Consultation with medical oncologist

If you can tolerate one more consult after this one, you might ask the medical oncologist to recommend a radiation oncologist in your area who has substantial experience with prostate cancer, so you can consider the alternative of radiation treatment (seeds or external beam radiation, such as IMRT/IGRT). Of course, I am not suggesting you have radiation, or wading into the "which treatment is best" debate. But it might be worthwhile to talk with a radiation oncologist before you make a final decision. I would also ask the medical oncologist about the alternative of active survailance -- though I think many do not recommend this for a guy your age. You might also ask the medical oncologist who he thinks is the best prostate cancer surgeon in your area. Couldn't hurt to get his view on that, if you are going to have surgery. Best wishes, Medved

Ahh. So a medical oncologist is not nessacary at this stage of the game?
This doctors practice is part of a larger group of doctors, which is a cancer treatment center. If I'm not mistaken, they do or can perform all treatment options for cancer.
Thanks for the info. He may direct me to RO.
I choose him based on my insurance PPO.
Looks like I was getting ahead of myself. :-/

Look into Proton therapy, it is an external beam radiation without the pass through radiation associated with IMRT/IGRT. I believe that it is just as effective, if not better, than all other treatment methods. The side effects generally are minor. I believe this is the future of initial prostate cancer treatment. Quality of life issues are huge. Do your own research and don't let the anyone tell you that you are the "poster child" for their treatment specialities. Good luck on your decision.

Regards,
Kris

Thanks guys.

I'll know more tomorrow @ 2.
Hopefully the decision fear will be a little less monstery. :-\

Had the consultation with the medical oncologists yesterday. Anyone want to guess his recommendation?


Yep, he recommended that I have surgery.

Now the hardest part of all this, is finding an experienced surgeon that is also in my insurance network.
The two surgeons I've talked to so far, never directly answered my question of how many surgeries have you done. :-\

lowandslow is giving you great advice. Any surgeon who has substantial experience probably would not hesitate to confidently give his stats to you. My local urologist had done about 460 DaVinci's and my eventual surgeon, at Mayo Clinic, was in the 650 range.

There IS a long learning curve associated with any surgery, including prostatectomies (open or DaVinci). You only get one shot at this and you do not want to be part of any surgeon's learning curve. Make sure that your doctor has performed at least 300 (probably 400+ is better) surgeries.

Since part of your clinical pathology report is a G7, you DO have some cancer cells that are somewhat more aggressive. To me, this would tend to eliminate the thought of AS. Some sort of treatment probably should be done.

If you choose surgery, also be sure that your doctor does not have a lot of positive surgical margins, etc. Any doctor who hesitates to give this info, along with the total number of surgeries performed, is unintentionally urging you to run away and find another doctor.

Another helpful hint is to seek such an experienced surgeon at a clinic that performs MANY such operations every year. They are usually the most experienced at handling the equipment.

Wishing you the best of luck in whatever you decide,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-erections now happening 14 months post-op & getting stronger.

Dont get down bro. It is a challenge, but this site helped me alot. When I found out, my head was swimming and I didnt know what to do. My wife and I researched every option out there. We dicided on Di vinci Robotic because mainly, we just wanted to get rid of the cancer. My PSA is now undectectable. Life is Good!

If you have to travel to get the best, by all means do so . Knowing you did the best you could will give you comfort post op. Good luck . It's not really as bad as your mind makes it out to be.