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Posted 2/27/2011 12:55 AM (GMT 0)
Been lurking for a few days now.
Thought I'd say hi.
The main reason my Urologist did a biopsy on my slightly enlarged prostate, is because my younger brother was diagnosed a year ago at Gleason 8, Stage 4.
So, here I am, reading all the post trying to educate myself.
My biggest concern now, is trying to find a experienced Urologist to do the Davinci R.P.

Sorry, this info is in my signature, but not showing for some reason.

Age: 55- good health. Exercise now and then.
DRE 02/2011- no lumps, just enlarged prostate
PSA checked regularly last 8 years, ranged from 0.7 to 1.2
Needle Biopsy 02/2011- 12 samples. 10 OK.
GS 3+3=6 2 cores involving 5%
Stage T2a

Post Edited (Bitman) : 2/27/2011 5:29:04 AM (GMT-7)

Posted 2/27/2011 1:28 AM (GMT 0)
Bitman, Where are you located can you give us some of the details of the Biop re****s?

Take your time and read , educate yourself, and read some more. We are here to help in any way we can. Do keep us posted on what is happening with you.

You will find a great group of guys willing to walk with you through all of this.

Cajun Jeff
Posted 2/27/2011 1:35 AM (GMT 0)
bitman,
sorry to hear about you and your brother. i don't post much but lurk almost daily. i can't tell you how helpful the people here have been to me and my recovery. i had rp in oct. 2009 after being diagnosed in aug. 2009. my brother (5 years older) had rp a year or so before me.
my uro is dr. benjamin lee who had done 300 rp's at the time of mine. not as many as some would like but i was really comfortable with him and am happy with outcomes to this point.
my surgery was done at st. josephs in atl. and they have a rp surgeon there that i hear is among the best. his name is dr. shah. others here are far more educated on pc than i am from start to finish, so they can probably provide a lot more.
my brother had his in texas and i'm not sure who the dr. is but he had done close to a thousand rp's i think. if interested i can get the info.
good luck to you and your brother.
Posted 2/27/2011 1:44 AM (GMT 0)
We have another Michigander but from West side of the state. Can you provide details on your pathology or findings???
Posted 2/27/2011 1:49 AM (GMT 0)
 

Bitman, my surgeon had 1800 prior RPs under his belt and the total surgery time was around an hour. I live in NM and we seem to have several very capable surgeons; RP and Robotic. UNM Health and Science center has one of the best Minimally Invasive surgery programs in the West.

Just had my 6 week report and PSA was undetectable. My recovery has gone well and by my conversations with our friends here at HW I think I know I am doing pretty well and want to do better.

I chose my surgeon after interviewing 2 others I had come into contact with thru my insurance carrier. Experience counts but also making sure you are comfortable with the specialist. I went from biopsy to diagnosis to surgery in 2 months. Not sure I would do anything differerntly if I had it to do over again. Good luck in your biopsy and moving forward.

sb3

Posted 2/27/2011 3:25 AM (GMT 0)
Just because your brother has PC does not mean that you will IMO. YES family history is a factor but ......From what I have read, each of us have a unique physiology meaning that our bodies are different even though we share some chromosones. To even think about surgery at this point without much learned testing may be a wee bit premature.

Please don't panic. I have found that education relieves worry/fear while allowing better answers from various specialists prior to any plan of attack.

Hope that helps.

Posted 2/27/2011 3:28 AM (GMT 0)
welcome aboard, bitman. a little more info would help steer some advice your way. please stick with us, and keep us well posted of your journey.

david in SC
Posted 2/27/2011 3:44 AM (GMT 0)
Bitman -

So sorry to hear you are joining the brotherhood.......these guys are extremely knowledgeable, compassionate and understanding - all here will help to answer any questions or concerns.

I live in Western PA, but I had my surgery done in Southeastern Michigan - in fact, the surgeon did my Dad, my Brother and I within 6 months of one another. Great Urologist and all 3 of us have done very well with the surgery. The hospital was outstanding and the level of care surpassed my expectations.
Please let me know if you'd like his name. =)

Best of luck to you - if there is anything that I can do to assist, please hollar.

Mark
Posted 2/27/2011 4:01 AM (GMT 0)
Mark:

Just curious: Ford Hospital or Umich?

Mel

Posted 2/27/2011 4:08 AM (GMT 0)
Compiler -

Actually Oakwood Hospital in Dearborn. I sincerely can't say enough positive things about the staff there - from pre-op / check-in to recovery and discharge - the staff at Oakwood were compassionate, kind and caring. The staff on 6 were outstanding. Not only were they kind to me, but they were very attentive to my family through the waiting process.

