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Posted 2/5/2019 7:02 PM (GMT 0)
my 7 was a 4 plus 3...

I was all set for radiation when a radiologist , the 3rd one, finally noticed that their was a note on the report that said "suspicion" that the caner protruded from the prostate. At that point I was told it was no longer a intermidiate cancer, it is now classified an aggressive cancer. As such, surgery is the prefered treatment.

***????????
Posted 2/5/2019 7:19 PM (GMT 0)
mentor5959,

Something's not correct...either what your doctor is saying, or what you are hearing...I can't say which. But this..."...the caner [cancer] protruded from the prostate. At that point I was told it was no longer a intermidiate [intermediate] cancer, it is now classified an aggressive cancer. As such, surgery is the prefered [preferred] treatment" is problematic.

Here's why.

If PC has left the prostate, surgery will NOT cure it. Surgery ONLY will remove the prostate. In fact, the common surgical protocol is that if a surgeon opens up a patient and observes an advanced case of PC which involves spread beyond the prostate, then he will stop and abort the procedure BEFORE removing the prostate because the surgery obviously will be insufficient and would require a secondary treatment...likely radiation therapy. The surgeon when then likely recommend the patient to see a radiation oncologist because RT has a greater possibility of resulting in a cure whereas surgery will not.

Something's getting lost in your communication...
Posted 2/5/2019 7:42 PM (GMT 0)
Mentor,

What Blackjack says is correct. It does not make since to undergo surgery if the cancer has left the prostate in your situation. Did the radiologist say this?

One other poster stated to look for physicians who are known to be the best. I don't know if you have the capability of traveling to be treated or have the resources, but it does matter tremendously on who is treating you. A "best practice" surgeon has had several THOUSAND cases to hone his skills. Same goes for a radiologist. The best practitioners also tend to know the best treatment plans and often network with other great practitioners. Where do you live? Many on this site may know the best physicians closest to you.

Paul
Posted 2/5/2019 9:38 PM (GMT 0)

mentor5959 said...
As such, surgery is the prefered treatment.

Not really. As Jack and PDL have noted, it may be that you were misinformed or misunderstood. For cancer that has escaped the capsule EBRT + Brachy + ADT, i.e. "Bracy Boost Therapy" is probably a better choice, especially if you want to avoid double whammy SE's from both surgery and radiation.

Jim
Posted 2/5/2019 9:52 PM (GMT 0)
That's new to me.

If it's suspected to be outside the prostate, and you have surgery, you're betting the note on the MRI report is wrong.

I don't see where you had one. Did you have an MRI? Is this where "suspicion of outside" came from?
Posted 2/5/2019 11:01 PM (GMT 0)
BlackJack, I'm a little confused by your statement," If PC has left the prostate, surgery will NOT cure it." According to The Walsh Book," Today radical prostatectomy provides excellent cancer control and cure for men,,even if the cancer has penetrated the wall or capsule of the prostate.."
Posted 2/6/2019 1:40 AM (GMT 0)
I believe penetrated the wall and left the prostate may be two different things.
How could surgery ( removal of the prostate ) cure the PCa if the PCa was already in other areas of the body?
Posted 2/6/2019 11:41 AM (GMT 0)
Mentor, a couple of requests:

If you have your written reports, please post the relevant comments by the pathologist and radiologist.

Second, where are you located? Where are you getting your scans and pathology done?

It does sound like you may have heard the reverse of the reality: If you have capsular penetration, then you may well need radiation to treat the whole pelvic bed, so surgery is less likely (I won't say it wouldn't be) to be curative. Why do surgery if future radiation is inevitable?
Posted 2/6/2019 2:24 PM (GMT 0)
mentor5959, I'll agree with halbert--something I've found myself doing frequently--that the exact words from your reports which are informing these "decisions" will be helpful to share with us. Above you used the words, for example, "protrude from the prostate," which means to extend beyond the prostate.

