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Surgery for early state prostate cancer.

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Posted 1/19/2014 7:44 PM (GMT 0)
Does anyone in this forum, know of a experienced doctor in the Dallas/Fort Worth area. Early stage prostate cancer, looking at possible surgery. Also very interested in outcome of anyone having surgery.
Posted 1/19/2014 7:49 PM (GMT 0)
Hello and welcome to this forum, its full of great guys with lots of experience with PCa
I am not from that area so I dont have any recommendations, but there are 10 or so of us that have had the surgery recently and we all seem to be doing well in regards to PSA level after surgery

Some more folks will chime in probably after the football games

Go Broncos and Niners

Pat
Posted 1/19/2014 8:13 PM (GMT 0)
If you are newly diagnosed, I highly recommend you visit the links below in my signature.

-Gedman
Posted 1/19/2014 8:40 PM (GMT 0)
Hey tirou... I was diagnosed in July and had surgery in late August. I'm 25 miles east of Dallas. I chose to hop a plane to Minnesota and had surgery at Mayo Clinic in Rochester. Only real difference between now and then, physically speaking, is the tiniest amount of incontinence that is all but a non factor in my daily living and some erectile dysfunction but I can still be intimate with my wife. Just not as stiff as I once was...orgasms are dry.

UT Southwestern in Dallas was the hospital my uro said was the gold standard for our area.

My suggestion is don't limit yourself to where you live, if possible. MD Anderson in Houston is a great place for prostate cancer treatment. Perhaps, call there and see if they could recommend a surgeon in Dallas for you.

Any questions you don't want to ask publicly, just send to my email on my profile page. It would be a pleasure to answer as much as I possibly can for you. I wish you well.
Posted 1/19/2014 8:47 PM (GMT 0)
Tirou, I don't know if you've noticed, but there are literally hundreds of page of previous discussions that you can access on the site. Looking at my screen, I see 850 pages of discussion.

When I first discovered HealingWell, I spent several days just browsing through those pages for topics of interest. Then I discovered the Search feature (the one IN the Blue bar at the top of each page), and I found I could look for particular topics using that feature.

In the three years I've been visiting HealingWell, no topic has been more widely discussed than the decision-making process in regard to early stage, or Gleason 6, prostate cancer. Search themes might include "overtreatment," "Gleason 6," "brachytherapy," and "Active Surveillance." \

I hope you find this helpful, and I wish you well. As you can see, my stats were a bit different than yours. My decision was probably easier. What to do, or not do, about early stage Gleason 6 prostate cancer presents more difficult decisions. Look for a thread started by "Ralfinaz" in the last few days. I think you'll find it pertinent.
Posted 1/19/2014 9:25 PM (GMT 0)

tlrou said...
Does anyone in this forum, know of a experienced doctor in the Dallas/Fort Worth area. Early stage prostate cancer, looking at possible surgery. Also very interested in outcome of anyone having surgery.

Hi,

Referencing Inchoation's post, I also had a da Vinci prostatectomy at Mayo Clinic and could not be happier. But if you cannot travel very easily, I'm sure there are great facilities in your area. Some of us will probably have good suggestions for you.

I had virtually no pain associated with my surgery and was virtually 100% continent within a couple weeks after surgery. No other side effects. Within 3 months I was carrying very heavy (picture tube models) TV's up and down my basement stairs. Doesn't even seem like I had any surgery.

Naturally every case is different and a lot also depends on the skill & experience of the doctor -- do not allow anyone to treat you unless they have done at least 300-400 of them. There is a long learning curve involved.

In the sex department, I'm pretty much the same as before the surgery -- not very hard -- because I had severe BPH affecting me. But things do seem to be getting better lately in that department.

Can you give us some of your stats so we can give you more comments? Such as your age, PSA history, biopsy results (how many positive cores & what percentage of involvement), Gleason score(s), staging, etc.?

Good luck,
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.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Firm erections now briefly happening in early mornings, 2 years post-op.
Posted 1/19/2014 11:12 PM (GMT 0)
tirou... Here's some cutting edge "cyberknife" treatment centers around or in Dallas. It wasn't a consideration for me but perhaps it will be for you?

www.cyberknife.com

Baylor Radiosurgery Center (19 miles)
3500 Gaston Avenue
Dallas, TX 75246 USA
Phone: +1.214.820.7285
Visit Our Website


Premier Cancer Centers Dallas (20 miles)
10425 N. Central Expressway
Dallas, TX 75231 USA
Phone: 1.214.954.7734
Alternative Phone: 1.855.203.6876
Fax: 469.250.4299
Visit Our Website


University of Texas Southwestern (22 miles)
5323 Harry Hines Blvd.
Dallas, TX 75390 USA
Phone: +1.214.645.4994
Visit Our Website


USMD Hospital at Arlington CyberKnife Center (51 miles)
800 West Magnolia, Suite B
Fort Worth, TX 76104 USA
Phone: +1.817.467.8480
Fax: +1.817.467.8478
Visit Our Website
Posted 1/20/2014 12:41 AM (GMT 0)
It would help to know more about your diagnosis and situation, before attempting any treatment advice. How many cores were found positive during your biopsy? How many were taken. What Gleason score and/or staging did they determine? This should be all on your copy of your biopsy report.

