Recent dx of Prostate Ca

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Timlong
Timlong Member Posts: 42
edited November 2011 in Prostate Cancer #1
Hello everyone. I'm new to the site so here goes.
I am 51 and in good health. The lab report which was included with an "approved" life insurance policy binder indicated a PSA of 22. My family Dr. was suprised the policy was approved and did new blood work which confirmed PSA 22. So I got plugged into the system and here it is:

Findings:
PSA 22
12 of 12 POSITIVE
4 plus 5 GLEASON 9
Scan is negative for obvious metastisis (Does not rule out Micro)
Prostate is normal size with palpable mass

Plan of attack:
Consult with Dr. Eun at Phila. Penn
Refers to this as the "Tiger"
Started Lupron 2 weeks ago pre surgery
Non-nerve sparing RP scheduled in late December (hohoho) DiVinchi
Along with nerve bundles...Lymphnode Dissection in pelvis and bladder neck area.
Post surgey plan is radiation with Lupron therapy.

Dr. Eun has indicated a high chance of Metastatic desease and a high risk of PSA recurrance.
He states we must "through the book at it"
How does this plan sound to you guys? Tim
«13

Comments

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,343 Member
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    Well
    My opinion as a non medical professional.

    If your cancer has metastatized, surgery is not appropriate, since you will also have to also have radiation. Each of these procedures have negative side effects which will be compounded. Consider radiation with lupron therapy, no surgery. The surgery is not necesssary.

    Also consider having an Endorectal MRI with a Tesla 3.0 magnet, a diagnosis test to see if there is extratcapular extension.
  • Timlong
    Timlong Member Posts: 42
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    Well
    My opinion as a non medical professional.

    If your cancer has metastatized, surgery is not appropriate, since you will also have to also have radiation. Each of these procedures have negative side effects which will be compounded. Consider radiation with lupron therapy, no surgery. The surgery is not necesssary.

    Also consider having an Endorectal MRI with a Tesla 3.0 magnet, a diagnosis test to see if there is extratcapular extension.

    It seems to me that removing
    It seems to me that removing the source and then dealing with what could be microscopic metastisis or not if the margins are neg, would be less chance of PSA recurrence dont you think?

    Tim
  • hunter49
    hunter49 Member Posts: 246 Member
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    Timlong said:

    It seems to me that removing
    It seems to me that removing the source and then dealing with what could be microscopic metastisis or not if the margins are neg, would be less chance of PSA recurrence dont you think?

    Tim

    Sorry to see your a new
    Sorry to see your a new memeber. You have other options. I would not do such a radical surgery or any surgery at all with your current diagnosis. The cancer almost gauranteed escaped. Taking away your quality of life will not help you. It may be better to treat this with HT and radiation. Also diet will play a big part. Get a second opinion from another good cancer center (I would recomend Hopkins ). I can get you a number there for an a clinic diagnosis meeting they do monthly for newly diagnosed. They will review your pathology to confirm biopsy Then you meet with their top doctors in surgery, oncology and radiation. You may even qualify for a clinical trial. But surgery is the last thing I would choose. I just had nerve sparing surgery 2 weeks ago but was much lower risk of it escaping the gland. Final path upgraded the gleason score but was all confined and not muti-focal. Good luck my friend and please let nme know if I can help.
  • Kongo
    Kongo Member Posts: 1,166 Member
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    Timlong said:

    It seems to me that removing
    It seems to me that removing the source and then dealing with what could be microscopic metastisis or not if the margins are neg, would be less chance of PSA recurrence dont you think?

    Tim

    It sounds "logical" that removing the "source" might be a good idea but I would encourage you to seek second and third opinions on this. Removing the prostate at this point is not going to do anything to stop the growth of cancer elsewhere in your body. It's only going to give you additional side effects to deal with. Prostate cancer tends to grow faster once it leaves the prostate gland and it travels through the blood and lymph system.

    If you're worried about the "source" I would look into radiation techniques such as SBRT or IMRT that completely radiate the entire prostate.

