56 - surgery vs seeds/ good doctor in CT?

also wondering what a reasonable time table would be to take action?. Just got this news 3 weeks ago, trying to read as much as possible to make the decission

Hello Klains. There are some confusing thoughts in your post. At least they are confusing to me. I think you need a doctor who will take some time and explain to you the options. Would it be possible for you to travel to Boston or to New York, from Connecticut? If so, you could see a doctor at Memorial Sloan Kettering Cancer Center in NY or Dana Farber in Boston. These are two extraordinarily well regarded cancer centers, with nationally regarded prostate cancer experts. I would not, for now, be thinking so much about what the "after treatment" is. You need to figure out what the first treatment is. That could be surgery. Or it could be external beam radiation (such as IMRT). Or it could be seeds. Or it could be seeds and IMRT. (And there are some other options too). A good doctor will be able to explain all this clearly. Best wishes.

Also I was thinking about even getting a second opinion on the biopsy and our insurace does not even cover a pathologist

klains, there is a surgeon at Hartford Hospital that is a DaVinci master. I'm near Danbury, and will have my surgery in late December locally.

Up until Danbury Hospital got it's own DaVinci, many people would go up to Hartford for this doc, whose name of course, I do not know.

Do a little research and you should be able to track him down without much difficulty.

klains,

You are doing the right thing....explore all your options and learn as much as you can about the side effects of each. It any of the docs tell you that his/her patients don't have any SEs, talk to some more docs. You will learn a lot on this site. After leaning first toward surgery, I ended up going with a combination of BT and IGRT and have been very happy with the result. While this is mostly a surgery site, there are others who have had seeds and/or external beam radiation who will probably share their thoughts. In the end, it has to be what feels right for your husband. Best wishes,

Joe

just not sure how much decission time we have, one doctor said , first of the year would be fine

Klains, perhaps the place to start would be to speak with your insurance company to see what hospitals are within their network and would be covered. While there are many excellent hospitals within a reasonable distance of the CT/MA border, no use speaking with them if your insurance won't cover the expenses. Sloan Kettering in NYC is excellent...probably one of the top five cancer hospitals in the world. But, they are very restrictive in terms of what insurances they accept (I know, I spoke to them and we have a very good private health insurance plan through my former employer). I was actually told by the Sloan Kettering representative I spoke with to contact Columbia Presbyterian (another excellent hospital in Manhattan) as they are more flexible in terms of insurance issues.

Question for you about your husband's Gleason score: was it 3+4 or 4+7 (I ask because there can be a difference with 7s). There are generally 3 risk categories for PCa: low risk, intermediate, and high risk. A Gleason 7 is generally considered intermediate risk. Often, the deciding factor is whether the majority of cancer cells are a Gleason 4 (which is more aggressive) or a Gleason 3 (less aggressive). I know this may be very confusing right now but, trust me, you'll learn stuff you never thought you would know as you walk with your husband through this journey.

I take it that your husband's clinical stage (that's the stage assigned at biopsy vs. the pathological stage which is assigned after prostatectomy) was a T1c (found through elevated PSA). If the doctor felt any hardness, ridges, or bulging on the prostate during the DRE (digital rectal exam), then your husband's clinical stage would likely be a T2. Technically, a T1 affords you time to make a decision and put the plans in place. After biopsy, there is a waiting period before surgery to allow the prostate to heal after the biopsy. So, if your husband was recently diagnosed (late October?), then he would have to wait about 7 or 8 weeks before the surgery. Don't know if the same restrictions apply for seeds or external beam radiation.

Hope you come back and let us know where you are in the decision-making process. We're here for you and your dear husband.

I think that the Surgeon that GTO was referring to is Dr Wagner. He is attached to Hartford Hospital and has done many DiVinci surgeries. He operated on me last year and it went very well. Also, if you go to Hartford Hospital they have several very good medical and radiation oncologists at the Harry Grey Cancer Center. Don't discount Yale. They are not up there with MSK and Dana Farber, but their reputation is growing. BTW, I am in Northeastern CT.

