Oncologists who use color doplar imaging

hello isg:

- every man and every diagnosis is different and I feel it is quite severe for you to say that " ... it is rare that surgery is the best solution to prostate cancer."
- depending on the stats of the person involved ( PSA, free PSA, gleason level, etc) , there are several treatment options - from AS, radiation treatment, and different forms of surgery.
- it is prudent to find out what is the best treatment option, the best hospital and the best doctor ....

- do you know your stats - and what forms of diagnosis have you gone through.

- from what I have heard about the book mentioned - it is one man's journey and not definitively the be-all and end-all of treatment for prostate cancer.

-see previous topic posting ( just bumped it) NEW BOOK - INVASION OF THE PROSTATE SNATCHERS -

-wishing you all the best.
BRONSON

Post Edited (tatt2man) : 10/8/2010 4:55:18 PM (GMT-6)

Hello Tuley and welcome to this forum.  I think you will find it full of good information and mostly well meaning folks who will help and support you any way they can.

You will also find that most of the guys and gals here are surgery people so don't be surprised at some negative reaction to your comment about surgery...especially from someone just arriving.  The surgery vs. radiation/other treatment debate is an ongoing one here and you might find it interesting to scroll back thru some of the previous discussions on the subject.  In any case, though, you are certainly entitled to your opinion on the subject.

I also think "Invasion of the Prostate Snatchers" is an excellent book and I now recommend it along with the more traditional Walsh and Strum books on PCa.  Together I think they provide the reader with a pretty full view of the subject.

Pleae keep coming back and let us know some more specifics and how you progress in your decision making.

Sorry I can't answer you question re Chicago docs but hopefully someone else can.

Tudpock (Jim)

Tuley,
the best color doppler Dr in your area is Dr Fred Lee in Rochester MI. It will be well worth the travel to see the "best of the best".
I agree with you that in most cases surgery should not be the 1st option, but there are cases where it should be considered as the 1st option.
1. When there is a high grade large tumor that is confirmed by scans to be fully contained.
2. when the patient has previous urinary issues.
3. When a patient is very young and has a confirmed contained tumor.
4. When a patient has recieved radiation for another cancer.
5. When a patient has an overriding psychological necessity "to get it out now"
6. To be used as a debluking procedure for confirmed advanced PC.
In most other cases radiation will result in similar cure rates with less side affects.
JohnT

Hi Welcome Tuley,
To make it easier to find the thread if the Bump goes missing the thread is at:
www.healingwell.com/community/default.aspx?f=35&m=1891532
and the link mentioned in that thread is:
well.blogs.nytimes.com/2010/08/30/a-rush-to-operating-rooms-that-alters-mens-lives/?src=me&ref=health

As for how you treat PCa, well I think that all we can be 100% certain about is that there is not a Perfect solution.
I chose surgery, and what matters is that it was the option that looked like it would deliver what I wanted. Yes I have a few unwelcome side-effects etc and my QOL has been affected, but I am getting on with life the way it is.

And, in passing, Dana Jennings blog at the NYTimes was the first thing I read online when I started searching for info about PCa.

The gist of the problem/dilemma we face seems to be that only one in seven cases of PCa are really nasty cancers, but the medical profession has yet to work out a way of telling you if you're one of the "lucky" six.

Alf

I considered all options and chose surgery. It turned out to be a good choice for me, so far. Joined the Zero-Club first PSA test, no complications or side effects (continence + potency) and cured all my prior ills: getting up two, three times at night, very slow urination (several min each time), etc. Many of the people at this forum also has good outcome from surgery.

While I think that saying "it is rare that surgery is the best solution to prostate cancer" is an extreme statement, I also think that any man who doesn't carefully weigh all his treatment options isn't approaching this prudently.

Avoiding all the short term side effects of treatment is important, but so is avoiding long-term side effects. However, those considerations take a distant second place to curing the cancer whenever possible. The main goal is to address the cancer as effectively as possible.

In my view, there are too many possible permutations on one's condition and too many treatment options for quick and easy answers. When new members make blanket statements that exclude mainstream treatment options out of hand, people become somewhat alarmed. Don't take it personally; we all kind of try to look out for one another.

