RALP VS SEEDS EBRT decision

Iam healthy 56 male dx gS 4+3 in single core, 3+4 in six cores and gs6in two cores
mpMRI resumts are organ confined and no sign of lesions on exterior capsule and no sign of svi or lymph involvement. Spoke with doc this morning he said the mri was good news . He said he thinks i will have good outcome based his experience 90% of his patients With similar cancer as mine are cured with only surgery.
He claims he has done 2700 RALP surgeries and is doing 200 per year. He said RALP is the only surgery he does.
Sounds to good to be true. Claimed Medstar washington hospital in DC is a high volume center on east coast but doesnt have published outcomes of their pca patients. Does this all sound on the up and up?

High volume and many surgeries does not equate to high surgical competence. The superstar surgeon in eastern MA I was originally referred to has awesome communication skills and huge volume. When I investigated his complication rate it was below average. Digging further I learned he has AC/DC on his headset during surgery. Seriously?
I went with an experienced ORP surgeon with a demonstrated commitment to learning who is the guy the Boston MDs use if needed. So far so good despite the "extensive and established EPE". He delivered clean margins and excised my prostate in one piece with 4oz blood loss. No inflation with CO2, quick & easy recovery, no subsequent incision hernias. Recommended.

Wilderness

Does sound like a bit of a sales job. Before you decide, consult with a RO.

Likely either radiation or surgery would be effective for you.

It's a tough choice with lots of conflicting information on both sides.

Johns Hopkins in Baltimore is not far away and is one of the top PCa institutions. Georgetown is well known also so you should have some good places to second opinions and procedures near by. You have time to do a good job investigating.

With your dx the combination of brachytherapy and external beam is better for overall cancer control than just surgery. why? Because the radiation covers a greater area than the surgeon can cut. about 35% of surgeries fail to cure because there is a little bit of cancer outside the surgical area that then needs to be radiated. The scans can not detect microscopic groups of cells and the surgeon can not see them either. It is usually these undetectable groups of cells that grow after surgery to signal a recurrence. Also, on average the negative treatment side effects are more significant with surgery due to the inherent damage surgery does. Simple physics. I had combination HDR brachytherapy and IMRT nine years ago and have no negative treatment side effects.

If I read it correctly you have 9 of 12 cores positive with seven cores with G4. That is significant and increases your risk as that is a lot of G4. Have you run the MSKCC nomograms to indicate the probabilities of recurrence? Did the uro-surgeon walk you through them? Why not? Suggest that you do to get a better idea of the probabilities.

Don’t fall for the “if surgery doesn’t work we can radiate, but if radiation doesn’t work we cant salvage” red herring. this simply isn’t true. And if radiation is the preferred way of salvaging a failed surgery, then why wouldn't it be preferred as the primary initial treatment? Also any surgeon who claims a 90% cure and no negative side effects simply isn’t being truthful. The best are in the 65% average range.

And as has been stated, only get an assessment from the board certified specialist that performs the specific treatment.

Three actions that I suggest:

Have another opinion of the slides by either Epstein or Bostwick. These are the best at PCa.

Meet with at least one more surgeon and several radiation oncologists that specialize in the different forms of radio-therapy for PCa. SBRT, Traditional EBRT/IMRT, permanent seeds brachytherapy and HDR brachytherapy.

Chose the combination that presents the best cancer control coupled with the least significant expected negative treatment side effects.

Since it looks like you live in the Washington DC area, I highly recommend that you also talk to Dr Sean Collins at Georgetown U. Hospital. He runs the CyberKnife program over there and has by now treated well over 1000 patients. Very personable and his research credentials are outstanding.

Also agree with JNF, I jumped into RARP before I found this site. I went to a renown cancer hospital near LA. They had an excellent record of cure rate. Surgeon was well qualified and said I may need Cialis after the RP. They have an excellent cure rate because they take everything out except the kitchen sink. I was left with no margins but also no nerves. There are 2 seperate nerve bundles. I creates erections and the other creates blood filling of the rest of your penis which includes the glans. A penile implant can give you the erection back but without the other nerves ,you have a lifeless cold covering.

Largebill68 said...
A surgical urologist will say you are a great candidate for surgery.

I don't know how accurate such generalizations are. The very first thing my uro/surgeon said in the the first of my two post-biopsy visits to discuss treatment was that RP and RT had basically equivalent ontological outcomes and that he had absolutely no problem referring me to a good RO.

Djin

Djin - what Jim said. From the reports we get here on HW, many, many men end up in a URO's office getting a sales pitch on surgery and are not told about RT options.

My case and yours sound similar - in my case the heath system I'm with had a different protocol that seems to not be the standard. In my case the URO who did my biopsy and the DX was not involved in my treatment decisions. Once the DX came I was referred to the hospital's cancer clinic where my first visit was with an education nurse, a surgeon, a RT, and my case manager. It didn't take long for us (the docs, me and my wife) to decide that RT was the best option for me.

Over the years I've found that to almost never be the story that is told by guys showing up here.

Andrew

InTheShop said...
Djin - what Jim said. From the reports we get here on HW, many, many men end up in a URO's office getting a sales pitch on surgery and are not told about RT options.

My case and yours sound similar - in my case the heath system I'm with had a different protocol that seems to not be the standard. In my case the URO who did my biopsy and the DX was not involved in my treatment decisions. Once the DX came I was referred to the hospital's cancer clinic where my first visit was with an education nurse, a surgeon, a RT, and my case manager. It didn't take long for us (the docs, me and my wife) to decide that RT was the best option for me.

Over the years I've found that to almost never be the story that is told by guys showing up here.

Andrew

I think many will mention RT and refer if you request but they recommend surgery. they are afterall surgeons so that's to be expected. my uro was an exception. but generally if you go to burger king you're gonna get a whopper.

you went through Kaiser, Andrew?

F8 said...


...

you went through Kaiser, Andrew?

Yes. Santa Clara. Since it's a HMO the bias is not to treat or at least do the thing that is most cost effective. They're also a bit bureaucratic - you don't get something expensive until you've had a couple of docs agree and/or have fought for it.

At the end of the day, there are guys in here who had surgery with good outcomes, and with bad ones. Same for radiation--some good, some bad. All any of us can really do is talk about our case, our choice, and our outcomes. The best we can do is suggest that newbies do their research, talk to the experts, and then choose their treatment.

Over and over, we have seen that the biggest regrets come from people who didn't do (or worse, know to do) the research.

halbert said...
At the end of the day, there are guys in here who had surgery with good outcomes, and with bad ones. Same for radiation--some good, some bad. All any of us can really do is talk about our case, our choice, and our outcomes. The best we can do is suggest that newbies do their research, talk to the experts, and then choose their treatment.

Over and over, we have seen that the biggest regrets come from people who didn't do (or worse, know to do) the research.

most of the bad outcomes are from surgery. most of the bad outcomes from radiation are post surgery. read the forum. it's pretty clear.

my message is: no surgery, or surgery as a last choice.