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Posted 3/21/2012 6:26 PM (GMT 0)
I've been lurking and reading for a few days so I figure it was time to introduce myself.

I'm 55 and was diagnosed last Thursday (3/15) with prostate cancer. My PSA was above 5 at my last routine blood test so the doc suggested a round on antibiotics and a retest. When my PSA hadn't changed he referred me to a urologist who performed a DRE and recommended a biopsy. I had the biopsy on 3/12 and received a call from the Uro on Tuesday night asking me to come to his office on Thursday. Tuesday night and Wednesday were the longest day and a half of my life so far!

Anyway, my PSA was 5.65 and they found cancer in one core (10%) on the right side and two cores (5%) on the left side. Gleason on both sides was 3+3. The clinical stage is T1c and the Partin projection for organ contained is 80%.

All in all it could be worse.

The Uro performs open prostate surgery but he isn't recommending that surgery for me because I am obese and he feels that there could be complications because of my size. He's recommended seed implantation and referred me to a Radiation Oncologist. I have an appointment on the 26th.

In the mean time I'm learning what I can and looking at other possible treatments. I am in the Chicago metro area so most treatments are available in this area. So far I am leaning towards Brachytherapy and would be interested in others experience, particularly if you had it done in the Chicago area. The Chicago Prostate Cancer Center seems to have the most experience around here but I would be interested in other options as well.. Has anyone dealt with them?

I have also looked at the new ProCure Proton Center at Central Dupage Hospital, which is 20 minutes from my home, so that's a possibility. It would, however, impact my job since I would have to be available for treatments over an 8 week period.

Finally, I want to look at RRP, and we have some big names in that area around here. I've heard good things about Dr. Shalhav at University of Chicago Med Center, Dr. Zagaja, also at University of Chicago and Dr. Madler at Northwester Memorial Hospital, but I'm not sure if my size would make me unsuitable for RRP. These docs are busy and I don't want to waste their time if I'm clearly not a candidate. Any big guys on here with any experience with that?

Thanks for reading. Sorry for the ramble I'm just trying to get my head around all of this.

...ron
Posted 3/21/2012 6:45 PM (GMT 0)
I met someone on Yana (google Yana) who used Dr. Zagaja and had great results.

I've read about a few surgeons who have performed robotic on very heavy people. You might not be a candidate, but it certainly wouldn't hurt to go have a consultation with Zagaja if surgery was your initial choice.

This link may help:

www.robotic-prostatectomy.com/articles/robotic-prostatectomy-and-obesity

"The data clearly show that robotic prostatectomy can be accomplished in patients whose BMI is greater than 30 without any significant increase in morbidity compared with patients whose BMI is 25 or less. "

good luck.
Posted 3/21/2012 6:56 PM (GMT 0)
Thanks! I found article that you linked the other day.

I think i saw the post on yana about Dr. Zagaja as well in my searching for info, but I'll go check it out.

...ron
Posted 3/21/2012 7:13 PM (GMT 0)
Welcome to the forum.

I couldn't do surgery either because of health problems - lung, heart, weight and selected external beam radiation. I've been happy with my choice so far. With your numbers it's likely that either radiation or surgery would work as well.

I've been reading about the proton treatment with interest and would like to know more about if you look into that.

Best,
Andrew
Posted 3/21/2012 7:21 PM (GMT 0)

Hi Ron, and welcome.

For someone with low risk prostate cancer (nothing you wrote indicates anything greater than a low risk case), the first question is really whether an aggressive treatment is really needed at all.  Be sure to educate yourself thoroughly on low risk PC first, because “'treatment regret' can have an adverse impact on a patient’s overall outlook and has been associated with a poorer quality of life.”  (quote from The “New” Prostate Cancer Infolink site, and excellent source for news and analysis of PC developments)

 

If you choose to aggressively treat, you are in an area with excellent medical facilities (I also live in the NW suburbs).  Chicago has not one but two Comprehensive Cancer Centers (U of C and Northwestern), and also the Chicago Prostate Cancer Center (for seeds), as you have noted.

