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Posted 1/6/2011 9:37 AM (GMT 0)
Just got my pre-treatment biopsy Pathology Report. Looking for opinions on treatment options. Thank you.

http://i215.photobucket.com/albums/cc293/hryderiii/pathologyreport2.jpg

date psa remarks
7/28/2001 3.3  
4/19/2004 3.39 biopsy - Neg
1/12/2006 4.3  
11/9/2006 4.4  
11/30/2006 5.2  
7/23/2007 6.8  
8/14/2007   biopsy - Neg
1/29/2008 5.5  
2/15/2008 6.6  
11/14/2008 7.3  
6/2/2009 7.6  
6/8/2009 7.1  
9/28/2010 8.4  
11/3/2010 8.1 after antibiotics
12/13/2010   biopsy - Pos

Age 66

PSA 8.1

DRE neg

Bone scan "normal"

T1c

Post Edited (Harryheart) : 1/20/2011 5:13:56 PM (GMT-7)

Posted 1/6/2011 9:58 AM (GMT 0)
Harry,
Perhaps a little more information would be good, ie, age, psa, stage, general health, etc.................Kev
Posted 1/6/2011 11:08 AM (GMT 0)
.

Pretty much this time last year , I was in the same position as you..
Commiserations on having to ask the question. 
From the experience I gained, I would suggest that you are likely in the exact same position as I was in.

The first favour that I called in was from a friend who I know worked for a Uro-Doc.
I sent him what you supplied and said simply  "What would  YOU  do ?"

The response was concise.  Have it out, Do NOT have radiation and have open-cut rather that DaVinci
I subsequently realised that this guy was a Professor of Radiology, and HE was telling me to avoid radiation.

I had the wicked cut and I am pretty much fine.

The thing with radiation is the it's great at first, but then things keep cooking for the next years in an UN-Reversible way.  After the radiation, you are as good as you are ever going to be and it's DOWN from there
If you THEN decided that surgery was needed, then it's too late as the flesh is now cooked and it can't be sewn up like uncooked flesh.

If however, you have surgery and it does not fully fix the problem, then radiation becomes an second option.

Some here will argue that you may live a long and whole life, by doing nothing, but that is just too much of a gamble, because if you then find that you MUST do something, it will likely then be too late.

Search for  threads like  Robot or DaVinci Vs RP.
There is a school of thought that argues that when the surgeon has his face in you crutch and can poke and twist things around, then he can do a better job in seeing and removing all the possibly cancerous tissue.
The other school says that via Robot (DaVinci), there is finer control and less surgical trauma, but ultimately, the results seem to be the same.
Australian Statistical data suggests that complications using DaVinci, are twice those of open-Cut.

Bottom line - you are on a steep learning incline, but fortunately there are a great many who have already been there.

Everyone that I know is suffering ED, so do not believe that you will be back to normal in 12 Mths.  Australian data shows that 66% of men suffer from ED after 3 years, which means for good..   BUT-That does not mean that ALL is lost, it just becomes different.

In my mind, there is no real choice, other than go for the BEST and MOST experienced surgeon, and out thoughts are with you..

.

.

 

Posted 1/6/2011 1:08 PM (GMT 0)
So this is a post op pathology on the removed prostate? The size descriptions they give don't seem like the level of detail a simple biopsy could provide?

In any event, please dont make any descisions until you ask your doctors the same questions you seek here.

Often, the answers folks give you here are best used to know the right questions to ask your doctor.

I could see a radiation oncologist viewing someone's medical chart and correctly advising them that surgery is the better treatment under that person's condition. My surgeon told me he would have advisedradiation instead, had he known the pca had excaped the prostate.

I dont think many of us want surgery.
I don't think many of us want radiation.
I certainly know I didn't want both.

Talk to your Doc(s), ask them these questions, then YOU decide who makes the best argument. The only right decision is yours.
Posted 1/6/2011 1:12 PM (GMT 0)
p.s.
Darker room, small fonts and refusing to admit my eyes are no longer perfect, is the reason for my spelling issues - ok most of them anyway. speedtyping doesn't help. sorry.
Posted 1/6/2011 1:26 PM (GMT 0)
This is my biopsy report....minus the header info.
Posted 1/6/2011 1:30 PM (GMT 0)
Hi Harryheart,

I wouldn't discount seeds as an option.

