MotownPaul said...
If I do have one regret about my cancer, it’s that I didn’t get a second opinion on my initial treatment. I took the word of my urologist that “99%” of doctors would agree that surgery was the way to go with my then-Gleason 9 diagnosis. I did reach out to a major cancer center after my diagnosis but ultimately decided I didn’t want to complicate things and delay treatment by getting another opinion. My wife pleaded with me to get the second opinion but my mind was made up. Would it have made a difference in the outcome? Of course I’ll never know, but it could have. So whenever I have the opportunity to speak to someone with a serious ailment, I am quick to urge them to get multiple opinions from the very best doctors they can find.
I had two post-diagnosis visits with my uro to discuss treatment (I learned by phone that my biopsy was positive, but the nurse said I'd have to get the Gleason grade from my uro.) At the first visit, my uro said--right after he gave me my G10 (5+5) biopsy results--was that surgery and radiation were
equally good treatment options and he had no problem setting me up with an RO consult. (At the time I didn't know about
2nd path opinions, but looking back, I still would not have sought one out with a G10 biopsy. My biopsy path report included a photomicrograph of a lesion with tissue architecture so bizarre that it makes the photos of Gleason Grade 5 that I've seen look good!)
From the outset I was learning away from radiation and toward surgery. Because of my regular (negative) biopsies, I felt we had caught my cancer quite early: there was no evidence it had gone beyond the capsule, my PSA--corrected for finasteride--was under 10, and I did not want radiation if surgery was an equally good option. I thought there was an excellent fit with my uro/surgeon. He had done my very successful TURP a few years earlier. He did
open RPs (and by coincidence I preferred an
open over a robotic procedure), and he was trained at Duke and had >20 years of high-volume RP procedures. We reviewed his favorable RP outcome stats for oncological control and continence. I decided against an RO consult.
My path results supported my feeling that the cancer had been diagnosed early on. My surgeon had no difficulty sparing both neurovascular bundles. I was downgraded to G9 (4+5), had a low tumor volume, no adverse findings other than PNI, a very low uPSA nadir, and got a low-risk for mets results on a Decipher test (I was even denied Decipher coverage by BCBS because of my good path outcome). Even if I should need RT for BCR at some point, I will have no regrets about
my treatment choice.
The time from my diagnosis to surgery was a little over 5 weeks. I would be the first to point out that statistically speaking,
my very good outcome is not the case for the majority of cases of high-grade disease (my estimate is that perhaps 20% of G9-10 men have an RP outcome of pT2 with negative margins and nodes) and I do believe that most men should have an RO consult.
Djin