Dr Shalhav performed my surgery about 3 years ago.  In a correspondence with his lead assistant last April with his lead assistant, Dr Shalhav had performed about 1,700 robotic prostatectomies (through that correspondence in Apr-11) and Dr Zagaja had performed about 1,800.  (Dr Shalhav had used the robot to perform other urological surgeries, too, not included in those numbers.  He did the very first robotic surgery in the Chicago-area.)  Either doc would be an outstanding choice.

Dr Shalhav has led studies on robotic RP for obese men with very good results.  See this article:  “Surgical robot makes prostate removal safe for obese men”.  He also published results in the Journal of Urology (LINK to abstract on PubMed); Dr Shalhav was principal author (listed last; Zegaja was one of the supporting physicians).

Please feel free to email me (you can find my email contact by clicking on my username) and I could provide you with the email and phone contact for Dr Shalhav’s lead assistant.  I would encourage you not to think the doctors—any doctors—are too busy to see you.

 

I hope that this helps.

 

 

 

Posted 3/21/2012 7:53 PM (GMT 0)

davidg said...


This link may help:

www.robotic-prostatectomy.com/articles/robotic-prostatectomy-and-obesity

"The data clearly show that robotic prostatectomy can be accomplished in patients whose BMI is greater than 30 without any significant increase in morbidity compared with patients whose BMI is 25 or less. "

I went back and read that article again and found a couple of interesting things...

"What is most apparent from the table are the higher rates of positive margins in obese men undergoing RALP."

"And yet positive margin rates are nearly double in obese patients as compared with normal-weight individuals undergoing RALP."

In addition, this article... http://www.ncbi.nlm.nih.gov/pubmed/18952266 that was linked in the article that Casey59 linked states...

"In this series, obese men experienced a longer operative time, particularly during the initial robotic experience. As such, surgeons early in their RLRP learning curve should proceed cautiously with surgery in these technically more difficult patients or reserve such cases until the learning curve has been surmounted. These details, including inferior urinary and sexual outcomes, should be discussed with obese patients during preoperative counseling."

These don't sound promising, and the last clearly makes an argument for a surgeon who has been doing this for a while.

...ron
Posted 3/21/2012 8:21 PM (GMT 0)

Casey59 said...
<span style="LINE-HEIGHT: 150%; FONT-FAMILY: 'Verdana', 'sans-serif'; FONT-SIZE: 9pt">Hi Ron, and welcome.

<span style="LINE-HEIGHT: 150%; FONT-FAMILY: 'Verdana', 'sans-serif'; FONT-SIZE: 9pt">For someone with low risk prostate cancer (nothing you wrote indicates anything greater than a low risk case), the first question is really whether an aggressive treatment is really needed at all.<span style="mso-spacerun: yes"> Be sure to educate yourself thoroughly on low risk PC first, because “'treatment regret' can have an adverse impact on a patient’s overall outlook and has been associated with a poorer quality of life.”<span style="mso-spacerun: yes"> (quote from The “New” Prostate Cancer Infolink site, and excellent source for news and analysis of PC developments)

Good point. I don't know if it's just my personality, or a desire to move forward, or an instinct or what, but I feel that I need to do something. Maybe that's a common reaction to being diagnosed with cancer? The Uro did suggest getting treatment in the next 4-6 weeks, but that may just be his standard recommendation.

The articles that you and DavigG linked are mixed. They show that robotic surgery can be performed on obese patients, but they also show that the surgery may not be as effective or may have more complications than on non-obese patients, so that makes my leaning toward brachytherapy or possibly proton therapy more attractive.

So, I guess I'm approaching a fork in the road, so to speak. I can move forward, at whatever pace) with a treatment that makes sense based on my current physical limitations, and implement a serious "get healthy" program that would continue after treatment OR Start he "get-healthy" program and then choose a treatment after I have reached a more "normal" health status. Unfortunately, to do that safely would take at least 12 months, and while 12 months may be OK I'm not sure that I can wait that long.

