Treatment Choice

Time is running out for me to make a decision. My two choices are Proton Therapy or Robotic Surgery. My first choice is Proton Therapy primarily due to the non-invasive nature. I work for a medical company and have spent plenty of time in ICU and operating room theater environments, which makes me want to avoid. My one issue with Proton Therapy is an all-eggs-in-one-basket. On the chance, that cancer should reoccur surgery could be more challenging or a no option. Robotic surgery, although invasive, does allow for other options, such as radiation, if there should be reoccurrence. In addition, surgery does allow a look at the lymph nodes during the procedure. Whereas, with radiation does not or a separate procedure might be needed. My other concern with Robotic Surgery is the experience level. The learning curve on these machines is rather steep, so finding a surgeon who has hundreds of procedures under their belt with a good long-term success rate. I live in the Mid-Atlantic area, so any sites east of the Mississippi river are viable locations (Front-runners so far: Henry Ford, Detroit; Cleveland Clinic, Cleveland; OSU, Columbus, and Florida Hospital, Orlando, FL.)

Both options seem to have about equal results over the short term, and long term that is the major question, again if there is reoccurrence. Having worked in the medical field for almost twenty-five years, I have seen amazing advances in the cardiology field. I am banking that in the next five, seven, or ten years that advances in prostate cancer treatment options will be the same, where long term issues now will have viable solutions in the future. However, as with all things in life there are no guarantees.

 

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Age: 52

Hi and welcome. 

And sorry you are here.  But this is a great site for us patients.  I am pleased to make the acquiantance.  My decision was made in December last year.  I had a high PSA (19.8) and my Gleason was 3+4=7.  For the same reasons you mention I chose surgery.  When the dust cleared and my post-op pathology came in, I was hit with the fact that my condition was worse than the clinical stage.  I was staged at pT3b (stage III cancer).  Since I was only 44 this was a shock, I mean this whole thing was shocking.  I am glad I chose surgery.  The Lymph system was clean on ten nodes removed.  I have had to have additional treatment, and have chosen the dam the torpedoes approach.  I am on hormone treatment and radiation is halfway completed.  I have additional ammo in the form of chemotherapy but have yet to make that decision.  I list my story to let you know I am sincere that I chose surgery.  The only other decision I needed to make at that time was which surgery.  After careful analysis, like you have done, I chose robotic at the City of Hope.  My Doctor had done over 1,500 of them since 2001, and was a master.  I had little down time and no heavy side effects. 

I too am sorry you need to be here but glad you are using the resource. I was 44 when diagnosed. I had the same options you have. After looking at the long term survival, recurrence and morbidity data I chose removal. I didn't have the option of laproscopic due to insurance problems regarding travel and lack of financial resources so perhaps my choice was simpler. "Get it out and be as sure as you can be it hasn't spread and is less likely to reoccur", was my thinking.

You don't say what it is about the operating theaters, you have been exposed to, that makes you hesitant to choose surgery. Perhaps a visit to one or more of your choice hospitals facilities would ease your mind on that account.

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I sure do wish I had found this site pre-surgery!! RRP 10/25/05 I don't remember all the scores. Have had clean checks ever since. Never had to use the pads!!

Hello NewJourney,

The one issue which most concerned us was getting the PCa out of my body as soon as possible. Surgery then became the option we focused on. We selected the DaVinci procedure because it was the least invasive, and we had gotten a strong personal referral. The surgeon that performed the operation had done over 1000 by the time it was my turn, and everything went very well. I too live in the Mid-Atlantic region, and found that many of the most experienced DaVinci surgeons in the country are practicing here. It's true that the radiation theropies offer the same high success rates as the surgical procedures so it will come down to what makes you feel the most confident.

As you mentioned Cleveland Clinic, Robotic surgery, and Perineural, you might be interested in an interview at www.prostatecancerupdate.com with Dr E Klein from Cleveland Clinic. Dr Klein discusses various topics including Robotic surgery and positive margins.

