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Posted 8/31/2011 3:14 PM (GMT 0)

Thanks so much for the great welcome.  So glad I was guided to this site.  I have learned so much already in these past few days.

I do have another question. I'm finding quite a few guys on this site with high gleason counts G9's that have had surgery.  All the Dr's I have spoked to said that isn't a good option for me due to the possibility the cancer is already out.  The same goes with seeding.

Are the Dr's here in the N/W to conservative? If I'm not being too personal, what were some of the deciding factors to have surgery verses H/T and Radition?  

Posted 8/31/2011 3:42 PM (GMT 0)
At least in my case, there was not a clear indication that the PCa had left the capsule. I did have a mix of G3+4 and G4+4 in 9 of 12 biopsy cores.

I was refused seeds by a big-name (often mentioned and well respected) cancer center, as potentially too far gone.

I had multiple ROs tell me the odds of a "cure" were in the 60-70% range using RT.

My surgeon was on the fence, so we took a chance with DaVinci. He did take a large swath of lymph nodes, and did "on the spot" path of some of them to make a last-ditch decision, reserving the option to declare it escaped and stitch me back up. The lymph nodes were clear, so they proceeded. My Gleason was upgraded to 4+5 in the post-op path.

That's how this G9 did surgery.

I'll say I did not have any of the benefits of the experience/suggestions of members here, as I did not find HW until long after surgery, so no comments about me not listening wink

 

Posted 8/31/2011 4:04 PM (GMT 0)
My biopsy was Gleason 3 + 4, so I didn't become 4 + 5 until after the surgery. I ended up with a positive margin, so the surgery was essentially a waste, except that I found out the real state of my cancer and had 4 lymph nodes analyzed. Had I had a second opinion on my biopsy, we might have known it was G9 before surgery, in which case many more lymph nodes would have been taken out, perhaps saving me from the whole-pelvic RT I'm currently undergoing. Or I might have chosen some other treatment.

I did like the idea of actually being able to see what was going on with surgery. Without surgery (or a second biopsy opinion), I would have been radiated for G7 instead of G9 (if that would even make a difference). There is also something to be said for debulking the tumor, as Dr. Myers has stated that hormone resistance usually starts in the prostate itself rather than sites of metastasis. Another good argument is that with surgery as opposed to radiation, you can quickly tell if there is a recurrence, and perhaps respond in time for another chance at a cure with RT.

Your doctors seem very pessimistic. With T1c cancer, why wouldn't they offer you a chance for a cure -- with either surgery or brachy + IMRT? Sure, G9s are problematic with greater chance of spread, but there is a sizable percentage of patients who do well with either treatment, surviving disease-free for ten or more years. Dr. Dattoli, who does brachy, published a paper this year showing that 60% of his G9 patients hadn't recurred yet ten years later. Mayo too published a report showing that high risk cases did fairly well with surgery.

I'm sure others will chime in with more information. I hope the consensus is that you should do more research and talk to an expert in prostate cancer. When you've got G9, you need to have the best doctor you can get.

Nellie
Posted 8/31/2011 5:57 PM (GMT 0)
I was G7 (3+4) before the surgery. I had a PSA of 54.9. Surgeon said he would stop the surgery if it had spread. 14 lymph nodes were removed .. all clear. Negative margins. But, seminal vesicles invaded. Upgraded to G9 (5+4).

Frankly, I chose surgery so I could still have a second shot at it with radiation.

Also, I had a pre-surgery consultation with the rad onc. He recommended surgery as well, to be followed by radiation, if necessary. In retrospect the rad onc says it was the right move given the G9 cancer upgrade .. get the G9 out and then do the radiation.

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