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Members with Anterior Transition Zone tumor

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Posted 7/3/2018 8:34 PM (GMT 0)
Well as you can see from my sig, it's time to be thinking about choices. My uro is asking for my thoughts on surgery or RT . from reading this forum it looks like RP to a TZ tumor could be problematic.. also RALP is out. (BMI and prior UHR) so it would be RPP. I think John T is in that category, wondering if there are others. thanks for any help or comments. Ed
Posted 7/3/2018 9:07 PM (GMT 0)
My husband had his primary tumour in the anterior zone with possible involvement of the fibromuscular tissue as well. He chose robotic RP and his last psa last August was 0.02.

Regards,
An
Posted 7/3/2018 9:56 PM (GMT 0)
Why do you believe RP is a poor choice - I think it is usually the best choice for men with TZ tumors because of the urinary relief it provides. With radiation, the swelling of tissue in the TZ might be problematic.
Posted 7/3/2018 10:14 PM (GMT 0)
Thanks for that An. I read your posts. @TA I am thinking I will have trouble because no RALP, I'm 66.5 and fat. am diabetic, the bulge they mentioned in the last MRI, possible extension.. also looking at other upcoming surgeries. 2 knee replacements, also another hernia, plus I swear I thought I read that RP is a little risky there. (I will go back and look thru notes). Ed
Posted 7/3/2018 10:53 PM (GMT 0)
My husband had a large TZ tumor. RP was a good option for him because it removes a portion of the urethra which happened to be where part of the tumor was growing into. At his MRI we were told EPE was probable but thank God after surgery we found out it was not.
Posted 7/4/2018 1:58 AM (GMT 0)
Risk of incontinence is higher with surgery. Radiation should reduce the size of the prostate long term. Brachy will cause temporary swelling, external radiation never caused me an issue with swelling.
Posted 7/4/2018 3:04 AM (GMT 0)

Jack & Diane said...
My husband had a large TZ tumor. RP was a good option for him because it removes a portion of the urethra which happened to be where part of the tumor was growing into. At his MRI we were told EPE was probable but thank God after surgery we found out it was not.

Great info. I assume his age was a factor also? Your blessed on the EPE not being an issue.. thats what has me on the fence. the "bulge" and "possible EPE" comment on my last MRI..
Posted 7/4/2018 3:12 AM (GMT 0)

John T said...
Risk of incontinence is higher with surgery. Radiation should reduce the size of the prostate long term. Brachy will cause temporary swelling, external radiation never caused me an issue with swelling.

Thanks a bunch John. I seen combidx in you sig and when i read about it I realized that the clear LN I got from MRI and CT may not be accurate? anyway as I am this minuet I may follow a similar path as you. thanks again, Ed
Posted 7/4/2018 3:36 AM (GMT 0)
We never even really got to the point where his young age needed to sway us. We were leaning towards surgery to begin with and then once we found out it was invading that section of his urethra that pretty much sealed the deal. His MRI didn't indicate possible EPE though, it was one step worse, it was "probable".

His RP was in February and in the same year in November he had a sinus surgery. The RP was 100 times easier on him compared to the sinus surgery.
Posted 7/4/2018 3:43 AM (GMT 0)

Jack & Diane said...
We never even really got to the point where his young age needed to sway us. We were leaning towards surgery to begin with and then once we found out it was invading that section of his urethra that pretty much sealed the deal. His MRI didn't indicate possible EPE though, it was one step worse, it was "probable".

His RP was in February and in the same year in November he had a sinus surgery. The RP was 100 times easier on him compared to the sinus surgery.

glad to hear he (and you) are hanging in there. was the RP "open"? Ed
Posted 7/4/2018 3:51 AM (GMT 0)
Glad you wrote back already because I was just going to edit my last post as I went back and read some of your history and wanted to sincerely thank you for your service! I truly mean that.
Posted 7/4/2018 3:58 AM (GMT 0)
No he had Da Vinci prostatectomy at the University of Chicago. I did briefly consider checking out open but only because we have the mac daddy of open prostatectomy right here in Chicago, Dr. Catalona at Northwestern.
Posted 7/4/2018 3:58 AM (GMT 0)

Jack & Diane said...
Glad you wrote back already because I was just going to edit my last post as I went back and read some of your history and wanted to sincerely thank you for your service! I truly mean that.