You mention Florida Hospital in Orlando as one option as far as a location for having surgery. I had my surgery there on May 21, 2007. On a scale of 1 to 10 I can say that the treatment and care I received there were a 9. I was admitted on Monday and discharged Tuesday morning. The surgery was performed by Dr. Rakesh Patel and Dr. Jeffrey Thill from Winter Park Urology.

 

Best to you and good luck.

Jack

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Diagnosed: March, 2007

PSA: 3.0

Biopsy: Gleason 6

Surgery May 21, 2007. Nerves spared and operation completed in 1 and ½ hours.

Pathology Report: Gleason 7 (3+4), multifocal, 15% of prostate, largest tumor 7mm, organ confined, negative margins.

1^st Post Op PSA: <0.1

No pads after five weeks and Erections after six weeks

Dear New Journey,
The choice for treatment is such a personal one, all any of us on here can do is relate our experiences and those of the people we know. I chose Robotic Surgery, because two of my closest friends had gone through it with great success. Although the jury is still out on me, The early signs are encouraging. I would make the same decision today that I made last winter, even if my lingering problems never fully disappear. Like many others, I wanted that @#$%^ Cancer out of my body ASAP. Good Luck, and we will all be here for you, no matter what you decide.
Best,
Mike

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June 2005 - Age 53 PSA 4.8 at regular physical
October 2005 - After several rounds of anti-biotics, PSA 5.2 at Urlogist
November 2005 - Biopsy negative
July 2006 - PSA 5.9 at regular Physical
October 2006 - After several more rounds of anti-biotics PSA 8.1
November 2006 - Second biopsy - Positive
December 2006 - Gleason (3+4=7), Tumor T1c, CT Scan and Bone Scan Negative
January 2, 2007 Robotic Prostatectomy, University of Rochester Medical Center - Tumor confined but larger than thought, only one nerve able to be spared. Margins clear.
February 2007 - Three to four pads a day, no erection with viagara.
March 2007 - Down to two pads a day, had first intercourse with Erecaid pump and bands, otherwise still flat tire.
April 2007 - First Post-Surgical PSA 0.02 and a great relief! Down to one pad a day. Still unable to achive erection without pump.
May, 2007 - Still one pad a day, even try a smaller pad on occasion. Slight improvement on the ED.
"If patience is a virtue, I feel like the most virtuous guy on the planet!"

I was in a very similar situation and glad I chose robotic surgery, because I wanted to get that cancer OUT!  My surgery and post operative recovery has gone very well - working on the erection issue, but that has never been priority one.  I probably wouldn't be still thinking about PC except that my post surgical pathology report was something I never expected.  Even my radiologist, who initially encouraged the seed therapy, agreed that because of what was found, it was a good idea to get rid of it.  Now I'm continuing to attack it aggressively, comencing adjuvant hormone and radiation therapy.  Hopefully by the one year anniversary of diagnosis in November, I can feel good that the probability is high that it's really gone, and I can look forward to many more years cancer free.

New Journey, I under stand there is another treatment for prostate cancer called HIFU that is going through FDA approvals process. HIFU stands for High Intensity Focused Ultrasound. It is still being looked at for long term effects, but is non-invasive. This technology may soon provide relief for many men, but when you are diagnosed, you have to take steps now.

Like other writers here, I wanted to get the #@!* cancer out asap. From my readings and study, the laser procedure has a higher effectiveness level, especially with someone at a younger age, than other therapies.

Good luck and my prayers are with you.

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Age: 56

New Journey, I have chosen the Robotic route and I have my pre-op this Wednesday and surgery at Duke 7/31/07. We did the research and like most I want this out of me as soon as possible. Our Dr. has performed over 600 so I feel very comfortable with him at the helm. I met with a neighbor that had the robotic surgery at UNC last year and he is doing very well. He is 48 and his continence control is great with some minor issues with ED, as expected.