I can't say enough great things about the care I received there. =)

Mark
Posted 2/27/2011 8:35 AM (GMT 0)
Thanks for all the warm welcomes.
I was going to use a Dr. Wood at U of M, but he's not in my insurance network.
I'm in the Grand Rapids, MI. area, and looking at a Dr. Maatman.
It is so hard to get information on any doctor. All I can seem to find online is their education.
As for more info on my Biopsy, not sure what you're looking for.
Two of the twelve cores are malignant.
Right medial mid, and right medial base. Both gleason score 3+3=6. TJP:spr, whatever that means.
Total millimeters of involvement, 0.6 and 0.8
Both at 5% involvement
HPIN: no
Perineural invasion: no
Extracapsular extension: no

I like my urologist, and feel comfortable with him. However he's only performed about 100 Davinci RP's.
I've pretty much decided on the nerve sparing Davinci procedure.
I've had a couple different surgeries in my life, and never worried about them much.
Because I was in so much pain, I just wanted to get it over with.
This is so different. I didn't even know anything was wrong with me. Now I'll be going through a life altering experience.
Just a little scary and unnerving. It's 3:30 am right now. I haven't slept much lately.
Posted 2/27/2011 11:54 AM (GMT 0)
You may be a reasonable candidate for A.S./W.W. (non treatment), your stats are what John Hopkins calls 'indolent PCa' or very close. My brother had similar stats to yours and has done nothing other than perhaps diet and monitor, been 6+ years and no psa change and apparently as in PCa books A.S. is not totally insane and some docs will definitely endorse such for the right type of patient. You may be rushing into a life changing event. Maybe look into this more before jumping into a one way street. Perhaps 5+ more years would be nice to have being your age, then maybe jump. It is perplexing on PCa issues.

John T- would you like to add some comments on this concept?
Posted 2/27/2011 3:21 PM (GMT 0)
Bitman:

You are going to be fine. Your scores are very low.

I was in our same boat, loved my urologist here in NJ, but was unsure about using him because of the amount of robotic surgeries he had performed ( 400 ). he told me the learning curve is 150-200.

I chose a renowned surgeon who has performed around 3000 and the results have been fantastic. Some here malign his name for some odd reason but I think we can all agree that volume makes the surgeon better for this particular surgery, specially in relation to nerve sparring techniques.

My guy wouldn't be for you because of distance, but you have the absolute best in MI in Dr. menon.

Feel free to email me if you have any questions about anything related to our condition. I just want to emphasize that 7 weeks out of surgery I am doing absolutely great and so will you. My email is [email protected]

Hope your brother is doing ok.

David
Posted 2/27/2011 4:14 PM (GMT 0)
Bitman - did any of your medical personnel recommend AS to you? As zufus posted, you seem to be a very reasonable candidate. No one here is a uro or doc, so they won't tell you what you should do as a treatment, but based on your posted biopsy stats (very similar to my husband's)I hope you were also informed of ALL your options.
Welcome...
Posted 2/27/2011 4:17 PM (GMT 0)
Go see Dr. Klein at the Cleveland Clinic. He is the best in your area...


You also need to understand the G6 PCa is different then more aggressive PCa. I will send you some study links about G6 PCa. Just to wet your whistle the last study I read said that out of 9,953 G6 people on 3 died over a 20 year period. I would question that the 3 were even G6...

Post Edited (ChrisR) : 2/27/2011 12:49:34 PM (GMT-7)

Posted 2/27/2011 4:28 PM (GMT 0)
Bitman:

Let me underscore something Zufus said. I researched this a lot when I was dx. I narrowed it down to Dr. Woods and Dr. Menon at Ford Hospital. I liked them both, but ultimately went with Dr. Menon.

Is it possible that he is in your network? If you were willing to travel to see Dr. Woods, then Dr. Menon is about the same distance.

Someone mentioned the Cleveland Clinic. I've heard great things about them, but that is much further away.

Mel

Posted 2/27/2011 4:57 PM (GMT 0)
I had to go out of Network in order to use the guy I wanted. I was actually given a hefty discount.

I would say that if Menon is out of network, you should contact him anyway and ask if they can work with you. I wouldn't be surprised if he took what your insurance did cover and then only charged you a small percentage of the remaining balance.

I think it's well worth a try considering Menon's reputation. That said, there are many other capable surgeons in your area.
Posted 2/27/2011 6:22 PM (GMT 0)
Bitman,

I think you are rushing things just a bit. All indications are that you have a very low grade cancer; both your psa and biopsy point to this. about 70% of the patients with your stats do fine without any type of treatment while maintaining all their sexual and urinary functions. Those 30% that do require treatment have similar results as those treated immediately. There are also other treatments that would work just as well with fewer side effects and better long term quality of life issues.

A decision that will affect your long term QOL should not be taken lightly and research into an Active Survelience program or other treatmens such as seeding should be a part of your due diligence.

Search the New Prostate Cancer Info Link on the latest studies on AS and read "Invasion of the Prostate Snatchers" to get a much better idea of the safety of current AS programs.