...ron
Posted 3/21/2012 8:55 PM (GMT 0)
 

Ron_L said...

So, I guess I'm approaching a fork in the road, so to speak. I can move forward, at whatever pace) with a treatment that makes sense based on my current physical limitations, and implement a serious "get healthy" program that would continue after treatment OR Start he "get-healthy" program and then choose a treatment after I have reached a more "normal" health status. Unfortunately, to do that safely would take at least 12 months, and while 12 months may be OK I'm not sure that I can wait that long.

You are absolutely right in terms of being at a fork in the road, Ron.  There's a lot of guys with low risk PC who go into "Active Surveillence" (AS) mode.  AS is a strategy of close monitoring of newly diagnsoed patients with the expectation to intervene if the cancer progresses.  For a portion of these men, they never have to go to an aggressive treatment.  For another portion of the men, if & when their low risk case migrates to an intermediate level and they seek treatment...successfully deferring treatment to a future date when further technological advances have developed and perfected.  Surgical outcomes for those seeking immediate treatment or deferred treatment have been shown to be indistinuishable.  The key to AS success working closely with a urologist well-versed in monitoring protocols...same approach as you are taking in looking for a skilled surgeon.

Regarding the fork in the road, once you choose an aggressive treatment, there is no going back. 

 

 

Post Edited (Casey59) : 3/21/2012 2:58:11 PM (GMT-6)

Posted 3/21/2012 9:26 PM (GMT 0)

Ron_L said...
I have also looked at the new ProCure Proton Center at Central Dupage Hospital, which is 20 minutes from my home, so that's a possibility. It would, however, impact my job since I would have to be available for treatments over an 8 week period.

When I had my Proton Treatment in Jacksonville, we had a Dentist from Orlando who saw his patients during the day and treked the 140 miles each way, every day for his Proton Treatment.

...Jerry

Posted 3/21/2012 10:19 PM (GMT 0)

Casey59 said...
The key to AS success working closely with a urologist well-versed in monitoring protocols...same approach as you are taking in looking for a skilled surgeon.

I'm quickly realizing that's my my Urologist. He referred me to a Radiation Oncologist in his medical group since he was recommending against open surgery bu when I asked him for another recommendation he told me that I didn't need any more. Maybe I need to find a different Urologist to start with.
Posted 3/21/2012 10:21 PM (GMT 0)

Jerry_Delaware said...
Ron_L said...
I have also looked at the new ProCure Proton Center at Central Dupage Hospital, which is 20 minutes from my home, so that's a possibility. It would, however, impact my job since I would have to be available for treatments over an 8 week period.

When I had my Proton Treatment in Jacksonville, we had a Dentist from Orlando who saw his patients during the day and treked the 140 miles each way, every day for his Proton Treatment.

...Jerry

It's not the distance, Jerry. It the commitment for 8 weeks (plus recovery). I travel twice a month on average and I'm not sure if my employer would support no travel for that long. If it looks like proton therapy is the way to go I'll talk to them about it.
Posted 3/21/2012 11:27 PM (GMT 0)
Ron,

Sorry to hear about your Pca, but as you have already seen this is a great place to be. If you look at my signature it pretty much parallels yours albeit I am a couple of years older. As Casey mentions "AS" (active surveillnace) could be your first step given your low grade, low risk stats followed by curative treatment at a latter date. IMHO, based on my own experience, if you are leaning towards surgery, don't discount this because of your weight issue. You have time on your side to address your weight and lifestyle improvements. I forgot the member's name but in another thread reply, he recommended to another member "don't just look after your prostate cancer but as important look after your heart as well" Good advice to do both, so to speak, don't survive prostate cancer but die of heart disease. Your a young guy with lots of years ahead of you!!!