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Age 44

Hi, i was in the same boat just a few weeks ago that you are now in. I was diagnosed at 52, PSA 3.1 and Gleason+6. I opted for the robotic surgery with Dr. Patel at Ohio State. By the way, i travelled from NC. Dr. Patel has done over 1000 of these surgeries so I thought i was in pretty good hands. I originally planned on going to Duke but I found out that Dr. Patel trained the guys at Duke. Better the teacher than the student!

I had the surgery last Monday and was released from the hospital on Tuesday morning. It is now one week later and i hope to have my catheter out tmorrow. My decision was based on what if something else had to be done at a later date. I spoke to a number of surgeons and they all gave the same answer- it may not be possible to remove the prostate after radiation. The procedure I had took a little over an hour and the only discomfort I realized after surgery was the slight pain in the abdomen at the point of the incisions. The pain got less and less each day. Let me know if you have other questions or concerns that i can answer for you

good luck!

 

Hi NewJourney,

I understand that this is a really tough decision and I'm sure that you will make the right choice. I'm not sure if you looked at the yana site where mentors discuss their experiences and treatments. Here the links:

http://www.yananow.net/Experiences.html (mentor experiences)
http://www.yananow.net/Radiation.htm#pb (go to the bottom of the page for proton beam)
http://www.yananow.net/LRSurgery.htm#lrrp (LAPARASCOPIC SURGERY, includes ROBOTIC)
http://www.yananow.net/Surgery.htm#surgery (Radical Surgery)

Best of luck to you with your decision.

AEG

HI New Journey. I had open surgery on May 30 2007. I was up and walking the next day and was released the second day. Pain was never over a 2 or 3 out of a 10. Had no pain meds after 1st day in the hospital. Still dribbling 3-4 pads a day. A friend had robotic at Duke and recommended it to me. I have sleep apnea so I was not a candidate for robotic. Dr. Moul at Duke did my surgery and I could not be any more pleased with the outcome. Negative margins. Went back to work today and had no problems. Good luck to you in your journey.

Mika mvesr

To all who replied, thanks. I appreciate your comments. Today I had an appointment with my Urologist. We discussed what I plan on doing to treatment. Though my preference is for noninvasive, logic dictates that I go for surgery. In the back of my mind that little voice was saying this, but was hoping to ignore and avoid. From my readings, it seems that the vast majority of guys around my age are opting for surgery. At this point in time the long term benenfits seem to side with surgery. Ok, so that hurdle crossed. Now to find where to go. As mentioned in opeing thread comment, the hospitals mentioned are good choices. The doctor suggested, strongly, I should find a site in my area. This would probably be Johns Hopkins, which is a two hour drive. The reason for this is in case there are any issues that require a followup. This makes since, but I would rather go the extra distance to someone who has much experience and has a good scorecard with few to no followup issues. OK, so now to mentally prepare for this. Physically I am working out at gym numerous times a week. in the last 11 weeks have lost 16 lbs and my blood pressure, IMO, is getting a bit to low. Maybe I can get off high blood pressure medicine also.

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Age: 52

As a counterpoint to the above responses it sounds to me like you are settling for surgery and possibly are resigned to it. I fail to see what logic is being applied here and I am not trying to sway you to one form of treatment or another, but of course your urologist is going to recommend surgery, it is what they do. If you have the opportunity to do so go to www.protonbob.com  and read some of the testimonials there regarding protons. Protons are certainly not an all eggs in one basket approach to treatment. There are many things that can be done if protons were to fail.

I start at Loma Linda on July 26th and have chosen protons as my treatment. If you have any questions I would be glad to contact you personally by email or voice. Take care and don't just settle for surgery if non-invasive is what you really desire. As far as the long term benefits to surgery vs. proton vs. brachytherapy vs. photons, they are all virtually the same.