If I have any regrets it would be that I should have put more effort in understanding the seeds option prior to surgery. Not sure that it would have been an option that Paul would have ever chosen (people have died young in his family of PCa and he just needed his prostate in a jar) but I should have been a little more open minded about it - I might have been able to persuade him to consider alternatives.

People tell you that if you do surgery then radiation is still available to you, but if you have seeds then surgery isn't.

However this is the neat thing about seeds - you get two for the price of one, your prostate tissue gets destroyed by the radiation and the radiation extends a couple of mm beyond the prostate in effect doing what adjunct radiation does post surgery. Also the side effects seem to be better with seeds - my husband was lucky in both the continance and ED department but most people doing surgery have issues with the latter and some people have issues with the former.

The negatives to seeds (for me) is that I am not convinced yet of its efficacy after 15+ years.
Also prior to surgery my thought was that you never get to know the type of monster you are really dealing with and whether its really gone. Post-op I realise that surgery is not the black and white clear "my cancer is gone" situation either. You sit and stress about PSA tests and whether radiation to the prostatic bed is necessary or not - radiation you would have got as a matter of course if you had gone down the seeds route.

Saying that, a lot of people have their surgery, and are effectively cured for the rest of their lives and die at 90 of something completely different.

Regards,
An
Posted 1/6/2011 2:01 PM (GMT 0)
This is what I see on the report. 2 of 12 cores are positive. 1 core is 3+3=6 involving 5% of the tissue sampled. The other core is 4+3=7 involving 8% of the core sample. Both positive core samples are located in the apex (bottom of the prostate). This is an area that is difficult during surgery to get all the cancer out.

I know that lots of people will recommend surgery, but don't over look seeding as a viable method to treat this.

Good news at this point. There is a very small percentage of cancer which will allow you some time for investigating your treatment options.

Good luck
Posted 1/6/2011 2:37 PM (GMT 0)
You look like a good candidate for surgery or radiadiation. Research and consider High Dose Radiation. This is a more modern and accurate version of brachytherapy. Rather than using permanent seeds, the HDR uses temporary seeding that delivers a considerably higher dose for a short time and then is removed. I just went through the procedure accompanied with IMRT. Long term results are similar to surgery and permanent seeds with fewer side effects. Permanent seeding is not as accurate as HDR. HDR placement is confirmed under a CT scan for more accuracy.

Check the website www.cetmc.com. Dr. Jeffrey Demanes has been doing these since 1981 and has great statistics on the long term results. Another is Dr. Martinez in Detroit. HDR is becoming more popular. I did mine in Atlanta with a Urologist and Rad-Onc team that have done more than 1000.

Take your time, do your research. Read the book "Surviving Prostate Cancer Without Surgery". Also get Snuffy Meyers book "Beating Prostate Cancer with Hormone Therapy and Diet". He is an oncologist that specializes in PCa and is a 13 year survivor. He used IMRT and brachytherapy. His is a good read no matter what primary treatment you choose. Another good book is "Invasion of the Prostate Snatchers" by Mark Scholz MD, a prominent oncologist specializing in PCa.

Good luck
Posted 1/6/2011 3:02 PM (GMT 0)
I'm -- let's see -- four months into the brachytherapy radioactive seed therapy, responding to a similar biopsy.

Diagnosed in June, I began my investigation into options by speaking to one of Canada's very best prostate cancer surgeons, who leads the prostate cancer centre at Canada's leading teaching hospital in downtown Toronto.

Based on my diagnosis, he strongly suggested I investigate the brachytherapy option in addition to considering surgery (the exactly opposite experience to the one related above). I'm relatively young (50 years old) and he suggested I carefully balance the therapetic and quality of life issues.

All therapies have pluses and minuses. I think a careful reading of this forum will demonstrate them for you pretty well.

- Some (but by no means all) surgical patients report long-term and distressing issues with continence. 

- Most BT patients seem to report relatively good outcomes on that front (that's my report, so far -- no continence issues at all).

- On the other hand, some BT patients report other urinary issues (you can be more prone to irritation, slow flow and similar issues).

- That also my experience, so far.

Everything I've read suggests these mostly quite tolerable symptoms will moderate over time, and they seem to be doing so in my case.

My reading of the many many research reports you can look at is that, taking it all in, surgery and BT seem to have similar outcomes for early-stage prostate cancers. Both seem to hold out similar, excellent odds of a cure.

