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oncologist put options to me by life span expected my T2C how do I pick?

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Prostate Cancer
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Posted 2/1/2013 11:23 PM (GMT 0)
I'm sorry guys, and gal. I'm not hysterical. I'm sure my prose is deficient. I am keeping a diary of all the notes and grouping by recommendations. Interestingly enuf, doctors and recommendations are coonciding! not a surprise. There is a very stable proven treatment based on age, health, etc

I might add, I have a low white cell count noone knows why but it has been low for 20 years. My first notice of ED was when I was 40! gee thats a long time ago. But I can still make it work, but sure not on my critical path. My sugar diabitus is well under control, 1/2 hour power walk a day and keep the carbs in small doses. I am losing weight, doc was concerned about that. I said hard to generate an appetite when one studies onces own mortality.
I Think ya'all will see My MBA and finance rearing its head here. I was always aggressive, slow down was not in my vocab. But analysis I can do I assure ya'all.
Posted 2/2/2013 8:16 AM (GMT 0)
I have spoke to 4 doctors now who have reviewed the path report.
They said Trimodal is the way to go that, diabetic heart attack guys had best stay away from surgery, as I would need surgery, AD, and radiation, and it may be too much.
They said don't get seed placement without markers. That is the standard now. don't get surgery, but if you do select a surgeon with 500 surgeries under his belt, and don't do laproscopic, stick with devinci.
with IMRT, the seeds would not be necessary one doctor said.
They can place the gold fiducery markers at the urology office then the treatments can start(Painful). Most the docs want ADT to start now. MD Anderson does not want an MRI here. They want it down there with the coil rectal scan. I have appoint with my cardio doc to JUST check for a surgery clearance in case? My confidence is a little rattled, most docs say they don't see all the quadrants positive. but in my case every core is black. But they didn't mark down the 8 cores that were negative?
Posted 2/2/2013 3:32 PM (GMT 0)
So Berdoo, when do you sleep???  tongue

Glad to see that you continue to be more focused!

Posted 2/2/2013 4:55 PM (GMT 0)
I sleep really good, but yeah I do take on projects and blow people away! But I have always believed knowledge is power, I have friends that don't know what their psa was what their gleason , what the slides looked like, they just trusted the doc and did what he said? is ignorance bliss? won't work for me. I spoke to the chief of surgery at Loma Linda, and the chief of urology san diego navel hospital! man I got my basses covered and the onocologist at Chicago prostate center. I'm definietly gonna know my options before the scans.
Posted 2/2/2013 5:21 PM (GMT 0)
Ber:

So, it sounds like surgery is off the table?

At least that narrows down the choices

Mel

Posted 2/2/2013 6:48 PM (GMT 0)
yes, age, diabitus, heart attack, stents, low white cells. and the biggy is Chicago doc said based on path there is a 60% chance PC has surrounded the capsil? here they say a 20% chance. why the differ opinion ? I don't know. Radiation after surgery is a tuff road to follow.
So here they are proposing trimodal, as my 7 is aggressive , 8 cores in all quadrants positive. and psa 10.4 so 8-9 months od ADT, then 2-3 months of external beam. and conclude with a brachy seeds. they dont have fiducial markers here, so I may slip away to a better place for that. and they only do 3 brachy a year, so notta for me. I would probably do the brachy at the chicago prostate center (a chance to go to a blues club!) Now I have an appointment at MD Anderson and they are BIG guns in the fight. At this point I am doing what the doctors say. I am paying them. You guyes advice is cooinciding. mostly. NOw a mystery for me is if Protons can be in the game at all.
Posted 2/2/2013 7:09 PM (GMT 0)
I wouldn't think 50 surgeries is enough experience for most procedures, esp prostate surgery. I haven't read all your responses, but you might want to consider a second opinion by another surgeon who has more experience. In addition to the other treatments offered, there is also proton beam to consider.
Posted 2/2/2013 7:22 PM (GMT 0)
One observation: It is starting to sound like all of your options start with ADT. If that is true then you could go ahead and start that as soon as you are done with the diagnostic tests that they like to run before starting HT. With your high-volume aggressive G7 and your highish PSA I don't see any way around hormone therapy for you, no matter what else you decide to do. If your doctors concur you can start that while you continue to collect data to sort out brachy vs protons vs EBRT vs HIFU or whatever else catches your fancy.
Posted 2/2/2013 9:09 PM (GMT 0)
yup, peter, precisely what the doctors say. 8 - 9 months ADT then 2-3 months Ext beam then conclude with brachy. but my second opinion at MD Anderson will help finalize an approach. The may even decide I am a candidate for protons? that would be nice. I have always been a fan but most docs I talk to are not a fan? go figure. My urologist surgeon here said surgery is no problem, even though he has only done 50 laproscopic. My cardi appoint is tuesday, it his will be his decision if surgery is even an option? It's all about the scans next friday!!!
Dr. Moran. He would recommend trimodal theapy (hormones, external radiation and implant) over surgery. The reason is because with your pathology the likelihood of needing post surgery external radiation is approximately 60%. And getting the radiation after surgery definitely increases your complications.
If you decide to go forward with trimodality treatment you could have the external radiation in your area (51/2 weeks) and then come here for your implant. ( 3 seed implants a year is not a good thing. We do 600-700 per year.
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