Hi new journey. one further comment. if you do decide to go out of state you should talk to your local urologist and make sure he is ok with doing follow-up. in my case, mine was very accomodating and will do most of my follow up. My understanding from talking to many is that most understand these issues and are willing to work with their patients but it is always best to know where you stand up front.

Journey, I had RARP at Duke with Dr Albala and am so far satisfied with the experience and would not hesitate to recommend Duke. They have a program where newly diagnosed patients can meet doctors from all the various treatments in one day to help in a decision. Contact them for details.

Also, check out Vanderbilt and Dr Joseph Smith and Duke Harrell. They are very experienced and were number two on my list of most qualified in RARP. Duke was closer and Insurance paid more of the cost. I had already chosen surgery when I referred myself to Duke.

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Age 64
5'6" 145#
PSA pre-op 5.2 (12% free)
Gleason 3+4=7
Robotic RP 4/24/07 Dr. Albala, Duke
Post-op- Organ confined Gleason 7
6/18/07 PSA >0.1
1 pad per day
ED Cialis and VED prescribed

New Journey,

just a quick response to Idoun's note- Dr. Abala at Duke is good- he was trained by Dr. Patel from Ohio state.

New at this. Am 87 years old and just diagnosed with prostrate cancer, must make a decision as to form of treatment.  Any suggestions.

hi tad and welcome!

First want to suggest making your own thread where people are more likely to see your question. Example "treatment advice, 87 years old". Or whatever title is comfortable for you. To post your own new topic just click the "new topic" button at the top or bottom of any thread (towards the left of the screen, you should see it right above the reply window at the bottom of this thread, for instance).

In addition, would be helpful if you gave some details in your new thread. For instance, PSA history, biopsy results, general health, etc.

Glad you found us and glad to have you here! There are many courses of treatment out there. Proton beam might be one you would like to at least look into (especially if you are on medicare ... because it is covered).

Best wishes! Please let us know more about your circumstances :)

Tanya

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Age: 63
Diagnosed: 10/30/06
PSA: 3.7 (2005: 3.4, 2004: 4.0)
Biopsy: 1/10 cancerous, 5% of one core, right apex.
Gleason: 3+3=6
Da Vinci: April 10, 2007, Denver CO
Path results: 1% of prostate involved. Very small tumors on both right and left apex. Negative margins, negative seminal vessicles, lymph nodes left intact. Gleason upgraded 3+4=7.

Tad:

Sorry to hear you have got to go down this path, but this forum is a great place to help you along your journey.  I too think your own thread and a little more info would be helpful.

I was 65 when I was diagnosed with Pca and was more concerned about quality of life than quantity.  I chose Proton Therapy at Loma Linda - noninvasive and I was fortunate to not have any side effects.  The side effects, if any, are minimal.  Check out www.protonbob.com for Loma Linda info. and testimonials.  There are also facilities in Boston, Indiana, Florida and Texas, but Loma Linda is the one with the most treatments and stats.

Look forward to hearing from you again and good luck on your search for a treatment that suits YOU.

Dutch

Tad,

As suggested, treatment options depend on your diagnosis details and overall health situation.

I have two friends who have recently used hormone treatment. One  is similar age to and  has been on hormone treatment for 5 months. He's tolerated the treatment well and his PSA reduced considerably to .2 after 3 months.

The other one has used it for 15 months. His symptoms of leg pains have reduced. His original scans indicated bone spots, which could not be seen on his recent scans.

In any event, the book "Beating Prostate Cancer: Hormonal Therapy & Diet" by Dr Charles Myers is certainly worth reading. It's very comprehensive and covers various aspects of PC diagnosis, treatment and lifestyle. Dr Myers underwent radiation and hormone treatment for his own PC some time ago.

John

 

 

Hi Tad,

Welcome to our forum. I hope you don't mind but I started a new thread for you, link is http://www.healingwell.com/community/default.aspx?f=35&m=860449.