Waiting for Surgery

Yank31

I have just been diagnosed with Stage II prostate cancer, PSA 13, Gleason Score 7 (4+3). I have selected robotic surgery with the da Vinci machine, but I have to wait 6 weeks for surgery. What is the normal wait time from time of diagnosis to surgery? How aggressive is a Gleason 7 and is there any danger in waiting? RT was a temptation, as it could be started right away, but I have been told removal of the prostate is no longer an option once RT has been done. I am 65 and in otherwise good health.

VascodaGama

Choices over timing in the decision process

Yank

Welcome to the board.

I can see from your questions that you are worried in both, the choice of the treatment and the correct timing to act on it. However, how well your diagnoses were done and in what basis has you chosen the therapy are more important than the timing. Cancer of the prostate does not spread overnight so that to decide on a treatment just for fear of “faster” spread and timing is incorrect.

Gleason score of 7 (4+3) stands for intermediate risk for metastases (4+3 is worst than 3+4) which if they exist and are confirmed (eg: positive DRE, several positive needles in biopsy, positive scans, etc), it could render surgery impractical, when one is looking for cure. In metastatic cases radiation out performs surgery with higher “points” for success. Surgery would treat the wound not cure you, and the risks and side effects will be superimposed when one treats recurrence. In the presence of micro metastases radical treatments are impractical. They may be administered as a principle of “debulking” because the cancer cannot be properly located and therefore cannot be directly “tackled”. The therapy would be based on guessing.

Why decide or thinking in having both radicals from the start (surgery plus radiation) and not just one that can achieve to the same goal?

Is there any image study or other evidence that leads you to think that the cancer is totally contained?

Whatever reason made you to decide in your treatment choice is intimate to you and surely the best, however you should know that you got the time and that there is no danger by waiting till you are 100% convinced and confident on what you have decided.
There is no return once treatment is done so that you should do things with knowledge. You should have a clue on what to expect from a major treatment. Remember that you are in “command”. You will have to sign an agreement relieving the doctor and the hospital of any responsibility in the outcomes. I would recommend you to read a book while waiting during these six weeks. 

A good book on surgery that also addresses radiation is “A Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition). You may also read the info in the following link which is like a Compendium on prostate cancer and care;
http://prostate-cancer.org/decision-aide/where-to-start/prostate-basics/

Diet and a change in live tactics become important to counter the treatment effects. UCSF got a “super” publication on Nutrition & Prostate Cancer, here;
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

Best wishes for a successful outcome.

Wishing you luck in your journey.

VGama 

Yank31

VascodaGama said:

Choices over timing in the decision process

Yank

Welcome to the board.

I can see from your questions that you are worried in both, the choice of the treatment and the correct timing to act on it. However, how well your diagnoses were done and in what basis has you chosen the therapy are more important than the timing. Cancer of the prostate does not spread overnight so that to decide on a treatment just for fear of “faster” spread and timing is incorrect.

Gleason score of 7 (4+3) stands for intermediate risk for metastases (4+3 is worst than 3+4) which if they exist and are confirmed (eg: positive DRE, several positive needles in biopsy, positive scans, etc), it could render surgery impractical, when one is looking for cure. In metastatic cases radiation out performs surgery with higher “points” for success. Surgery would treat the wound not cure you, and the risks and side effects will be superimposed when one treats recurrence. In the presence of micro metastases radical treatments are impractical. They may be administered as a principle of “debulking” because the cancer cannot be properly located and therefore cannot be directly “tackled”. The therapy would be based on guessing.

Why decide or thinking in having both radicals from the start (surgery plus radiation) and not just one that can achieve to the same goal?

Is there any image study or other evidence that leads you to think that the cancer is totally contained?

Whatever reason made you to decide in your treatment choice is intimate to you and surely the best, however you should know that you got the time and that there is no danger by waiting till you are 100% convinced and confident on what you have decided.
There is no return once treatment is done so that you should do things with knowledge. You should have a clue on what to expect from a major treatment. Remember that you are in “command”. You will have to sign an agreement relieving the doctor and the hospital of any responsibility in the outcomes. I would recommend you to read a book while waiting during these six weeks. 

A good book on surgery that also addresses radiation is “A Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition). You may also read the info in the following link which is like a Compendium on prostate cancer and care;
http://prostate-cancer.org/decision-aide/where-to-start/prostate-basics/

Diet and a change in live tactics become important to counter the treatment effects. UCSF got a “super” publication on Nutrition & Prostate Cancer, here;
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

Best wishes for a successful outcome.

Wishing you luck in your journey.

VGama 

Thank You!

VGama

Thank you for your prompt reply.