Speak to your URO about AS. You have your first Bx baseline results, he may monitor your PSA every 3-6 months to keep an eye on it and if you are up for a second Bx 12- 15 months later to compare what your cancer has done in that time period. This worked for me, but may not work with everyone. Having the extra quality of life was great, but somedays knowing the cancer was there was like a constant pebble in my shoe every day. Why don't I just get rid of it now. It worked for me, but definetly speak to your URO. My second biopsy 15 months latter only showed a marginal increase with a couple of cores moving to G6(3+4) and from 5% to 10%. It was based on this second Bx my URO and I agreed to move to curative treatment. I chose RRP and am 6 weeks out post surgery.

I have provided you with a few links that were extremely valuable to me in helping me with my treatment option. I hope they offer you some additional insight. 

http://urology.jhu.edu/prostate/cancer.php - this was a great website for me - Johns Hopkins Hospital

http://urology.jhu.edu/prostate/advice1.php - from Hopkins specifically talks about "active surveillance"

http://www.charlierose.com/view/interview/9016 - Dr Patrick Walsh form Hopkins a must watch 20 minute video

Wishing you a great journey and fight beating your PCa.

TJ

 

Posted 3/22/2012 3:25 AM (GMT 0)
isn't Dr. Catalona in Chicago? You should speak with him.
Posted 3/22/2012 3:42 AM (GMT 0)

FrackMe said...
isn't Dr. Catalona in Chicago? You should speak with him.

Yes, he is in Chicago, but doesn't he only do open surgery? I've already been told that the risk is too high for open surgery due to my size.
Posted 3/22/2012 3:58 AM (GMT 0)
Actually, I was told that high BMI favors open. I lost almost 80 pounds to get ready for my surgery, but I chose open surgery anyway. Robotic surgeons want thinner patients.
Posted 3/22/2012 11:10 AM (GMT 0)
Ron, Your stats seem similar to mine. I had permanent seed brachy after nearly two years of 'watchful waiting'. Now the preferred term is 'Active Surveillance'. At any rate, I couldn't be happier with my decision at this point. I am now 60 years old and have never been more active or felt healthier. God Bless.
Posted 3/22/2012 11:24 AM (GMT 0)
Dear Ron,
Firstly welcome, secondly take a deep breath, you’ve pretty much had the rug tugged out from under your feet with this unwelcome news but your stats are good so take your time to research and decide which treatment choice, if any at the moment, to go with.
If your uro, as a surgeon, is leading you away from surgery because of the possibility of complications, take notice!
As you are considering Brachytherapy, I just wanted to pitch in as the wife of a Brachy guy who is doing fantastically at 15 months post treatment with zero side effects. You can see Jeff’s stats below.
Read all you can, educate yourself but don’t rush into anything at the moment, you don’t need to. As mentioned above there is no redo with this.
Wishing you well and sending you a healing hug from ‘over the pond’
x
Posted 3/22/2012 11:53 AM (GMT 0)
Really, as Over said, take a deep breath. You are going to be okay. I know it can be overwhelming when you first get the news. Please, don't rush into anything. Educate yourself and take your time deciding what to do (if anything right now). I chose Brachytherapy and have been happy with the results and side effects so far. You can read my journey by clicking on the link in my signature. Feel free to ask any questions you have here. It's really a good support group with a lot of information on all treatment options.
Posted 3/22/2012 10:28 PM (GMT 0)
open Rp is not your only option. My current Uro does pereneal surgery on people who are overweight. It is a different approach making an incision between the scrotum and the anus. His success rate is pretty good. See if you can find a surgeon who performs this type of surgery.
Posted 3/23/2012 3:46 AM (GMT 0)

Ron_L said...
So, I guess I'm approaching a fork in the road, so to speak. I can move forward, at whatever pace) with a treatment that makes sense based on my current physical limitations, and implement a serious "get healthy" program that would continue after treatment OR Start he "get-healthy" program and then choose a treatment after I have reached a more "normal" health status. Unfortunately, to do that safely would take at least 12 months, and while 12 months may be OK I'm not sure that I can wait that long.

