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With the benefit of hindsight would you have chosen a different remedial option

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Posted 12/20/2013 3:49 AM (GMT 0)
I am absolutely convinced that my choices re treatment (IMRT & Lupron) were the correct choices, and that my radiation oncologist choice was one of the best I have made! In hindsight, the picture is even clearer!
Planning to start Provenge as soon as I can get insurance pre-authorization. After that - who knows?
Bob
Posted 12/20/2013 5:35 AM (GMT 0)
Nope. At the time RALP did't really exist. Non-Ralp "keyhole surgery" was still pretty new in the U.S., though being worked on in France. I opted for open R.P. These days I might -- and might not -- have chose differently. But at the time, I'm satisfied I made the right decision based on the state of the art at the time.
Posted 12/20/2013 6:36 AM (GMT 0)
Bohemond,

The options we had are the ones to evaluate. What got accepted the week/month/year after our intervention is irrelevant. Only hindsight is 20/20.

As you did, I made the best choice I saw in the many options I had. I am still here, one year more than the most optimistic doctor predicted.

But I have learned something. That which doesn't kill you will be back to try again tomorrow. You don't get stronger, you just learn to sleep with one eye open.
Posted 12/20/2013 8:56 PM (GMT 0)
I might have chosen RALP over open surgery.
Posted 12/20/2013 9:03 PM (GMT 0)
I can't answer the question honestly. If I did, I would be visited by the nice young men in their clean white suits. :-\
Posted 12/21/2013 2:01 AM (GMT 0)
Tough question.  I am twenty months out and am in the zero club.  I am continent but I must admit that I just don't feel like I did prior to surgery.  I often have vague urgency and am always conscious of my urinary sensation.  I don't wear pads and never leak unless I drink way too much alcohol.  My ED is what is the deal wrecker.  I am a lot better than I was just six months ago.  Pills get me 80 percent or more.  But at 20 months I feel that I am not seeing more improvement.  Sex is more challenging and certainly less spontaneous.  My wife was a  champ when it came to rehab but now that things are "better" she is relieved but at the same time losing interest since the overall experience is just not what it used to be.  I often think about the way I was and wonder if I had never checked my PSA - where would  I be now. I had little disease .  I think if I had it over again I would have looked at AS and more at brachytherapy.   
Posted 12/21/2013 2:49 AM (GMT 0)
No regrets. No reason I could possibly have any, at this point. I was back to work 5 days after surgery. Three weeks after surgery I felt pretty much normal. I'm 11 weeks out and, except for dry orgasms which are odd but fine, I could not tell any difference in my life. As long as I stay in the Zero Club, I gotta count myself very lucky.
Gonna thoroughly enjoy Christmas!
Mikey
Posted 12/21/2013 12:02 PM (GMT 0)
..One thing that I would certainly do different would be to test PSA & DRE earlier. I had a family history, I was fore warned by my Father, my Wife and my Sister to start testing. But me in my infinite wisdom at 38,39,40 while being told, waited till 41 1/2 y/o to finally stop their nagging and prove I am health as a horse, yea a sick horse.. I could of saved myself some trouble with early testing for sure. So any young buck feeling good with family history, go get checked..

.......Appleseed........
Posted 12/22/2013 4:44 PM (GMT 0)
No regrets as to choice of treatment, because I didn't even know what the term "PSA" meant until the day my GP ask me if I wanted a PSA test!! Since Sept. 11, 2012, have put my trust in my doctors the past fourteen months and am in the zero club.

My emotions (now that I've been DX) are ALL OVER THE CHART!! Tomorrow morning, going for my PSA test (been almost three months since last test) and little on the edge only because these past few weeks, been having a lot of pain (again) in my lower to middle back, right hip\BUTT!! Hope all is well and REALLY TRYING TO be positive about this whole ordeal!!

Praying for everyone and think about my HW family very often.

Dave in Bartlett, TN
Posted 12/22/2013 7:54 PM (GMT 0)
I don't know whether I would have chosen a different treatment option. Maybe.

What I certainly would have done differently -- and this may be instructive for those trying to choose a treatment option -- is to have considered my treatment options much more carefully. I wouldn't have dismissed any option out of hand, I would have talked to more doctors, and I would have thought long and hard about the options, particularly brachytherapy.

