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Posted 3/12/2008 1:16 PM (GMT 0)

Howdy from Texas.

Just had my biopsy done a week ago and am still doing my homework. Ran across this great looking site with what appears to be some wonderfully nice people.

 

I have spent some time reading through the threads here and will be reading many more. I’m finding a bunch of great information.

 

I’m currently facing the old dilemma – Surgery versus Radiation. My Urologist has recommended the de Vinci procedure and from what I’ve been reading it sounds good to me. I'm about 98% certain I'll be doing the de Vinci.

 

So far I’m feeling extremely lucky, in that my nodule was basically found by accident. This past July 2007, I went to a Saturday morning “Free Men’s Health Screening” at a local hospital. Had it not been for that, there’s no telling how many more years it would have been before being found. I don’t exactly come close to getting an annual physical.

 

Food for Thought – I’m not sure that sharing the following will help anyone that finds HealingWell.com but…..January 2008, I went to a Family Doctor for a physical and second opinion on my nodule. While this Doctor is a very good doctor and I will continue a relationship with him, he is Asian. Due to his small overall body size, he was unable to locate the nodule. It’s almost scary thinking about seeing him first and Not knowing I had a nodule…

 

Steve

Posted 3/12/2008 1:37 PM (GMT 0)
Welcome to HW, Steve.  Sorry you have to be here, but there's comfort in

finding many others in the same boat, so to speak. 

A question for you.  You are speaking of 'nodule' and the doc not detecting them/it.  Are you speaking of the prostate itself, or the cancer lumps that can be detected occasionally by the digital rectal exam?  Is this DRE and nodule detection your first warning, or did they test PSA at the health screening?  I'm curious, as I never had anything detected digitally, it was all PSA results for me.  

Posted 3/12/2008 1:47 PM (GMT 0)
Howdy Tex,

Welcome to the site. I am new as well and was given some great advice when I came. Your Doc is your artist. Experience with him and the facility is important. If you choose Da Vinci choose someone that has done a lot folks say, maybe 400 is a good marker. As you can see below my situation is similar to yours. I scheduled surgery twice. (You can always cancel with proper notice) . I cancelled with Northwestern with a good Doc with only 170 under his belt and went with a Doc who has 700 Robotic.
This site is great for information as well as nother favorite site "yananow.com". My surgery is March 27th but I continue to seek information about my case. You will see there is a lot of conflicting and incomplete information or recomendations.

Frank
Posted 3/12/2008 2:00 PM (GMT 0)

Thanks guys for the welcome.

James - my nodule/lump was found via a digital rectal exam by the first doc at the free screening...The PSA that was done on the same day was 1.3...

The second doc couldn't confirm the nodule cause as he put it: "short and stubby fingers."

Third doc is my new urologist. He being a big guy also easily found the nodule on one side. There were a few days of possible hope after the biopsy...He didn't commit, but thought the nodule was only a calcium build up...The pathologist confirmed otherwise....boo hiss ;-)

Posted 3/12/2008 3:44 PM (GMT 0)

Welcome Steve,

How fortunate that you kept looking despite the low PSA. I know you're not feeling lucky right now but early is better. Keep reading all you can. One site that answered a lot for us was www.yananow.net/Mentors/GlenL.htm

at that same site there are lots of people who chose different treatment options. Knowledge is power.

Lili

Posted 3/12/2008 9:14 PM (GMT 0)
Steve,

Sounds like you have done - and are doing - your homework.

No one here or even your physician/specialists can really know all of your health and personal issues but yourself.  That and everyone else sees the world from their oh-so-passionate perspective!
My two cents: Based on what you've said about age, health, and Gleeson, I too would lean toward the Surgical Removal.
I STILL would get a second opinion from the best facility you can manage. 
If you choose surgery and have an excellent surgeon lined up, waiting times can be long so this second opinion can be scheduled and done while you go ahead and schedule with your physician of choice.
Second opinions involve sending your biopsy slides on to the next physician.
Any good physician will not be offended and most insurance pays for this.
(These two points indicate some of the merits of the second opinion.)

The second opinion is a great time to take a list of questions about other options (e.g., Proton) and clarifications about options  (e.g., Most patients overcome incontinece from surgery between weeks 12 and 16.  When does incontinence usually begin after radiation and how long does it take the average radiation patient to overcome it?  Similar questions about E.D. would be in order.)  I persoanlly would never let incontinence or E.D. make the treatment choice decison for me.  Co-morbidities are the real issue to my mind!

Many here highly recommend the Yanow site.  UsToo is another.
Many top-ranked facilities (Boston General, Johns Hopkins, Cornell, Philadelphia, M.D.Anderson, UCLA, Stanford, und so weiter) can offer helpful links, too.