...ron

Start the serious "get healthy" program before you worry too much about what you are doing with PCa - it won't keep you from either moving forward on treatment or deciding to delay treatment until it's progressed a bit. ANd it won't keep you from doing more research. But it may actually even help slow your cancer down (not that it's likely to be a fast one with those numbers.) And it will help you in any case, even if you don't manage to turn into Mr. 6-pack abs. Talk to your primary care doctor about it beforehand and see if your health insurance and/or employer has any support mechanisms, because it sure ain't easy. But it may also be the biggest favor PCa can do quite a few of us. Unfortunate that it often takes something this dire to make us change, and I'll tell you that even then it's phenomenally hard to get eating habits reprogrammed (at least for me) but the fact is that you probably stand a much better chance of "dying from being unhealthy" than you do of "dying from PCa" unless you make some serious changes.

Among other things, radical prostatectomy by any method is serious surgery, and the ~3 hours being under are the most hazardous aspect of the robotic surgery, IMHO. Better fitness will improve your odds, even if it's "I get out and walk fast daily" and it's only taken off a few pounds or a single hole on the belt. If you can make it back to "overweight" from "obese" you'll not only make your surgical odds a great deal better for any surgery, you'll also make your life odds regardless of PCa a lot better. That may well be worth putting the treatment off for a year or more - the getting you in in 4 weeks thing is one of those "are they concerned for me, or concerned with a billable procedure for their bottom line?" things.

Edit. Dang, I totally missed that you got your dignosis on the Ides of March.
Posted 3/23/2012 5:25 AM (GMT 0)
My Husband had a Radical Perineal Prostatectomy (that is what another poster was refering to) He is not overweight at all but this is the way his uro like to go as it has a much faster recovery than an open. Hubby was up and walking the next morning and apart fom some dicomfort till the drain was removed he was fine. was back to normal within a week and has not had any probs with healing or any other isuues at all.

This procedure is often used on Obese patients as it is a safer option and surgery time is reduced.

Posted 3/25/2012 2:27 PM (GMT 0)
Sorry for the delayed reply. Things got busy at work late last week.

I did find out that I have access to health counselors through my employer and I am set to talk to one of them on Monday afternoon. I have an appointment with a radiation oncologist on Monday morning and I'm started the process of setting up a consultation at the proton center in Warrenville, IL. I am also trying to set up appointments with the Chicago Prostate Cancer Center to talk to them about brachytherapy.

I did some research on RPP but I'm having a hard time finding anyone in this area performing that procedure, so if anyone has any suggestion that would be great.
Posted 3/25/2012 3:48 PM (GMT 0)
Ron,

You are doing all the right things by researching your options. Be sure to consider SE's of the various treatments. I started out thinking surgery but finally decided (after the research I did....including doing a lot of reading on this site) to go with a combo of BT and IGRT. Very happy with that decision.

Best wishes with your ultimate decision. Once you make it, don't look back.

Regards,

Joe
Posted 3/25/2012 5:54 PM (GMT 0)
Ron,
Pick up a copy of "Invasion of the Prostate Snatchers" by Dr Mark Scholz as it is by far the best reference for "low risk Prostate Cancer". You should also consider AS as a viable option along with your other options.
The Chicago Prostate Institute has a long and excellent reputation for Brachytherapy. Since any treatment for low risk PC has excellent results you should focus your choice on the side effects for each treatment option. Since the risk of surgery, given your condidtions, is much higher than any of the other options available and the other options are equal or better in terms of cancer control and side effects I think surgery would be your last choice.
Your risk of dying from a heart attack is many multiples greater than your risk of dying from PC and this is one area of your health that you can control.
JT
Posted 3/25/2012 9:39 PM (GMT 0)
John, it's the best reference in your opinion. I read the book and found it to be almost comical at times. many people have had serious reservations about the book.

I would say that at 55 he might be a little young for AS. One of the links you posted a while back also suggested a cut off of 60 for AS. It was from a major center of excellence.

Looks like Ron is doing all his research thoroughly which is great.
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