David
Posted 1/20/2014 1:06 AM (GMT 0)
Welcome to HW, sorry you need to be talking to us.

A few more details might help. Being from California, I am sorry to say I don't know any medical professionals east of Sacramento.

Andrew
Posted 1/20/2014 1:54 AM (GMT 0)
You have come to the right place. After I was diagnosed this past Sept., I do not know how, without the people here, I could have made the choices I made that led to my RALP in Nov. and my very good outcome.

Best of luck to you!
Posted 1/20/2014 4:47 PM (GMT 0)
Hey tlrou,

Just had my RARP done at UT Southwestern in December. During the emotionally trying time of looking for a surgeon I came up with 3 names in the DFW area: Cadeddu (UTSW), Roerborn (UTSW) and Lee (USMC in Arlington).

Ended up with Cadeddu who is super. Check his creds online. Trained at Hopkins, lots of research and publications, including pubs with Partin and Han. He's big into anatomical reconstruction of bladder support. I was out 24 hours after surgery (during the ice storm too), on ibuprofen 48 hours after surgery, immediately continent, and little Elvis is somewhat perky at 6-1/2 weeks.

UTSW has a nationally ranked urology department (21) and the Zale hospital has a urology floor and couldn't have taken better care of us.

I'm an engineer, did a lot of analysis, had lots of questions, was very rational, and of course ultimately ended up going with my gut. The guy's smart, competent, caring and my wife and I trust him.

Never tried the PM thing here, but let me know if you want some more information.

Cheers,

Dave
Posted 1/23/2014 4:56 PM (GMT 0)

Hey Dallas Dave

Thanks for your reply. Can you give me a recap of how your surgery went. I am also interested in your recovery and the experiences you have had with that.  Would you use the same surgeon again, if given the chance?

I have been to USMD and have a consult scheduled with Dr. Lee, but want a second opinion for sure.

Thanks for any information that you can share.

Terry

Posted 1/23/2014 7:23 PM (GMT 0)
Hey Terry,

Went very smoothly despite the ice storm. Minimal pain. Dr. Cadeddu uses a suprapubic catheter, so when I woke up I had two catheters: it plus a urethral. When I left the next day the urethral was removed and I had the suprapubic for about 12 days. 48 hours before my 2 week appointment I plugged the catheter and began urinating normally. A few drops of urine for a couple of days and I've been dry ever since. Pain was so minimal that I switched to a couple of ibuprofen every 4-6 hours 2 days after surgery and nothing at 4 days. 7 incisions, all but the bellybutton are 3/4" or less and all were glued.

Path was negative margins and no spreading, so it looks like a pretty darn good chance of a zero PSA at 3 months.

I tried to start working again 5 days after surgery and discovered that wasn't a great idea--hurt to sit and I got really tired. Felt good enough to work after about 10 days, but didn't feel "normal" levels of energy and well being until about week 5.

Pretty much full ED for a week or two, some signs of life from 2 weeks until weeks 5-6, then definite signs of life but not more than 30-40%. Started Cialis at 6 weeks and am now getting some nocturnal activity in the 40-60% range, so things are looking pretty good there. Dry orgasms are surprisingly good--maybe even better than the messy kind.

Had a bit of depression which I think is primarily let down after the excitement of planning for the surgery, having the surgery and dealing with the catheter and recovery. Now I'm just a guy with ED and back to real life. Nothing really bad though.

On the financial side, UTSW is awesome because you get 2 and only 2 bills: hospital and professional services. Everybody that sees you works for UTSW. No flurry of other bills from folks you never saw that are out of network and aggressively balance bill you for ridiculous fees. I ended up paying my max in-network out of pocket ($2k) and that was that. I think the fictitious bill was over $50k and the insurance ended up paying mid-20s, but I'd have to check.

UTSW is also awesome because (unlike my suburban uro, suburban GP and suburban ortho) the folks working there are all happy, competent and very, very nice. Also fun. Zale hospital is great, and it looks like most folks get a private room with a couch that converts into a bed. Nice for Deb as she didn't have to drive home during the ice storm. Meals are room-service model: you call and order from a (surprisingly extensive and good) menu and Deb was able to get her own meal for $10, again nice with the weather.

As far as doctors, Dr. Cadeddu speaks pretty highly of Dr. Lee, if that's any help. Ultimately, after I pre-qualified the guys on training, experience, etc., it came down to a gut feel. Guts were apparently right.

Cheers,

Dave
Posted 1/23/2014 9:29 PM (GMT 0)
Terry,
My wife and I also interviewed Dr Cadeddu and found him to be a very qualified Surgeon. I would have been very happy to have him operate on me or Dr. Roerborn (UTSW), as he operated on a friend of ours, who had Gleason 8 and is doing great 2 years later; however, we selected Dr Lee from USMD.

