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Surgery in Nov, or wait to January? Pros/cons?

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Posted 10/21/2009 8:53 PM (GMT 0)
 

Wow, I just found out that my doctor has an opening for Robotic Surgery November 16. Which is just a little more than 3 weeks. The next available dates for me would be in January.

I was just diagnosed 2 weeks ago - PSA 5.1, Gleason 6 (3+3) in 1 core out of 12.

It just all seems really sudden! But then I worry about waiting too long and this cancer growing or spreading.  But I hear that it is 'slow-growing'.

Does anyone have any feel for this? Is it better just to get on with it and get it done? Or does it help to give yourself time to let everything sink in and mentally prepare - or is 3 weeks plenty of time to prepare?

Posted 10/21/2009 9:03 PM (GMT 0)
Hi Denver....actually in your situation, whatever decision you are most comfortable with. I am actually surprised a little about given the opportunity for surgery so soon after biopsy. My uro said it needs to be at least 8 weeks to let the inflammation "cool" down. But I guess it is left up to the doc to make that kind of call.

Your current stage and gleason actually indicates no need to rush if that is what you would like to do. Waiting until next year would be my choice, but that is only because of insurance deductibles restart in January for me and for the fact I am not one to take major surgery lightly. (And you get to live without the cathater or ED issues that much longer)

Best of luck in whichever way you decide.
Posted 10/21/2009 9:18 PM (GMT 0)
Hi Denver,

You could go either way, but its up to you to decide if you are most comfortable with the evaluation of all the available treatment options. Did you speak to anyone about Radiation yet ?

Another thing to think of is the Thanksgiving and Xmas Holiday season, you may still have a catheter and very likely will be on pads during that period.
Posted 10/21/2009 9:36 PM (GMT 0)

Thanks, guys.

And yes, MrGimpy, I'm scheduled to talk to a radiation oncologist next week, but I'm 95% sure that I will go with Robotic removal (at least at this point).  I was thinking the Holidays would be a good time to be 'gimpy', because work seems to slow down a little bit during that time and just seems like a better time for taking it easy. But just hope the doctor wouldn't be in too much of a holiday mood. 

LV-X, I'll check with my doc about the 8 weeks waiting period. I was just talking with the scheduler, and maybe she didn't know that my biopsy was only 3 weeks ago.

Posted 10/21/2009 9:39 PM (GMT 0)
Hello and welcome,

With your low level stats, not sure I would be agreeing to either surgical date at this point. You have plenty of time to think through all your options and to get other opinions. Not downplaying the fact that you have cancer, and I am a surgery and now radiation person.

I went through all last Thanksgiving and Christmas season after my surgery, and it was miserable time for me and can't remember any of the good from the holidays. So if you don't have to, I sure wouldn't mess up my holiday season on purpose.

With your stats, you should have a full range of options, even aside from surgery.

Please keep us posted of your journey and once again, welcome here.

david in sc
Posted 10/21/2009 9:47 PM (GMT 0)
Don't schedule any surgery this soon after diagnosis. It's only been 3 weeks. You should be checking on all options be it surgery, radiation or just watchful waiting. Your numbers are low. If you want recommendations to other Urologists, Radiologists or Urological Oncologists let me know I'm in the Denver area too. You have much to learn and evaluate before you make any decision. I understand your present anxiety to "get it out of you asap!!!" but you have much time. There are no do overs with radical treatments, understand that and know what you are possibly getting yourself into.
Posted 10/21/2009 9:56 PM (GMT 0)
Research all your options and get 2nd opinions. Your PC is slow growing and you probably have years before it gets to the point that it may hurt you. Get information on AS as it could be your best option. Throughly research all side affects as they may affect you much more than your PC ever would.
JohnT
Posted 10/21/2009 10:00 PM (GMT 0)
Denver I would heed the advice you are receiving in this thread. You have plenty of time to get a better education about your diagnosis.

Sorry to do so, but welcome to the club that has all reluctant membership. This is a great forum and many will answer your questions with experience.

Tony
Posted 10/21/2009 11:03 PM (GMT 0)
Hi Denver,
I am 51 as of this month.My initial psa was 4.2 in July. The biopsey was 4 out of 10 cancer with gleason score of 6 which was upgraded to a 7 after the path report post surgery.I took a month to reasearch all of my treatment options and decided that robotic surgery was my choice and it would be no matter how long I waited be it years or days.I was scheduled for surgery on Sept. 25 but an opening came up a week earlier and I took it. In my case I decided to go ahead with the surgery and I am glad I did as it put me one week ahead in recovery if you want to think of it that way. I stress that there is no rush as others agree here, but decide what you want to do and be confident in your choice. I am waiting on my first psa test on Dec .11th .I do not think the cancer will grow a lot in 3 months but I do know what it is like to worry about it. Good luck , Wes
Posted 10/22/2009 1:15 AM (GMT 0)
Hi Denver,
My doctor will not operate in less than 6 weeks after the biopsy. This allows for healing. In your situation I don't think that waiting till January is going to make your PCa any worse. Enjoy Thanksgiving and Christmas without the side effects of PC surgery.
Posted 10/22/2009 1:29 AM (GMT 0)
Denver: You have been given very good advise from other members however, you are the person that must make the decision of what is best for you. I know that like many of us "I wanted to get rid of that thing (cancer) that was in us to be taken out". You do have time to make the decision. I would suggest that you read and find out as much as you can about what the complications can be for each kink of treatment.

