what precludes surgery

After one has a biopsy, there are results. So what kind of result takes surgery off the table as an option?

If there is extracapsular penetration, is that a deal breaker?

Or does it depend on the # cores?

Is Gleason 8 a deal breaker? What about Gleason 9 or 10?

Mel

Patients considering surgery among their treatment options should consult the Partin and Narayan Tables, Bluestein predictions and other predictive algorithms to get a sense of risk for extracapsular extension as well as lymph node involvement.

The Partin tables are probably the best known, and are compiled by analyzing thousands of pathology specimens removed at the time of radical prostatectomy (RP; surgery) to determine the probability of organ-confined disease, capsular penetration, seminal vesticle and lymph node involvement.  The Tables (and more info) can be found online at http://www.prostate-cancer.org/education/riskases/partin.html.

Partin Table inputs include PSA, Gleason score and clinical stage.  Of course, the Gleason score comes from the biopsy.  The PSA value should be the maximal PSA prior to any treatment.

Here’s the bottom line…if you know you have spread, then surgery makes no sense whatsoever because surgery only removes the prostate.  If you go forward anyhow, you will suffer the side effects of surgery AND will have not succeeded in removing the cancer (thereby requiring some secondary treatment, like radiation).  If you have known spread, radiation is probably a better first treatment because it also treats an area around the prostate.  The problem is that if you’re in a “gray zone” you won’t know if you have spread or not…thus the purpose of the Partin Tables, to give you an indication of your probabilities.

Number of cores simply refers to the number of biopsy samples taken, one by one, by the doctor.  Many consider this a needle in a haystack.  Dr Patrick Walsh has written that each sample is only 0.01% of a normal sized prostate.  The typical number of cores taken is 12, but since it’s a needle in a haystack, more is better.  Taking 20 cores is becoming more common as a result.  I encourage that you talk to your doctor about taking a maximum number.

Seriously just WAIT until your biopsy and its results before you begin to panic again. Besides a normal biopsy still leaves much out. By far a 3D saturation biopsy would tell you much more.

http://alprostate.com/mapping.aspx

You age, your weight, your current medical condition, and even your past medical history including previous surgeries could all rule out surgery.

I agree with realziggy, if you are going to have a biopsy, and you dont want to keep repeating them until they find gold, then a good satuation biopsy is the ticket.

But Mel, once again, you have jumped way over the fence and fretting about the unknown.

David in SC

Nothing has to be taken off the table with surgery, still done many times on uncureable patients. Generally (surgery) (PCa)if found in lympnodes which should have been sampled during surgery, and quickly analyzed, prior to gland removal, ..I have heard a surgeon say he did not sample them on lower Gleasons patients (6-7's), then if found the patient can be given the option to finish the surgery even if  PCa had spread...for the reason of "debulking" your overall tumor burden (in other words get rid of alot but not all your PCa) or sew you back up with gland intact and suggest hormone therapy, radiations, cryo, hifu, and other options for possible control.

No guarantees on cured PCa at any level (per se), not trying to scare anyone, but the truth of the matter is  usually not frankly given to patients and can be highly sugar coated. Failure rate is mentioned by Dr. Barken and others (long term 5-10 yrs.+) likely 25-30% or higher. Same can be said for other treatments or worse, alot of worse stats patients don't even go surgery or some docs will tell them 'you are not a reasonable candiated for successful surgery'. So the non-cured rate in radiation might and probably does look worse, but it also has a much worse patient base of high risk folks within it, which would skew a direct comparison.

 

With low stats and indolent PCa levels likely a patient could be cured or do fabulously well (there is maybe 70-75% cure rate with surgery overall, and likely much better numbers on the low or indolent presentations of PCa-90%-???). Not sugar coating anything, we take risks in treating and making decisions on PCa. Alot of imprecise data given to come up with imperfect Partin tables and nomograms, which are also an averages type basis thing...some higher and some lower. Missed biopsies possible, you can have multiple gleason scores within your gland(I have 3 different-7,8,9's)...so very possible to miss a higher one or others, you can have 12-14 variant types of PCa not easily identifiable even by experts, they don't all respond the same or play on a level field either. Thus it is a Jungle, sadly we get to try an navigate within it, even with all the impreciseness.

 

Not mentioning this to discourage any treatment or ones choices, but to open the curtains and make awareness of the whole situation, so when a possible doc guarantees a cure or such, then perhaps you can further your questions and find out what types of answers and frankness you are getting, which may indicate what type of person you are dealing with and overall truthfulness is in the situation.  The other option is not to care what is said to you and hope all is good, which is a choice and taken by enough people on any treatment type. Only you the patient has to walk the walk, live with whatever side effects and issues thereafter, alot of things are not told straight up or mentioned, alot of times it is what is not said that is telling information, too.  Anyway brother Compiler, don't rush into this and realize that PCa can take along time to get to where it is discovered in patients, you have time to analyze, study, compare, get opinions and postphone instant treatments in most cases....although how many docs will tell you that straight up????  Many are more than anxious to sign you up even on the spot, how do I know?.....get 8 opinions and see what you learn about the process end of it.

Post Edited (zufus) : 11/29/2009 5:46:11 AM (GMT-7)