Am I making the right choice here?

Welcome to HW.

How many solo daVincis has the partner done ? If he hasn't done several hundred, I would consider looking elsewhre, or if he has done several hundred opens, I would consider going open.

This is just a matter of experience.

Good luck on your decision. At this point, waiting another month most likely will not make any difference in your outcome. Have they done an MRI to see if they can detect whether the cancer has escaped the prostate ?

You may also want to consult a radiologist, and a medical oncologist. 3 100 % cores is a little unusual, and may indicate a stronger possibility for escape of the PC outside the capsule, in which case surgery may not be the best option.

My thinking was that at my age, I could tolerate surgery better now than later. If surgery does not catch it all, radiation is still an option. Or does surgery disrupt the area too much to where radiation will not be as effective?

I have less than a week before my surgery date!

Welcome. I don't see where waiting the extra 3 weeks for your original doctor would have made any difference at all in your outcome. And yes, if your surgery utlimately fails to stop the cancer, then in most cases you could have radiation as a secondary treatment. But there are a lot of factors to consider even then. Radiation would only be still curative, if any remaining cancer was still local to your prostate bed. Way too earlier to be thinking about the details of that. And did you consider any other treatment other than surgery? I had both surgery and radiation, so I have no treatment bias myself.

Good luck to you. The skill of the surgeon is going to make the biggest difference to you, and though it won't guarantee anything, may lessen the degree of any incontinence or ED issues you may or may not have after surgery.

David in sC

If surgery does not catch it all, radiation is still an option.

with a 100% and an 80% core salvage or adjuvant radiation is almost a certainty, imo.  has the uro explained this to you and the fact that radiation after surgery has a much greater chance of producing undesireable side effects? 

ed

 

Another minor thing to note, doing HT drugs prior to surgery like Lupron and others do help shrink the prostate gland and makes it alittle like sticky or some such phenomena and thus makes surgery a little bit more difficult although many docs seem not to have a problem with the proceedure, but some other docs mention they either don't like or don't do surgery on patients whom did similar HT prior to surgery. Since you are on this drug you bought more time to consider all treatments and the PCa will be held at bay and even reduced. So, you might wish to think about all the whom, what and where on your options. Best to your decision, never is an easy task.

Dr. has already said he is going outside the capsule on the left side to capture more cancer. In regards to the surgeon, both surgeons will be in surgery with me, so I am getting the experience of both. If the cancer is outside the capsule, is brachytherapy even an option? I agree that an MRI or doppler sounds (no pun intended) like a good idea. I chose surgery partly because of the longer term survival rate of those that have surgery. Perhaps that number is biased because surgery is for lower risk patients....

You have some time....don't rush into anything. There are no do-overs!

At least consult with a radiologist. Consider seeds. The SE and recovery time are usually less and is a simple procedure as opposed to the operation You can read what I went through by clicking on the link in my signature.

Whatever you decide, get the best doctor you can find. It does make a difference!

You use brachytherapy rather than the surgery. Instead of cutting out the cancer, the brachytherapy kills it through radiation. The radiation can form a much larger kill zone than surgery and that is why it can be more effective in higher risk cases. The foremost prostate surgeon that invented the modern nerve sparing procedure, Patrick Walsh, would generally not operate on a person with your risk profile because of the significant probability that the surgery would not be curative.

You really do need to learn all you can about the radiation treatments combining brachytherapy and external beam radiation. The combination is as effective and can be more effective at cancer control than surgery and with less severe side effects. The most significant combination of risk and side effects result when both surgery and radiation are used. That is why it is in your best interest to consult about radiation treatment.

My urologist-surgeon refused to operate because the probability was greater than 50% that the cancer had penetrated the capsule. When that happens one usually has to also have radiation to get what the surgeon had to leave behind. My urologist-surgeon did not want to subject me to the risk and side effects of both surgery and radiation, so he suggested High Dose Rate brachytherapy and IMRT radiation. I am also on ADT3 hormone therapy because of my high risk status.

You have G7 and four cores between 80-100%, which means there is a very high probability the cancer has escaped the prostate. When that happens, surgery will be difficult to remove all the cancer and will fail as a treatment. The larger kill area of radiation can get cancer that can't be reached by the surgeon and can be more effective. Go see a radiation oncologist that specializes in brachytherapy before deciding on the treatment.

Also, I'm curious why everyone always says you have time to make decisions.

my doctor told me to take my time but not longer than two weeks.  i'm in that camp also.  at some point the cancer escapes the capsule.

ed

 

Dear Don't Know:

Welcome to HW...sorry you have to be here.  You have received some excellent info on this thread so I will not be repetitive...I'll just say that the most recent post my JNF contains some excellent advice, IMHO.

Jim

Why do you say that Ed?

because it's a fact. 

ed

 

I think there may be a world of difference between a "fact" and "in your opinion"

in my post i said: "with a 100% and an 80% core salvage or adjuvant radiation is almost a certainty, imo". "imo" means in my opinion.  now i did not say the cancer has escaped the capsule but, if it were me, with three 100% cores and one 80% core, i'd bet the cancer had escaped and i would move quickly to treat not only the tumor but also the prostate bed.

i'll bet the nomograms would agree with what i'm saying but i don't have the time right now to check that out.

ed