    Remember that it's not PSA recurrence your're worried about...it's cancer recurrence. PSA is just one of several indicators that might signal the presence of cancer. PSA recurrence or a risking PSA after RP is an indication that cancer is continuing to grow outside the prostate.

    K
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,343 Member
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    Timlong said:

    It seems to me that removing
    It seems to me that removing the source and then dealing with what could be microscopic metastisis or not if the margins are neg, would be less chance of PSA recurrence dont you think?

    Tim

    Also, a cutting edge diagnosis test -USPIO in Fl. for extra
    capular extention in the lymph nodes


    http://csn.cancer.org/node/227353
  • rch
    rch Member Posts: 79
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    New Prostate cancer Dx
    Sorry to hear about the diagnosis. If you ARE going to have the surgery, I would check with the Surgeon if open radical Prostatectomy would be better than Robotic in your case, since the Surgeon can actually touch and feel the capsule and the lymph nodes , and remove whatever feels suspicious. With Da Vinci, the Surgeon does not feel or touch any organs. Please discuss with your Surgeon. That is my opinion.
  • Timlong
    Timlong Member Posts: 42
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    rch said:

    New Prostate cancer Dx
    Sorry to hear about the diagnosis. If you ARE going to have the surgery, I would check with the Surgeon if open radical Prostatectomy would be better than Robotic in your case, since the Surgeon can actually touch and feel the capsule and the lymph nodes , and remove whatever feels suspicious. With Da Vinci, the Surgeon does not feel or touch any organs. Please discuss with your Surgeon. That is my opinion.

    My friend Tim
    My name is Jeff and I've posted on behalf of Timlong. He reads the responses but wants me to do the posting. Not sure why... but I'm his best friend (35 years) so I'm with him on this journey. His surgery is scheduled 12-28-11 at Penn. In reading various posts I've convinced him to have a second opinion which is scheduled this Thursday at Fox Chase. I dont quite understand why the Penn crew wants to "go wide" in an attempt to get good margins without first doing a biopsy on the surrounging structures. "Going wide" as you see in may first post means Prostate, nerve bundles, lymph node beds in pelvis and bladder area. With his numbers of PSA 22, Gleason 9 (4+5 and 5+4),neg scans and 12 of 12 positive are they assumming the "Tiger" has escaped or is there a chance of containment. This Gleason 9 tumor is palable but nothing in the scan shows up in the lymph or Seminal Vesicles yet we are "throwing the book at it and going wide with radiation and HDT afterwards" according to Penn. If we hear a different plan from Fox Chase then Tim may want to get a third opinion at John's Hopkins. I've read alot about people with these numbers electing no surgery and going with HDT and radiation only. The problem here is if the "Tiger" wakes up they will not do RP because they can't get good surgical planes post radiation. I'll let you guys know what Fox Chase says and in the meantime any feedback or opinions will be most welcome.

    Thanx everyone..Jeff for "Timlong"
  • Kongo
    Kongo Member Posts: 1,166 Member
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    Timlong said:

    My friend Tim
    My name is Jeff and I've posted on behalf of Timlong. He reads the responses but wants me to do the posting. Not sure why... but I'm his best friend (35 years) so I'm with him on this journey. His surgery is scheduled 12-28-11 at Penn. In reading various posts I've convinced him to have a second opinion which is scheduled this Thursday at Fox Chase. I dont quite understand why the Penn crew wants to "go wide" in an attempt to get good margins without first doing a biopsy on the surrounging structures. "Going wide" as you see in may first post means Prostate, nerve bundles, lymph node beds in pelvis and bladder area. With his numbers of PSA 22, Gleason 9 (4+5 and 5+4),neg scans and 12 of 12 positive are they assumming the "Tiger" has escaped or is there a chance of containment. This Gleason 9 tumor is palable but nothing in the scan shows up in the lymph or Seminal Vesicles yet we are "throwing the book at it and going wide with radiation and HDT afterwards" according to Penn. If we hear a different plan from Fox Chase then Tim may want to get a third opinion at John's Hopkins. I've read alot about people with these numbers electing no surgery and going with HDT and radiation only. The problem here is if the "Tiger" wakes up they will not do RP because they can't get good surgical planes post radiation. I'll let you guys know what Fox Chase says and in the meantime any feedback or opinions will be most welcome.

