Debunking Peter Grimm study and question about cancer return?

Here's a wonderful account, from a wonderful site, by a very smart man.

He documents his journey, his research, his decisions and his choices very well.

www.yananow.org/display_story.php?id=558

davidg,

You are right that there are many, many DaVinci patients that have experienced no side effects from the surgery. I am one of them. I suppose you can say that there is one side effect in that my erections have not yet fully returned 14 months after surgery. But, as they say, there are 3 goals in treatment in this exact order:

1- cancer control, 2- urinary function, 3- sexual function

I have been told to consider myself to be cured by my surgery (time will tell, of course), I have absolutely no urination problems whatsoever, and I do hope to recover my sexual function as the nerves do seem to be slowly coming awake now.

To be fair, of course, surgery is not recommended unless the cancer is localized and a cure is highly possible.

One of the other posters basically said "sorry but surgery is no longer the gold standard." I'm very sorry myself -- because it indeed DOES remain the gold standard. At least according to Dr. Walsh's new edition (3rd) of "The Guide to Surviving Prostate Cancer."

I am a reporter by profession, so I am very grounded in being balanced when discussing (or reporting on) a topic. So, to be fair, it is possible that a new gold standard will arise in the coming years. Perhaps it will be radiation, a new form of surgery, or perhaps something not on our radar at this point.

But, to sum it all up, probably the majority of DaVinci patients have little side effect (aside from a temporary lull in sexual function) and surgery is still the gold standard. This is not ME saying this because I do not have an M.D. behind my name. Nor do most of us on the forum. I am merely reflecting what one of the most popular PC books says.

And I trust that Dr. Walsh knows more about this than I (we) do.

Now, it IS true that (in my case, at least) EBR could have cured my prostate cancer just as surgery (hopefully) has. But, in my case, even EBR could not have reduced my 98.3 gram prostate & eliminated my urination problems. That is why a Mayo radiation oncologist recommended that I reject any RT and go with surgery.

I suppose another reason why surgery is considered the gold standard is that there is no prostate remaining to cause any further cancer problems (ASSUMING THERE HAS BEEN NO ESCAPE, OF COURSE), whereas a less than surgical method leaves the gland intact -- which can, in theory, offer a pathway for a recurrence.

In addition, currently there is really no other sure fire way to give a final grade & stage to the cancer than to remove the prostate and hand it over to a pathologist.

Oh well, I step aside now so that the debate can continue................ LOL

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-firm erections now happening 14 months post-op & slowly getting a bit stronger.

The pathology can do you a LOT of good if you KNOW that the grade was not worse than estimated by the biopsy. Same with the staging. It's worth it just for the peace of mind.

Or, if the opposite happens (and it IS worse than estimated), it can be a guide to immediate followup treatment that might be needed instead of going into the future blind to the true situation.

I should think that such a pathology might do a patient a LOT of good.

Chuck

Post Edited (HighlanderCFH) : 2/14/2013 12:25:15 AM (GMT-7)

Aachen, just by the title of your thread you were bound to generate controversy - which of course it did.

So here we are once again *****ing and moaning at each other like a bunch of old LADIES (sorry PCa sisters....). What good does this do? Guess the old adage of "Opinions are like ***h0!&s - everyone's got one" - and we're showing that more than IMHO we should be.

So then Aachen please chime in here on your post - how are you feeling about the back and forth going on? Do you find it helpful, or harmful?

*****i guess some guys will sleep better knowing they are really a G8 instead of a G7 .*****

Perhaps some would if it led to quicker treatment. But I would guess that some guys would also sleep better knowing they were actually a G6 and not a G8.

On a side note, your sarcasm is not very constructive or appreciated. We're only trying to lend our experiences & uneducated knowledge to others who are just starting down this road.

No need to get combative when someone has an opinion different from yours.

Not sure why some get so defensive and aggressive about it.

David -- no offense but you were pretty vocal about samadi when you got here and you are generally negative about radiation -- citing your boss who had a very atypical reaction to BT.  so yeah you do it too and so do i so let's not pretend it's everyone else talking up their treatment .

ed

 

I'm still vocal about Samadi. I think he is a wonderful human being and an amazing surgeon.

