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Posted 11/4/2021 12:21 AM (GMT 0)
Also, I have been gathering this information over the past 2 1/2 weeks. I know that I will need to decide a treatment plan within the next few weeks. with treatment execution beginning this calendar year - which is why I value all of your input. I put out the March 2022 because that's the earliest I could get into JH - but if I cannot accelerate the consultation - I will look for another surgeon. My urologist is terrific, but has not completed enough RALPs for me to consider as my surgeon.
Posted 11/4/2021 12:46 AM (GMT 0)
Todd, who in Atlanta are you discussing HDR-BT with? There are several great practitioners you can speak with. I wouldn’t stop at one.
Posted 11/4/2021 12:56 AM (GMT 0)
JNF

I just sent you an email. Let me know if you did not receive it.
Posted 11/4/2021 2:46 AM (GMT 0)
Todd,

You've gotten many excellent and hopefully helpful responses. Just a couple of things: My prostate was 150cc from MRI, 152 grams from pathology after surgery. I had been dealing with troublesome urinary symptoms (urgency, frequency, weak stream) for several years. I didn't do a deep dive but felt pretty confident that my urinary symptoms would likely be worse if I underwent radiation. BTW, a guy in my support group had a 260cc prostate! Please, if you decide on surgery, find the most talented and experienced surgeon possible. I interviewed four and chose one I felt real good about, he had performed thousands of RALRP's. A couple of guys I had appointments with were really high volume guys, 300-400/year but I didn't feel good about them. I encourage you to start doing your kegels now. Learn to do them correctly and just do a couple of good sets every day. Lastly, I know you are consumed by this stuff now but it's good to take a break and have some fun once in a while. I remember, I'd go play a round of golf at a challenging course or go surf some good waves, come back refreshed with a new perspective and get back to work. Good luck, you're going to be fine!
Posted 11/4/2021 8:26 AM (GMT 0)
"Median lobe" is an extension into the bladder. No big deal but a major contributor to LUTS and a bit trickier to radiate. Gets cut out obviously in surgery but since the bladder neck is usually reconstructed anyway there is no impact.

ADD Only a bit trickier: random google https://pubmed.ncbi.nlm.nih.gov/10900427/ /ADD
Posted 11/4/2021 8:32 AM (GMT 0)

maddie7 said...
Todd,
Just a couple of things: !

Dang this forum needs an upvote/downvote feature. 1,000 upvotes.
Posted 11/4/2021 12:17 PM (GMT 0)
Thanks, just reading it now and will respond soon.
Posted 11/5/2021 2:27 PM (GMT 0)
If one comes through surgery with no adverse findings whatsoever, i.e. a pT2 staging with negative margins and an "undetectable" post-op PSA, the recurrence rate is reported to be independent of one's Gleason score (7 and up). In such cases there is no consideration of any further treatment as long as one's PSA remains sufficiently low.

Of course there are no guarantees. You posted your doc's estimate of having prostate-confined PCa.

Djin
Posted 11/8/2021 2:33 AM (GMT 0)
My husband just had surgery 2 days ago. We went through the same decision process. His Gleason Score changed when we had his slides sent to Johns Hopkins (Dr. Epstein) for a second opinion. I highly recommend doing that. It's easy, results come back in about three days, and our insurance covered the costs.

https://pathology.jhu.edu/patient-care/second-opinions

My husband's Gleason Score went from 3+4 to 4+3 when Johns Hopkins reviewed the slides. We did an MRI and it showed the cancer hadn't left the prostate but was pressing to do so.

We decided on surgery for two reasons: 1.) Get the cancer out of the body, and 2.) If there is a reoccurrence we can then fall back on radiation.

As people on this forum told us, if you choose surgery, get the best surgeon you can find. My husband had the da Vinci robotic surgery, and we worked with the surgeon who was the director of that type of surgery. Today, we are home. The surgery went perfectly. My husband is feeling great, considering it's day three. He has six small incisions. Catheter has been very manageable. He'll have it out in a week.

That's our journey so far. Everyone on this forum served as a guiding light. We would have been lost without them. The information they've shared has been spot on. You will get a lot of reliable, smart help here.

I wish you the best.
Debralyn
Posted 11/9/2021 9:53 AM (GMT 0)
Todd: on your cross-post "Haven't made my decision regarding surgery versus radiation+ADT+HDR? yet, but pleased that my consulation appointment with Johns Hopkins got moved up to next Friday. Should be ready to decide prior to Thanksgiving."

Outstanding news!
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