My personal, anectdotal advice is do not wait any longer than necessary. 
My years of "DRE maybe-sort-of-hard-spot" and slightly elevating PSA and even eventual post-biopsy one-core-5% "6" Gleeson all suggested I had a lot of time to wait. 
The post surgery biopsy suggested waiting would have been risky. 
Whatever you decide, I would not let "promising" statistics lull you into inertia!

You have found friends here.

CCedar
ICTHUS!

Posted 3/12/2008 9:21 PM (GMT 0)
welcom steve

You have come to the right place for discussions on prostate cancer. I myself am still deciding what to do, as I have canceled davinci operation in February, to review other options. My choice right now is to try estrogen reduction and progesterone supplementation to try to shrink prostate size, and hopefully the cancer. If my next scheduled testing of psa shows it is dropping, I will have a second biopsy done. If that confirms reduction I will continue along that track. We have one gent here named pepper lover who has reduced his prostate cancer to undectectable by using capsaicen Read his thread (posting) He still has his prostate. Read my postings on estrogen reduction and the use of DIM.

Ken
Posted 3/12/2008 9:25 PM (GMT 0)
welcom steve

You have come to the right place for discussions on prostate cancer. I myself am still deciding what to do, as I have canceled davinci operation in February, to review other options. My choice right now is to try estrogen reduction and progesterone supplementation to try to shrink prostate size, and hopefully the cancer. If my next scheduled testing of psa shows it is dropping, I will have a second biopsy done. If that confirms reduction I will continue along that track. We have one gent here named pepper lover who has reduced his prostate cancer to undectectable by using capsaicen Read his thread (posting) He still has his prostate. Read my postings on estrogen reduction and the use of DIM.

Ken
Posted 3/13/2008 12:04 AM (GMT 0)

Steve,

I have a PSA of just 0.75, no symptoms, normal size prostrate and yet have a Gleason of 3+3.  It was detected by the DRE during a routine physical.  I just found out last week and have decided to have the Davinci surgery.  But I'm still going for a second opinion at the Mayo clinic where I have asked them to re-examine my biopsy samples.  I expect them to find the same thing since some of the samples had 50% of the tissue with cancer.  But this is important enough to be double sure.

There are a lot of worse things that could happen so I consider myself lucky that they found it.

Posted 3/13/2008 2:18 AM (GMT 0)
   Hi ~ Steve n Dallas, & Loved Ones ,   W elcome     to…    ~ HealingWell ~   and   A    “ Special ”    Warm Welcome   to   You !   Knowledge gives us POWER….   POWER takes away the fear.   ~      ~      ~      ~      ~      ~      ~      ~      ~      ~      ~      ~      ~     Click   on   link   below for important information that will help you ~ help us!!      Welcome New Members ~ to HealingWell   The information (link) listed above is to help you get around the forum!    v        This is a journey best traveled with friends.  Welcome ~ New Friend from all the members here... on HealingWell.com   v       IdahoSurvivor ~   Moderator for Prostate Cancer Forum http://farm2.static.flickr.com/1160/1313099593_9f819e3ff8.jpg   v       TC-LasVegas ~   Moderator for Prostate Cancer Forum   v       bluebird ~   Moderator for Prostate Cancer Forum http://i206.photobucket.com/albums/bb179/mamabluebird1955/mamabluebirdWelcome.jpg
Posted 3/13/2008 2:22 AM (GMT 0)
Hi Steve,
And Welcome to HealingWell. This is the best place on the web that I was able to find that I could interact with prostate cancer patients. I have already seen you posting with the group and feel free to ask anything you wish. These great people will be happy to assist you if they can. Stay with us and stay positive. God Bless you and good luck in your decisions. We have three moderators that can point you to things but you can get there pretty much with interaction.

Tony
Posted 3/13/2008 5:13 PM (GMT 0)
Thanks all....Looking forward to chatting....

To add to my confusion, my 80 year old dad (cancer free) has sent me some litature on "Hormone Blockade" treatment....I've pretty much skipped over reading anything on the subject..But am going to read more...

Also just found out that my older brother (by two years) had a biopsy six months ago and was A-OK...

Steve

Posted 3/13/2008 6:42 PM (GMT 0)
Steve,

Just a few thoughts to toss out.  All of us here have dealt with the decision process you are going through and the dangers are many of trite, one-size-fits-all comments.
Just some thoughts:

Brothers have more correlation in the occurrence of prostrate cancer than fathers and sons.  Your father & brothers should get tested annually!