Failure in either treatment option generally seems to be associated with misdiagnosis -- the cancer was more advanced/aggressive/widespread than believed.

In my view, the most likely "plan B" should this turn out to be what happens in my case would feature hormone therapy and (possibly) external beam radiation therapy, aiming at controlling cancer that has spread outside of the organ.

In my own case -- and I very much respect those who argue the other side -- I didn't find the "you can go to BT if surgery doesn't work, but you can't go to surgery if BT fails" argument very persuasive. It seems less likely surgery would be the best thing to do if my BT therapy fails. And if surgery did prove to be the best thing, the surgeon I consulted said that salvage surgery after BT is technically possible in the hands of a skilled and experienced surgeon. But surgery would likely not address a cancer that has spread outside of the organ, and that takes you to hormones/external beam... probably, depending on the details.

My father was treated with combination hormone and external beam as primary first therapy in an Ottawa hospital about a decade ago; tolerated it well; and seems to have been cured. I would be hoping for an experience like his if I ended up there.

But I had a third-month test about a month ago and, so far, my numbers are coming down and things seem on track. So this holds out hope that I might be cured through this therapy with a better quality of life (hopefully for 30 years or so) than might have occurred if I had been unlucky in some of the side-effects that sometimes -- but not always, by any means -- occur after surgery.

If you feel there is some ambiguity in what I'm saying, that's because from what I can make of it there is a lot of ambiguity in the pluses and minuses of our treatment options. Our brothers and sisters in this fight are giving you good advice above in advising you to speak to both a surgeon you trust and a radiation therapy expert you trust. I did, and I was glad I did.

You then have to make a call, based on your confidence in the teams and your personal assessment of the pluses and minuses. My resolve once I made my decision was to tackle it with determination and to not look back. So far I think it's going ok.

    

Posted 1/6/2011 3:49 PM (GMT 0)
Harry:
FIRST, do nothing in haste. Your biopsy indicates that you have all the time in the world to come to a conclusion. You may need to do nothing more than watch closely and wait until you are comfortable with a treatment decision. Your cancer is not life threatening at this time. It may never be.
Your numbers indicate that you are eminently curable by all methods, assuming the very best practitioner and top quality care and equipment. That is the key. This is the most important decision and it needs to be provided by the very best, most highly skilled person you can find. Again, you are in no hurry to decide.
Most doctors would be pleased to have you as a patient as you will respond well to their mode of treatment, whatever it is.
I assume you are healthy enough to undergo anaesthesia, major surgery, radiation of a high or intermediate dose, have adequate resources to find and employ such personnel and mobility to access them as well.
Best advice? Find and join your local Prostate Cancer Survivors group. Their opinions are worthless but their experiences are priceless.
Posted 1/6/2011 4:12 PM (GMT 0)
Dear Harry:

Welcome to HW.  Sorry you have to be here but I think you will find this is a great forum with lots of caring people and lots of people who have good information to share.  I think you have come here at EXACTLY the right time as now is the time to be looking at options and making one of the most important decisions of your life.  Post treatment help is nice but pre-treatment is also where you need to do some thorough research.

As others have pointed out, it is likely you have time to research your treament options.  With two cores, small percentages and a relatively low PSA it is likely that most of the treatment options will work for you.  Your bone scan is likely unnecessary and the result from that is almost certain to show nothing.  One thing you might consider at this point is to get another reading of your biopsy slides if your pathologist is not one of the acknowledged experts.  Two extremely qualified pathologists who do second readings are Dr.  Epstein at Johns Hopkins and Dr. Bostwick at Bostwick Labs.  You can find both of these easily on the internet.  PCa pahtology is very tricky.  If Epstein or Bostwick give you a G6 on that one sample instead of G7 then Active Surveillance might come to the top of the list as an alternative.  What another poster said in his posting about "doing nothing" (I assume he meant active surveillance) in not true.  There are studies that have been posted on this forum that shows outcomes  from delayed treatment after AS are as effective as those earlier treatments.

But I digress.  The posting from An was excellent.  You should absolutely consult a radiation oncologist and/or prostate oncologist.  Surgery is likely an option but...you are also a likely candidate for brachytherapy and/or IMRT.  Both of those options provide equal cure rates to surgery but considerably less onerous side effects.  And the oft repeated scare tactic that you can't have surgery after radiation is largely true but...what is left out is the fact that there are equally effective salvage treatments after failed radiation as there are after failed surgery.