Words have specific meanings, and I find that doctor's reports are quite unambiguous, so it will be helpful for us to help you by commenting on exactly the words in your report(s). So far, you post seems a bit ambiguous...but we'd be pleased to offer our peer insights, when possible...
Posted 2/15/2019 9:36 PM (GMT 0)

Blackjack said...
mentor5959,

Something's not correct...either what your doctor is saying, or what you are hearing...I can't say which. But this..."...the caner [cancer] protruded from the prostate. At that point I was told it was no longer a intermidiate [intermediate] cancer, it is now classified an aggressive cancer. As such, surgery is the prefered [preferred] treatment" is problematic.

Here's why.

If PC has left the prostate, surgery will NOT cure it. Surgery ONLY will remove the prostate. In fact, the common surgical protocol is that if a surgeon opens up a patient and observes an advanced case of PC which involves spread beyond the prostate, then he will stop and abort the procedure BEFORE removing the prostate because the surgery obviously will be insufficient and would require a secondary treatment...likely radiation therapy. The surgeon when then likely recommend the patient to see a radiation oncologist because RT has a greater possibility of resulting in a cure whereas surgery will not.

Something's getting lost in your communication...

I believe the word was "protruding." Not left the prostate. Suspicion it was.

I cannot find the report, I have order a copy. I'll post it when it arrives.

I had this biopsy done at Columbia in NYC. The second opinion on these slides were sent to Johns Hopkins, Baltimore, MD.
Posted 2/15/2019 11:10 PM (GMT 0)
mentor -- sounds like there's a good chance the cancer is is out of the prostate. I had a 60% chance mine was out. look at my numbers and what I did, and where i'm at today.
Posted 2/22/2019 10:49 PM (GMT 0)

Blackjack said...
mentor5959, I'll agree with halbert--something I've found myself doing frequently--that the exact words from your reports which are informing these "decisions" will be helpful to share with us. Above you used the words, for example, "protrude from the prostate," which means to extend beyond the prostate.

Words have specific meanings, and I find that doctor's reports are quite unambiguous, so it will be helpful for us to help you by commenting on exactly the words in your report(s). So far, you post seems a bit ambiguous...but we'd be pleased to offer our peer insights, when possible...

OK, got the report and found the exact wording

Perineural invasion is present, best seen in Part J

Also in part J are foci suspicious for extrapprostatic invasion by the carcinoma
Posted 2/23/2019 1:09 AM (GMT 0)
PNI is one thing--that may or may not be a significant issue. Suspicious of EPE--yeah, that means the cat is trying to escape the bag. Which generally mitigates against surgery, not in favor of it. If it's out--and radiation is in the future anyway...why cut?

Also, PNI more or less means that surgery would remove the nerve bundles--which means permanent ED immediately. Again, another reason to look seriously at radiation---and you need to talk to an experienced radiation oncologist who specializes in PC treatment.
Posted 2/23/2019 8:04 PM (GMT 0)

halbert said...
PNI is one thing--that may or may not be a significant issue. Suspicious of EPE--yeah, that means the cat is trying to escape the bag. Which generally mitigates against surgery, not in favor of it. If it's out--and radiation is in the future anyway...why cut?

Also, PNI more or less means that surgery would remove the nerve bundles--which means permanent ED immediately. Again, another reason to look seriously at radiation---and you need to talk to an experienced radiation oncologist who specializes in PC treatment.

The radiologist said that I needed surgery because of this!
I am working with Columbia Presbyterian , not some local hospital or inexperienced doctors.... Both surgeon and radiologist said surgery. I am trying to avoid surgery. ***??????

Get a second opinion from a different radiologist????

