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Posted 12/19/2015 7:54 PM (GMT 0)
Hello All,My Uro called me with my down grade from John Hopkins.He wasnt that xcited.My Uros group does the Davinci and IMRT.He says even with the down grade he would recommend surgery or a combo,meaning RT and HT.I believe he is concerned about the PNI with the partin table at 60% chance of EPE.Is he a little quick to recommend a combo?.So surgery would be followed by radiation,I suspect.I have been doing all the research thats out here on SBRT, and if radiation seems to be in the works,why have surgery first? The Mrs.thinks the pathology is important after surgery to see what you have.I dont know.I was Dxd Nov.18 and was thinking of late Feb.for treatment.Get thru winter here in Chicago first.

I will be setting up an appointment wit Dr.Andy Su at the CyberKnife Center of Chicago soon.Also another visit with Dr.Shalav,surgeon, at the Univ.of Chicago Medical center.

Has anyone on board here have primary treatment with SBRT in the Chicago area?Thanks in advance,SemperFi
Posted 12/19/2015 9:47 PM (GMT 0)
I agree with you. IMHO, it is insane to have surgery with the intent going into it of having radiation and hormone therapy afterwards. Of course, if surgery fails and one has to have salvage radiation, that's quite a different thing. Whoever recommended such a thing seems to be unaware that the SEs of adjuvant radiation are worse than for primary radiation. I'm glad you'll be talking to a radiation specialist who actually knows about the cancer control and SE one can reasonably expect.

Many people choose surgery for the reason your wife espouses, and if you feel that you can only feel comfortable seeing a pathology report, that's a valid reason. A clean pathology report and undetectable PSAs can give one a feeling of confidence going forward. But what if the path report is not clean and the PSAs are detectable - would you be better off knowing or not knowing? Only you can judge your psychological comfort with it.
Posted 12/19/2015 10:00 PM (GMT 0)
0311,
Allen is the foremost patient advocate on SBRT. I take what he says on it very seriously. I also respect the work at UC at a very high level. I am indirectly tied to that group but they have had one of the very best PCa programs dating back to initial research that brought us hormonal ablation therapy.

Good luck in your decisions. Keep up the research.
Posted 12/19/2015 10:15 PM (GMT 0)
No one have PCa surgery if the intention and hope is NOT to be cured! That would be an unacceptable unethical treatment otherwise. Insane as Allen wrote. Are you sure you didn't misunderstood? Didn't the uro sugest surgery OR combo RT + HT. He can't mean a combo with surgery. The PNI could mean that they cut deeper if choosing surgery or add HT if choosing RT. And about the pathology report, for me it was a strong argument.
Posted 12/19/2015 10:19 PM (GMT 0)
When I started my journey I was leaning toward surgery, but when it became clear that my chances of needing radiation were pretty significant I chose to cut to the chase and have radiation as my primary treatment. (For the record, it's worked out well.) While I'm not a doctor, I think you're on the right track by investigating SBRT.
Posted 12/20/2015 12:45 AM (GMT 0)
Thanks to Tall Allen I had uneventful SBRT over a year ago but it was at UCLA by Dr. Chris King. For Gleason 9 the only choices I know of are LA, NY or Toronto.

Since your are G7, you have a lot more options for SBRT or Cyberknife.

