Cancer confirmed

Sorry to hear of your Dx - I'm sure others will ask as well, would you mind sharing the rest of your statistics, such as grading, prostate size, DRE results, etc? Typical stuff you'll see in most of our "signature" sections at the end of our posts. Depending on your total stats there are probably other options besides surgery that you may want to consider. . .

I wholeheartedly agree with Yooper that with one core positive, Gleason 6, you should think very carefully before accepting the current adivce you're being given. 

I'm not a doctor, and I don't have all the information your uro has, but I would want a much better explanation of (1) why surgery is required at this time, and (2) why that nerve bundle can't be spared.  Maybe it's because of the location from which the positive core was taken, but the number of biopsies doesn't seem like a logical explanation to me.  Active Surveillance might be a very good option for you.

In a DaVinci surgery, you will certainly be intubated and thoroughly anesthetized.  The surgery may take as long as 3 or 4 hours.

This is major, life altering surgery, and I think you need better information and better explanations before agreeing to this.  A second or even third opinion would be well worth your time, and not all of them from a uro/surgeon.  Brachytherapy should be investigated, or external beam radiation. 

If your uro didn't thoroughly discuss with you the possibility of Active Surveillance, if he didn't thoroughly discuss options other than surgery, if he didn't thoroughly explain why it would be necessary to remove that nerve bundle and what the implications of that would be for you, if he didn't talk to you about the differences between your Gleason 6 diagnosis and a diagnosis of Gleason 7, 8, or 9....if he didn't do all those things I would drop him and find a new urologist. 

Good luck in your decision-making process.  I'm sure other guys will add their thoughts.

 

Post Edited (clocknut) : 12/5/2012 1:29:38 PM (GMT-7)

you said...
Because of three biopsys, nerves can't be spared

You keep saying that. Now it's in your signature. It's obviously a concern. I'd get a second opinion from another surgeon. It shouldn't hurt your urologist's feelings. Second opinions are a routine part of due diligence on the part of the patient.

I'm retired,
You are making a major decision and a second opinion is warrented. We have seen many patients on this forum plunge into a treatment based on only one doctor's recommendations that have regretted it.
The issue of biopsies affecting the nerves is the biggest bunch of bull I have ever heard. I had 13 biopsies, treatment and never had a problem with ED.
Since you already have ED and incontinence surgery probably makes sense, but you still need other opinions.
"I will have the best urologist overlooking my operation" I hope this means that he will actually be doing it and not just watching it. Would you rather have Tiger play in a golf tournment or "overlook" someone else that is actually swinging. There is a major difference.

When my uro gave me the news about my biopsy and recommended surgery, my wife and I left the meeting completely convinced that's what I would do. The guy is a very talented Da Vinci surgeon and a very personable and caring guy. I told my wife I didn't even see the point of getting a second opinion.

After a week or two, I re-thought that decision under the encouragement of some on this forum. I'm so glad I did. Not because it necessarily made me change my mind about treatment (although it did), but because I learned so much more from the input. Even if I had still decided to have surgery, it would have been worth it since I would have felt even more confident about my decision.

I don't want to throw a wrench in the works since you've landed on a decision, but it couldn't hurt to slow things down a bit. My two cents and I wish you all the best no matter what you decide. Like it was said above, "we're all brothers in this."

BTW, I've had two biopsies (I realize you've had three) and it wasn't mentioned as having anything to do with nerve sparing. My surgeon indicated that he would remove 15% of the nerve from the right side based on the location of the cancer, but that was all that was mentioned.

With a Gleason 6 and only 1 positive core, I think a 2nd opinion is more than warranted. You very well may not even need surgery.

And I agree with some of the others, this notion of "having too many biopsies to spare the nerves" is utter b.s. in my opinion, never heard or read of that anywhere else in the world of Prostate Cancer.

With advice like that, I would be nervous about this doctor, and definitely want another opinion. There are no re-set buttons once you do a primary treatment. With your stats, you shouldn't be in any hurry to do anything, until you can learn all you can about your situation and your options.

And no need to be defensive, there are dozens of men here, over the years I have been here, that rushed into surgeries and got more than they bargained for in the end, and only wished they had gotten another opinion. Just something to think about.

david in sc

about 8 years ago I had a turp done because of a swollen prostate. Three biophys with 36 holes in my prostate, that's a lot of damaged tissue. The Urologist cannot feel or see the other side of the prostate, nor sample it. It could be worse than the numbers are showing.
I will do some thinking. But radiation will burn my nerves anyway and I would be worse off than before.
I have had a lot of family members damaged by radiation that hastened their death.

My cancer model is: Indolent Cancer 23%
Organ Confined Disease 90%
Extracapsular Extension 7%
Seminal Vesicle Invasion 1%
Lymph Node Involvement 1.3%
My Primary Treatment Outcome
Progression Free Probability after Radical Prostatectomy 5 Year 98%, 10 Year 98%
Probability of cancer Specific Survival 10 year 99% 15 year 99%

I'd say those are pretty good odds.
I have a friend that is 70. He had it done and was glad he did!