That is a tough choice. I had the RRP but for the added saftey factor of the surgery leaves you better options if further treatment is needed and a big plus in my mind is once the prostate is removed you get a pathology report. As far as final outcome, I don't know but I liked the idea of saving some bullets for later. In reality the idea of additional saftey is only that, an idea but it that made me feel better. One thing I didn't know about the seeds which are sometimes billed as a non-event recovery wise is that they can give you a rough time. My friend who is older had the seeds and almost imediately it made him sick. Diarrhea and trouble urinating and the half life of his seeds was something like six months and it was a tough six months until the radiation started to subside. Appartently this doesn't happen to everybody. In my mind the whole selling point of seeds is a relativly tolerable proceedure and for him it wasn't.
For me with a relatively high gleason and if I was your husbands age I personally would get the surgery or maybe the proton beam ( if available in your area). But everybody has different lifes and haveing a treatment that fits into your life is big.
Since I have already given advice where maybe I shouldn't, I will stick my neck out a little further and say that I think most of the treatments will cure the cancer.
So whatever you do will probably work and as I mentioned it may come down to what sounds the best for your life.
Good luck and once you make the choice I know you and your husband will feel better as it is very unsettling to have such a decsion thrust on you like this.

A lot of good input here. The decisions are tough and the information can be misleading depending on the source of your information. At 58, I had Stage T1C and Gleason 6. I had Da Vinci surgery Oct 6 in Swedish Medical in Seattle.

Some key points (some mentioned about):
1. Make sure your insurance covers your surgeon and hospital of choice. Get a listing from them of those covered and start there.
2. I choose surgery over radiation for several reasons
- Get the cancer out and get quick information through the pathology report. Radiation will take time.
- You can still end up with the side effects from radiation as with surgery (incontenance and ED)
- With surgery, you have a fall-back plan with radiation if cancer comes back. With radiation, surgery is nearly impossible. I had several surgeons tell me they did not know of anyone that would even attempt it. Radiation turns your organs to somewhat of a gooey mess and hard to work with in surgery.

3. Get and read the book by Dr Walsh "Surviving Prostate Cancer". Well written with tables to help understand risk categories.

Hi klains,

I think you are doing a fantastic job in exploring and asking as many questions as possible, and to get to the "truth" keep cross referencing these answers and asking more questions of others. You may want to consider keeping notes and such after different consultations--there is a lot of info--and our minds get focused on certain comments and we miss other info. The other thing is there is no right or wrong answer---each situation is unique in itself--and as you see the different options, you will also see what's best for your situation.

When finally making some decisions, the best advice I got from a friend was "choose the doctor that you feel most confident in his/her ability and experience". My friend actually put it more bluntly---"choose the doctor that you want there if something doesn't go exactly right, if there is a problem---who do feel has the most experience in handling it". I think this advice is outstanding, not only for the actual procedure/operation, but also in dealing with any post-op problems etc.

Look long and hard at their credentials, length of time doing these procedures, how many have they done, the hospital they are associated with, and the testimonials on their web-site. And maybe even talk to a reference. When I visited for my initial consultation, I met a guy who had the same procedure 3 months ago---it was great to see a person face-to-face and talk for a few minutes.

Just keep reminding yourself, you are in control, these are your decisions to make. And as I said, from the fantastic way you are intelligently attacking this---all will work out just fine. Take care. You are in our thoughts and prayers.

Thanks Spartan, That comment was timed so well, I have been told believe it or not ," looking into it to much" I my opinion , it is a very important decision, and as you also pointed out cross reference the answers. Such a good point. How did you go about getting to talk to a reference? Is this something that the doctor will provide. Odd question, just on unfamiliar grounds. I have done the research online and did narrow down a couple of surgeons. Would be great to speak to someone that has been through the process.
Fulltlt.. would you mind me asking your age and when you had the seeds?