For an unbiased second opinion of your case (not SBRT) I highly recommend Dr. Brian Moran at Chicago Prostate Center. I consulted with him twice before choosing another form of radiation.
Posted 12/20/2015 5:45 AM (GMT 0)
Thank You All very much,my Uro is a well respected Dr.in our area and in his group.The phone conversation he had with me made me believe that surgery was a option but would probably need more.Or a combo,RT,HT.So until I can sit down with him soon and discuss this I just seem alarmed that a combo is being mentioned at my pre therapy consuls.I guess maybe thats good? Dont Know.I agree that if surgery cant give me the best chance for a cure,go to radiation,cut to the chase.I still have a lot more visits to PC Drs.before I make the final decision.Thanks Tall Allen,Nomar,Michae_T,Gemlin.All of your knowledge and insight make a world of difference to me.
Posted 12/20/2015 1:00 PM (GMT 0)
I chose surgery as a G7 (3+4) and wanted the cancer out (and didn't want to risk possible side effects years later with radiation), but pathology post-surgery revealed I was actually a 4+3 with a positive node. At that point I was classified Stage 4 and unfortunately had to go the salvage route with Lupron and IMRT. My point is pathology and node dissection revealed the true and accurate situation in my pelvic bed which you don't have with a biopsy.
Posted 12/20/2015 2:36 PM (GMT 0)
Hello John_TX I understand your decision to have surgery.They say dont look back after the final decision.But I think its human nature to second guess oneself.This is why Im having all the tests I can and if these tests,especially the Prolaris produces a aggressive finding ,this will lead me to SBRT.If you knew of the 4+3 at first biopsy would of you looked into radiation as your primary treatment?Especially knowing radiation was the next step? Thanks
Posted 12/20/2015 2:38 PM (GMT 0)
My surgeon would not operate as there was a very high probability I would need radiation. He simply would not subject me to the additional risks and side effects of the combination treatments.

In addition to SBRT, you are an excellent candidate for High Dose Rate brachytherapy. You have many treatment options that are as good or better then surgery with fewer side effects that you can pursue.

And please understand that at the end of the day there is no advantage of getting the cancer out (via surgery) versus killing the cancer (via radiotherapy). Either way it is gone. Best to get it gone with the least side effects, in my opinion.
Posted 12/20/2015 2:52 PM (GMT 0)

0311 said...
......I still have a lot more visits to PC Drs.before I make the final decision....

Superb input in this thread.

If you need more info and sorting out prior to a final decision I'm thinking you might wish to consider consulting with someone like Prostate Oncology Specialist in Marina Del Ray, Snuffy Myers in Va, or other Prostate Oncologist that doesn't treat but guides your treatment. I have noticed that several posters here have seemed happy with using them.
Posted 12/20/2015 3:05 PM (GMT 0)
JNF,thank you for your insight.I must explore these options to the fullest.Im for the least side effects and kill the SOB.Unless you have PC,most men if not all will never know what we are up against.This stage of finding a cure of which method to use is a real challenge.And believe me all you guys here on HW are giving me an education and a lot to think about.

I just talked to a Marine Nam buddy of mine that has PC ,Dxd 2yrs ago.He had a PSA of 19,they gave him RT,40 some treatments.I asked him what his gleason score was,he said he didnt know.He said his last PSA was 2.7 and he is doing good,no more treatments.I mentioned HT and SRT and he didnt know what I was talking about.Knowledge is power.And to all my new Brothers thank you for giving me the knowledge to fight this,a Big Thank You.SemperFi
Posted 12/20/2015 7:56 PM (GMT 0)
Ken,that is a very good suggestion.In my signature you can see I was down graded from John Hopkins.The first path report from QUEST was a 3+4,3+4,4+3.I still have a 7, a 3+4 from JH.The upgrade helped but how significant? My PCA3 was 38 with a PIRAD 4 ,so Im putting a lot of weight on the coming Prolaris.It was mentioned that 40-50% path is up graded to a higher Gleason score after surgery.I already feel,gut feeling that the stats are pointing in 1 direction.So it seems like skipping surgery and get on with it might be the therapy of choice.Decisions,this cancer, is like a combat patrol,its like do we take this trail or that trail. ,or no trail,trust the man with the experience.Some make it to the end of that trail, some dont.You always need to weigh the options.VA dont give away money for nothing.They classify PC from Agent Orange as a life threatening cancer.Thats a big wake up call.I have always been a glass half empty guy rather than a glass half full.Its just me.There it is,as we used to say.SemperFi,
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