Brachytherapy is not a safe thing. If a seed comes loose it could travel thru you body and spread radiation, or lodge in a lung. Plus you are wounding the prostate many times over. No thank you! I got that information from the American Cancer Society

iamretired - I'm just going to call a spade a spade here - you are very opinionated and I for one don't understand as some of the things you are stating are simply, well, incorrect. Believe me I get the anger part, we all go through stages when DX'd with this beast! But stating that Brachytherapy is not a safe thing is simply wrong. In the old days there was a SLIGHT risk of seed migration, but in today's world they use what are called "stranded seeds" and now the risk of seed migration is < 1%. Are you aware of that? Also stating that "radiation will burn my nerves anyway and I would be worse off than before" is not a correct statement. The placement of seeds is very precisely done and in fact the SE's are minimal; if you send an e-mail to me I would be happy to reply with copies of studies that I have purchased and/or downloaded that will provide FACTS to some of the statements you have made. 

You also stated that "The Urologist cannot feel or see the other side of the prostate, nor sample it."  There is another form of biopsy called "Stereotactic Transperineal Prostate Biopsy" that "is performed by taking an average of 40 samples of the prostate through the perineum while the patient is under general anesthesia. Performed as an outpatient procedure, it allows more comprehensive sampling, compared to the transrectal method, which takes fewer samples through the rectum. Unlike random sampling with transrectal prostate biopsy, with the extensive template-guided approach, they are able to identify exactly where the positive and negative specimens were retrieved. This allows for more sophisticated treatment plans for those with positive biopsies, and relief for those patients whose biopsies were negative."

I've been sitting on this post, not sure if I should send it or not - because I absolutely do not want to try to tell you, or anyone else, what to do - we are all different, our cancers are all different, and this is not only a very personal decision but also most probably one of the most important decisions we have to make in our lifetime. But since you're now reading this looks like I decided to hit "Submit" anyway = why? Because I/we CARE for you brother. . . . . . Now I'll apologize for hitting you right between the eyes with the first two paragraphs of this post - but at the very least try to understand where I, and others out here, are coming from. . . . .

Again, Peace - and my very best to you as you continue down this darn path. . . .

Iamretired,

Welcome to HealingWell. I'm sorry to hear about your diagnosis. It's always a kick in the head.

I've hesitated to jump into this thread because you're probably already feeling like everyone is beating up on you. Sometimes that happens here, but only because people care.

I won't add to the chorus of people telling you you're wrong, but I would just like to add that my experience before choosing surgery taught me the value of getting second and third opinions. Although many of us here have a lot of knowledge on this subject, none of us are doctors. Before choosing surgery, I also talked to a medical oncologist who specializes in PCa. If I had it to do over again, I would have also talked to a radiation doc, even though I have the same misgivings that you do about radiation. If you'd like to talk with me about my experience, please feel free to email me.

Second and third opinions are an opportunity to get new information that might change your mind about a course of treatment, or they might confirm your initial inclination. Either way, they're valuable. You don't get a do-over on this, so I urge you to get at least two or three professional medical perspectives and consider them carefully. If those additional perspectives serve to strengthen your commitment to DaVinci surgery, you'll only go into it with that much more peace of mind.

Best of luck to you, whatever you decide. Based on your numbers, it sounds like they'll manage your cancer just fine whatever you decide. Please let us know what you ultimately decide and how you make out.

Best,

Jonathan

Hi all!
I want to thank everybody for their help. My Urologist is with a team of Urologists. They review each other's cases. If this isn't the right thing to do for my health, I will get a call. Also I am going to my MD right after Christmas and ask his opinion. I have been reading about treatments for months. With my health conditions I have to look what would be best for me. I do have time. But if this thing showed up ,when my urologist didn't feel it in July, that tells me something.

Dear Iam:

You have already received a lot of good advice on this thread so, at the risk of being repetitive, I will just emphasize a couple of things:

1.  Assuming you heard your doctor correctly about the biopsy being the reason for non-nerve sparing...that is a load of cr*p.

2.  Your assumptions about brachytherapy are misguided.  Of course there are risks in any treatment but to flatly assume that brachy is "not safe" is a gross mischaracterization and shows lack of being educated on the procedure. 

3.  IMHO, you should definitely speak with physicians who specialize in AS and radiation (including brachy) before reaching any conclusions.

4.  You may want to be the one who lets a junior and inexperienced surgeon work on you while being supervised.  I would NEVER do that.  Let them learn on someone else.  I want the best odds and esperienced practioners give the best odds...I never want to hear, "Oops, sorry about that but please understand that I'm just learning".

Jim