Prostate cnacer treatment options

I would be most grateful for any insights on robotic surgery as an option.  I was just diagnosed with cancer.  Though the PSA was 2.47 (only), the Gleason score was 3+4, and it is T2a, and moderately aggressive.

I am talking to Dr Ash Tewari at Cornell and Dr Vip Patel in Florida.

Any advice?

 

Brasil,

Welcome to healingwell, sorry you have to be here.  Ask away, you will find a lot of help here. 

Everyone's cancer is different and eveyone's treatment has different successes and side effects. Please keep reading as much as you can.  The best thing you can do is to make an informed decision.  Consider getting another opinion from another treatment plan. One item that keeps recurring is that whatever treatment you decide on to get the best experienced doc available. 

It was davinci for me and I am happy with my decision.  The final pathology was a higher grade and more involved than the biopsy showed. 

Get yourself in as good of physical shape as you can before any treatment.  It will help in the recovery stage. 

I know the mental state is difficult to keep on track right now. Don't panic! You do need to be thinking clearly right now.  Do you have someone close that can help you in this part of your journey? 

Whatever your decision is, I wish you only the best and a future of 0 psa.

Dan

Brasil,

The first thing that you must do is get informed about the options. Go to the book store and buy one of several good books about PCa and treatment options. You will find your situation (statistically speaking) and what the professionals say about treatment options, risks, and benefits. Then you will be an informed decision maker. Refer to some of the sources available at the top of the welcome screen, I used the book written by Johns-Hopkins surgeon Dr. Patrick Walsh which is good and there are others.

best wishes,

Ted

Brasil,
1st, welcome to the site. A gleason 6 with a 2.9 psa doesn't sound like a moderately agressive cancer, but more like a low grade cancer. Is there something the doctor's told you that makes them believe it's agressive? Do you have a nodule that can be felt by a DRE?
Getting a 2nd opinion and educatating yourself is the best thing you can do right now before making any decision. You have gobs of time.
The Prostate Cancer Research Institute's recommended treatment for a G6, psa less than 10 and no nodule is "no immediate Treatment". go to their web site and you can get alot of info on treatment options and the best way to make a decision.
To get the best results:
Know the biology of your individual cancer.
Choose the treatment that best fits your biology.
Pick the best expert in that treatment.
Most patients fail to go through the first two steps.
Good luck, get informed and get 2nd opinions.
JohnT

You are welcome, Brasil,
At your age with half your cores positive, plus the 3+4=7, I would think you are on the right track. I have seen many guys do very well with these numbers, so as my motto says ~ stay positive!. A good positive attitude goes a long way in the cancer world. So does good medicine, and for you there are many options. I chose surgery with half my core positive and a Gleason 7, and even though we found that my cancer had already begun to move around, I am doing very well. Again, stay with us, and I am sure you can gain a lot from this great group of people.

Tony

Brasil, I'll provide insight on the da vinci robot as you requested. That said, all of the comments and advice above are good. Learn as much as you can about the options available to you. There are no do-overs on this. One more thing I think everyone will agree on is to work with the most experienced doctor you can.

If you search the internet, you can find good information about prostatectomy using the da vinci robot. My experience was close to those descriptions. My surgery was at about 7:00 am. By about 8:00 pm that evening, I was able to walk the halls of the hospital while holding on to my wife. I sat in a chair for about 30 minutes after my walk then returned to bed. I felt like I was very bloated. Enough so that I was very uncomfortable. I did not get relief for about 48 hours. I was discharged from the hospital about 36 hours after the surgery. The ride home was difficult. I felt like my wife hit every bump and hole she could. Pain was not bad. I did not need pain medication to control pain. I began to walk around the house the next day and then walked outside by the second day home. Third day home I walked about 1/2 mile. I continued to walk more each day. I had a cath for six days. It was a blessing to get rid of the cath. I have an office job. I took 4 weeks off work but could have returned after two weeks. I don't know what else to say, so I'll stop before I begin to ramble.

Hi Brasil, it's never fun to see a new member show up as I remember how stressed I was when I first got 'the call.' But, I agree with all the others above who say this is a great supportive spot.

My numbers (3 plus 4 in the most pessimistic read) and PSA, 1.5, are not too different from your situation, although at 67 I have a couple of years on you.

15 days ago I danced with daVinci and I couldn't be more pleased. I looked at other options and chose surgery for all the pathology reasons Barry sets out so well above. Good, or bad, I wanted to know exactly where I stood so I could deal with it. My nature isn't of the watch and wait type. My surgeon said he had two sets of patients who always wanted the surgery to get the pathology: businessmen and engineers. I'm a businessman, although with the way the economy is beating us up these days I sometimes wonder.