You do not have a "death sentence" as patient's with you stats have a .00003 chance of dieing in 10 years, about the same as being hit by a bus. Slow down, do your research and come to a logical decision that is dictated by your conditions and not by fear.

JohnT

Posted 2/27/2011 6:27 PM (GMT 0)
The NY Times review of the Body Snatchers book pretty much tore it apart. Both authors had clear agendas. If you look for this book on Amazon you will also see a great thread with reviews of the book and deconstruction of its agenda and purpose. Just saying look at both sides.

I was in the same exact bot as Bitman and my number 1 priority was taking the cancer out of my body immediately.

7 weeks out of surgery I have complete urinary control and perfect sexual function so that isn't a real issue.

quality of life issues concerns are not what they were only 5 years ago thanks to improving technology and increased skill of the many surgeons who have perfected this technique.
Posted 2/27/2011 6:34 PM (GMT 0)
Now that you have given some specs, it looks on the surface, that you are in a good position to do AS/AW as some have suggested, surgery of course is an option, or Seeding with or without RT added in. Assuming that your biopsy really hit the largest portion of cancer you have, you seem to have a low level Gleason 6 case going on their, with a small volume of cancer. Don't get me wrong, cancer is still cancer, but you are definitely in a physical condition not to feel rushed or intimidated by any particular doctor in having immediate action. Keep doing your homework like you are, you will do fine.

But we are here to support whatever decision you make, so don't worry about that.

David in SC
Posted 2/28/2011 3:08 AM (GMT 0)
I am a strong believer in checking out seeds - I was too far down the road for them (I was refused by multiple doctors, and my post-op path proved them right), but they are a very valid solution for many.

Oops, Forgot that 'Welcome' - sorry you find yourself visiting here, but we are here just the same -

Posted 2/28/2011 3:30 AM (GMT 0)
Whenever a biopsy is right on the edge (2+2=NOTHING, 3+3=6) It's a good idea to have an expert lab give you a second pathology opinion..A good, quick read on prostate cancer is Gerald Chodaks's "Winning the battle against prostate cancer"..
Posted 2/28/2011 6:09 AM (GMT 0)
Sorry to see you here but I welcome you to the brotherhood.

It seems like you have already decided on robotic surgery. If so, selecting a surgeon that fits you is very important. Different people had given you recommendations and different ways to select but you need to find your own comfort zone as it is surgery skill, it is also emotional compatibility so you are comfortable to trust him with your life and future.

My insurance allowed me to seek the service of almost any famous surgeons in the US but I ended up selecting a local community hospital surgeon because his ethics impressed me. Skill is important but to me characters count.

He won me over because he took the time to comfort me, answered all my questions and gave me emotional support when I was most vulnerable. He shared with me his results and provided references. He could have easily perform more surgeries but I was impressed that he limited himself to two surgeries a day and no more than 4 to 5 a week because he did not want to stretch himself at the expense of his patients.

Good luck on your journey and best wishes.
Posted 2/28/2011 10:06 AM (GMT 0)
To be honest with everyone and myself, part of me wants to do the watchful waiting, and part of me wants it removed.
I don't know if the color doppler or MRI tests would give me a little more info to go by.
Because of my younger brothers situation, of being G8/stage 4, at 50 years of age. I'm scared to death mine will advance or spread during the waiting. The more I read and try to learn, the more confused and frustrated I become. This really sucks.
Can the cancer grow without having an increase in your PSA?
How high do you let your PSA get, before you make the choice to remove the prostate?
Am I just prolonging the inevitable?
Right now it's contained within the prostate, why not just remove it and be done with it?
Posted 2/28/2011 12:06 PM (GMT 0)
Bitman:

I am younger than you by 15 years. Every surgeon, oncologist and professional I spoke with told me that although radiation would also probably work, it could be dangerous for me to not act at all vis-a-vis my cancer. This includes specialists who did not perform the surgery and had no personal interest associated with my case. The thinking across the board seemed to be that I was young, that it's impossible to predict exactly how/when the cancer would spread and that this would give me the best chance for longevity.

On a personal level, gut feeling, I just wanted the darn thing out. Whatever my chances would be, and whatever the fight entailed, I wanted to do it without the known cancer in me.

Also, because this disease is so common, I was able to hear many accounts of men who had their prostates removed in the mid 90s the "old way". They were all happy about it, recommended the course and reminded me that there had been great advances in the field since then anyway.

My initial biopsy scores were very similar you yours so I had hope that everything would be confined within the prostate and it was. Do keep in mind that very often after surgery the gleason score goes up.

I have absolutely no regrets at all with my decision and frankly couldn't imagine still having the cancerous prostate in me. I understand that it could always come back, but statistically at least, I'm in a very good place now. With the exception of dry orgasms I am exactly where I was before my surgery which took place 7 weeks ago. It's really not that big a deal. Recovery is lightning fast.

Once the thing came out my entire mood and outlook changed.

Good luck.
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