In any case...take a deep breath...study the heck out of this disease...and then make an informed decision.   Three excellent books that may help you are "Guide to Surviving Prostate Cancer" by Walsh, "A Primer on Prostate Cancer" by Strum and "Invasion of the Prostate Snatchers" by Blum/Scholz.

Good luck and please stick around and let us know how you progress.

Tudpock (Jim)

Post Edited (Tudpock18) : 1/6/2011 11:49:23 AM (GMT-7)

Posted 1/6/2011 5:08 PM (GMT 0)
Harry,
The others here have given you good advise. The good news is that both the psa and the PC is on the lower end of the scale, which means it is very curable. After getting a 2nd pathology as Tud recommended you will have a better idea of your options.
As Les noted, the APEX is by far the location that has the worst chance for a positive margin in surgery, 51% of all positive margins are found in the APEX. This as well a Quality of life issues should be a significant factor in decision making.
Seeds should cover the APEX very well and have the least impact on your QOL.
JohnT
Posted 1/6/2011 9:18 PM (GMT 0)
I am no doctor either, and I didn't even stay in a Holiday Inn Express last night, but you look like a perfect candidate for Brachy. I chose that route in October of this year, and so far am quite glad that I did. I am retired and work a part time job with lots of old farts like myself. I know literally dozens of guys who have had surgery...mostly open, and frankly I don't know one whose results I would want as my own. And as I read through this forum, I see very few guys here who have results that I would want. The thought of surgery scared the hell out of me. When I found out that I was a candidate for brachy, I jumped at the chance. In the long run, who knows if I chose wisely? We all do our research and play the card that we think is the best one. Right now I am very pleased with both the results and the lack of side effects. Do your research, make a good choice, and don't look back. God bless you, Man.
Posted 1/6/2011 9:39 PM (GMT 0)

questionaboutit said...
I wish I had a biopsy report like that. I received little information.

Could I respectfully say that anyone who does not ask for and keep such reports is being very foolish.  Most doctors have them on computer, so you can ask for a print-out "For your records"  and as for getting a report with a sticker saying  "To be opened by doctor", then if you accept that then your unwise.   Every report I have EVER been handed is first copied, and NOT one doctor has ever said  "Oi!  Who opened this"..  Your Body,  Your Report,  Your Right..

HarryHeart - there seems to be still some confusion because of the lack of detail.

I presumed that because you are awaiting the Bone-Scan then you are JUST starting the journey.  Just been told of the problem..  As has been already said  --  DO NOT panic -- you are in a position of control and not despair.

In last year I had 4 others close to me in the same position, all with similar results and all with the SAME outcome - WE ARE CURED...

Don't forget to look at the top of the threads list  "Prostate Cancer Resources"

It will all be overpowering, but it is far from new.

If you are into what the operation is all about and can appreciate the technical side, have a look at...

http://www.drslawin.com/robotic-surgery/robotic-surgery-videos

I must admit that this has partially changed my thoughts about DaVinci, despite the small increase in complications  ( 0.2 to 0.4% I think it was).

Just to think that my surgeon did this through a 4" hole - Luckily he has a small head and could get it in OK  smilewinkgrin

ses.library.usyd.edu.au/bitstream/2123/6835/3/Let-sleeping-dogs-lie.pdf

If you want to have a concise read about things and options and terminology, this is not a bad read.   Pages  59 to 88.

Some here (and me) disagree with the book, written to convince others that screening for PCA is a waste of time.. but - the general advice on the disease seems greatly main-stream..

   Screening has likely saved your life !

Be sure to also   keep the thread   Prostate Cancer Abbreviations..  open so that you can quickly learn what all the abreviations are that folk here use.

..

.

 

Posted 1/6/2011 10:44 PM (GMT 0)
Hello Harry,

I agree with the other's sentiments. Looks pretty low volume and low grade on the surface, best part of that news, is that you should have all or most treatment options open to you, and you shouldn't feel a sense of rush to decide. That 2nd opinion is good advice for sure. Please keep us posted of whats going on with you.

David in SC
Posted 1/6/2011 11:22 PM (GMT 0)
 I was very disappointed in the pathology report, it did not have the info lots of members here seemed to get.

Naturally, I was not having a shot at ANYONE, and how disappointing that the full information was not readily available to you..  It all helps to paint the full picture for ANYTHING that follows.  The greater the time passes - the harder it is to get that information.

