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Posted 10/19/2010 10:40 PM (GMT 0)
Hi,

I was recently diagnosed with PCa after a biopsy of September 10th. I've decided on doing a Da Vinci surgery, but, am trying to figure out what's better.

I have a choice of going with Dr. Davis at MDAnderson in early January, or, I can schedule something sooner with Dr. Fagin in Austin.

Does anyone have any advice? Am I waiting too long if I have the surgery in early January (this would be four months after Biopsy)??

Thanks! My stats are below.

Age: 61
Biopsy: 4/12 cores positive
4+3 in one core
3+4 in the other three cores

PSA:
3.5 in Jan 2010
5.2 in Aug 2010

DRE: negative for bumps, nodules
Posted 10/19/2010 11:23 PM (GMT 0)
Hi Newdx,

As they say welcome to the club, that no one wants to belong. This is just my opinion, but definitely DONT, wait, if you can get in somewhere quicker. Take a look at my stats, you will see we are very similar, and I am very please I did not wait. Had I of waited, I dont think I would have been so lucky, to have the cancer contained within the prostate capsule. Doc tells me it was knocking on the door.
Good luck with your decision, and I hope my thoughts may help you................Kev
Posted 10/19/2010 11:23 PM (GMT 0)
NewDX,

My PSA jumped from 2.8 to 4.5 in December 2008 after Nissen Fundo Surgery. I had difficulty urinating after surgery, and I thought it was prostatitis. I had three DREs, by three different doctors who said my prostate felt normal. Eventually, my PSA dropped back below 4 ng/ml but I was still concerned, so I went to the Mayo Clinic in Jacksonville, FL in December 2009. My PSA was 3.1 and their Urology Chair suggested a biopsy. I was positive in 3 of 10 cores, and my gleason was a six. My "open" surgery was in February 2010 at Mayo, and I'm happy with the results. I was however, found to be 3 & 4 Gleason 7 after surgery. If I were you, I would enjoy the holidays, and schedule for MD Anderson in January. I've heard a lot of good things concerning that facility, but then again, I've had cancer three times, so I try to keep on top of things for future reference.
Posted 10/19/2010 11:38 PM (GMT 0)
Newdx,
I live in Austin Texas and had my DaVinci surgery done by Dr. Fagin. I'm glad I chose him. Even though I had a High Gleason I'm so far in the zero club after 21 months.
Posted 10/20/2010 1:20 AM (GMT 0)
Thanks for the advice everybody.

Yes - it's hard to pick through the finer details of the plan. I can have the surgery done at MD Anderson by their most experienced surgeon, Dr. John Davis - and I get the benefit of being at MDA, etc... but, he has fellows and they do a portion of the surgery.

Or, doing it with Dr. Fagin, I can do it much earlier, he does the entire case... but, will he rush through it because he does up to 4 in a day? If there are complications post-op... then what? In many ways I feel comfortable waiting until early January because it will only be 14 weeks after my biopsy and if something happens, then I'll be at MDAnderson...

Tough decision.
Posted 10/20/2010 4:14 AM (GMT 0)
Hello, sorry for the need of being here. I almost waited too long. Local doctors missed it for two years - PSA 4.1 Gleason 3+4 stage IIIa clean margins

Went to Dr Kevin Slawin- Davinci Oct 1 2007 Ultra sensitive PSA varies from .003 to .008 for 3 years

Check out his website

Houston Memorial Hospital - Downtown

He and God saved my life

Go for it!
Posted 10/20/2010 11:01 AM (GMT 0)
There's no rush to have surgery. Your numbers aren't going to sky rocket in a few months.

Most surgeons make you wait at least six weeks after a biopsy before they'll do their thing.

The only advantage in doing it before the end of the year is if you have a high insurance deductable and have already met it.

Posted 10/20/2010 5:14 PM (GMT 0)

NewDx,

I wouldn't make it a question of timing as much as a question of who you want to do your surgery.

John Davis did mine at M. D. Anderson.  I think he is an excellent surgeon and a nice guy.

However, I have had many hassles with his support staff (which may be more of a reflection on me than on them, of course).

Also, my experience with M. D. Anderson Hospital was not good at all.  I don't have time to tell you all the stories.  I'm painting with a very broad brush here, and there are certainly some fine and dedicated people working there, but M. D. Anderson is a large state bureaucracy like the Department of Motor Vehicles.  They are the best in the world at what they do (which is good) but they know it (which sometimes isn't good).  But again, my experience may not have been typical, so get some other opinions.

I would say that if someone has advanced cancer or a rare type of cancer, then by all means go to MDA and just resolve to put up with all the foolishness.  But for a more "routine" cancer - comparatively speaking, of course - I would at least look into Memorial Herrmann in Houston, which has put many millions of dollars into its cancer programs and staff in recent years and is making a concerted run at MDA's premier status around town.  I have heard that they accordingly make a point to be very user-friendly.  I've also heard good things about Dr. Brian Miles at St. Luke's or Methodist (I forget which). 

But again, the bottom line is that I think John Davis at MDA is very good.  And in the end it's your surgeon who really counts.

I have no experience with Dr. Fagin in Austin.

Good luck.

Zen9

Posted 10/20/2010 11:46 PM (GMT 0)
Hello New DX..

4+3=7 and your PSA velocity is almost off the chart? I would be getting treated as soon as possible. JMHO..
Posted 10/21/2010 2:45 AM (GMT 0)
My husband was diagnosed in July and we briefly thought about waiting until the Christmas holidays for his surgery because we know that is always a quieter time at his office and having him out then would have less impact on our finances. My brother who had the surgery 6 years ago when he was 48 strongly urged us not to wait. He basically said that the dollars we earned during the wait would seem like nothing if we found out that the cancer had moved beyond his prostate. We would never know if a couple of months sooner would make the difference between a cure and non-cure. Patrick Walsh in his book "Surviving Prostate Cancer" also says something to the effect that "the cancer cells do not send a memo to warn you in advance of the date they will leave the prostate to take up residence in another part of the body".

We opted for the earliest date we could get - October 1st. Once the decision was made to have surgery even waiting for our "earliest" date was stressful and somewhat emotionally debilitating.

I wish you the best as you make your decision.
Posted 10/21/2010 4:19 AM (GMT 0)
NewDX,
sounds like you have a couple of good options. You have some time to decide and what you two decide will be the right thing for you. Good luck with your journey and best wishes. Keep us posted. I'm typing with an armband on and getting ready for surgury Friday.
Mike
Posted 10/28/2010 4:40 AM (GMT 0)
Thanks for all the advice / kind words.

We decided to move forward with a Robotic Prostatectomy - having it done at Methodist Hospital in Houston, early January!

I'll make sure to keep y'all posted.

Thanks.
Posted 10/28/2010 10:40 AM (GMT 0)
Good luck to you.
Posted 10/28/2010 12:26 PM (GMT 0)
Good luck buddy, Do keep us informed. My only advise to you at this time it get in the best physical shape as you can between now and surgery. Get to the gym and shape up. I found that it made the recovery easire.

Cajun Jeff
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