skilled surgeons that open is better in his mind. That said, Dr. Moran (my RO) actually mentioned that if I was going to consider surgery that I might want to talk to Dr. Schaefer at NW (whom ddyss suggested). So, that is helpful and actually makes me appreciate Dr. Moran's objectivity.
I appreciate the thoughts on getting a 2nd opinion of my biopsy. A number of folks have suggested that I send it to Epstein's lab at Johns Hopkins. However, the pathologist that completed my biopsy is Jimmy (Ximing) Yang who trained under Dr. Epstein and is known to be very competent.
My next step is MRI and a Bone Scan at Northwestern to get some more information to help with my decision making.
Dr. Moran's recommended treatment is a multi-modal treatment of IMRT combined with Bracy seeds. He would put me on the Casodex only for a couple months to soften up the prostate before radiation treatments and my understanding is that Casodex is not as severe as other forms of HT and it would be a short window that I would be on it. So, I'm currently leaning this way depending on what my MRI & Bone Scans show. I'm thinking that rather than endure surgery, if there is a question that any of the cancer has escaped the prostate the multi-model approach would be better anyway and I can mitigate some of the more concerning side effects of Surgery.....
Moran was very through with me. My uro was from NW, didn't like him, no way I was doing surgery. Went to Moran 5 days later. After a DRE and consultation he gave me the low down. I knew this was the place for me the minute he came outside while I waited for the volume study and we talked cars for about
20 minutes After volume study which takes about
15 mins, he said best to send my biopsy to Epstein before anything else. Then he wanted a genetic study done. He's very thorough and isn't trying to steer you one way or another. He collaborated with the RO at NW, most likely the one he will recommend to you if you go this route. Took the casodex for a month (couple of hot flashes here and there, no biggie), then into imrt (prostate bed), then Brachy. Cancer sucks, but going to Moran made it so much easier. The facility is pretty amazing, and the nurses are fantastic.
If you go with Moran, you are in good hands.
10/21/17 psa 5.6
12/15/17 psa 5.2
2/23/18 psa 6.3, P2PSA 19.40, PHI:55.35
3/8/18 Creatinine POC 1.0
3/8/18 MRI showed two lesions both PI-RADS:4. Prostate size: 40cc, density: .16
5/4/18 Biopsy-Gleason score 3+4=7 with perineural invasion. Tested at NWMH and with Epstein.
10/26/18 LDR Brachytherepy