Should we go outside of state for surgery

You should go where ever, to who ever you think is the best and who you trust the most to do the right thing.

Andrew

Kit, first of all, try to slow down and take a deep breath. Seriously.

You don't say what state you're in (besides confusion and anxiety), or what facilities are available to you, so that would help us.

With a 3+4 primary diagnosis--and when Epstein reports in, you'll have a real understanding--you are blessed with having time to examine all the options.

You really should look into other treatment options than surgery. And, regardless of which treatment you choose, you need to find someone who is highly experienced. For surgery, you want someone who has done thousands of them, not dozens or hundreds. Similarly with the radiation options, find someone who has a lot of experience--and be willing to consult with experts in each of the various 'flavors' of radiation therapy.

If you don't know where else to start, google "NCCN centers of excellence", and go to the nearest one to you. They can set up multiple consults with their inside experts in each treatment program they offer.

Seriously, it's not the end of the world. As we've said often in here, PC, particularly in the intermediate risk categories--which is where you are--is far from the immediate action/potential death sentence that other cancers are. If the G3+4 is confirmed, treatment is needed, but not next week.

Did you get Epstein's second opinion yet? That's important.

I agree with Halbert above, to an extent. G7(3+4) is low intermediate risk, and you likely will see your husband live for many more years, even decades depending on his age, and health aside from PC. You should investigate radiation, unless you have already. I'm a surgery guy, not saying you shouldn't do surgery. but it's important to understand all options, and you have many.

With that said, the comment about bulging at the capsule, indicates that the tumor may (not definitive, but possible) be about to, or already has escaped the prostate capsule. For that reason, I would...
1. Be measured about your decision but Not take An inordinate amount of time before treatment
2. Ask the surgeon (and any radiation oncologists you meet with) whether surgery is a really a good idea, considering the possibility of extra prostatic extension (escape from the capsule).

I don't want to alarm you further, and there is no reason to panic, although it's normal, most of us have panicked at time of diagnosis, just stating what you should be aware of.

Remember however, in the end, it's gonna be ok. You guys will deal with it, and move on. Life will still be good. We've all gone through what you are going thru, and we're still here. Most if us many many years later.
Prostate cancer might make his life tough for a while, but it isn't gonna kill him. He's going to be ok. So take a breath and tell him to do the same

Kit,

I had my surgery at Barnes-Jewish in St. Louis, and had a great outcome. I'm pretty sure they are doing SBRT, as well as brachytherapy there at Siteman cancer center. Depending on where you are in Arkansas, you could also check out MD Anderson in Houston, or Vanderbilt University in Nashville.

KIT: As many have already said "slow down, take a deep breath or two and begin to learn.
Surgery may be an option but if the cancer is at the margins you could just be looking at surgery and then radiation which usually carries heavier SE's than just radiation. There are multiple TX options available to someone with the pathology you have posted. You keep stating "we just want this out" well that is understandable but be sure that it can be "GOTTEN OUT".

You have some time to learn and make the best choice. DO NOT RUSH into something you don't yet fully understand.

May the two of you be well.

Roger

Kit, let me say again: slow down. Here's what my diagnosing Urologist told me, based on my biopsy which was all G6--but even so: He said, "you have several months to make a decision. Use it." Yes, my surgery pathology came back at G7, but that is because PC is multifocal, not because it was expanding over the few months between biopsy and surgery.

Walsh is an excellent guide--as far as he goes. His book is very out of date. Lots of people in here travel for treatment. Sometimes across country--or across the world.

Heck, I did. I lived in rural east-central Illinois, where my only local option was open (non-robotic) surgery. Clots are a rare side effect, and they don't happen with radiation at all. IMO, in the future the standard of care for low-to-intermediate risk PC will probably be some future enhancement of SBRT, where they plant fiducial markers inside the gland and give 5 radiation shots over a 2 week period. If it hadn't still be brand new where I was at the time 3 years ago, I would have seriously considered it.

You're rushing into an emotional decision--get down off the ledge and get really good answers from real experts. You have the opportunity to do it--as others have said, you have one chance to get it right. With PC, it's actually pretty common to take several months between diagnosis and treatment. He'll be fine.

SLOW......SLOW down. PLEASE take a breath.

Roger

Concern about out of state is ridiculous. This is the United States. Please do not be defined by your insurance. You are on the low risk side and close to Medicre. That opens up treatment choices as you are no longer bound by networks.

Please slow down and understand that time is on your side.

kit: I wish only the best for you and your husband but I don't hear/read anything from you that sounds like you are listening. YOU, not someone or something else needs to become your own best advocate. You now have the chance to NOT be one of those that will say later "gee I wish I had listened and learned more"

Please slow down and learn "FOR YOURSELF" what you need to know.

Roger

Geezzzzz I wish I could be so dark and obtuse but then I could be accused of being intelligent Hmmmm?

Fine thinking and words LOGO if only they could/would be followed.

May all beings be well and free from oppression.

Roger

I recommend you get Medicare A, B, D, & F, rather than a Medicare Advantage plan. That will allow you to go anywhere for treatment. I have found very few doctors who won't take Medicare if a supplemental plan is included.

You are probably within a day's drive of Dallas. Robert Timmerman at UT Southwestern can do SBRT. It's a short plane ride away, but for brachytherapy, Steven Franks at MD Anderson is very good, or Gregory Merrick at Wheeling Hospital, West Virginia would be another good choice. For HDR brachytherapy, maybe JNF's doctor in Atlanta. There are good, experienced surgeons at almost every major tertiary care hospital. Very few, like Vipul Patel in Orlando are in private practice.

When I was first diagnosed I started psychotherapy and learned the practice of Mindfulness-based stress reduction. It's very easy to learn - it just takes practice until it becomes a habit of mind. For me, that took about 2 months of daily practice. It helps one stay focussed on the present moment rather than grow anxious from the mind racing ahead to imagined future scenarios. There are classes available in almost every city these days.

555j Not computing the dark and obtuse....but thanks...btw I do try to follow it...in spite of Yoda...to try is to do....