Please keep us informed.

Jeff T
Cajun Country
Posted 10/22/2009 2:13 AM (GMT 0)
As many have suggested, spend some time researching your options. Don’t be rushed because it fits some surgeon’s schedule! You’ve got time.

I wasn’t ready for the snow here in Denver today. It is supposed to wait until Halloween….
Posted 10/22/2009 2:17 AM (GMT 0)

Denver:

My advice is similar to what you are getting from many of the posters on this thread.  With your stats you should have plenty of time and do not need to rush it.  This is a HUGE decision.  Seek mulitiple medical opinions from docs in different fields, read, study and learn as much as you can and get informed/educated.  And, whatever treatment you choose, use a doctor with plenty of experience in the specialty.  They will be messing with very important real estate and you want to get this one chance right...

Good luck,

Tudpock 

Posted 10/22/2009 2:55 AM (GMT 0)
I agree with the advice others have given. I waited six months and was much better educated about prostate cancer and felt infinitely more comfortable with my treatment decision by the time I had my cancerous prostate surgical removed. Enjoy the holidays!
Posted 10/22/2009 10:36 AM (GMT 0)
INSURANCE. You probably start a new deductible on January 1st smhair
Posted 10/22/2009 12:35 PM (GMT 0)
Denver, as already stated, you have some time to decide on your treatment. And, I definitely agree about 3 weeks from biopsy being too soon - our urologist said he wouldn't do the surgery for at least 6 weeks after the biopsy because the prostate gland needs to "heal" from the biopsy procedure.

Take this time to research and to "interview" different doctors. I'm a big believer in picking brains for information and if your budget (or insurance company) allows second and even third opinions, you should consider it.

Please keep us posted, and good luck with your decision.
Posted 10/22/2009 4:39 PM (GMT 0)

Greetings, Denver.  I don't have much different advice to add but rather to reinforce what some others have said. 

1.  You have time so don't feel rushed - my doc is just like many others here and said that you need to wait at least 6 weeks to heal from the biopsy.

2.  Look at all your options.  There are many good options that can be right for you in your particular circumstances.  Look at all of them.  I chose open surgery and still believe that was right for me.  Others have chosen radiation or brachotherapy and those were the right decisions for them.  Take the time to consult with a couple of different medical professionals in the various specialties and do the research and find the treatment that is right for you. 

3.  For what it's worth - and probably not much - while Active Surveillance may be good for some I'm not a big fan.  Mainly because it is not unusual to find out that the cancer is somewhat more agressive than originally thought.  In my case I went from 3 +3 to 4+3 and so was glad I had chosen to have an active treatment and glad that I had gotten it out. 

Best wishes on your upcoming treatment.  Don't be shy about asking questions here - I have found the people on this board to have more personal knowledge on the various issues because we have already been right where you are.  Hang in there!  David

Posted 10/22/2009 5:18 PM (GMT 0)
Since you are reading here, you know the extent of the potential side affects that accompany surgery. While hopefully you will be one of the lucky ones in the side affect area, you just never know with PC.

If you enjoy an active sex life, enjoy it for another 3 months. It may never be the same after surgery. The same can be said for continance.

I fully understand the idea of wanting to get the treatment over with and move on with your life, it's just not always that simple. Enjoy your current life for another 3 months and take the time to fully educate yourself. And make sure your surgeon has the necessary experience.

Good luck.
Dave
Posted 10/22/2009 5:22 PM (GMT 0)
Denver,

You are getting some very good advice here.

Just wanted to chime in on the surgery date. My surgery doc (supposedly one of the top 5 in the world) would not consider surgery until at least 8 weeks following biopsy.

The main reasons stated were to give the prostate time to heal from the biopsy. It needs time to recover and reduce the trauma and inflammation. A swollen and inflamed prostate presents a whole other set of complications during surgery. If it is swollen the space and tissues around it may also be inflamed. Doing surgery this delicate requires a clear field of vision and room to work.

While the holidays may look like a good time for surgery as far as time off and so on; don't minimize the importance of the time we spend with our families and how much we depend on them for support through this process. While you may be willing to tough it out through the holidays, your family and loved ones will be along for the ride and it will impact their holidays as well. IMHO.

Good luck and God bless,

Sonny
Posted 10/22/2009 9:34 PM (GMT 0)
Hi Denver........I was diagnosed in 8/08 with somewhat similar stats. I consulted 3 surgeons, including my own treating urologist, a Brachytherapist, and an oncologist who specializes in PC and had no dog in the race-----all concurred that I could wait as long as 6 months to research, decide and schedule whatever treatment. If one had said that wating might be a problem, it would have given me pause for concern, but might not have altered my ultimate decision. I was able to confidently select a treatment (Robotic prostatectomy), and schedule it 5 months after the biopsy in a time period that worked well for me. That said, everyone has a different anxiety threshold, and you have to do what's right for you. I would say as long as you feel you have enough time to research your options and weigh everything and make a reasoned decision, then go ahead and schedule.

