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we have got the gleason score results

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Posted 9/29/2011 12:04 AM (GMT 0)
 

well after a PSA of 50.  we now have more information.  bone scan and ct are clean yeah!  however out of 12 samples all came back with a gleason score of 8.  What now surgery?  should we do it?  can anyone give thier thoughts onthe removal surgery?  should we go with the robot? or the man?

 

Posted 9/29/2011 12:43 AM (GMT 0)
With your stat, before deciding on surgery, you should also consult an oncologist and a radiation oncologist who specialize in prostate cancer. Also, read up on prostate cancer treatment options as much as you can.

I am not a doctor, just my opinion.

Good luck and best wishes.

Posted 9/29/2011 1:23 AM (GMT 0)
If I knew then what I know now, I would have gone with the man. Just my take on my situation, but look at all of your options.
Michael
Posted 9/29/2011 1:33 AM (GMT 0)
From what I've heard, the best thing is to find the most experienced and expert surgeon and whether it is robotic or traditional surgery is a secondary consideration. That's the path I'm currently exploring. I wish you the best for your upcoming surgery.
Posted 9/29/2011 1:44 AM (GMT 0)
I agree with newporter. You shouldn't jump into surgery. Talk to a radiation and medical oncologist. With a PSA of 50, G8 and 12 positive cores you need to explore all your options. Best wishes. BB
Posted 9/29/2011 2:39 AM (GMT 0)
A good place to start would be to read Dr. Patrick Walsh's book, "Guide to Surviving PC" and learn all you can...

Surgery may not be your best option at this point...
Posted 9/29/2011 2:53 AM (GMT 0)
Firecracker,

Lots of good advice here. You have a little time to think about this, so don't rush into a decision.

I suggest you take some time and educate yourself. The Walsh book that Fairwind recommended is the bible. There's also a wealth of information in this forum. Read the threads, search the threads, scour the stickies, ask questions.

There's no simple answer to your question. Your age is a factor, as is your Gleason score and cancer stage. Newporter's advice to see a general oncologist and a radiation doc who specialize in prostate cancer is solid. You'll get perspectives from them that you won't get from a surgeon.

If you do decide on surgery, the skill and experience of the surgeon is far more important than whether he uses a robot. The difference is a week or two of recovery time. A year later it will make little difference. If you go with surgery, just go with the best surgeon you can find and trust the hell out of him.

Good luck with your journey, and let us know how you're doing. Questions are always good; there's a wealth of information here.

Jonathan
Posted 9/29/2011 3:50 AM (GMT 0)
Take a little time and explore every option. I had the same PSA but a Gleason of 7,4+3=7. I had robotic and doing well so far, but every ones journey is different in the silly disease.
Posted 9/29/2011 5:49 AM (GMT 0)
Given gleason of 8 , 50 PSA, and all cores positive it's very likely that the doc will recommend a combined approach either radiation and HT or Surgery and HT or some other combination along those lines. As others have said, it is the experience level and skill of the surgeon (if you go the surgery route) that matters most, rather than the use of a robot to assist or not.

Also, they may well recommend that you have a color doppler to estimate whether the tumor is capsule confined or not (good chance it's not give your stats) and that data will influence the recommendation. If not, you should ask about this. You still have a lot of factors to consider. You might want to look up the SMK nomograms online calculator to estimate the chance of capsule-confined cancer and other factors that will influence your decision.

Be prepared to encounter conflicting opinions from different experts.
Posted 9/29/2011 12:08 PM (GMT 0)
I was in a similar position and my surgeon said no surgery. He showed me that the probability of capsular escape was too high and he would almost certainly have to follow surgery with radiation. He suggested radiation and hormone therapy from the start to spare me the risk and side effects of a highly probable surgery failure. You can see my treatment from my signature.

I do wish I had known about the color doppler as it might have been worthwhile. I did ask about the Prostascint scan and my uro and oncologist both were soft as to its value. My uro published a paper a few years back for the urological association pointing out the shortcomings.

You are by definition high risk and have to attack this condition. That begins with multiple opinions from the three disciplines that treat this, urology, radiology, and oncology. You should seek out PCA specialists and ask the question....how many men with worse statistics than mine have you treated? What did you do? How are they doing. You do not want to be the most advanced case they have seen. Find someone that has treated many men worse than you. It also means that you have to learn as much as possible in order to make the best decisions.

Finally, it also means that you don't have the same luxuary of time that a low risk patient has. Your cancer could be growing rather fast and you want to quickly arrest it. With your statistics it is almost certain you will be on hormone therapy. You can always start HT while you are deciding on the balance of the primary treatment. My doctors wanted me on HT for one month before my radiation began. In the doctor's language this is referred to as neoadjuvant treatment.
Posted 9/29/2011 1:17 PM (GMT 0)
JNF gave you some awesome advice in my opinion.

