Newly diagnozed G7 PC- Any recommendations for the best RALP surgeon in Dallas/DFW area?

Why limit yourself to surgery? If you are so concerned about preserving continence and sexual function I suggest you thoroughly investigate the several radiation based therapies. They are as good or better than surgery for cancer control and present far less significant side effects than surgery.

Radiation is used for children. When I see doctors say that a 40 year old is too young for radiation I want to puke. Because the same doctor will prescribe radiation when his surgery doesn't cure the cancer. How hypocritical.

Please go see several radiation oncologists that can properly advise you for SBRT , High Dose Rate Brachytherapy and permanent seeds brachytherapy. Then decide on a primary therapy.

Have you consulted with a radiation oncologist? If not, you really owe it to yourself.

Within the past few years, I keep reading great results. with both high cure rates and low side effects, from SBRT and HDR brachytherapy, while continuing to read the same old complaints about side effects from surgery, robotic or not.

The previous poster has been trying to correct his post. He meant RALP, not SBRT. I saw this on his profile, but he seems to have difficulty posting.

ATX, welcome to our club none of us would have chosen. I'd like to suggest you go to the top of the forum main page and read the 'sticky' to the newly diagnosed. We've all been there: the phone call with your results, and you ask the doc...what do I do? And he says, "cut it out!" The diagnosing doctor is a surgeon, and that's what they recommend.

You really do owe it to yourself to slow down, take the time it takes to consult with radiation experts in each of the radiation therapies. At a G7, you can be cured by any of the major types, so the key point is to truly understand what the possibilities are.

I'm a surgery guy who had a great outcome. Others aren't so lucky. Lots of guys in here went radiation for their G7's, and have had equally great outcomes. Keep us posted.

ATX, please fill us in with more information. Please include PSA, number of cores positive, G score of each core, percent of each positive core, stage, etc. This will better enable us to be of more specific assistance. Just knowing G7 means very little without the other information. I suggest you develop a signature like most of us have detailing your situation.

It is more important to choose the best primary treatment method for your situation, rather than choosing a treatment that you perceive may have a better salvage method in the event the primary fails. The facts are that for local cancer, radiation based therapy rarely fails. Unfortunately many surgeries do fail and then require radiation therapy to attempt to salvage. The reason for this is simple. Radiation based therapies cover a much greater area than the surgeon can cut. Since radiation based therapies rarely fail local cancer, fewer need to be salvaged than surgeries. While radiation is normally used to salvage a failed surgery, surgery is rarely used to salvage a failed radiation. It is too difficult and few great surgeons perform it. Rather, there are many focal based methods that can be used including types of radiation.

It irks me to hear people, particularly surgeons, say that if you use surgery you have great salvage methods, but if you use radiation then you don't. Simply not true and in my opinion very disingenuous. And I ask, if radiation is such a great way to salvage a failed surgery, then why not start with radiation and avoid the inherent harm and risk that surgery presents?

A lot of this depends on us having more information. As you can see I, too, was a G7. However, I was not a candidate for surgery. Three surgeons told me they would not operate. Why? Because I was too high risk. My nomograms indicated a 98% probability of the cancer already being out of the surgical field and clearly indicated that surgery would fail and require radiation in addition to the surgery. The three surgeons all said they would not knowingly subject me to the double risks and side effects of surgery and radiation. Thus I used two forms of radiation and seven years later my PSA is undetectable and I have no negative side effects from treatment.

So my message to you is to do the research. Take your time. If you are intermediate to low risk you have plenty of time, many months. If you are as high risk as I was, still 90 days is not a problem. You only get one shot at the initial therapy method. Take your time to get it right so that you have 100% confidence and no future regrets. Understand you must talk to the specific specialists. You met with a radiation oncologist. Dose he specialize in PCa? What methods does he use? HDRBT? SBRT? Permanent seeds? How many men does he treat each week? If you want to know about seeds, then go to the seed expert. But that person probably won't be an expert with SBRT. So you will need multiple meetings with the different experts. Don't let anyone in one expertise inform or advise about a different expertise. Don't talk to a surgeon about radiation and vise versa. You get the idea.

In 30 days I met with three surgeons, two radiation oncologists (one seed expert and one HDRBT expert) one medical oncologist, and about ten men that had received various forms of treatment with differing results and side effects. Plus I read a lot and got on this board. All of this gave me the information and direction to make life-long decisions and get into the treatment mode with 100% confidence and commitment. I never second guessed anything and everything has turned out better than I expected.

All of this drove my wife nuts as she was afraid that I would get bogged down. Pretty quickly she realized that it was a necessary and great exercise and very glad I put the work and attention into it. This is your life and hopefully a long one at that. Take this very seriously and make this a job that you do better than any job you have ever done and you will do well and be able to live with the treatment consequences gladly for a very long time.