    Thanx everyone..Jeff for "Timlong"

    Tim, Jeff, or Whomever ...
    Not sure I get this posting sequence but whoever has the cancer you describe here is faced with some difficult choices. I read recently that more than 80% of the men diagnosed with prostate cancer do not seek second opinions and go with the recommendations of their original diagnosing urologist. It is smart that he is having a second opinion here.

    My opinion is that the cancer you describe (I am assuming that it is adenocarcinoma) is well advanced and undoubtedly metastatic, bone scans and x-rays notwithstanding. The aggressive approach Dr. Eun suggests with surgery is unlikely to find a cancer contained in the prostate. It is palpable indicating that he can feel it and it appears to be present throughout all areas of the prostate. The 4+5=9 assessment of the Gleason score indicates an advanced and poorly differentiated form of prostate cancer for a man only 51 years old. Even a wide surgical margin is likely to cut across the cancer and contribute to spilling more cancer cells into your friend's system. Although you don't describe all the details of the biopsy report that address PNI or extra capsular extension the presence of these indicators in the context of the rest of the biopsy are likely predictors of metastasis (although in and of themselves they are not). This is why the doctor is saying there is high risk of metastatic cancer and recurrence regardless of the initial treatment course.

    The course of surgery and radiation will not stem the spread of this cancer outside the prostate. I would suggest your friend take additional tests involving bone marrow aspiration to look for evidence of prostate cancer. If it is present there (and i suspect that it is likely that it is there) I would urge your friend to cancel any plans for surgery or radiation.

    The hormone therapy will arrest the growth of the prostate cancer by depriving the cancer cells of testosterone. The median doubling time of prostate cancer is 475 days. A regimen of hormone therapy for a year and a half is going to allow those cancer cells that need testosterone to avoid apoptosis to die without mitosis. Some of the prostate cancer cells, particularly those that are very poorly differentiated and primitive compared to when it first starts, will either generate their own testosterone or not require it to continue to divide and hormone therapy is not effective for these although chemotherapy might be.

    While some may well argue that "throwing the book" at this cancer is prudent, my opinion is that your friend should seriously consider the potential impact on his quality of life if all of these potential treatments are piled on top of one another. My impression, from reading many papers on this is that there is only a small, incremental increase in total long term survival as a result of actions such as surgery or radiation for advanced prostate cancer. Tough decisions all around.

    Best of luck to your friend as he sorts this out.

    K
  • VascodaGama
    VascodaGama Member Posts: 3,689 Member
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    Kongo said:

    Tim, Jeff, or Whomever ...
    Not sure I get this posting sequence but whoever has the cancer you describe here is faced with some difficult choices. I read recently that more than 80% of the men diagnosed with prostate cancer do not seek second opinions and go with the recommendations of their original diagnosing urologist. It is smart that he is having a second opinion here.

    My opinion is that the cancer you describe (I am assuming that it is adenocarcinoma) is well advanced and undoubtedly metastatic, bone scans and x-rays notwithstanding. The aggressive approach Dr. Eun suggests with surgery is unlikely to find a cancer contained in the prostate. It is palpable indicating that he can feel it and it appears to be present throughout all areas of the prostate. The 4+5=9 assessment of the Gleason score indicates an advanced and poorly differentiated form of prostate cancer for a man only 51 years old. Even a wide surgical margin is likely to cut across the cancer and contribute to spilling more cancer cells into your friend's system. Although you don't describe all the details of the biopsy report that address PNI or extra capsular extension the presence of these indicators in the context of the rest of the biopsy are likely predictors of metastasis (although in and of themselves they are not). This is why the doctor is saying there is high risk of metastatic cancer and recurrence regardless of the initial treatment course.

    The course of surgery and radiation will not stem the spread of this cancer outside the prostate. I would suggest your friend take additional tests involving bone marrow aspiration to look for evidence of prostate cancer. If it is present there (and i suspect that it is likely that it is there) I would urge your friend to cancel any plans for surgery or radiation.

