Posted 8/26/2016 7:08 PM (GMT 0)
Hope you don’t mind this long post. My husband has been recently diagnosed with prostate cancer and we’ve already found this board to be a tremendous resource, and are so impressed by how supportive you are for folks struggling with this. Now we need to make a decision so we thought we’d solicit input from you all (I’m more comfortable with internet chat so I’m the one writing in).
Here’s the story: hubbie is 56, with family history of PC. Father diagnosed in his 60s (over 20 years ago) had surgery, is in his late 80s now and robustly healthy (though recently confessed he’s been impotent since surgery and would not do it over again if he had the choice). Hubbie’s 58-year old brother diagnosed two years ago (G7); had proton beam therapy in Bloomington, IN (he choose that treatment largely because it was just down the block from his house; the center has since closed). Brother has been fine – no SEs – but of course it’s early yet for him to draw conclusions about the effectiveness of that treatment. But because we’ve already been through this with two family members we are not too surprised or shaken profoundly by hubbie’s diagnosis. It’s making the treatment decisions that is the biggest challenge.
Hubbie was initially diagnosed as G6 but the pathologist review through his urologist upgraded to G7 (3+4). We are in Chicago and University of Chicago also reviewed slides and confirmed two cores at G7 (3+4) and two at G6; the other 8 negative. PNI present in the G7 core.
We met the urologist for the first time when he did the biopsy; he is a surgeon and strongly recommended surgery (and this was when hubbie was still a G6). To us he seemed cavalier about the SEs from surgery; we were inclined against surgery and his manner made us more so.
So next we met with Dr. Brian Moran at the Chicago Prostate Center, who we know is highly regarded here. (In fact, it’s because we had read all the good things said here about him that he was our next consult.) Like so many others we were really impressed with him. He believed hubbie would be good candidate for brachy; hubbie did a volume study there and confirmed that he is.
So we were pretty ready to go with brachy with Dr. Moran but we wanted to make sure, and by this point hubbie’s slides had been reviewed again by the urologist’s team and was declared to be a G7. And since we are in Chicago we have some of the world’s experts to chose from. So we met next with a radiation oncologist at Northwestern Hospital, who insisted that not only should hubbie have EBRT in addition to brachy but that he should also undergo 8 months of hormone therapy too. That seemed to us to be way more treatment than was necessary, given that hubbie is in the favorable intermediate risk zone. This doctor too was cavalier about SEs from combined radiation therapy and from hormones. And we felt that this doctor was not really cued in to hubbie and his particular diagnosis and priorities. But the visit left us a little shaken, and so then we wanted yet another opinion.
So next hubbie made an app’t with Dr. Stanley Liauw, a radiation oncologist at University of Chicago. Hubbie was impressed off the bat because the person he spoke with to make the app’t was warm and spoke to him for some time about his particulars. She also told him that Dr. Liauw would want to have hubbie’s slides reviewed by their pathologists (Northwestern had not asked for that). When we went to U of C we were impressed by everyone there, including the resident and medical student who we met initially, as all of them (even the student!) seemed to have really familiarized themselves with hubbie’s case. And then we met Dr. Liauw, who we really, really liked. He had the laid-back but authoritative manner that you want (or at least we want) in a doctor. He spent a long time with us but did not waste our time going over what we already knew, which we appreciated.
And his diagnosis: he is emphatic that hubbie’s best treatment would be mono brachytherapy. He believes that brachy is more effective than EBRT and he thought that in hubbie’s case combining the two therapies would increase the SEs unnecessarily. He also thought hormone therapy was uncalled for. It seemed to us that at U of C (as opposed to Northwestern) they are very attuned to risks of SEs for all therapies, and recognize that for younger men these concerns are quite valid – even though, of course, we all want to live as long as possible. If hubbie had stayed at a G6, Dr. Liauw made it clear he would have urged active surveillance for a while, as he feels that putting off any SEs for as long as possible is optimal. (Unfortunately the U of C review confirmed the G7 diagnosis). Given all the whiz-bang technology they have at U of C we were struck by the fact that they seem to refrain from using it unless really necessary.
So we have a dilemma (maybe the best kind, given the circumstances): now we need to chose which doctor to do the brachy. We liked Dr. Moran and he wins hands-down on the experience front (which Dr. Liauw acknowledged; he’s done about 200 procedures vs. the thousands done by Dr. Moran). And we know that’s important for brachy. But we felt we “clicked” the most with Dr. Liauw. He is one of the U of C’s prostate cancer experts and has done considerable research on PC. We asked him why, if we were going to go with brachy, we should chose him, and he did not try to argue us out of going with Dr. Moran. But he did say that he would continue to be hubbie’s doctor and provide all follow-up care, which Dr. Moran will not (follow-up with him is to be done though one’s urologist, and we don’t really have one we like right now). We like the fact that if there are any problems right away or recurrence down the road, hubbie would already be in Dr. Liauw’s care and in the orbit of the U of C team.
So what do you think we should do? I know there are fans of Dr. Moran out there but has anyone been treated by Dr. Liauw? Should a gut-level connection, and follow-up care, surmount greater experience? We’re really wrestling with this one. Luckily, we are soon going on a long-scheduled trip to Europe for a few weeks and don’t really need to decide until we get back. Will appreciate your advice, and any other suggestions you experts out there might have!