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Posted 1/22/2009 5:55 PM (GMT 0)
zufas, you are quite right, i have two full body bone scans, and its really neat to see your entire skeleton from head to toe! about the only real bone(ers) i can prove right now.
Posted 1/22/2009 7:09 PM (GMT 0)

Hello smc64:

Glad the discussion on this thread is helping...this is a HUGE decision, obviously, and it's best to get all of the info you can before making it.  Your point about experience is so, so, so important.  If you want some data, check out my thread called "Experience Counts".  It shows the quote from a John Hopkins study demonstrating statistically that outcomes improve up to 250 procedures.  The study as I recall was for open RP's...it's just commons sense that experience is also key (maybe even more so) for robotic surgery.  In my brachytherapy procedure, my radiation oncologist had over 1000 procedures notched and, as he was assisted by my urologist, they had done 500 of these together.  As I have told my friends who are facing the same issues...let them learn on someone else...me, I want the experienced guy (or gal)...

Tudpock

Posted 1/22/2009 7:38 PM (GMT 0)
Tudpock, sounds like you had a first class very experienced team working on you, that's what you want if you have any choice. My open surgeon had done around 400 opens himself, and was backup on a lot of others. I don't know if is common or normal, but at the hospital I was at, to do that surgery, he had to have a back up surgeon near his experience level.
Posted 1/22/2009 7:59 PM (GMT 0)
Tudpock
I agree, experience is what you want. The Dr I will likely use if I go with surgery is in a high volume hospital and claims to have done thousands of surgeries. He has been trained on robotic procedures but only does and prefers open surgery. He told me that open surgery has slightly better continence rates than robotic. Slightly better, is still better so I’ll go with that. Thanks for the Hopkins study link.
Posted 1/22/2009 8:29 PM (GMT 0)
smc64
I am curious. At your age and no symptoms what led to the biospy?

Scott
Posted 1/22/2009 9:08 PM (GMT 0)
Gpg,
For whatever reason, my GP starts to do psa testing in the early 40s. My first psa test was in Sept. 08 and came back at 2.4. She said it seemed high for my age and referred me to a urologist. I had that appointment in late Oct 08; he did a dre and sent me for a fpsa also said he felt some roughness on the right side. The fpsa came back at 2.6 with 11% free. The urologist said based on the numbers and that he seemed to feel something on the right side I should get a biopsy, scheduled the biopsy for early Dec. 08. At this point I wasn’t happy about the biopsy but did for the piece of mind. The day of the biopsy he did an exam the stated he didn’t feel any roughness, the ultrasound showed nothing then told me I doubt you have cancer seconds before he start shooting the needles. On the way out the door I asked him to call when he had the results, he told me he doesn’t call if the results are positive, so I made an appointment for two week out to get the results. So a week later My wife and I are out shopping for Christmas and preparing for my company Christmas party that evening when my cell phone rings and it’s the dr. I’m thinking great, he doesn’t call with positive results so I’m all set…Wrong…he started with the good news is 11 cores are negative. So I had a couple extra martinis at the Party and the rest is history.

So there is my story…that will teach you to ask a simple question, lol.
Posted 1/22/2009 9:15 PM (GMT 0)
Your earlier start on the PSA in your case may prove to be a positive thing. I started at the old standard of 50, because my insurance pays for a yearly physical including PSA, and I had the same family dr. for 16 years. Should add, there is no knowledge of PC in my family ever, but then, lots of older men die of something else but have PC and not even know it.
Posted 1/22/2009 9:17 PM (GMT 0)
as my wife said, "family history has to start somewhere"
Posted 1/22/2009 9:19 PM (GMT 0)
right you are, now that I have PC, both my sons, aged 25 & 31, have promised to have their first PSA at age 40 just to be on the safe side. both my brothers, aged 44 and 59 had their checked after my dx, and they are good for now.
Posted 1/22/2009 9:23 PM (GMT 0)
that is good news, it bums me out to think my boys 14, 15 might have to deal with this someday.
Posted 1/22/2009 9:26 PM (GMT 0)
My Dr. is a family friend, we went for physicals two years ago at my wife's insistance. He did the PSA because 'I know I am going to give you a clean bill, and you are not going to be back to see me until Vandy haranges you into it in another 5 years"

He unlike your Dr. did not find any abnormalides on the DRE, in my case it was the elevated PSA which led to further diagnostics.

I tend to be brief in my communication and am sorry if the earlier posts were interpereted as dismissive, they were the distillation of your age, proven cancer and the low % FPSA.

Had my Dr. not done the PSA, now two years ago, I would almost surely be incurable.

You have a serious descison to make concerning your treatment, but I really do not think observation alone has anything to do with it. I think you know this too. Please stick around and ask us and others. You need as much information as possible to make the best choice for you.

Best to you and yours. Scott
Posted 1/22/2009 9:32 PM (GMT 0)
Scott,

I've read your other posts and know you have been through hell with this like many others here. It makes me feel like my issues are trivial. Anyway how did your post-op patology compare to your initial dx, grade and staging? If you don't mind me asking.
Posted 1/22/2009 9:51 PM (GMT 0)

smc64 said...
Scott,

I've read your other posts and know you have been through hell with this like many others here. It makes me feel like my issues are trivial. Anyway how did your post-op patology compare to your initial dx, grade and staging? If you don't mind me asking.

You have to understand that I am the result of a failed procedure.  My post op pathology was considered undescipherable by Pee Dee Pathology and was forwarded to Epstein @ Hopkins who concurred.  The conclusion was that it was closest to Gleason six but not really classifiable.