    The hormone therapy will arrest the growth of the prostate cancer by depriving the cancer cells of testosterone. The median doubling time of prostate cancer is 475 days. A regimen of hormone therapy for a year and a half is going to allow those cancer cells that need testosterone to avoid apoptosis to die without mitosis. Some of the prostate cancer cells, particularly those that are very poorly differentiated and primitive compared to when it first starts, will either generate their own testosterone or not require it to continue to divide and hormone therapy is not effective for these although chemotherapy might be.

    While some may well argue that "throwing the book" at this cancer is prudent, my opinion is that your friend should seriously consider the potential impact on his quality of life if all of these potential treatments are piled on top of one another. My impression, from reading many papers on this is that there is only a small, incremental increase in total long term survival as a result of actions such as surgery or radiation for advanced prostate cancer. Tough decisions all around.

    Best of luck to your friend as he sorts this out.

    K

    "Second Opinions" is a must do thing in Prostate Cancer
    Timlong

    It seems that your doctor has recommended you the “Mother of all Therapies”, with no explanation on the consequences. Radical Prostatectomy with adjuvant Radiotherapy is a treatment from the 19th, when surgery was considered the “golden” standard to treat prostate cancer. In this “century” newer modalities of treatments have surged getting results on the same levels of standards and in successes.
    In fact the two ways for treating PCa, surgery and radiation, do not complement each other but get to the same levels in outcomes, independently. Both are good in contained cases (the whole cancer is laying within the prostate gland) but surgery loses any advantage in localized cases because it cannot assure a total “removal” of the cancer. High risk patients have still other ways of treatment such as Brackytherapy (HDB or Seeds) with long standing successful outcomes.
    I hope you inquire about this in your next visit to the doctor.

    At 51 years old you tend to lose a lot if your decision is simple based on one solo opinion. I would scrap the scheduled surgery and do more researches before committing. Postponing the treatment by one month would not change the present status and it would provide you the time to get second opinions with specialists in each type of treatment (two or three). You could also do other tests to certify your real diagnosis, as commented above by Hopeful.
    I would recommend you to get some sort of understanding about the risks and side effects from each treatment. Many become permanent affecting your quality of life. (Cured but handicapped)

    Radical therapies are the norm in young patients (long life expectancy). Nevertheless, hormonal treatments are also recommended for cases were the choice may not assure “intent at cure”.
    HT is palliative but it can hold the advancement of the cancer in long periods (years). You could discuss with your doctor about the possibility of starting now HT and doing a radical latter.

    Wishing you peace of mind.

    VGama
  • Timlong
    Timlong Member Posts: 42
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    "Second Opinions" is a must do thing in Prostate Cancer
    Timlong

    It seems that your doctor has recommended you the “Mother of all Therapies”, with no explanation on the consequences. Radical Prostatectomy with adjuvant Radiotherapy is a treatment from the 19th, when surgery was considered the “golden” standard to treat prostate cancer. In this “century” newer modalities of treatments have surged getting results on the same levels of standards and in successes.
    In fact the two ways for treating PCa, surgery and radiation, do not complement each other but get to the same levels in outcomes, independently. Both are good in contained cases (the whole cancer is laying within the prostate gland) but surgery loses any advantage in localized cases because it cannot assure a total “removal” of the cancer. High risk patients have still other ways of treatment such as Brackytherapy (HDB or Seeds) with long standing successful outcomes.
    I hope you inquire about this in your next visit to the doctor.

    At 51 years old you tend to lose a lot if your decision is simple based on one solo opinion. I would scrap the scheduled surgery and do more researches before committing. Postponing the treatment by one month would not change the present status and it would provide you the time to get second opinions with specialists in each type of treatment (two or three). You could also do other tests to certify your real diagnosis, as commented above by Hopeful.
    I would recommend you to get some sort of understanding about the risks and side effects from each treatment. Many become permanent affecting your quality of life. (Cured but handicapped)

    Radical therapies are the norm in young patients (long life expectancy). Nevertheless, hormonal treatments are also recommended for cases were the choice may not assure “intent at cure”.
    HT is palliative but it can hold the advancement of the cancer in long periods (years). You could discuss with your doctor about the possibility of starting now HT and doing a radical latter.

