Hi Ellen: My two-cents are below in blue.
We went to the Claire & John Bertucci Center for Genitourinary Cancers @ Mass General Hospital yesterday for a 2nd opinion.
Their team reviewed Dave's slides and records prior to arrival. We met with Dr. Donald Kaufman (Clinical Director) & Dr. William Shipley (Chief of Radiation Oncology) They downgraded him from Gleason 7 to 6. They behaved as if this was terrific news. (is it?)
Yes it is terrific news. A Gleason of 6 is better than 7, although a 7 doesn't mean it's curtains or anything. There are many guys I know who had Gleasons of 7 or 8 and PSAs that were way up there -- and they have been cancer-free and in great health 15-to-20 years post-surgery. If you decide on surgery, the post-op pathology will give you a more reliable Gleason score, because they will be able to examine the prostate in ways that are impossible through the initial biopsy specimins.
I asked how can these numbers change? I was told it's subjective they gave me a brief description and that "in Dr. Young we trust".
Numbers can and will change. When I went in for surgery, my biopsy suggested that I had major infiltration in both lobes -- from 100 percent, to 90 percent, to 80 percent, two 50s, per core sample. And I'd had two negative DREs. Right after my surgery, the surgeon told my wife he believed the post-op patholgy would be much more favorable than the biopsy suggested. And he was right. I had about a 14 to 15 percent involvement in my lobes.
Dave had another DRE and we were told was "unremarkable".
"Unremarkable" means they didn't feel anything abnormal. That's a good thing.
Both doctors recommend surgery and we left with an appointment to see Dr. Francis McGovern on August 21st. They told us he specializes in "nerve sparing" laparoscopic prostatectomy. They said incontinence should not be a problem for more than a few months. They said the nerve should be left in tact. They told us that five years from now we look back at this experience as a "nuisance".
If you feel that you are being pressured into surgery, be sure to explore the radiation options as well. Both have the same success rate and both have side-effects, although different. It's a matter of decision.
Unlike CMC here in Manchester, they do not use the DaVinci robot. Still, this was wildly different from the grim news we were given here in Manchester.
Go with the good news and research laparoscopic compared to robotic laparoscopic. Make as many appointments as possible with radiation and surgery docs. You can always cancel -- THEY ARE ALWAYS BUSY.
David left with a good comfort level with the team. Even though he has yet to meet the surgeon, he has made the decision to have this taken care of in Boston. Am I missing something?
It would have been nice for you to be able to meet the surgeon during your visit. In my case, the surgeon was my only M.D. contact after doing my research in Vegas and choosing City of Hope. And I liked that. It made me feel comfortable about my decision.
The most important thing -- in my opinion -- is to find out how many procedures this surgeon has done. Just ask. I did here in Vegas and that's why I went to California for my surgery. Call your local Cancer Society and ask for a PCa contact. They could lead you to men who will share their experiences with the doctor you have chosen.
Trusting you to straighten me out-
I'm just sharing experience and opinion. Don't put all of your trust in any individual. I think everyone here will agree that the most difficult part of your stage in this PCa thing is deciding what you want to do and whom you want to do it. Once that's established, you're on you're way to healing.
Best to ya,
Your man will be fine.
54 years old
PSA = First ever was 9.8 in late Oct. ‘06, two weeks later, 10.1
Biopsy results 11/22/06 (6 out of 8 cores positive), both lobes, Gleason 3+3 = 6
Da Vinci Robotic RP surgery, City of Hope, Jan 12, 2007
Post surgery pathology – Organ confined, Gleason still 6, margins clear.
First post-surgery PSA -- Undetectable, 2/20/07
Post Edited (PianoMan) : 8/7/2007 8:46:07 PM (GMT-6)