Update on this: My friend just returned from his consult at Hopkins. The RO he saw told my friend that if he were 10 years younger recommendation may be different but, given his age and very slow PSA...
Thanks everyone for the inputs so far. My friend has decided he'd like to get an expert 2nd opinion on what to do / not do from a risk-based perspective. His insurance will apparently pay for travel...
I was approached for advice from 75 year old family friend who had RRP in 2001 and just became aware that he is in midst of a BCR (see PSAs below) after his PCP who has been ordering PSAs for last...
Congratulations Gedman. You are a great success story!...
Per their most recent joint guidance, the American Urological Association and the American Society for Radiation Oncology recommend that SRT be considered after two consecutive readings of 0.2 (not...
Glad to try to help, Casper. What my research on surgery told me is that experience on the order of hundreds of cases is necessary but not sufficient. Achieving the lowest margin rates also seems to...
Pratoman, I just misread your original post I missed the "WITH" and just noticed the "without". Sounds like normal PCa study......
I was initially GS6 but wanted that 2nd opinion to be sure. Some have been downgraded to non-PCa avoiding unnecessary treatment (rare but happens). Some are upgraded. If you were considering active...
Its uncomfortable but not terrible, and I didn't have any sedative (just local numbing, IIRC). But I would ask why no contrast (not a "functional" exam showing diffusion)... MRI for prostate is...
Pubmed is a good place to start. I spent a lot of time searching back when I was diagnosed. Here is a spreadsheet compiling my results (but has not been updated in over a year):...
Hi Angel, I agree with others that the G6 is GREAT news and, given that, there is no need to panic just due to the positive margin! With that said, if it were me I might want an expert second reading...
Hi Pratoman, Definitely agree that Tewari is one of the 2-3 best RALP guys in terms of published hard numbers... 2.1% (4 of 188) for pT2a and 33.3% (7 of 21) for pT3+ which worked out to 5.3% (11 of...
Hi Casper, One thing to consider with surgery and, perhaps to a slightly lessor extent, Brachytherapy is that the chance of a good outcome (both in terms of cure and side effects) is HIGHLY dependent...
Totally agree. Regardless of PSA you need to have the nodule checked out and it seems unlikely a nodule would go away so I'm puzzled what he expects to change in 4 months....
Sorry to hear of your unpleasant experience Clanda. I am no expert but here are a few thoughts based on what I've learned. Better erections while upright (e.g. standing, kneeling) vs. horizontal and...
Quoting further: “In the age of cost-containment and concerns about overtreatment, we can’t assume that involving patients more in treatment decision-making will help solve these problems,” Dr. Katz...
I have heard before that nerve recovery is believed to be associated with continence improvement. It makes sense as, besides the erectile nerves, the neurovascular bundles contain nerves running to...
Great story, Dude! Congrats on the excellent outcome and being able to move on with your life and family......
Hi Hank. It sounds like you've done your homework. Hopefully that included getting hard statistics from both docs you are considering including in particular their positive surgical margin rates. As...
I would next try 15 mcg (at most), not 20 mcg. I have found 2-3 mcg can make a big difference and the same dose that gives a 90%/1hr response one time can give a 110%/3hr response the next. From the...
James sorry about the diagnosis and runaround you are getting but welcome to the forum. There are plenty of knowledgeable guys here to help you sort through it all. Sounds like you are intermediate...
My experience was similar. I have been pad free for nearly two months but late in the even I sometimes have a couple drips. I think it is just the pelvic floor muscles fatiguing as the day wears on...
My understanding is PSA elimination half life is about 2-3 days so 6 weeks (when I was first checked by my local uro) is 14 to 21 half lifes or somewhere between 16,000x and 2,000,000x reduction from...
Those are great results. Congrats. My understanding is that the finding of some perineural invasion (PNI) in the final pathology of entire prostate is not generally considered to be a significant...
My father was DXed in his 80s with Gleason 8 and his bone scan lit up like a Christmas tree -- due to age and extensive arthritis. His PC was successfully treated with IMRT and never recurred. With...
I don't think you are being too hard on your doc at all. Many doc are this way but that's no excuse. One of the reason I chose my surgeon was how accessible and responsive he was (and still is). He...
Most are using compounded medications ("bimix" and "trimix"), which can be more potent and often more well tolerated (less aching) than pure alprostadil. Although Cialis works for me, I've been using...
The examples from the YANA site are interesting but you have to wonder if a couple of them who ended up with HT / chemo were really even true G6 under modern ISUP 2005 grading. In the Donin et. al....
And here are a few other names I've seen come up that I had not considered but seem to be potentially great options: Bruce Dalkin, University of Washington Hospital, Seattle Gerald Andriole,...
Assuming you are referring to me, Mikla. Here is a link to my initial post on HW discussing my thought process and evaluation of many of these doctors:...
Actually I was offered an opening less than 2 weeks from when I decided, but I opted for a date about 4 weeks out that worked better for me, which worked out to about 8 weeks from biopsy to RRP (but...
I had two prior inguinal hernia repairs (the most recent being bilateral with mesh). It is often claimed that robotic surgery is better for dealing with these but I preferred open surgery for a...
There is no evidence to support two weeks being significant in terms of cure rate. Having surgery sooner than 6 weeks from the biopsy before the inflammation can go away may compromise the quality...
Great news. Congrats!...
Hi Melg, While I am not an expert, I can offer some educated speculation. It seems like there are several possibilities: *Some benign prostate tissue was left behind. Notwithstanding the fact that...
I think the point is that age, race and T1 stage are likely causal factors for delaying surgery. Clinical stage was apparently controlled for in terms of time to biochemical recurrence: "On...
Casey, That's the first time I've ever seen it stated that deferred treatment has been shown to result in better outcomes. I am aware of at least one study that showed the opposite. Can you...
Welcome Brewer. Assuming you are GS3+3, your stats are remarkably similar to mine. I was diagnosed at age 40 in March and had surgery about eight weeks later. Now nearly 6 months later I am doing...
scrappy, 4 weeks post-op may be a bit early to ensure an undetectable result but, assuming a PSA elimination half life of 2-3 days, this is still between 9 and 14 half lifes or a reduction by...
Let us know how he explains the downgrade. In any event, you are the exception that shows that GS6 is not always indolent....
Mikey72, your case is very interesting in a couple of respects: First, the downgrade from GS7 on biopsy to GS6 on final pathology. Was the GS7 ever reviewed by MSK or another expert? Second, the...
Welcome scrappy. Sorry to hear this. It would help to know your pre-op PSA and other stats (Gleason score, number of positive cores, clinical stage) but positive nodes do correlate with higher PSA....
Congratulations on making the decision. Assuming you are relatively young (bread winner) and in a good surgeon's hands, there is a good chance the side effects will be relatively minimal in severity...
Hi Dan, It is still early and it is common to plateau with seemingly no progress for a couple weeks at a time. The urgency could be bladder spasms. After having the cath in you need to retrain you...
Good to hear things went well, Clanda. Wishing you a speedy and full recovery!...
I'm no AS expert, but this statement puzzles me. Isn't everyone on AS low risk (at the outset, that is)? And from what I saw from Hopkins (which, again, has some of the most stringent risk criteria...
Your thought process makes sense. Obviously you need to balance the value to you of deferring treatment and its side effects against the risk of potentially worse side effects and/or unsuccessful...
Welcome AtTheLake. I can't answer your insurance question. Regarding active surveillance you may be aware of this, but in case you are not, I wanted to point out that you fail to meet the Johns...