Just getting started

Headed to Vanderbilt tomorrow for a second opinion. Why? When I went to the local Oncologist and started asking questions like "How many procedures do you do a year?" he sat back in his chair and acted like I was questioning his abilities. Then he started looking at his watch. The NP was excellent but the Doc lacked bedside manner!! Nuff said. Guys.....I'm going to ask questions and I will find the "right" team. Will inform and I will keep this as my thread for those who are also just getting started with this thing called "Prostate Cancer". There is tons of information out there and this forum has been the best source for others traveling down this road.

You are doing the smartest thing by going for a second opinion at Vanderbilt. My opinion is you want to go to a great teaching hospital. My experience was similar. The first doctor I saw wasn't that qualified. I got in the car , left Dallas and went to MD Anderson in Houston. Got a great Doctor, Chapin, and 2 years later with G8 I'm kicking doors down. You're doing the right thing. If you win the battles you can't lose the war. Good luck, God bless.

After getting a bit more knowledgeable thanks to the guys here, I asked my urologist how many prostatectomies he's done and he was also a bit taken aback with the question. I didn't care - like JNF said I'm not looking for a friend, I'm shopping for the best qualified professional to trust with my life.

Also, my situation was almost exactly like duke48 - after I dumped this urologist I went to MDA.

Dr. Joseph Smith at Vanderbilt has thousands of RP procedures to his credit.

I had a similar experience. The urologist who did my biopsy, diagnosed my cancer. Being a surgeon, he advised surgery and went on to brief me on the procedure. My wife and I left his office with a lot of information, but little perspective as I knew very little about PCa prior to the diagnosis.

I did my due diligence, and got several opinions. I learned that you only get one shot at RP, so you want a surgeon who has done the procedure lots of times. There are differences of opinion as to the learning curve for either open or robotic surgery. 250-300 times is a good number to start with. In Chicago, I met with surgeons who had at least 2,000.

I reported back to my diagnosing urologist. He was a younger man beginning his private practice. He had come from a teaching hospital. When I asked him how many robotic surgeries he had done, I didn't get a straight answer, and there was a feeling of dismissive nature in what he said, like numbers don't matter. I wasn't confident in choosing him.

I went with experience, and overall I am sure I made the right choice. He will not be my friend, or even the urologist I'd see on a regular basis in the future, but he did the job I hired him to do. Ultimately, I had the outcome I wanted.

Choose carefully. It is your body. Be comfortable with who treats it.

Budreaux-

I notice you are in Alabama. I've been impressed by the work they do at U of Alabama Birmingham, particularly John Fiveash.

There's a list of questions to ask various specialists at the end of the sticky for the newly diagnosed.

As someone else said, one of the top RALP surgeons in the country is Dr. Smith at Vandy. You'll be in good hands there, even if you choose radiation.

Manfred: Looks like I'm not a candidate for surgery due to my PAD and risk of blood clots. I will probably opt for AS or Radiation. I'm going for a true 2nd opinion. I'm hearing more and more good things about Vanderbilt.

Good luck happens when preparedness meets opportunity. Bret Harte

Here's some clarification for you:

/prostatecancerinfolink.net/2016/08/09/is-adt-giving-you-alzheimers-disease-another-look/

You should be aware that these kinds of association studies are very problematic. For every study showing an association, there's one showing no association. But the media only report the studies that show an association, and lead readers to believe that the effect is real and something to worry about. Only a randomized clinical trial can demonstrate a cause/effect relationship. Here are a few studies that found no association:

/www.ncbi.nlm.nih.gov/pubmed/27870566
onlinelibrary.wiley.com/doi/10.1002/cncr.30320/abstract
/www.ncbi.nlm.nih.gov/pubmed/28067607
/www.ncbi.nlm.nih.gov/pubmed/27232853

In the last couple of years, there have been some changes in the way intermediate risk PC is categorized. There is general agreement now that "favorable intermediate risk" PC like yours (no GS higher than 3+4 and less than half the cores positive) has a similar prognosis and ought to be treated the same way as "low risk" PC.

The following is from my review of the subject of adding ADT to EBRT. Go to the the article for links to the actual published studies in peer-reviewed journals.

My review said...
Favorable vs. Unfavorable Intermediate Risk

In an earlier article, we noted that Dr. D’Amico raised a caution that the results may look very different if the intermediate risk men were divided into favorable and unfavorable groups. It may be that with further follow-up time, significant differences will appear among the intermediate risk men, and particularly among those with unfavorable features. In a retrospective study by Castle et al. where intermediate risk men were divided into favorable or unfavorable intermediate risk, favorable risk patients had no discernable benefit from the addition of ADT. Unfavorable intermediate risk patients had significantly higher 5-yr freedom from failure if they also received ADT, 74% vs. 94%, respectively. Similarly, Edelman et al. found that ADT combined beneficially with RT only in intermediate risk patients with GS 4+3, more than 50% positive cores, or multiple intermediate risk factors.

Another retrospective study by Keane et al. confirming that finding was presented at the recent Genitourinary Conference. They analyzed the oncological outcomes of 2,668 intermediate risk men (71% favorable, 29% unfavorable) treated between 1997 and 2013 with dose-escalated RT and with and without adjuvant ADT (median 4 months). After a median follow-up of 7.8 years, they found that there was a significant amelioration of the risk of prostate cancer-specific mortality among the unfavorable risk patients who also received ADT, but adding ADT did not make a difference to prostate cancer-specific mortality in those men categorized as favorable intermediate risk.

/pcnrv.blogspot.com/2016/08/androgen-deprivation-therapy-adt-and.html

Budreaux-

I agree. I call it the problem of "irrelevance." By the time we get the results of long-term studies that we need to make decisions, therapies have changed so much that the findings are irrelevant. It's especially true of radiation technology because it has evolved so rapidly. Here's an article about it:

/pcnrv.blogspot.com/2016/08/how-long-is-long-enough-length-of.html

I participated in a clinical trial when I was treated over 6 years ago. It's good of you to want to contribute.