Thank you but I think this war is more freighting.. Ed
Posted 7/4/2018 4:03 AM (GMT 0)
Stick around this place. These people are amazing, they will help you through this.
Posted 7/4/2018 4:09 AM (GMT 0)
seems like a great bunch of folks. Ed
Posted 7/4/2018 4:52 AM (GMT 0)
FWIW my husband also had a prior hernia surgery so he too had mesh. I asked our surgeon about it because I had also read that it can be an issue and he was not concerned. It turned out not to be a problem at all. The hernia surgery was about 20 years ago though so I'm not sure if that matters.
Posted 7/4/2018 8:38 AM (GMT 0)
GG had a very large TZ zone tumor, and surgery was an excellent decision for him. His 2-year RARP anniversary was on Sunday and he remains very happy with his decision and progress. Whatever you decide, we really hope it all works out for you.
Posted 7/4/2018 2:25 PM (GMT 0)

Jaybee&GG said...
GG had a very large TZ zone tumor, and surgery was an excellent decision for him. His 2-year RARP anniversary was on Sunday and he remains very happy with his decision and progress. Whatever you decide, we really hope it all works out for you.

Thanks for your insight. If they would offer me Davinci I would consider leaning that way,, but my care is thru the VA. as it stands right now with,, BMI, UHR, diabetes, blood pressure. they are looking for someone that would accept me. I don't want RPP.. as I said before I could start RT soon, which is swaying me that way. Ed
Posted 7/4/2018 2:30 PM (GMT 0)
I had Focal Laser Ablation on my Transition Zone tumor 5 weeks ago. Feeling no negative effects from the surgery whatsoever. In fact, I now can whiz again like I was in my 20’s. My tumor was abutting the fibromuscular stroma as well. Will have my first PSA, post surgery, in August. Although early, I have no regrets about my choice of FLA versus RALP or SBRT, the two other options I considered.

Good luck!
Posted 7/4/2018 5:04 PM (GMT 0)
You are right that RP carries higher risk of hernias and may exacerbate existing ones. But, as you've heard from several members here, surgery provides immediate relief from urinary blockage. Your diabetes will slow down healing, and that is true for both radiation and surgery.

I think PC Legacy raises a good option if your 4 positive cores are all in the same place. But you would have to pay for FLA on your own - the VA won't cover it. They might cover cryoablation, however. You can ask about it.
Posted 7/4/2018 5:56 PM (GMT 0)

PC Legacy said...
I had Focal Laser Ablation on my Transition Zone tumor 5 weeks ago. Feeling no negative effects from the surgery whatsoever. In fact, I now can whiz again like I was in my 20’s. My tumor was abutting the fibromuscular stroma as well. Will have my first PSA, post surgery, in August. Although early, I have no regrets about my choice of FLA versus RALP or SBRT, the two other options I considered.

Good luck!

Wow great outcome so far for you.. hopefully price will come down someday. Ed
Posted 7/4/2018 6:14 PM (GMT 0)

Tall Allen said...
You are right that RP carries higher risk of hernias and may exacerbate existing ones. But, as you've heard from several members here, surgery provides immediate relief from urinary blockage. Your diabetes will slow down healing, and that is true for both radiation and surgery.

I think PC Legacy raises a good option if your 4 positive cores are all in the same place. But you would have to pay for FLA on your own - the VA won't cover it. They might cover cryoablation, however. You can ask about it.

TA Interesting, I'm sure FLA is out.($$) Cryo I looked up briefly and seems like there are very few long term studies to go off of. true? at this minuet I'm being real about what is available to me. McGuire VA is offering BT to Vets thru referral. but I don't know how long the process is to approve. will check that out this week. told my uro yesterday to get me RO MO and she said fine. really appreciate all the help here. hope to give back someday. Ed
Posted 7/4/2018 6:19 PM (GMT 0)
As I responded in another post, cryo was the coming thing 25 years ago. My dad was one of the early subjects for whole gland cryo in the mid-90's (at Cleveland Clinic). For cancer treatment we'll call it somewhat successful--he developed mets to his spine and passed away in 2004.

I think whole gland cryo fell out of favor because it was not as good as advertised on cancer control, and pretty much guaranteed total ED, and uncertain continence.
Posted 7/4/2018 7:39 PM (GMT 0)

halbert said...
As I responded in another post, cryo was the coming thing 25 years ago. My dad was one of the early subjects for whole gland cryo in the mid-90's (at Cleveland Clinic). For cancer treatment we'll call it somewhat successful--he developed mets to his spine and passed away in 2004.

I think whole gland cryo fell out of favor because it was not as good as advertised on cancer control, and pretty much guaranteed total ED, and uncertain continence.

WoW Halbert. those are some serious SE.. Sad story on your Dad.. both my parents died young of cancer Mom 54 breast cancer with Mets 2 year slow death.. dad 63 a form of skin cancer that somehow slipped into the spinal fluid and went to the brain. horrible, horrible disease. I may be forced to stick with BBT,SBRT, EBRT, IMRT or similar.. time is of the essence now. Ed
Posted 7/4/2018 8:06 PM (GMT 0)
Cryo has a long history. It was the first kind of ablation therapy ever used and is covered by Medicare (and I would assume the VA). I don't know if they'd cover FOCAL cryoablation, however, which is what you'd be interested in. The results have gotten a lot better in the last few years. here's one example:

/meetinglibrary.asco.org/record/106058/abstract
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