Be sure to keep ALL Xrays and Scans..  Your Bone-Scan  can be used for the rest of your life as a usefull tool  ( ie.  how you were in 2011 )

 

 

Different strokes different people. 

That is the whole issue, but as you trawl through these PCa threads you seem to find a fairly common thread to guy's PCa adventures.

Also, even though I was still a G6, the pathology showed much more widespread cancer than the doctor expected and many tumors along with a large component of 4's. 

Something that MUST be understood , is that a Biopsy takes small samples, and folk here have shown that they knew soemthing was wrong, but the Biopsy kept missing the critical spots - the unreachable spots, until finally a  "BINGO" .

Most seem to find that the pathology of the removed organ is significantly different to the TRUS-Bx.  ie.  WORSE than expected..  So in the 'Unknown Stakes', it is likely better to assume the worst.

Mine too, was worse (G7) and far more wide-spread (Pockets here and there)

He said, and I recognize his self interest, that I was lucky I did not choose radiation.

The entire saussage-machine called "PC-Treatment" is based on self-interest..

The Surgeon wants to cut.  The Beam Radiologist wants to blast away, and the Bead guy knows exactly where he wants to shove his beads.

The "Radiation Professor" showed me TOTAL lack of self interest.

Finding someone without self-interest is the hard part.

When I was First diagnosed, they had it all mapped out - a schedule of Specialist Appointments, to tell me of all my options.   Then I was given a small book and it was thorough and concise, and it told of the good and the bad of each treatment.

It HAD to be thorough, because it was PUBLIC knowledge, capable of criticism.

Having read the book, I knew that there was only two options.

Take-the-risk and wait and try to cure myself with diet and supplements... or

Get cut and have it removed and accept the  95% "Guarantee" that it would all be ended.

We have all learnt to be very cautious of specialists using words like MAY, and MIGHT, and POSSIBLY.

Remember that all treatment seems to be based on AGE and YOUR situation.

I think they do not like radiation in the younger men, because Radiation does actually smhair   cause cancer.  That's why they all run from the room..

At younger ages, anything that leaves your body as unchanged as possible, has to be better.  Removing something sounds traumatic, but nothing much else has changed

BONE-SCANS

Fantastic tools - The Bride had a stress fracture in her foot, and it could only be confirmed with a bone-scan..   To our surprise, they did a whole body as well..

(The dye is in there - don't waste the chance)

It lit up every Arthritis spot and the fracture and a spot in her skull.  We still don't know what it is, but even if nothing,

we NOW have a record of it from 2010, if things develop in ways we don't want to see.

Demand and Keep all scans/tests.  You will NEVER be finished with them !

..

.

Posted 1/7/2011 12:27 AM (GMT 0)
Harry, it's all I can do to control myself from flaming the poster who wrote the following:

"Having read the book, I knew that there was only two options.

Take-the-risk and wait and try to cure myself with diet and supplements... or

Get cut and have it removed and accept the  95% "Guarantee" that it would all be ended."

 

"I  think they do not like radiation in the younger men, because Radiation does actually smhair   cause cancer.  That's why they all run from the room..

At younger ages, anything that leaves your body as unchanged as possible, has to be better.  Removing something sounds traumatic, but nothing much else has changed"

So, all I will say is that this is the same poster I was referring to who provided incorrect information about AS and the above statements are pretty nonsensical, IMHO.  You have gotten much better advice from the other posters on your thread but I guess you will just have to sift thru the good and bad and make reach your own conclusions.

Continued good luck in your journey.

Tudpock (Jim)

Posted 1/7/2011 12:41 AM (GMT 0)
Tud, I would have to agree with you on the excerpt you posted. That was a lot of misinformation in a short amount of space. People should be careful seperating fact from opinion.

David in SC
Posted 1/7/2011 12:59 AM (GMT 0)
Hello fallonboy, glad you made it over here ...as you can see, you got more posts in a day than you got over there in a week...

Be careful of information overload..And welcome to Healingwell..
Posted 1/7/2011 1:05 AM (GMT 0)
What are the steps to get a second opinion on the biopsy report? Thank you
Posted 1/7/2011 1:13 AM (GMT 0)
You ask the doctor who ordered the biopsy to ask the lab who did the pathology to send the slides to one of the "Expert" labs..I'm going to butcher the spelling, Bostwick is one, Epstine at Johns-Hopkins is the other..

