new to group..gleason 7

The local urologist who diagnosed me immediately discussed robotic surgery as my best option. Then he heard I'd had abdominal surgery in 1978 and he could not get rid of me fast enough. I left with a business card of a nearby RT doctor and advice to choose radiation as my treatment. I was upset and confused. I got great advice from a friend (breast cancer oncologist with and MD and PhD from Yale) who said, "Get out of the "community" and get to a major cancer center". Next, I decided I needed to talk to a prostate oncologist who would help me choose a treatment option. I figured talking to a surgeon or radiation specialist would be like talking to hammers who see every problem as a nail. I found a wonderfully knowledgeable doctor at Sloan Kettering (Karen Autio who specializes in treatments for recurring PCa)who had clearly reviewed my case and spent as much time as we needed to pick a treatment. We chose surgery, and Dr Laudone, a an incredible surgeon, was not the least bit intimidated by my 1978 surgery. I am delighted with my results. I encourage you find an oncologist that you are really confident in. Once we (my wife and I) were confident that we had made the most informed choice, a great weight was lifted.
God bless!
Mike

Hi Bubbafish (Finchrat),

You have received quite a lot of good advice already.

At biopsy I was a Gleason 6 (3+3). Got the biopsy pathology report with Epstein at Hopkins. I decided to have surgery, as I did not fit the Hopkins active surveillance profile. Remember that the Gleason score given in the biopsy is just an estimate or educated guess of the actual Gleason score of your prostate.
The biopsy cores collect only small samples of the prostate, and can underestimate the correct Gleason score. In addition, it is important to have the slides read by expert prostate pathologists, as the reading of the slides is somewhat subjective, and experience and expertise are of fundamental importance.

Any kind of treatment has potential side effects (and Dr. Walsh's book is indeed very useful). Any decision that you make involves risk assessment, which requires good information and data. I had surgery at Hopkins, but the final pathology report showed an upgraded Gleason 7 (3+4) and a small positive margin. I was doubly unlucky because of the upgrade and the positive margin. However, even with these adverse findings which I knew were possible, my thinking was that I would have more complete information about my PCa having surgery and perhaps a better chance of a cure. Only time will tell if this was the right choice.

If you have access to a larger prostate cancer center, it may be useful to go to a multidisciplinary clinic consultation, where you can consult with a surgeon, radiation oncologist and medical oncologist all at the same place and in the same day.
I did that at Hopkins, and it was quite useful for me, as it helped shape my decision of primary treatment.

All the best,

Joe.

Hi All,

  Ive been to about all the doctors I want to see for now. I am at this point leaning toward surgery.

Looked into radiation but I don't think that's for me. In my case it would require getting a TURP done, hormone therapy and wait another 3 months for the docs schedule to open up.  Just not acceptable in my case.

Talked to 3 surgeons, and to be frank they all basically said the same thing. The bone of contention was what to do about the Lymph nodes. My scans were clean no suggestion of cancer in the nodes. Dr Kawachi, well known surgeon, wanted to remove them altogether. Another cancer center/teaching hospital doctor wanted to do a dissection of a few of them. Lastly, a local surgeon with a very good reputation suggested that to remove them would be extra time operating, and he preferred to monitor the PSA afterwards for any sign of a rise. At that point he would take action. I asked how he would know where to treat and he said something about how the PSA rises would indicate it.  Of the three  I was most comfortable with the local surgeon. He called me the other night rather late, just to see how I was doing with all of this. I asked him why would I have my surgery done locally when I can go to a well known cancer hospital with a well known surgeon. He said in those institutions you might not get the personalized care that he would give, saying im not just another prostate to be removed but he would follow my care even after I was operated on. Also that he handles all aspects of the operation personally and doesn't have someone else stand in for him. So the man said. Anyway I feel a bit less confused now. Kawachi felt that a single modality "might" be all I need but nobody could say for sure until the prostate is out and examined. surgery leaves my options open whereas radiation does not, he said.

Yeah Im a bit less confused.

Bubbafish

You have mail, I just sent you an email!

Bill from Florida

Simple question. Why wait? OK, the classic reply might be why not? Because you are dealing with cancer that once spread outside of the prostate cure is not likely.