Zzarth,

I am very sorry and quite surprised at the outcome of your surgery with Dr. Tewari. From what I can tell from your info, you seemed to have a fairly low-risk, contained PC with no complications. You are very young, and your surgery was performed by one of the experts in this field. Can you share your experience with regards to your surgery with Tewari, and if you prefer, we can discus this offline.

ATX

The three DFW surgeons you mention are among the best. Dr. R is likely the best. I thought that Dr. Lee had retired, but that may not be the case.

TA said...
ATX said...
I think the most spontaneous and automatic response from a few surgeons (and surprisingly from a radiation oncologist) has been that considering my relatively younger age and longer life expectancy, surgery may be better.

As an empowered patient, I think you have to ask - what is the evidence for that assertion?

One concern is the small risk for secondary malignancy.

"In the long term, there is a small but over time increasing risk of secondary malignancy (151). This should be weighed in for patients with expected remaining life over 20 years, especially in low and medium risk because the risk is low for the patient to die from his prostate cancer."

(151): Radiation-Induced Secondary Malignancy in Prostate Cancer: A Systematic Review and Meta-Analysis
Conclusion: RT is associated with increased secondary malignancy in patients with prostate cancer; this effect only become conspicuous more than 10 years after treatment.

ATX

To assist in your research I suggest you use the website www.cetmc.com. This is by Dr. Jeffrey Demanes the pioneer of High Dose Brachytherapy. He most recently has been the head of the department at the UCLA Medical Center. I found this valuable in my research. I ended up using HDRBT as part of my successful treatment. Demanes has been using HDRBT since 1981 for PCa and many other cancers. Based on the information you appear to be a candidate for mono-therapy. Essentially one or two procedures with no cutting, catheters, nerve damage, etc. as the long term results show it is very effective for cancer control and with low incidence of serious side effects.

Andy Grove the founder of Intel did extensive research and chose HDRBT as his treatment nearly 20 years ago. There is a great article in Fortune magazine about Grove and his treatment.

As to the myth of secondary cancers, TA provided great information. One study I read indicated a 15 year incidence of potential secondary cance to be less than 0.3%. Did the surgeon explain that the incidence of dying from complications of the surgery is about 1%? And remember that the two secondary cancers most often cited are bladder and bowel. These are common cancers anyway and one must be careful to link them with PCa treatment particularly when the occur closer to the PCa treatment. My brother in law had IMRT in 2012 and then was dx with bladder cancer in 2014. Was this a radiation induced cancer? Absolutely not. He asked and the doctor laughed and said you have had this cancer a good 15 years just like you had PCa at least 15 years before it was detected. This is too small a risk to take seriously unless you give equal weighting to the risks of surgery including infection. I always love it when a surgeon points out the risks of a competing treatment while downplaying the risks of his method. That is why you do independent research and meet with each specialist for a proper assessment

NewDay...very sorry that about your Dad. Lost mine to cancer in 2003 and I'm still not over it. That said, things have changed since 1998 and it wouldn't be fair to the OP to not mention the current state of play.

First off, there is a "Plan B" with both radiation or surgery. With surgery it's radiation--most folks are familiar with that. But with radiation, they use different types of radiation different from the initial radiation as a back-up.

But equally important, when primary treatments fail it's often because the cancer bird has already flown the coop.If the cancer has already escaped the prostate--and there aren't scans that can monitor individual cells escaping--it doesn't make a difference if the primary treatment was surgery or radiation. At that point, you're looking at systemic treatments (hormone therapy, chemo, etc). So the decision between surgery and radiation is (unfortunately) moot at that point.

Nothing wrong with choosing surgery--and I can think of several advantages with it--but the fact that if offers a Plan B, while radiation doesn't is not accurate anymore. Hope you can stay on AS for a very long time (hopefully forever!) and glad you have your plan in place. All the best to you...

New Day-

I don't agree with the kind of long-range preparedness you espouse. I think it's enough to know that there are salvage options out there. What they may or may not be at some imaginary future date when they may or may not be needed is just an exercise in pointless anxiety. As you can tell from the following article, there are now 10 different options in case radiation fails - some of those options did not exist 5 years ago. In another 5 years, there may be 10 more. Also, detection of metastases is improving rapidly - so patients will be selected better and earlier who can benefit from them. And therapies like SBRT that are now showing 97% cure rates for intermediate risk patients are obviating the need for any salvage. I couldn't imagine living my life worrying about what I will do if failure occurs at every turn - that would be a self-inflicted hell. I prefer living with things as they are instead of the demons my imagination is capable of giving birth to.

/pcnrv.blogspot.com/2017/09/focal-salvage-ablation-for-radio.html