I chose the daVinci route because A) it had outcomes as good as open surgery with a much easier recovery, providing the guy flying the robot is experienced. and B) I was accepted by a surgeon who had 500 laparoscopic prostatectomies plus near 200 daVinci ones under his belt before I lay down on his table. I went for surgery totally calm, and convinced I was doing the right thing, the right way, in the right place, with the right OR team. Getting to that mind set wasn't easy. Learning about PCa wasn't what I wanted to do, and I was an emotional basket case as I worked my way through all the options. I was lucky to have a friend who is a GP doctor who helped. Not by telling me what to do but for an hour or two on the phone night after night challenging my thinking, making me ask myself the tough questions about what I really wanted, and challenging the information I had which led me to go back, and back again, to the various practitioners of the PCa options to ask further questions, to seek further clairifications. The eight weeks were far far worse than the surgery, but well worth the mental agony.

I was discharged by my doctor 30 hours after I arrived at the hospital. He was pleased with himself as he said he didn't think I'd lost but an ounce of blood in the whole surgery. That means I wasn't anemic when I was rolled out of the OR suite and was up walking up and down the ward that afternoon. The next morning, after a shower, I went down to the hospital cafeteria for coffee with my wife.

It's not all a bed of roses. The rubber tail for 10 days (otherwise known as a catheter) wasn't great, but it wasn't a big deal either, and I was able to sleep the night through without heading to the bathroom for the first time in years! And, now that it's gone, I find the whole pad business a bit of getting used to. But, bottom line, I've had only a fraction of the pain and discomfort I expected to have and I can go out and walk a mile a couple of times a day, have dinner out with friends, which I did this evening, and hit the shopping centers, which I did the day after I was discharged.

I wish you well, and I hope this helps,

Sleepless (it's 1 a.m. CDST) AKA Sheldon

As with many here, I had DiVinci Robotic from a very experienced surgeon. The surgery experience itself was relatively easy, and the healing process fairly quick. Continence took some time, and even after a year I have some minor occasional dribble. ED is a reality, and the alternatives, pills, pumps, and shots work to a lesser degree than before and are inconvenient. All that being said, I wanted the cancer out of me (hoping it would all be removed), and feeling like I took the best possible long-term approach. I cannot say I have wondered if my long term ED would have been better if I had gone radiation, but I believe I would have had greater anxiousness about cancer return had I not had it removed. That was the #1 goal. So - I would still do the same thing again. I hope you find comfort in your decision.

Studies have shown that Finestaride can actually delay the onset of prostate cancer. But there has been some debate that when prostate cancer occurs while on it, that it is more aggressive when it occurs. Not study has been complete to prove it is the case, but discussions exist. As far as suppressing the PSA that to is in the investigational stage, but it isn't looking like there will be mech support for it.

For now it's water under the bridge, and a moot point. I think we all have looked back in our lives to see what we could have done wrong that gave us this cancer. I really don't spend much time with such thoughts. Instead, there is plenty of living ahead...That is a much better thought...

Tony

Thank you all wonderful people, wish I could advise you on something! Brasil

On surgeon experience, see:

http://www.ncbi.nlm.nih.gov/pubmed/19342300?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Numbers aren't everything--some surgeons don't learn from their mistakes. But a tyro will have more problems than an old hand.

BRAZIL YOUR IN THE RIGHT PLACE , I STRONGLY AM AN ADVOCATE OF ROBOTIC , IF YOUR A YOUNG GUY ITS EVEN MORE IMPORTANT , YOUR SPEAKING TO TWO HIGHLY COMPETENT SURGEONS , IF YOU CHOOSE SURGERY AT LEAST YOU KNOW WHAT YOU HAVE  WHEN ALL IS SAID AND DONE , MY OPINION ONLY , FOR ME THE BIOPSY WAS WORSE THAN THE SURGERY , SO THREYA  GO . I WISH YOU WELL AND HOPE YOU STAY WITH US IN HOPES WE CAN ANSWER YOUR EVERY QUESTION ,   ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,DIRT  

ttrapski,

Having an open isn't so bad, I had one, several others here have as well. It's more important that the surgeon you use is very experienced, that is far more important than the method. Some surgeons feel an advantage with an open surgery, since they can feel with their fingertips what is going on inside. In the old days, an open surgery was a major bleeding risk procedure, nowadays, it's not as much an issue. They had 3 units of blood on the side in case it was needed on mine, and none was needed, zero. And my surgery turned complicated, and still no bleeding issues.

Both methods are invasive, and both are major adombial surgeries, and both require time to heal properly, more than the surgeons like to advertise.

If you have access to a good open surgeon in your neck of the wood, he/she should be able to do a good job for you. I could have come home in 2 days after my open, but insurance paid for 4, and my dr. and I decided not to rush things, so I stayed the entire 4.

Just my take.

David in S. Carolina