The Treatment Decision
Before we met with the urologist I did a lot of research on what to do, read as much as I could and looked for messaged boards, unfortunately I didn’t find this one until I was all scheduled and ready to go. At first I read about
the clinic in Georgia and their seed and beam radiation procedure and thought this was the way I would go, maybe not there but that treatment. Then I read about
the surgeon in Florida who does hundreds of the laparoscopic procedures each year and the patients would be up and moving around the next day almost as nothing had happened. Well on November 15th 2006 I and my wife went to meet with the urologist and see what options we had. I had already did a lot of research and knew there were numerous options available, actually more overwhelming then learning I had cancer. He went over the numbers with us, PSA 6.22, 2 of 13 cores positive each 10% cancerous, 2 others suspicious, Gleason 3+3=6 and Stage T1. We spoke briefly about
surgery and that he preformed the
open radical surgery and completed about
20 to 25 a year. We talked about
seed implants and external beam and would be happy to set up an appointment with the radiology department to go over those treatments. We also discussed laparoscopic surgery and Robotic surgery with the De Vinci. He told me they didn’t see any better results with those surgeries than the
open procedure they did that warranted them going to either of those procedures. He also stated I was young, in good shape and his recommendation would be surgery because I should have 30 plus years of life and good health in front of me, this I did agree with. We talked more in depth of what he would do if he preformed the surgery and along with removing the prostate he would automatically remove the limp nodes and at least one set of nerves along with everything else, just the way he did it. He said I didn’t need to decide right away, I had time and I could call him next week. Well as we left the office and on the way home my wife and I had time to confer. God love my wife but being the worrier of the family was ready to schedule the surgery with this doctor and get the thing out. I said no, I had time and wanted to check with our insurance and a 2nd opinion. Also I had learned that even if I choose surgery and which method, the most important thing was to find an experienced surgeon who preformed many surgeries each year and 20 to 25 per year didn’t seam to meet that. Nothing against the doctor or the hospital, they are well known for many things and are very good at them, I just wasn’t ready to turn myself over to them in this case.
Sometimes fate steps in, in finding a few patients that had made the same type of decisions I ran into two others that had my same doctor locally and both chose to go else where. One of them had chosen University Hospital in Madison WI to perform a laparoscopic procedure about
18 months ago and was very happy with the outcome. Also at this same time our insurance got back to me and while they were
open to a second opinion they highly recommended it and we had a service called, Cancer Resource Services that helped in directing you to one of 21 approved cancer centers they recognize which in my case happened to be the Paul Carbone Cancer Center at University Hospital in Madison WI. So I made a call to them to discuss getting a second opinion and to meet with an urologist and I really was interested in discussing the De Vinci procedure. In the days between meetings I had come to the conclusion that I was 90% sure surgery was for me based on the following.
1 My present age (48)
2 My present health condition (Excellent)
3 The fact I had two young kids (9 & 12)
4 The fact I should have 30 plus years life remaining
5 The fact if cancer had spread, I could still follow up with radiation where in reverse surgery was not as easily preformed after radiation.
6 The stage of my cancer hopefully still contained with-in the prostate
7 And plus it felt like the right thing for me, personal decision everyone makes.
Also there were three items that I rated in order of importance that I wanted to accomplish
1 To have the best chance of long term cure. (Without item 1 item 2 and 3 wouldn’t matter if I wasn’t here in 5 years or whatever.
2 Incontinence. Next in line of priority of life was this issue and now that surgery looked like the way I was leaning it appeared that there may be a slightly better chance of regaining this utilizing the robotic procedure. However I don’t believe there is any difference in the procedure it’s the surgeon who makes the biggest difference.
3 ED problems. This rated third in my list of priorities but again with surgery it appeared there was good nerve sparing capabilities utilizing the De Vinci. Again if you have a good surgeon I don’t know that there is a major difference.
And a bonus number 4, the De Vinci had the added benefit of being less evasive and able to get back to normal life and work sooner.
Age 49, PSA 6.22 on 9-26-06
Biopsy 11-01-06, 2 of 13 cores 10% cancer, 2 other cores abnormal Up-dated 20% prostate cancerous
Gleason score 3+3=6 After Pathology report 3+4=7 some agressive 5 cells found
De Vincie surgery 01-09-07 UW Madison
Pathology Report- cancer 100 % capsual contained 1-18-07
Catheter removed 1-18-07 suffered bladder spasms Catheter reattached 1-18-07
Catheter removed 2nd time 1-24-07
1st Post PSA Blood Test Scheduled for 3-22-07