           Arnie in DE

Posted 10/23/2009 12:36 AM (GMT 0)
Hi Denver -

I cut my upper lip shaving the other day. It scabbed over a bit and made shaving the next few days tricky - I did not want to re-open the wound and had to sort of shave around it.

The injury to your prostate from the recent biopsies is similar. Twelve needles passed through the rectum, through the perirectal and periprostatic soft tissues, and into the back side of the prostate. If you choose surgery, your urologist will have to "develop a tissue plane" between the rectum and back side fo the prostate in order to separate one from the other. The inflammatory reaction caused by the needles will make it more difficult to "get a clean shave" when separating these tissues. Also, there are LOTS of nerves in that area, and you ideally want to minimize injury to those nerves in order to protect erectile function. Finally, all indications at this point are that you have a low grade cancer. Your poor pathologist will have to determine where the cancer ends and the inflammatory healing reaction of benigh prostate glands begins, and in the face of an acute injury and a low grade tumor this can be challenging.

So, in addtion to all the "what's the rush" answers others have provided, I think that there is also medical justificaiton to waiting until the biopsy injury has totally healed. Most suggest a minimum of 8 weeks for that. You can objectively guage your healing progress to some degree by how long it takes for your semen to return to normal color, and the contractions of your orgasms feel normal again.

Best wishes.

Doc
Posted 10/23/2009 4:46 PM (GMT 0)
Denver,

I agree with the majority of the people in this thread. Wait. Wait and research. Read everything you can about the disease and the treatments. Get a color doppler test to see how advanced your cancer is. With your low numbers Active Surveillance might be a good alternative to surgery or radiation.
Posted 10/23/2009 5:16 PM (GMT 0)
Last Christmas I was walking around with a Foley catheter with a urine bag attached while the house was full of children and grandchildren. Miserable!!! Wait until after the Holidays whatever your reason.

Dave
Posted 10/24/2009 4:44 PM (GMT 0)
hate to say ste ve hits the target but there are usually financially concerns..

if you have had lots of medical bills this year either to meet deductibles or copays or to achieve an I

rs deduction finishing before dec 31 could be a huge advantage..

If things have been relatively affordable, and you know in a dvance you face a major surgery and los of related follow up care in 2010 you might want to start the clock early in2010.  I passed up a mid dec surgery last year because kids had already made xmas plans to visit, and knowing I needed bariatric and davinci operations in the same year i scheduled to first fr jan 23 and the second, the da vinci was this week, so I had at lest 9 plus months of recovery..

you are ina great area with great docs in colo springs, pueblo and denver, and listen to others who advise second and third opinions...having said that also seriously consider that  watchful waiting or hormone treatments are not without side effects....early one i was adviced to get a copy of Dr Peter Scardino's prostate book and it remains the best thing I have read on the subject although the latest edition is now probably three years old and you will need to go online or post here for further questions..

take control...become the expert...listen to urologists but dont be afraid to actuallybecome more knowledgeable about Pca than many primary care physicians.

good luck

Mbshine

angel fire, nm

AGE 62  davinci  10/19/09

DX 7/08 

psa HAD GONE FROM 1.7 TO 4.3 IN THREE YEARS...DIGITAL AND ULTRA SOUND EXAM SHOWED NO ENLARGEMENT.

BIOPSY SHOWED 2 OF 12 CORES POSITIVE.

TWO TUMORS SHOWED GLEASON 4+3 AND 3+4

NO INDICATION OF ESCAPE FROM CAPSULE OR METASTASIS

STARTED CONSULTATIONS AT SLOAN KETTERING 8/09

DR GUILLONNEAU SAID NO SURGERY UNLESS MASSIVE WEIGHT LOSS.

AT DX 333 LBS, SLEEP APNEA, AND HIGH BP

BARIATRIC SURGERY RECOMMENDED.

LAP BAND SURGERY IN EL PASO, TX 1/23/09

10/1/09  276 LBS, TRIGLYC AND CHOL NORMAL, NO SIGNS OF  SLEEP APNEA, ONE BP RX REMOVED AND OTHERS CUT DOSAGE IN HALF;

 

  STARTED QUARTERLY ZOLODEX BY TAOS,NM UROLOGIST, WHO TRAINED AT MSKCC, INJECTIONS AND CASODEX 50MG DAILY 9/08

Posted 10/25/2009 2:12 AM (GMT 0)
I had surgery just 4 weeks after my positive biopsy, and this contributed to my developing an anal fissure. It is a side effect that I didn't expect, and that has been negatively affecting my quality of life (as if I needed any more problems considering incontinence and ED).

IMHO you should wait until your rectum has had plenty of time to heal before inflicting more trauma on it.
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