Most of those of us that chose radical removal/surgery generally were (relative to our life expectancy "young" and) hoping both for that post surgery biopsy that indicates no capsular penetration and insignificant PSAs for life. 
Others, like TC-LasVegas  ("Tony"), assumed penetration and used surgery as part of an aggressive "look-see" treatment.

While I'm not versed in "Hormone Blockade," most hormone treatment and research is indicated for patients with capsular penetration. 
I appreciate diet and supplement approaches like pepper research (personally, only as part of a "watchful waiting" treatment choice for those with co-morbidities and situations that deter more aggressive treatments) and
  I think especially promising is HiFU work being done in Europe (not Mexico).

Radiation is an important choice for some that may or may not have capsular penetration (only through surgery can you be certain).
We have many members here that can tell you about why they chose radiation. 

If surgery is not your choice, with your numbers and health, you might be a good candidate for Proton Therapy (M.D. Anderson is likley closest to you.  Loma Linda has more experience).  Still no definitive examination of the capsule, but fewer side effects. 
I am a little suspicious of the Proton Therapy success rates as they seem to only accept healthy, low-Gleeson candidates like yourself for the Proton programs.
I still personally feel  it is the best form of radiation in use.

My advice is, don't JUST let a surgeon (or surgery patient) sell you on surgery or a radiologist (or radiology patient) sell you on radiology.  You and your loved ones will have to weigh your entire situation and seek out the treatment team that matches your needs.

The members here will be here with our genuine concern, and very specific knowledge & experiences  - to help where we can.

Sincerely,

CCedar
ICTHUS!


Post Edited (Cedar Chopper) : 3/13/2008 12:46:08 PM (GMT-6)

Posted 3/13/2008 11:54 PM (GMT 0)
Hi Steve, Welcome, but sorry you are here. My husband had the da vinci last year. My father-in-law, next week. To be honest, I didn't read all of the others postings, but saw you were from tx and leaning toward da vinci. We are from OK. We went to Austin to dr. Randy F.A.G.I.N for Kurts surgery. He was awesome. I believe his web site is www.theurologyteam.com. We had an appointment in the beginning with a onocologist who was a family friend of mine. He asked me what I had researched, and I said a doc in Tx. He said, Dr. Fagin's the best. I never told him who or where. He is very personable. We went back 6 months after surgery, and he answered all of our questions we had, before we even asked them. I highly recommend him. And by the way, we found him through others here. Good luck to you. Courtney
Posted 3/14/2008 3:06 PM (GMT 0)

Thanks again one n all…

 

One of the really mind boggling things about PC are the opinion/options….

 

What’s that old saying: “Opinions are like prostates – everybody’s got one!” <insert laughter here>

 

I’ve repeatedly read about “almost always, doctors recommend the treatment that they administered.” Have also read that the frequency of side effects and the complication rates are usually higher then the rates quoted..Oh Boy…

 

And thanks to all the feedback I’m getting here, I should be able to avoid saying: “I wish I knew then what I know now.”

Posted 3/14/2008 3:57 PM (GMT 0)
Hi Steve,
You may still end up saying that. No matter what you choose to do. I can say I had a radiation oncologist tell me that surgery was best for me. But keeping it in true form my surgeon said the same and my first urologist said the same. And after surgery my medical oncologist said the same. The only time I had conflict was after surgery. I did not have successful surgery in the sense we did not get the desired results in the pathology. My Medical oncologist said that there is no supporting data for adding radiation. My radiation oncologist disagreed. I did add the radiation and hormone therapy so both won in my decisions. I went with the "dam the torpedoes" approach still searching for a cure. For the record, my plumbing works great and I have no incontinence through after all of the treatments treatments. The HT is not doing me much good for libido.

Tony
Posted 3/14/2008 7:40 PM (GMT 0)
Thanks Tony...I'm leaning towards surgery...I'll be making appointments with an Oncologist and the Urologist that will/might do the daVinci.

Hope everyone has a good weekend...I'm off to grab a few cold ones with friends..

Posted 3/15/2008 7:51 PM (GMT 0)
New guy here too. We went to the post biopsy result meeting with the urologist sure that seed radiation was the way to go. Lots of subsquent research confirmed that each patients solution will depend on their own circumstances, among them age, extent of cancer, other health issues, etc. Two factors that influenced our decision to go with surgery were that surgery offered better options in the event of reoccurence and second, radiation also had other side effects. Lastly, a friend in the medical profession who is exceptionally paranoidly fastidious about medical outcomes opted for surgery after an exhaustive examination. At my age surgery seemed the best option especially since my HMO was using the DaVinci. Oh yes, the pathology report showed a more advanced condition that the biopsy revealed. That makes it pretty definitive, not a guess.
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