Someone please rescue me.....
Posted 1/7/2011 1:29 AM (GMT 0)
2nd Opinion on the Lab

I called the Uro office and the lady who answered the phone thought it was an "odd request" but she took my request for a 2nd opinion on the biopsy and said she would ask the Dr about it....no answer yet.

Medicare and my 2nd insurance payer covers it.

Question: does the 2nd opinion lab also get the pathology report from the lab #1 or the Urologist? I hope not.
Posted 1/7/2011 2:38 AM (GMT 0)
Harry, getting a second opinion on PCa slides is done frequently and, as I said earlier, I think it's a great idea in your case. But...make sure the opinion come from an EXPERT, e.g. Bostwick or Epstein. Here are some info/links that you may find helpful. You can Google Bostwick Labs or Jonathan Epstein Hopkins and get more info if you wish.


Tudpock (Jim)




BOSTWICK
The Most Sought After Second-Opinion Practice for Urologic and Prostate Biopsies in the World

This service continues the long and proud tradition of Dr. David G. Bostwick’s consultation practice, which set the standard of excellence at the Mayo Clinic.

Bostwick Laboratories is now one of the busiest consultation practices in the world while remaining reliable, accurate, and fast.

Slides are personally read by Dr. Bostwick with the request available by fax within 24 hours of his signing out the case.

Dr. Bostwick is the final signing pathologist on second opinions/consults.

To request a second opinion, please call your local Bostwick Laboratories representative.
Posted 1/7/2011 9:31 PM (GMT 0)
So sorry if you do not like views that are not "Mainstream" !
I had a practicing Radiation Professor say that Radiation should be MY LAST choice.
I had a University Professor of Urology, also declare that Radiation should be MY last choice.

One cannot differentiate between forms of "Ironising" radiation. Be it X-Rays, Cosmic Radiation (Cabin-Crew with Higher Cancer rates), or Cancer-Therapy.
Just because it's "Therapy" does not remove the danger. Radiation passes straight through the body. It does not start and stop at the tumour.
Even Bead-Therapy is potentially questionable.. Blood and other fluids flow in and out of the Prostate, and these cells can be damaged and then travel around the entire body.
NOTHING is risk free, and people should understand the facts before they make their decisions.
Ask the patients who are suing hospitals at this time, because Radiologists either missed the target, or used the wrong dose, and INSTANTLY destroyed patients lives. ( They can't 'see' the radiation or the beam and rely totally on the machine to focus and control the beam )

I am not saying that I would NEVER think of RT, but it would be my alternate to surgery, and left as a safety-net should things be found to far worse than expected.

There is just so much FACTUAL information out there.. It is just that the Radio-Therapy people NEVER include those references in the list of side-effects.
..
.
Radiation from Medical Procedures in the Pathogenesis of
Cancer and Ischemic Heart Disease:
http://www.ratical.org/radiation/CNR/RMP/index.html

Hypothesis-1: Medical radiation is a highly important cause (probably the principal cause) of cancer mortality in the United States during the Twentieth Century. Medical radiation means, primarily, exposure by xrays (including fluoroscopy and CT scans).

Hypothesis-2: Medical radiation, received even at very low and moderate doses, is an important cause of death from Ischemic Heart Disease; the probable mechanism is radiation-induction of mutations in the coronary arteries, resulting in dysfunctional clones (mini-tumors) of smooth muscle cells.

http://www.drheise.net/xrays.htm

In general, ionizing radiation refers to high-energy electromagnetic waves (x-rays and gamma rays) and particles (alpha particles, beta particles, and neutrons) that are capable of stripping electrons from atoms (ionization). Ionization changes the chemistry of affected atoms and any molecules containing those atoms. By changing molecules in the highly ordered environment of the cell, ionizing radiation can disrupt and damage cells. Cellular damage can cause illness, increase the risk of developing cancer,
http://www.merckmanuals.com/home/sec24/ch292/ch292a.html
..
.
SECOND-OPINIONS - The single best recommendation

My First-Opinion Specialist (50 Rp/Year) said that I was good for years of Watchfull-Waiting.
My Second-Opinion Specialist (150 RP/Year) said DON'T wait, and after the RP he confirmed that the cancer was due to break out from the capsule.. 6Mths max.
We are all different, but the facts remain the same.
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