My original Urologist recommended Lee and also Cadeddu, but told me to ask Cadeddu how much of the work the students would do. I did and he said he does all of the main procedure, but this is a teaching hospital and I am obligated to involve them, but not with the delicate parts. Even with that he would still have been a great choice for my operation.

I agree with Dave that you must go with your gut feeling.

June 2013 I was diagnosed with PCa at age 65, am now 66.
PSA 5.3
12 biopsy samples taken (6 benign, 3 Gleason 3+3=6, 2 Gleason 4+3=7 and 1 Gleason 3+4=7.
Stage T1C

I was operated on, using Da Vinci robot, August 2013. My surgeon (Dr. Justin Lee) has done 2500 DaVinci prostate surgeries.
My wife was able to stay in my room and was very grateful for that.

He said everything went well, routine. Spared 90 + percent of nerves.
I never had any pain that Advil could not take care of, while in the hospital and did not need any after . They brought me to my room at 3 pm and had me up walking at 8 pm that evening. Nurses are great.
Supra Pubic Catheter was removed 8 days after surgery, was given antibiotics for a few days.
Plan was to go back to work after 2 weeks, but I got Urinary Tract infection the week after removal of Supra Pubic Catheter. I was given antibiotics during week 3, but ran fever off and on for a week between 99.0 and 101.2. I went back to work the following week.

Pathology report confirmed surgeon’s assessment.
Margins negative
Organ confined
Seminal vesicles negative
Lymph Nodes clear
Downgraded Gleason from 4+3=7 to 3+4=7
First PSA in December was <.01
Started out doing 60 Kegels a day. After 7 weeks since started doing 80 Kegels a day. Three months after surgery Dr Lee advised me to only do 3 sets of 10 Kegels as pelvic floor was getting sore. Never had serious incontinence, dry today.
I am taking 5 mg of Cialis daily. Getting sensations from time to time, even a chubby, but no Woodrow yet.

Roy
Posted 1/24/2014 3:35 PM (GMT 0)
Hey Terry,

Some stuff I was concerned about pre-surgery that I neglected to mention. I'd done a lot of reading and was concerned about issues related to the position I was going to be in during surgery, the "steep trendelenburg position". These included facial edema, bruising and loss of circulation from inadequate padding or things leaning against me, damage to shoulder nerves from certain types of strapping, corneal abrasions, etc. These weren't issues and I wish I hadn't spent so much time worrying about them. I had slight bruising around one of the incisions and that was about it.

Also, to address a point Roy made, yeah I was concerned about the student issue, although the "students" involved are either senior/chief residents (4-5 years?) or fellows (6+ years and I think fully accredited and getting advanced training). Dr. Cadeddu was the sole console (robot) operator and the chief urology resident was the "bedside" surgeon who scrubs in, does the incisions, passes stuff like sutures in and out, applies traction and probably closes.

I was also in slightly longer because I apparently have a 3rd artery (uncommon) that had to be dissected away. I didn't notice...

Based on what Roy said it looks like we've identified the big 3 in DFW, although I wish someone that has had Dr. Roerborn would chime in. Hopefully others in DFW will find this email chain because I found almost nothing about local guys when I was searching back last September.

Cheers,

Dave
Posted 1/24/2014 4:26 PM (GMT 0)
Terry,
I believe Dave and I did similar research and came up with the same doctors. My wife and I had picked out Roehrborn and Lee and surprisingly my Urologist said I can get you Roehrborn, but he preferred Cadeddu. He then said Lee is the man at USMD. So, we interviewed Cadeddu and Lee. To address Dave's question about Roehrborn, he is a fine surgeon and as I mentioned in my post, he operated on a friend of mine who had Gleason 8 and it had gotten outside the capsule, but Roehrborn was able to scrape the surrounding tissue and as I said in my post he has been PSA <.1 for over 2 years.
I am sure there are plenty of doctors in this area that are more than qualified to operate on you, with great success, but my Urologist only came up with 2 names he would recommend in the entire DFW area and my Urologist is in Lewisville, some distance from UTSW and USMD.
Cadeddu and Lee.
Roy
Posted 1/31/2014 5:47 AM (GMT 0)
For what is worth , I went with David Shepherd MD at USMD for my surgery and felt that he did a very good job with my robot assisted radical prostatectomy. He did his oncology training at MD Anderson. I have no regrets with his care .PSA has been undetectable since surgery. I did chose to do IMRT radiation therapy as adjuvant therapy since I had EPE and Gleason 8 tumor. PSA continues to be undetectable. , James
Posted 1/31/2014 9:57 AM (GMT 0)
My URO/Robotic Surgeon was www.drkeithwaguespack.com/

He has offices in Arlington, Las Colinas and Plano Baylor.

He's been taking good care of me for the past 5½ years.
Posted 1/31/2014 4:35 PM (GMT 0)
How about a drive down to Houston to MD Anderson??
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