I'm not negative about radiation, that's not fair. I've always said that I was told right off the bat that it would be equally effective for me. I've also said that I would advise my dad to seriously consider Brachy (he might have to), and I tried my very best to ge tmy close Italian friend who has chosen surgery to consider Brachy. I've just said that radiation definitely wasn't for me. My boss did HT along with brachy and he would pee himself on th esubway, in the office and on th etrain to his summer house in the Hamptons. He had a great attitude about it and laughed it off but he had a bad reaction. He also suffered from what he called "hot flashes" and wasn't as sharp as he normally is for a period of time. But I've also pointe dout how he's still scoring a zero PSA and went in with a gleason 8.

I have absolutely no issues at all with treatment choices. I do question choices like Imus has made. i do have an issue with people who constantly try to discredit surgery as I see it a san attempt to "sell" their choice of treatment at the expense of another.

 My boss did HT along with brachy and he would pee himself on th esubway, in the office and on th etrain to his summer house in the Hamptons.

what?  no private helicopter ?

ed

 

well i had HT, BT and IGRT and urinary urgency was powerful but i never pissed myself.  we're all different though.   nowadays even running water makes me have to go the the bathroom or sometimes the backyard if it's closer .

i've made a note to do kegels regularly at some point because i think they could be helpful as i age.

ed

 

"In addition, currently there is really no other sure fire way to give a final grade & stage to the cancer than to remove the prostate and hand it over to a pathologist."

I've never understood why this was important. It seems to me that with all treatments providing cures that are roughly the same - depending on a man's statistics - what is the medical significance of knowing? Peace of mind would not be reason enough for me to decide on surgery.

If PCa treatment fails with any treatment isn't it because the cancer has escaped the prostate? Is that a fair statement? If that is the case then we're talking about 1.) cure 2.) maintaining the best quality if life we can.

One of my surgeons said the same thing about surgery being the only way to get a true staging but was unable to tell me the why it was important. The only thing I can think of is when they remove it and restage it and it comes back a G7-G8-G9 etc. and/or see the PCa has escaped then you will be looking at salvage radiation and maybe hormones?

I've learned a lot from reading these debates.

I can't comment for him, but I am in the same situation he is in decision-wise and I have found this discussion extremely helpful.

and that's what really matters!  BTW, you're an excellent candidate for BT .

ed

 

Also I should probably clarify my current classification:

Readiagnosed by Johns Hopkins as Gleason 7 (3+4), T2a
5 of 12 cores cancer (40%,20%,60%,40%,10%)
Bone scan clean
MRI shows nodule bulging possibly into capsule(?)

Kaiser originally had me as a 6. But Johns Hopkins disagreed.

I think just the way I posted my stats some guys may not have read all the way down, and assumed I was a Gleason 6.

Also another update:

Both the Johns Hopkins radiation guy and the Kaiser radiation guy both said they would want to to external beam, not brachy.

The Kaiser guy has done over 1000 brachy seedings, and he said he would do both external and brachy. The Johns Hopkins guy said external and hormones. He wouldn't rule out doing brachy, but seemed to really strongly discourage it.

A couple extra questions.

If I did external and brachy doesn't that increase my likelihood of side effects considerably?

And what are the side effects if you do surgery first, then have to to do salvage external radiation? I assume it's some sort of cumulative effect, and the ED becomes a given. But what about urination?

Last question. I understand all radiation treatments may give bowel problems in the future. Could someone tell me more about that?

I already have bowel issues. Specifically a mild case of what some would call irritable bowel syndrome. Diarrhea and constipation. I've had this for some time. Not severe, but definitely noticeable.

I assume that plays a role in what the doctors are telling me as well, particularly if radiation has an impact on bowels.

Aachen - I also started out a 6 and was upgraded to a 7 on second reading. The day I found out I was really bummed out. My first reaction that I thought my chances of cure and longevity had just been altered to some extent. I had had enough of the whole situation already and upon hearing that I remember just breaking down with my wife. Then an angel (my surgeon's nurse) told me that it's a subjective process and that a lot of the studies we read about online listed gleason 6 cancers that today would be classified as 7s. She told me my chances of beating this were still overwhelmingly in my favor.

I don't know about your radiation questions, others will surely respond. I do have a relative with IBS and he handles it without issues taking pills. I'm not sure medication would be any less effective after undergoing radiation.