New member -Robotic Surgery Questions

While you are scared is an absolutely terrible time to make a decision. I strongly believe that no doctor should accept any decision from a man within a month of his diagnosis, and preferably within 3 months - even if diagnosed as "high risk."

You have to let your emotional temperature drop first. "Just cut it out," is the first reaction we have all had. And you may even come back to that decision later. Let it rest. Do some research. Meet with a variety of specialists, including a specialist in active surveillance.

Also, send your biopsy cores to Epstein's lab at Johns Hopkins for a second opinion.

You have plenty of time. Take it.

Mikey,
I've been on this forum for nearly 10 years and by far the number one mistake men have regretted is making a decision too fast and not researching all of their options.
Active surveillance and all of the various forms of radiation should be investigated by talking to experts in each discipline.

Mikey, my stats are similar to yours. If your decision is a panic decision with little research STOP and do all the reading you can first. If , like me, your decision is not panic then I wont try to persuade you to rethink. It should take a lot of back and forth thoughts and a lot of research and stats before deciding. I have said on here that after my diagnosis I went on AS for 3 days then signed for surgery a month ago. Thats true.

But my first psa reading was in september last year, 3 months before my diagnosis and 7 months before my surgery. THATS when I started to entertain a journey with the dragon and started my research. I am going to assume that you have thought long and hard about your decision. You should also be clear that advice given here are from people with different perspectives and different approaches to this disease. Including myself.

I was exactly like you scared and wanted it out. I had an appointment with Dr. Patel to discuss RP. Fortunately for me, I also got to see a top RO and once I had all the info I choose HDR BT. I am not suggesting this is for you but I am suggesting pause, learn, be your own advocate. Until you deeply understand the options please do not make a choice. In the end you may still choose RP, but give yourself the gift of deep learning first. Denis

Hi Mikey....it’s good that you found us, but unfortunate that you had to. While you request encouragement, you’ll need to sift through a variety of differing opinions. Here are some of mine.

1. If you’ve already done your homework and you mind is made up, ignore the noise, and go for it.

2. Assuming that’s not the case, you have time to do the research required to make an informed decision. The choices can be a bit disconcerting as well as overwhelming. We all will be here to help you.

3. Do post your detailed biopsy pathology results to get better advise, and do tell your doctor to send your slides to Johns Hopkins for an all impottant second opinion. If you don’t mind, tell us your location and the name of your surgeon.

4. As far as slow moving prostate cancer is concerned, you are not in bad shape, and you have time. Fear and worry are neither your friends, nor productive.

Good luck, and keep us posted.

Will echo the others.

Surgery will work but is not necessarily the best course for you. And you want a well experienced practicioner if you do go with surgery.

Surgery is usually the procedure chosen when there is an immediate rush to treat. But if time is taken for research and reflection often a form of radiation treatment will then be chosen instead. Think I am pretty safe in surmising there is more movement from those first thinking they will go with surgery who in the end opt for radiation, than the other way around.

Some guys will be better with surgery from an emotional standpoint of "cutting it all out". For me, I was ok without that, and my research led me to believe that in my case surgery and radiation treatment would be comparably effective, and that radiation would be an easier course to follow and would have lower risks of side effects.

Do your research and good luck,

Do you read?

I recommend the 2010 book Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment Or Loss of Sexual Potency

It was written by one of the world's most renowned prostate cancer care providers for men with cases just like yours. He speaks to many of the ethical and practical issues, and as a leader in PC care is harshly critical of doctors at "the community level" who still—even today—usher their scared patients into quick treatments.

Post Edited (NKinney) : 5/7/2018 9:38:19 AM (GMT-6)

Thankfully you are very low risk and have a lot of options available.

Certainly surgery for you is the very definition of over-treatment. And if you do treat to kill the cancer, there is no difference between cutting it out (invasive surgery) and killing it ( several radiation based therapies available) as far as cancer control goes. There is no magic to surgery. I used radiation and the cancer is "out of my body" just as effectively as surgery could have done. I am also free of any negative treatment side effects.

