Recently diagnosed - seeking advice

Hello Everyone,
I'm 54 and was recently diagnosed in June after Artemis biopsy at Stanford with the following results:
6/20 cores (3+3) <5%, 10%, 70%, 25%, 20%, 20%
2/20 cores (3+4) 50%(10% pattern 4), 70% (30% pattern 4)

Prior to the biopsy, I had multiplanar, multisequence MRI of the pelvis, including diffusion, T2, and DCE that revealed an 11 mm lesion on the right posterolateral peripheral zone at the apex. This is the area of the (3+4).

My PSA's leading up to the MRI were:

01/31/2017 4.99
12/16/2016 5.77
10/24/2016 4.78
08/24/2016 4.13
03/14/2014 3.59

I don't have any symptoms and I'm in excellent health otherwise (although I've notice some recent weight loss possibly due to stress)

I met with the oncologist who did the biopsy and he recommended RALP, which is his area of practice. He has performed about 250 surgeries over the past 4 years (he assisted in about 150 surgeries the prior 2 years). Are 250 surgeries sufficient to develop the skills needed to perform the delicate nature of this kind of surgery? He wouldn't allow me to speak with any of his past RALP patients, citing privacy concerns. Is this typical? I read a paper from
a JH surgeon who said that he recommends that his potential patients speak with his former patients.

I'm meeting with a radiation oncologist in a few weeks to see if SBRT is a possible treatment. From what I've read, SBRT seems to have similar results as RALP without the inconvenience and complications of surgery, but with similar side effects effects. Is SBRT generally recommended for older patients or those with certain types of tumors?

Does anyone have recommendations for RALP surgeons in the Nor Cal area with more experience? I was initially leaning towards SBRT, but I'm not sure if SBRT is recommended for someone with my Dx and background.

How many surgeons should I speak with? The oncologist recommends that I have treatment within 3-6 months.

At times there are literally so many thoughts going through my head that it's overwhelming and other times I feel fortunate that this was detected early and that I'll be able to beat this beast.

I would appreciate any feedback or advice on my choice of treatment given my Dx and background.

Thanks.

You have time to figure out your best course of treatment. Regardless of which one you choose you want the Dr. that has a wealth of experience. Your question, "Are 250 surgeries sufficient..." The long and short answer is NO. You want someone who has done thousands... You have one bite at the apple so to speak, so you want the best you can afford.
Take care, stay in touch. This forum is a tremendous resource.
All the best.

Welcome to HW, sorry you need to be here.

Kick in the head, isn't it?

Jim's post is a great summary of things to consider.

Good news, those numbers are treatable. You have time to make an informed decision. SBRT is a great option. Stanford and UCSF are likely two of the best places in Nor Cal for treatment.

Bad news, choosing a treatment plan will drive you crazy. There are tons of options and it's not always a clear cut choice between them.

Ask all the questions you have,
we're here most days,
Andrew

Hi John,
Sorry you're here. But here is where you get a lot of support and good people who are fighting the same battle. The suggestions made by Tudpock18 are right on target. Its one of the most confusing projects you'll probably ever undertake in your life. But you'll get throught it. Take some time. Research. Ask questions. Do your homework. You want to be sure of your choice. As others have said, thousands or more procedures would be a good number to consider a doctor proficient. And if he doesnt want to let you speak to his patients, theres a reason. Dump him. Be your own advocate. Its your life. Its your fight. Get the best for yourself. Take a deep breath and take the time you need to make a decision. At GS7, you have an excellent chance fighting this.
My first post on here was "GS9 and overwhelmed". I was much more able to breathe once I made my treatment decision and stuck to it.
Good luck brother
Dennis

Hello John,

I'm 64, a 4+3, and will be getting surgery tomorrow. My two cents are, a surgeon that has done about 250 is a beginner. Here in Chicago I researched the top two and both have done around 4000. I also wanted to go with the most prestigious teaching hospitals. I went through two months of exploring all options before deciding on surgery, but what you''ll find here is that every guy's case is unique.

If I were you, I would concentrate on men your own age with the same Gleason score. To me that would be logical and find out what they chose. You can also private message them and have a phone call, I found that useful.

When I considered brachy, the uro who owned the clinic said he would provide me a couple of email addresses of satisfied patients and they never got back to me. I believe HIPPA precludes doctors from giving out a list of names.

You're quite young to have gotten this and your time horizon of longevity will factor in to which treatment to consider.

Best of luck,

Nick

My MD Anderson surgeon has performed over 2,000 RALP procedures - he usually does two a day. I also asked if he hands off the console to a resident for opening and closing. Nope - he's at the controls for the entire surgery. He's highly skilled and I've had practically zero continence issues.