Hindsight would be a wonderful thing if it had any practical value. The only way it has practical value is to share it. I hope my little bit of hindsight does somebody some good.
Posted 12/22/2013 8:32 PM (GMT 0)
Questions like this are interesting, but not really helpful. Patients that have researched all available options throughly and list all pros and cons before making a decision are the exception and not the norm. Treatment option decisions reflect our beliefs and values and how much value we put on our first doctor's opinion. Since our beliefs and values rarely change it is little wonder that very few would now change their decisions after the fact regardless of the outcome. It would be even rarer for a patient with a successful outcome to favor other options that may have been equally successful.
Posted 12/22/2013 8:50 PM (GMT 0)
Disagree, John. There's nothing like experience. Hopefully, others can benefit from ours, good and bad.
Posted 12/22/2013 11:32 PM (GMT 0)
Phenom,
There are 24 no change, 2 change to less aggressive options and 2 maybe. How is this info helpful? Will any new patient change their opinion based on this?
It only shows that most would not change their decisions regardless of outcomes. It's human nature, and totally expected.
As I mentioned in another post, I would bet someone could design a personality test that could predict with 85% accuracy what treatment option a patient would choose.
Posted 12/22/2013 11:44 PM (GMT 0)
My thought process now jogged by what someone else posted above, I'll amend my previous post. I'd still not change my treatment choice. But the one thing I would change would be to have had regular doctor checkups. I'd ignored having a physical for several years. When I finally went my primary care doc felt something on doing a DRE and the subsequent PSA test came in at 9.4. Maybe if I'd had a physical a couple of years earlier I could have had treatment before I became T3b. But at this point, that's all water over the dam.
Posted 12/23/2013 1:52 AM (GMT 0)
This is an ongoing question for me in that I am scheduled for another year of Lupron (post IMRT <.1) with all of the associated side effects. My G7/no mets suggests intermediate risk (6-12 mo. ADT), but my pre dx PSA of 60 suggests high risk (18-24 mo. ADT). How long should I stay with Lupron?
Posted 12/23/2013 2:03 AM (GMT 0)
PSA - that's a question that only you an your doctor can really answer. To many personal variables in the mix.

David
Posted 12/23/2013 4:04 PM (GMT 0)
I would have been more agressive with my SRT. I had surgery which I don not regret followed by SRT after BCR. I had SRT to the pelvic bed, but would have added the lymph nodes if I had to do it again.
Posted 12/23/2013 4:15 PM (GMT 0)
PSA-60

Great question. This might be wortha telephone or regular consultation with Dr. Scholz or Dr. Lam.

They are up on the very latest research.

Mel

Posted 12/23/2013 4:17 PM (GMT 0)
Thanks, but it is a question that only I can answer. Every doctor I have seen has a different opinion. The only common thread is their reliance on statistical studies rather than specific diagnosis.
Posted 12/23/2013 4:25 PM (GMT 0)
Oh, in answer to the question, absolutely no regrets.

I researched everything and made my choices with the knowledge I had at the time.

As John T. said, our decisions are also a function of our psychological make-up (I am the "get it out" mentality).

But, John T., I also think you are insulting us (not intentionally). You are making it sound like purely an emotional decision. You are doing us a disservice.

I know, despite my emotion stated above, my decision was based solely on logic and the knowledge garnered by my research at the time. I did analyse the data. At that time, I had a world class surgeon available to me in my State. Surgery looked like the most viable option. I won't rehash the pros and cons and the reasons I chose surgery, No brainer. Suffice it to say I did have a list of pros and cons and based my decision on that list.

I was dx. 4 years ago.

Now, if I was in the same situation today, with the current thinking, I would still choose surgery but it is a MUCH closer call given the current state of the art.

Mel

Posted 12/23/2013 4:27 PM (GMT 0)
I would need more information on this hypothetical ability to send information to my past self. Is it a one-time thing? Or can I do it more than once? If I can only do it once then why settle for what I know now? I'd certainly want to wait until I know what my PSA does for the first couple of years after my HT ends. I'd bide my time until I see how happy I am with the sling and implant and whether my cancer recurrs, then I'd hop in my trusty time machine and be able to give my past self more info.

On the other hand, if I could do so repeatedly, I might go back and tell my previous self to try brachytherapy, changing the past and thus the future, and then I'd see how that worked out. If it didn't work either, I'd go back again -- a little farther this time -- and tell my pre-diagnosis self to get a saturation biopsy (and catch the cancer earlier). I would simply live out all the branches of the decision tree and then go back one last time to select the one that works out best.
Posted 12/23/2013 4:44 PM (GMT 0)
Peter:

Well Put!!!

Mel

Posted 12/23/2013 4:55 PM (GMT 0)
Geez, John T, don't take it personally! There's a lot of things in my life I might have changed if possible with the benefit of hindsight. Seems common sense that the experience of actually going through a treatment modality might provide information that if available beforehand could have possibly changed the original decision. It's just a hypothetical question that I tried to answer honestly. Maybe the answers could possibly help a newbie, maybe not, I don't know and you don't know, but what's the harm in asking?
Posted 12/23/2013 4:57 PM (GMT 0)
Not a chance. Very, very happy with the seeds implanted by the renowned Dr. Moran and his capable team at Chicago Prostate Center (commercial plug). :D
Posted 12/23/2013 5:01 PM (GMT 0)

Buddy Blank said...
Not a chance. Very, very happy with the seeds implanted by the renowned Dr. Moran and his capable team at Chicago Prostate Center (commercial plug). :D

Even the answers in the negative such as this one, which happily seem to be the majority, could be useful information to someone struggling with the treatment decision.
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