I suggest a simple method of deciding what to do;

First, am I low risk? If yes, which you are, then do I need to treat the cancer to live longer? Studies will show that you do not based on your initial diagnosis. If treatment will not demonstrably extend life span, then start with a very good Active Surveillance plan. You may find that you may never have to treat. And if you do have to treat, you will have gained hopefully many years of being free from treatment side effects.

If I do need to treat ( either now or at some future date) to extend my life span, then I research all the various methods by speaking directly with each different specialist for their specific assessment. Do not allow the urologist to speak for the radiation oncologist, as an example. Then choose the method that offers effective cancer control with the least negative expected side effects.

Slow down, relax, this is nearly as good as winning the lottery when it comes to a PCa diagnoses. Certainly cancel the surgery and begin to learn about all the ways you can deal with this. Your diagnoses in no way is life threatening as we know it. A rush to judgement and treatment is the worst thing you can do. Shame on your urologist for rushing you to surgery. Very irresponsible, in my opinion. Find a great urologist that has a very robust AS program and can show you all the men with similar risk profiles that are thriving with out invasive treatment.

Mikey,

The risk of second cancers from radiation is very small:

/pcnrv.blogspot.com/2016/08/the-real-risk-of-secondary-malignancies.html

A specialist in one technique (like surgery) usually has no knowledge of the risks and benefits of other techniques (like radiation). Even a specialist in one kind of radiation (like IMRT) may have no knowledge of other kinds of radiation (like SBRT). It falls to the patient to make the effort to go out and meet with specialists. You are worth the effort. Make the effort.

Make sure you have gotten answers to all these questions from your urologist:
/pcnrv.blogspot.com/2017/12/questions-to-ask-and-not-ask-on-first.html

Mikey66 said...
...so he can't be sure if thats just a 'lucky' sample that went right through the biopsy need or or if that section actually has that much cancer...

Troubling. Troubling if this is where he left the conversation with you. Red-flag type of troubling. This situation is the sole purpose of a "second, confirmatory biopsy" within 12-months for low-risk men with cases exactly like yours. I'm guessing he didn't mention this...

Post Edited (NKinney) : 5/7/2018 1:08:35 PM (GMT-6)

As Tall Allen pointed out, the risk of a secondary radiation induced cancer is very low....about the same risk as dying during surgery or from the complications. And as NKinney said, the doctor's comment means better investigation should be performed before invasive surgery or any other type of treatment is taken. And AS is not simply monitoring the situation. That Dr. Gaertner used such language indicates to me that he does not manage a robust Active Surveillance program You really should consult with another urologist that does.

For another take on treatment options that do not cut see www.cetmc.com. This is the website of Dr Jeffrey Demanes, the pioneer of High Dose Radiation brachytherapy. He has successfully used it since 1981 on tens of thousands patients. Andy Grove, genius founder of Intel, used it for his PCa because of the technology used and no cutting. I used it more than seven years ago and am cancer free and free of negative treatment side effects. Also permanent seeds brachytherapy and SBRT/Cyberknife should be seriously investigated. All are excellent for cancer control and generally have less significant negative treatment side effects than surgery for most men.

I saw seven different specialists in 30 days before making a treatment decision. So can you. Read my high risk stats, my back was up against a wall to get started. Thankfully, you are not in any way in a threatening situation.

Please pardon my direct take on this, but I sense a knife happy surgeon and a patient that is naive to the issues of prostate surgery. It is one of the most difficult and delicate surgeries performed and I suggest you take it more seriously than you are exhibiting here.

Again, slow down, take your time, learn about Active Surveillance from a practicing expert. Learn about non-surgical methods of treatment. You have plenty of time to make decisions, but you have only met one doctor for an assessment? I bet you perform more comparative research and diligence when buying a car.....that will only last a few years. You are making a lifetime purchase of PCa treatment....take it much more serious. Remember what your mom taught you....haste makes for waste.

I will agree with what everyone else said due diligence is MOST important at this time. You only get one chance to do it right the first time.
The link below will give some light on invasion of the prostate snatchers. It was the first thing I read after my DX. The book was given to me by a retired doctor friend of mine.

http://prostatesnatchers.blogspot.com/2016/05/a-better-prostate-cancer-test.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+Prostatesnatchers+%28prostatesnatchers%29

Good Luck
Perry