Need your collective wisdom to help a friend

Ok here's the deal. A good friend of mine here in Michigan was recently dx. with PC. His biopsy said G 3+4, but his PSA was not acting like it (jumped from roughly 6 to 15 very quickly). Bottom line, he got a second opinion on the biopsy slides from Epstein. He is now a G 4+5. Quite a shock.

He spends half the year in Arizona, near Phoenix/Tuscon. He is about 73 years old and in very good shape (plays serious tennis, etc.). He did the research and strongly prefers surgery over radiation. I just found out about his current status today. He asked me about surgeons. When I did my research 7 years ago, I narrowed it down and chose Mani Menon, at Ford Hospital in Detroit. However, he strongly want to stay in Arizona, if he could find someone he is comfortable with. So:

1) Any recommendation about surgeons in his current geographic area.

2) I mentioned that he probably should get an MRI and some scans BEFORE doing surgery, because if it was very widespread, surgery might not be advisable. He said if he found the right surgeon, he would ask him/her. But, would he get an honest answer? After all, surgeons push surgery. Also:

3) Should he be seeing a medical oncologist specializing in PC? The usual wisdom is: not yet. But it would seem that with the scans question, maybe he would get better information from a MO? If so, I might even recommend my MO, Dr. Lam, in Marina del Rey.

Any other words of advice?

Also, I remember someone (TA?) once published a really complete list of questions to ask in his situation. If someone has it, if possible please post it.

I'm going to send him this link. I'll try and get him to join!

Also, he looked at:
http://www.propepsurgical.com/

I never heard of this -- it is apparently a method of locating nerves during surgery that results in better outcomes concerning nerve sparing. Anyone familiar with this.




Mel

Post Edited (compiler) : 11/11/2016 11:12:02 AM (GMT-7)

Sorry to hear about your friend's condition. I am by no means an expert and am still researching possible treatments myself. But wanted to mention that I saw a presentation made by Peter Grimm, D.O. at a conference recently and he presented favorable data on the use of IMRT w/ brachytherapy boost for those with high risk P-ca. His presentation was entitled: “Comparing Treatment Results of Prostate Cancer - Impact of the ASCENDE Trial”

Mel,

I agree with Jim. For high risk prostate cancer, radiation makes more sense both from an efficacy viewpoint as well as side effects.

Paul

Did he do his research when he initially thought he was G7, or after he knew he was G9?

Needs to know how much if any mets before deciding on surgery versus radiation. agree with recommendation that he visit Marina del Rey to see any one of Dr. Cholz, Dr. Lam or Dr. Turner

Has he looked at Mayo in Phoenix? There are some great doc's in all area's there.

He should get scans first.....very high percentage of high risk come out of surgery with the need for RT anyway.

Todd

With a psa of 15 and a G9 I would suspect it is already systemic. See an oncologist.
JT

Your friend needs to get a CT/bone scan and/or a MRI before he operates. In my case, the bone scan was negative but the CT scan picked up cancer in one pelvic lymph node. Since it has spread they normally do not operate, but after a long discussion with my surgeon I had DaVinci surgery last April. That was followed up with radiation and hormonal treatments. I will never be cured but I hope to manage it as long as I can.
With a Gleason of 9, he may be past the option of surgery. That does not mean there is not hope. Please refer to the "Gleason 9" club here.

For DaVinci surgery I recommend Dr. Menon at Henry Ford Hospital. He pioneered the use of DaVinci surgery for prostate cancer back in 2001 and has done thousands of them. He is constantly coming up with new techniques.

I also agree with Pax and Dr. Grimm:

Pax said...
IMRT w/ brachytherapy boost

There will be less side effects than if surgery is done. Also with this agressive tumor you will probably need a salvage radiation after the surgery anyway.

But I would avoid to check if the cancer is wide-spread now. In this case the doctor may refuse to do the radiation. However, I think treating the primary tumor is beneficial in any case.

George