Post Edited (Jazzman1) : 10/9/2010 3:08:28 PM (GMT-6)

Didn't mean to be misleading. The facts have their limitations and I wanted to point that out. I wasn't criticizing radiation therapy as a treatment, my criticism is for the evidence for deciding whether radiation or surgery is better. It's full of holes. Swiss cheese.

I looked a little more and found a 6 year study on later effects of radiation. This shows some deterioration in sexual and urinary function after brachytherapy, but that overall quality of life wasn't affected:

http://www.ncbi.nlm.nih.gov/pubmed/20097486
Int J Radiat Oncol Biol Phys. 2010 Mar 15;76(4):1054-60. Epub 2010 Jan 25.
Health-related quality of life up to six years after (125)I brachytherapy for early-stage prostate cancer.
Roeloffzen EM, Lips IM, van Gellekom MP, van Roermund J, Frank SJ, Battermann JJ, van Vulpen M.

There is evidence for existence of urinary and erectile problems years after radiation; what I couldn't find are long term studies comparing surgery and radiation urinary and erectile problems years after treatment. There is a real good study doing this comparison for the first 24 months after surgery (you can get the whole article free on line):

http://www.nejm.org/doi/full/10.1056/NEJMoa074311
N Engl J Med. 2008 Mar 20;358(12):1250-61.
Quality of life and satisfaction with outcome among prostate-cancer survivors.
Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L, Lin X, Greenfield TK, Litwin MS, Saigal CS, Mahadevan A, Klein E, Kibel A, Pisters LL, Kuban D, Kaplan I, Wood D, Ciezki J, Shah N, Wei JT.

There is no question that radiation has fewer side effects that surgery, short term. I couldn't find good long term studies. If you can find a study that shows a lower LONG TERM incidence of urinary and ED side effects with radiation, well, bring it on...

As for effectiveness for cancer control, there was a thread about this some time ago. There are some studies that show better outcomes for surgery:

http://archinte.ama-assn.org/cgi/content/abstract/167/18/1944
Short- and Long-term Mortality With Localized Prostate Cancer
Arnaud Merglen, MD; Franz Schmidlin, MD; Gerald Fioretta, BSc; Helena M. Verkooijen, MD, PhD; Elisabetta Rapiti, MD, MPH; Roberto Zanetti, MD; Raymond Miralbell, MD; Christine Bouchardy, MD, MPH
Arch Intern Med. 2007;167(18):1944-1950.

This one is a Swiss study. These studies have limitations, but this one is a large population based study. You can get the whole article for free at that website. If you know of similar studies showing that radiation has a better outcome that surgery, well, er, bring it on...

It's human nature to think that we absolutely made the best decision about treatment. I chose surgery, but I'm actually not sure that I made the best choice. I think the evidence guiding treatment choices is really c****y. Prostate cancer and the effects of treatment roll out slowly over the years, and it's incredibly difficult and time consuming to do definitive clinical trials to get level 1 evidence (another thread from several weeks ago).

The reality is that no one really knows whether radiation or surgery is better. That's not backhanded.

Postop,
I have to agree with your conclusion that the studies are all over the map and that they are all retrospective and not controlled. There is a wide variation of cure rates depending on institutions ect.
I do think that the vast majority of studies have showed that radiation does in general have fewer short and long term side affects than surgery. This is it's biggest advantage over surgery. Both techniques have improved over the last 10 years, but the improvements in radiation have far out shadowed the improvements in surgery, especially when it comes to side affects. The latest studies indicate that the effects of the newer radiations peak within about two years and that effects beyond this are rare.
The older ERBT did cause longer term affects. As accurracy improved, side affects diminished.
Since most men treated with radiation are in their 60s or 70s one would expect some deteriation of sexual and urinary functions as a normal course of aging. The major issue with radiation is a 2% incidence of bowel issues that can be very severe, and does not occurr with brachy. The incidence of incontinence is very rare. ED rates are lower and respond better to meds than ED resulting from surgery. One thing I have recently learned is that patients that have a tendency to scar easily have a high probability of strictures when undergoing surgery. I'm on several radiation sites and the rate of posts regarding side affects doesn't come close to the discussions of surgical side affects on this site. 50% of all posts on this forum relate to postop problems. This too is unscientific, but indicates that something is going on that can't be ignored.
JT