    Wishing you peace of mind.

    VGama

    Tim's Second opinion at Fox Chase
    Tim met yesterday with Fox Chase and was told that they would make a decision on surgery after an Endo Rectal MRI. They want this study to see if the Ca has spread to the rectum or other surrounding structures. If it has spread and depending to what extent they may not recommend surgery and the treatment would be radiation and HDT. Penn did not do this study nor even suggest it. When we called Penn on this Tim was told this is " an old technic" but if he wanted to they would order it. Seems like some surgeons prefer it and some dont. Seems to me it is very useful in determing to go with surgery or not. His procedure is set for the 23rd at Fox Chase.

    Looking for feedback.......Jeff
  • Kongo
    Kongo Member Posts: 1,166 Member
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    Timlong said:

    Tim's Second opinion at Fox Chase
    Tim met yesterday with Fox Chase and was told that they would make a decision on surgery after an Endo Rectal MRI. They want this study to see if the Ca has spread to the rectum or other surrounding structures. If it has spread and depending to what extent they may not recommend surgery and the treatment would be radiation and HDT. Penn did not do this study nor even suggest it. When we called Penn on this Tim was told this is " an old technic" but if he wanted to they would order it. Seems like some surgeons prefer it and some dont. Seems to me it is very useful in determing to go with surgery or not. His procedure is set for the 23rd at Fox Chase.

    Looking for feedback.......Jeff

    Old Technic?
    Jeff,

    Not sure what Penn means when they say "old technic." For a discussion on using various tests on the bone marrow as a decision point for surgery or not I would recommend your friend read Chapter 10 of "The Big Scare: The Business of Prostate Cancer" by Dr. Anthony Horan. It may be available in your local library but I downloaded my copy from Amazon.

    K
  • VascodaGama
    VascodaGama Member Posts: 3,689 Member
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    Kongo said:

    Old Technic?
    Jeff,

    Not sure what Penn means when they say "old technic." For a discussion on using various tests on the bone marrow as a decision point for surgery or not I would recommend your friend read Chapter 10 of "The Big Scare: The Business of Prostate Cancer" by Dr. Anthony Horan. It may be available in your local library but I downloaded my copy from Amazon.

    K

    "Old and Bald" may be the surgeon
    You are doing the right thing. The E-MRI (with resolution ts3) may find spread of cancer which would alter your friend's clinical stage. This tests may be the best actual technic to find localized cancer.
    I still believe that your friend should know about the risks and side effects before any commitment. In PCa, the best diagnosis leads to the best choice of treatment and to success. Do the investigations and make a decision timely.
    Do not rush but act coordinatly.

    Merry Christmas to both of you.

    VGama
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
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    Timlong said:

    Tim's Second opinion at Fox Chase
    Tim met yesterday with Fox Chase and was told that they would make a decision on surgery after an Endo Rectal MRI. They want this study to see if the Ca has spread to the rectum or other surrounding structures. If it has spread and depending to what extent they may not recommend surgery and the treatment would be radiation and HDT. Penn did not do this study nor even suggest it. When we called Penn on this Tim was told this is " an old technic" but if he wanted to they would order it. Seems like some surgeons prefer it and some dont. Seems to me it is very useful in determing to go with surgery or not. His procedure is set for the 23rd at Fox Chase.

    Looking for feedback.......Jeff

    Ask for a MRSI Too!
    In addition to the E-MRI also ask to have an MRSI (Magnetic Resonance Spectroscopic Imaging) done as well. The combination of both is a better assessment tool than E-MRI alone in determining the extent of PCa expansion.

    For additional information, see: http://www.prostate-cancer.org/education/staging/UCSF_CombinedMRI_MRSI.html.

    Good luck!!!
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,343 Member
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    Ask for a MRSI Too!
    In addition to the E-MRI also ask to have an MRSI (Magnetic Resonance Spectroscopic Imaging) done as well. The combination of both is a better assessment tool than E-MRI alone in determining the extent of PCa expansion.

    For additional information, see: http://www.prostate-cancer.org/education/staging/UCSF_CombinedMRI_MRSI.html.