I really think you should be considering a saturation biopsy.

Scott

Posted 1/22/2009 10:00 PM (GMT 0)

smc64:

Re your doctor's opinion on continence of open vs. robotic, I think most experienced robotic surgeons would disagree.  Here is a link from the davinci site: http://www.davinciprostatectomy.com/treatment-options/treatment_comparison.aspx

They clearly have a reason to be biased but the data is worth reviewing.  While you are seriously considering options, I think you might find it worthwhile to talk with a doc who has not only been trained on robotic but also one who has done hundreds of them.  I suspect he or she will have a different opinion than your guy who recommends open.  Anyway, it just points out why each of us who has to face this issue needs to get multiple opinions before making such a life changing decision.

Finally, there are tons of guys (and wives) on this forum who have opted for one form of surgery over another and who are undoubtedly far better qualified than I to give you advice and perspective on that comparison.

Tudpock

Posted 1/22/2009 10:18 PM (GMT 0)
smc64

I am certainly happy with my own decision to go with the davinci procedure. One night stay in the Hospital, really the only bad pain was from gas in the colon. Home the next day, off the catheter 6 days after surgery. 13 days post-op I wear one pad a day and today I don't think there is a wet spot in it. I do have that ED problem but we will go to work on that on Feb. 17. I caught this in time, found a great fullcare Urology Clinic with a highly skilled robotic surgeon, and got the cancer out of my body before it could grow or spread. I'm glad to be alive and it's so great to see my lovely wife content in the knowledge that her husband will be around for many years to come.

smc64, whatever you decide to do make sure it involves saving your own life first.
Posted 1/22/2009 10:50 PM (GMT 0)

Sandstorm

Sounds like things are working out well for you, Congrats.  There are a lot of statistics out there and everyone going into this wants any statistical advantage they can get.  Trust me I've looked at a lot of statistics, the funny thing is, it seems that they don't really matter that much.  Whether you go with open or Robotic it comes down to the skill of the person doing the procedure and the anatomy and maybe luck of the person lying on the table.  Any surgeon or device manufacturer can skew numbers in their favor.  No one ever really knows which procedure is best for them because it’s a one shot deal.  I guess you got to go with what you feel is right, then hope for the best.

Regards

 

Posted 1/22/2009 10:54 PM (GMT 0)
Selmer,

I did get a second opinion on the biopsy which confirmed the first. Had another psa done the other day, still waiting for the results.
Posted 1/22/2009 10:59 PM (GMT 0)
sandstorm, glad you are doing so well still, you are having a pretty good recovery so far. looks like you and i could be admitted hopefuly to the "zero club" about the same time, got my fingers crossed for you too.
Posted 1/22/2009 11:08 PM (GMT 0)
selmer, in what you just said, if it came back positive, the person would still have cancer, regarldless of the psa, or am i missing the point?
Posted 1/23/2009 12:00 AM (GMT 0)
i see your point, selmer, sorry it was me that missed the point earlier....lol. PC is just not cut and dry like we want it to be sometimes, so many variable, so many inconsistencies, too many different versions of the same stories. even thought my 2nd biopsy cam back "clean" this past august, my dr. said after that he saw some suspicious shadows on the left side, so he set up #3 as soon as it was possible, and did a targeted 7 core biopsy that came back paydirt. for whatever it is worth, my dr. was dead on accurate with his suspicion.
Posted 1/23/2009 2:39 AM (GMT 0)
SMC,
There is another alternative in AS. I was originally diagonised with a 5% G6 and was considering AS as one alternative. My oncologist said this type of cancer was "statistically insignificant" and most people walking around would have this type of cancer if sampled enough.
He recommeded a color doppler ultra sound with a targeted biopsy to confirm the 1st diagnosis. ( he suspected something else because of my high PSA. They never found the cancer in the origial diagnosis because it was so small) (He found another tumor , but that's a different story) The Doc doing the color doppler said that once a base line is established he could spot any changes that occured and futher biopsies would be done only if he saw changes. He has a lot of AS patients and said there was little risk as the color doppler would pick up any chages before they got serious. Dr Bahn in Ventura Ca and Dr Lee in Chicago use Color doppler. In the hands of a skilled operator it is highly accurate as it picks up the increased blood flow that a tumor needs to grow.
The benefit of AS is that you put off all the side affects of all other treatment options for years and possibly forever if you can mentally live with having prostate cancer and the very small risk of not catching it if it getting worse.
A diet that avoids meat and dairy and taking some supplements like pomagranite and lycopyne can delay the grown of small tumors.
JohnT
Posted 1/24/2009 4:20 AM (GMT 0)
smc64,

Get a second opinion. If the first one told you to have surgery as best option and 2nd one tells you to have surgery as best opton - have surgery. We are all fearful of surgery but if you have cancer and find it early enough to rid yourself of cancer why keep it and let it spread? That is why they tell you to have surgery because you are at the age for the best chances of cure by removing it.
Posted 1/24/2009 2:12 PM (GMT 0)
I would think you have time to try AS and see how you do with that. Certainly, with your stats, you don't need to rush into anything.

For me, the problem with AS would be psychological. While I never really considered it as an option, I became more paniced about what was going on inside me as the 3 months passed between the time of my biopsy and surgery.

I have a lot of respect for the psychological toughness I think it takes to do AS. On the one hand, it makes sense to delay the onset of the quality of life issues that often follow treatment. On the other hand, eventually treatment is likely to be necessary, so why not get the treatment over with. But, it's not that simple, because none of us can be sure how we'll be affected by the side effects of treatment.
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