None of us has the "right" answer - that belongs to you.

A few thoughts from my view:

*12 out of 12 gives reason to assume it has grown for some time - either due to some combination of time or it's aggressiveness.

*One would have to think that the chances it has escaped the prostate capsule are high.

*Surgery is often used in attepmt to "cure", that is, remove the prostate and if the cancer is contained in the prostate, you can be cured. If pca has escaped the prostate, removing it does not solve the entire problem.

*I had Robotic surgery last May+- and pathology showed "positive margins" - so when they look at the prostate they saw cancer cells at the end...where the actual cut took place. My uro immediately said Radiation was my next step - just logical now in retrospect. Sure enough, 6+- mo later, psa started to rise, did the radiation, now at zero (will get 6 mo psa test in Nov/Dec).

*I'm not convinced that the conventional surgery would have somehow changed the results of the surgery.. if the pca cells had escaped - they had escaped. I will say that - all things being equal - robotic surgey will typically be easier on the patient, pain, scar, recovery. BUT, I certainly agree that you want the BEST surgeon you can find, regardless of how (mine was very experienced in both - as those who do robotic likely did conventional prior to).

*You have tome to do what youre doing now, investigating the options, but you dont have time to waste. BUT ISNT THAT THE POINT REGARDLESS OF PCA?!

*if you happen to not feel comfortable with you doctor, for whatever reason.. remember YOU are the boss. Do NOT allow anyone to make you feel that they are in charge here. This is YOU life, not theirs. I had to leave the URO who found my pca - as good a dr and man as he was - but I realized his patients were typical late 60 and older.. and I was 52. So I saw that HIS mindset and experienced was based on factors not similar enough to mine. *Just another thing to keep in mind.

I certainly wish you well in this journey!
Posted 9/29/2011 2:53 PM (GMT 0)
firecracker...Im pretty much in the same boat...PSA of 94, and 10 of 12 cores gleason 8 or 9. My final score was a gleason 9. I would talk to a oncologist first and have him take you through the partin tables...that will give you an idea of whether its outside the gland or not. I was told with my stats.....that there was a 92% chance it was outside the gland and that I would need radiation more than likely anyway. So my Urologist took me next door to the Radiation Oncologist.

My first 2 local Uros wanted to do surjury without doing the research....so I finallly found one I can trust. I believe with a gleason 8 and and high PSA...you will more than likely have to attack it aggressively...which will be radiation/ or surjery along with Hormone therapy.

at such a young age.....they will want to attack it hard right away....I believe. Good luck on your journey.
Posted 9/29/2011 4:45 PM (GMT 0)
JNF gave you some good advice. Ask your doctor to run your stats through the Partin tables and I trust that you will find an extremely high probability that your cancer is not contained and that surgery would not result in a cure, but only in a debulking of the tumor load. There is a very high probability that along with the surgery you will also need radiation and HT so the question you should be addressing is that do you want the side effects of surgery if you will have to undergo radiation and HT anyway. Dr Stephen Strum's "Primer on Prostate Cancer" and Dr Charles Myers "Beating Prostate Cancer: Hormone Therapy and Diet" should be good references for your high risk stats.
Good Luck.
JohnT
Posted 9/29/2011 5:24 PM (GMT 0)
Firecracker - Here is a controversy you may encounter:

Some docs think that if the cancer has escaped the capsule that surgery is pointless and you should focus on radiation and HT in combination.

Other docs think that even if the cancer has escaped the capsule it can be worth removing the prostate because having a smaller amount of cancer left (called "debulking" as John T. says) seems to help people avoid mets longer, probably because there is less tumor volume to mutate into forms that don't respond to hormone therapy. Dr. Charles "Snuffy" Meyers in in this category (his book is excellent, as John T. has said.) But the more treatments you pile on top of each other, the worse the side effects.

As far as I can tell from my research as a patient, there are smart, respected doctors on both sides of this question. So it can be confusing and difficult for the patient to decide. It can be a personal choice: how much risk do you want to take with the cancer, vs. how much risk do you want to take with side effects of treatment? No doctor can make this decision for you.

If you get the doppler ultrasound you may be able to know in advance if your cancer is still capsule confined, but more likely it is not. If you are comfortable looking up your records and inputting the data into an online calculator you can check out your own odds at the online calculator that Sloan Kettering has posted here: nomograms.mskcc.org/Prostate/PreTreatment.aspx If not, your uro can walk you through the Partin Tables, as Casper319 has advised.
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