    Good luck!!!

    amen on the spectroscopy
    although it considered investigation and not covered by insurance, it improves the accuracy of the MRI.........good idea to use a Tesla 3.0 magnet, or at least a tesla 1.5 with the mri


    additoally I mentioned a USPIO in a previous comment on this thread.
  • robot1
    robot1 Member Posts: 1
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    Second Opinion
    Timlong,

    Like you I am also new to this forum. Also like another responder I would strongly recommend a second opinion. Since your Doctor is in Phil. I can recommend one of the best robotic surgeons in the country and he is in Phil. Please consider Dr. David Lee at Penn Presbyterian which is part of the Penn medical system. Dr. Lee has performed over 4000 robotic procedures of which about 2600 were Robotic Radical Prosectomies.

    I was very near 63 when I got the PC diagnoses. A rapid PSA jump (0.4 - 5.1) within a thirteen month span had me having a biopsy rendering a Gleason score of 9. CT and bone scan were negative. My NJ Urologist set me up with a NJ Radio Oncologist. He also highly recommended Dr. Lee. I met with both Doctors and decided on having the surgery. Due to the very aggressive nature of my PC the Radio Oncologist would only take me on if I committed to a one year regiment of HT prior to radiation followed by another year of HT.

    Dr lee indicated that if I had the surgery, follow-up radiation might be required but it would depend on a) what he sees during the operation and/or b)the first post operative PSA result. The surgery revealed that the cancer spread to small part of the right side nerve and part of the seminal vessels. However, he indicated the he was confident that he got it all and was able to spare most of the right nerve and all of the left side nerve.

    The bottom line, if I can say that in under 10 years is the post operative pathology of the entire prostate had the Gleason score at 7. All of the 5 post surgery PSA test have been <0.1 or non-detectable. Post surgery my chances of a re-ocurrence was 30%. This figure lowers with each <0.1 PSA test. At this writing I belive I am at 10%.

    It's been 17 months since my surgery and most systems are a go so to speak. A non medical eraction occures most of the time and is improving monthly. Continence is not yet at 100% but also improving monthly. I would say that I am in the 85-90 % range.

    Finally, besides being a talented and very experienced surgeon, Dr. Lee is realy a very nice guy.

    Good luck
  • Timlong
    Timlong Member Posts: 42
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    robot1 said:

    Second Opinion
    Timlong,

    Like you I am also new to this forum. Also like another responder I would strongly recommend a second opinion. Since your Doctor is in Phil. I can recommend one of the best robotic surgeons in the country and he is in Phil. Please consider Dr. David Lee at Penn Presbyterian which is part of the Penn medical system. Dr. Lee has performed over 4000 robotic procedures of which about 2600 were Robotic Radical Prosectomies.

    I was very near 63 when I got the PC diagnoses. A rapid PSA jump (0.4 - 5.1) within a thirteen month span had me having a biopsy rendering a Gleason score of 9. CT and bone scan were negative. My NJ Urologist set me up with a NJ Radio Oncologist. He also highly recommended Dr. Lee. I met with both Doctors and decided on having the surgery. Due to the very aggressive nature of my PC the Radio Oncologist would only take me on if I committed to a one year regiment of HT prior to radiation followed by another year of HT.

    Dr lee indicated that if I had the surgery, follow-up radiation might be required but it would depend on a) what he sees during the operation and/or b)the first post operative PSA result. The surgery revealed that the cancer spread to small part of the right side nerve and part of the seminal vessels. However, he indicated the he was confident that he got it all and was able to spare most of the right nerve and all of the left side nerve.

    The bottom line, if I can say that in under 10 years is the post operative pathology of the entire prostate had the Gleason score at 7. All of the 5 post surgery PSA test have been <0.1 or non-detectable. Post surgery my chances of a re-ocurrence was 30%. This figure lowers with each <0.1 PSA test. At this writing I belive I am at 10%.

    It's been 17 months since my surgery and most systems are a go so to speak. A non medical eraction occures most of the time and is improving monthly. Continence is not yet at 100% but also improving monthly. I would say that I am in the 85-90 % range.

