Prostatectomy or Hormone & Radiation Therapy?

Hello to all I am the new guy on the block tonight!

I am an active (still employed as a Florida business broker) 65 year old man with parents that have lived into the late 80s, but both were challenged with cancer. I have been diagnosed with prostate cancer and has had significant testing done todate.

 

The results reported are as follows:

*   PSA: 199

*   Gleason score: 7, 3 + 4 in 11 of 12 samples with one at 4+3

*   Bone Density: T score of a negative 1.7, moderate

*   Nuclear whole body scan: No evidence to suggest skeletal metastatic disease

*   CT scan of abdomen and pelvis w & w/o contrast: No evidence of andenopathy or aneurysm. Right Inguinal Hernia noted.

*   CT Pelvis: No evidence of metastatic disease or adenopathy. Moderate prostate enlargement.  No evidence of bladder outlet obstruction or acute abnormality.

*   Chest x-ray: Normal

At the suggestion of my Urologist Dr. Adam J. Ball I had made the decision to have the prostate removed, and with a referral from Dr. Ball I visited with Dr. Vipul Patel to do a pre-surgery consultation. During this consultation Dr. Patel indicated that surgery was not his recommendation. His reasoning was that surgery while it would remove the prostrate and likely the lymph nodes would not assuredly remove all of the cancer, especially given the high PSA level and the presence of cancel in all twelve of the prostrate biopsy zones. Dr. Patel suggested that the operation would only put off the inevitable need for hormone and radiation therapy. Dr. Patel then referred me back to Dr. Ball.

 

In a subsequent meeting with Dr. Ball initial plans were made to begin hormone therapy leading to radiation therapy. The confusion that is troubling me at this time is during my meeting with Dr. Ball he indicated that if I wanted to go ahead with a prostrate removal operation that he could find someone to do the operation. This comment was made in such a way that I was left with the impression that he still thought that was the way to go but did not want to challenge Dr. Patel’s evaluation.

 

Now I am confused and need another opinion.

 

My questions of you are:

*   Would you suggest a prostatectomy or go immediately to the hormone and radiation therapy? What is your thinking that supports this recommendation?

*   If your recommendation is for a prostatectomy then would you recommend a robotic or an open procedure? And again what is your reasoning here.

 

Thank you for your thoughts and input!

 

I agree with what F8 quoted, and stated.

That is exactly what the radiation oncologist told us. He also told us that he gets ONE really good shot at radiation, and he would rather it be before having to deal with the scar tissue of surgery.

Good luck with whatever you decide and may you have the best recovery possible.

I suggest you ask Dr. Ball to refer you to the best radiation oncologist, who specializes in prostate cancer, in your area. Have a conversation with the radiation oncologist about radiation options -- maybe external beam radiation (IMRT or IGRT), maybe that combined with seeds, maybe hormone treatment too. That way you can learn about the radiation options and see if you think that might be the best treatment for you. I don't know what you will decide, but that seems like a reasonable next step. You could seek advice from a medical oncologist too, as another point of reference. If you do that, I suggest one who has a major focus on prostate cancer, rather than a generalist. Dr. Patel may be doing you a favor. Some surgeons will do surgeries, even when it is not the best option, because they get paid for it. Others are more "honest" and only recommend surgery when they honestly believe it is best for the patient. I am not recommending any treatment course here -- that would be foolish since I am not a doctor. Just some thoughts. I wish you the best. Medved

Dear Pcinfl:

Welcome to HW but sorry you have to be here.  It sounds like you got good advice from Dr. Patel as it makes a lot of sense.  As for the other guy shopping you around for another surgeon who might still cut...let's just say I would kick your uro to the curb at this point.

With your stats you should probably consider consulting with an oncologist who specializes in prostate cancer.  There is a list of some of these folks in the back of the Scholz book, "Invasion of the Prostate Snatchers".  Alternatively, one of the best radiation clinics in the world is in Sarasota - Dattoli Cancer Center.  You may want to consult them as well.

Good luck.

Tudpock (Jim)

Have you started Hormone Therapy?   At least you could start on Casodex and then add in Lupron/Eligard and Avodart in a couple of weeks and slow this down while you decide what to do.   I would stress that with your high risk statistics that the search right now is for a top PCa specializing medical oncologist.   Your urologist should at least get you started on HT while you get with an oncologist. 

Also be looking for the best radiology oncologist you can get to.   The best surgeons won't operate on you now as the probability of the cancer being out of the capsule is just to high for surgery to be curative.   You are now looking at hormone therapy, radiation, and potentially forms of chemotherapy.   The good news is that there are a lot of treatment options available and they can bring a long lasting remission if started early and done properly.

Check out the Dattoli clinic in Sarasota.   He is the premier radiology clinic specializing in Prostate Cancer in Florida.   I would be calling them immediately.   Check his website at www.dattoli.com.  Phone is 1-877-dattoli.   He would be an excellent consult and will have referrals for medical oncoligists as well.   I was not treated there as I am in Atlanta.   One of the most renowned PCa medical oncologists, Dr Snuffy Meyers, did his radiation treatment at Dattoli's several years ago and routinely refers men to them for radiation therapy.

Casper319 said...
same here pci...although Im only 50.....my doctor told me I had a 90% chance of it being outside the prostate also. My first 2 docs wanted to do surjury so I went to a bigger city and proatate specialists. So I opted for IMRT/HT. When my 3rd doctor...who was a urologist and one of the best at the davinci surgery told me Thats not my best option...I believed him because that told me he was not in it for the money...but for the patient. he was the first guy to take me thru the partin tables....the others just told me I need surjery.

Mt PSA was only 94 though but a gleason of 9.

I find this scandalous. Were your first two doctors simply ignorant of the facts, or just plain greedy? Why would any doctor subject a person to surgery knowing that there is a 90% chance that the PCa is out of the prostate and the patient will eventually have to have radiation anyway? That seems almost criminal IMO.

Sancarlos