I have no clue how to proceed. I am waiting for second opinion from Johns Hopkins on the biopsy.
Posted 2/24/2019 2:27 PM (GMT 0)
mentor - one thing you will find in this adventure is that you can not hurry things along. The story unfolds with time and information acquisition and eventually you will presented with the two primary options for your situation: surgery or radiation, so study these in depth and determine which one you prefer after reading lots of conflicting documents and stories that will make your head spin. You can tell them what you prefer to do as it is your decision and usually they are pretty clear about that. I had surgery but could just as well had radiation for a very similar condition, both arguments were compelling. My wife was at the meetings and thought surgery was the best option but said whatever I chose was good with her, thanks a lot dear wife!

I may have missed it but sounds like you are in the NYC area? Memorial Sloan Kettering is probably your best bet for 2nd (or 1st) opinion. I just asked my urologist and he was happy to provide referrals. You can do it yourself also. Just call and make sure they have all the documents that you and your doctors have. My RO got everything from the urologist before I got there so he was well prepared to discuss options although I had copies with me. Don't wait for the JH results, just start the process tomorrow and you will feel better once you have an appointment setup. PCa will not go from treatable to incurable in a couple of weeks so just push forward and don't worry about the time so much. Once you decide what to do then you have to schedule the treatment which is another delay and you have to wait for that day. It is a start-stop process that messes with your brain but knowing that, try to be patient and good luck.
Posted 2/24/2019 5:16 PM (GMT 0)
Mentor,
Mumbo is right about MSK. Best in the area. See if you can get an appointment with Dr. Zelefsky. He is a radiation guy, specializing in brachy. He headed my group with the surgery vs radiation choices. Call their patient support line. tel:+1-800-525-2225. You can try Zelefsky's office directly and see what they say about getting an appointment. (212) 639-6802. Go to MSK website and you can pick and choose doctor’s if you want to.
Give it a shot. You have nothing to lose
Posted 2/24/2019 5:18 PM (GMT 0)
I will second the reco of MSK and Zelefsky. They are top notch.
Mt Sinai also has a good group, both surgery and radiation as well as a top MO.
Posted 2/24/2019 5:24 PM (GMT 0)
Another example of a totally incorrect statement: Please be sure to verify any and all statements that you read on the big web with a real physician!
"Also, PNI more or less means that surgery would remove the nerve bundles--which means permanent ED immediately"
Hero
Posted 2/24/2019 6:00 PM (GMT 0)
Mentor, I'm sorry to hear about your condition. Hang in there and don't let these guys scare you, even though they do make some good points. There's a lot of knowledge here but there are no docs, and nobody here has seen your report.

My only suggestion is stay cool, educate yourself as best you can, get a couple of opinions from the best docs you can find. I suggest seeing a surgical oncologist, a radiation oncologist and a medical oncologist with specific knowledge of prostate cancer. The first two will have some professional bias, but it's worth hearing their opinions anyway. After you've seen all three you'll have a very good idea of what your options are.

The main thing I'd like to emphasize is to not choose a course of treatment until you're comfortable that you've earnestly explored all the possibilities. And when you choose a course of treatment don't look back. Chances are you'll be ok for a very long time.

Best,
Jonathan
Posted 2/26/2019 4:35 PM (GMT 0)

Dogdays said...
Mentor,
Mumbo is right about MSK. Best in the area. See if you can get an appointment with Dr. Zelefsky. He is a radiation guy, specializing in brachy. He headed my group with the surgery vs radiation choices. Call their patient support line. tel:+1-800-525-2225. You can try Zelefsky's office directly and see what they say about getting an appointment. (212) 639-6802. Go to MSK website and you can pick and choose doctor’s if you want to.
Give it a shot. You have nothing to lose

I called Dr. Zelefsky. His office is obtaining my MRI, PSA and Biopsy reports then they will schedule an appointment.
Posted 2/26/2019 9:46 PM (GMT 0)
Good job, try to relax while waiting now. Play some word games on your phone or tablet. Find things to occupy your mind. The idle mind is the devil’s workshop so stay busy not searching the internet until after your next meeting. Good luck!
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