    Finally, besides being a talented and very experienced surgeon, Dr. Lee is realy a very nice guy.

    Good luck</p>

    Endo Rectal MRI today
    Thanx Rpbot1.
    Today is Tim's E-MRI at Penn. The second opinion at Fox Chase created what he felt was a need for the MRI and if it shows spread to the rectum he may not pull the trigger on surgery. BTW.....his Penn surgeon is Dr. Eun who also has a great reputation along with Dr. Lee. We should know the results in a day or two.
    I will keep you all posted when Tim hears from Penn.

    Thanx......Jeff
  • tarhoosier
    tarhoosier Member Posts: 195 Member
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    Timlong said:

    Endo Rectal MRI today
    Thanx Rpbot1.
    Today is Tim's E-MRI at Penn. The second opinion at Fox Chase created what he felt was a need for the MRI and if it shows spread to the rectum he may not pull the trigger on surgery. BTW.....his Penn surgeon is Dr. Eun who also has a great reputation along with Dr. Lee. We should know the results in a day or two.
    I will keep you all posted when Tim hears from Penn.

    Thanx......Jeff

    Surgery? WHAT?
    IF the G score is confirmed, and it likely would be considering the other specs listed and the locale of the biopsy doctor, then this man should never be recommended for surgery. Immediate hormone treatment and consultation with a respected radiation oncologist is the step to follow. A surgeon seeking business in a patient such as this is untrustworthy.
  • Timlong
    Timlong Member Posts: 42
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    Surgery? WHAT?
    IF the G score is confirmed, and it likely would be considering the other specs listed and the locale of the biopsy doctor, then this man should never be recommended for surgery. Immediate hormone treatment and consultation with a respected radiation oncologist is the step to follow. A surgeon seeking business in a patient such as this is untrustworthy.

    I'm trying to understand.
    Based on Tim's numbers alone are you saying that surgery should not be done? Based on my own research am I understanding correctly that the treatment and prognosis is about the same.
    The difference being that he would not suffer the post-surgery effects.

    Jeff
  • Kongo
    Kongo Member Posts: 1,166 Member
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    Timlong said:

    I'm trying to understand.
    Based on Tim's numbers alone are you saying that surgery should not be done? Based on my own research am I understanding correctly that the treatment and prognosis is about the same.
    The difference being that he would not suffer the post-surgery effects.

    Jeff

    I agree with Tarhoosier
    I would also avoid surgery based on the numbers you have described. Despite the negative bone scan this cancer has almost certainly metastasized and the mass which can be felt in the prostate has likely spread to the tissue surrounding the prostate. Removing the prostate will not curb the growth of cancer elsewhere in his body and should the surgeon cut across a positive margin he will dump millions more cancer cells into the bloodstream.

    Obviously the choice is up to your friend but it seems to me that he is being rushed into surgery with no good prospects of a successful outcome and he will require radiation and hormone treatment in addition to the surgery.

    K
  • tarhoosier
    tarhoosier Member Posts: 195 Member
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    Timlong said:

    I'm trying to understand.
    Based on Tim's numbers alone are you saying that surgery should not be done? Based on my own research am I understanding correctly that the treatment and prognosis is about the same.
    The difference being that he would not suffer the post-surgery effects.

    Jeff

    Surgery? What?
    I am saying exactly what the doctor is saying: high chance of metastasis and strong likelihood of recurrence (persistence) after surgery. BUT, I am saying that this contra-indicates surgery. If the doctor KNOWS he will be unsuccessful in curing the patient, yet believes the best choice is to undergo surgery, with all the problems, certain impotence, significant chance of incontinence (whether he admits it, this is so) he is a man looking for his own interests and not that of the patient. Radiation with hormones is the preferred choice in such cases as it avoids the surgical risks and side effects. If the doctor can explain how certain surgical failure can be best for the patient I would be interested the magical thinking with which he supports this decision.
    I wish I could be more uplifting. I would create such a post if there were not so much research and data indicating that radiation with hormones is absolutely the better choice.
    Do not depend on me, or anyone here for your decision. A medical oncologist who can make an opinion without bias would be the very best investment of time and money.