Yes, I have Dr. Walsh's book, and I have found it most useful.

To clarify: I had a trans urethral biopsy with 21 needle samples taken, and 5 were positive. I was also subjected to an MRI, CT Scan, X-rays, and a bone scan. All of these tests showed no abnormalities. The DRE revealed no abnormalties. The doctors feel that the cancer is still confined to the prostate, and that I am a candidate for the surgery.

Thank you for the reassurnace in re: timing and waiting for surgery. You have given me some important things to think about.

Thank you for the links. I will check these out tomorrow.

hopeful and optimistic

Yank31 said:

Thank You!

VGama

Thank you for your prompt reply.

Yes, I have Dr. Walsh's book, and I have found it most useful.

To clarify: I had a trans urethral biopsy with 21 needle samples taken, and 5 were positive. I was also subjected to an MRI, CT Scan, X-rays, and a bone scan. All of these tests showed no abnormalities. The DRE revealed no abnormalties. The doctors feel that the cancer is still confined to the prostate, and that I am a candidate for the surgery.

Thank you for the reassurnace in re: timing and waiting for surgery. You have given me some important things to think about.

Thank you for the links. I will check these out tomorrow.

Some information to

Some information to compliment vg's excellent reply

 

Determining gleason scores are subjective, so a second opinion by a world class pathologist is very imptant to confirm the results of your pathology. The information contained is this pathology is the basis for your treatment decision.

You did not list the involvement, that is the percent of each of the cores that were positive for cancer. This information is helpful in a treatment decision.

Various forms of radiation can treat a greater area than surgery. Not saying that this is what you want to do but consider this. There is a radiaion form called SBRT that you may wish to investigate.

Determining a qualified surgeon is very important, unlessa robotic surgeon does at least 250 to 300 , he is practicing, now there are surgeons who have done 1000 or more. There are also other criteria to look at for a surgeon, surgical margins, etc

As vg mentioned to you, make the right decision, since prostate cancer is very slow growing, don't react out of fear, and take your time to make a decision that you are comfortable with.
There are no second chances.

Josephg

Evaluating Options

Hi Yank,

Welcome, and you've picked a great place for support and advice.

You have some phenominal folks here in the forum who can provide you with advice and guidance regarding your current situation and evaluation of options.  From a technical/clinical perspective, I am not one of them.

The advice currently on the table, however, is spot on.

1.  As strong as the urge may be to 'do' something 'now' to start your battle with the bandit, you do have some time available to you for research, consultation, and consideration of your options.

2.  Get as much information as you can, from as many sources as you can.    There is no magic answer that is available now, nor will there be coming out of your research, but your level of comfort regarding your eventual decision will grow as you accumulate and evaluate more infomation and gain the knowledge that is currently available.

3.  At the end of the day, the decision regaring your options is yours, and yours alone.  And, it is a very personal decision.

4.  Once you've made your decision, select the best and most experienced medical team that you can afford to perform your treatment of choice.  I understand that all medical professionals have to start out somewhere to build their experience portfolio, but it does not necessarily have to be on you.  Regarding robotic surgery, if that is your choice, find a surgeon who has performed at least 1000 of these procedures (mine had 2100+), as accumulated skill and experience really matters there.

From a patient experience perspective, I've had da Vinci robotic surgery, followed by an AMS 800 artificial sphincter implant (to restore my continence, lost through the surgery), followed by adjunct hormone/radiation therapy to hopefully kill off some remaining cancer cells in the prostate bed.  I'd be happy to share my experiences with any of these procedures with you at the appropriate time.

Good luck with your research, consultation, and eventual decision. 

Yank31

hopeful and optimistic said:

Some information to

Some information to compliment vg's excellent reply

 

Determining gleason scores are subjective, so a second opinion by a world class pathologist is very imptant to confirm the results of your pathology. The information contained is this pathology is the basis for your treatment decision.

You did not list the involvement, that is the percent of each of the cores that were positive for cancer. This information is helpful in a treatment decision.

Various forms of radiation can treat a greater area than surgery. Not saying that this is what you want to do but consider this. There is a radiaion form called SBRT that you may wish to investigate.

Determining a qualified surgeon is very important, unlessa robotic surgeon does at least 250 to 300 , he is practicing, now there are surgeons who have done 1000 or more. There are also other criteria to look at for a surgeon, surgical margins, etc

As vg mentioned to you, make the right decision, since prostate cancer is very slow growing, don't react out of fear, and take your time to make a decision that you are comfortable with.
There are no second chances.

To hopeful and opt...

Thank you for your input. SBRT? I will check this out.

Yank31

Josephg said:

Evaluating Options

Hi Yank,

Welcome, and you've picked a great place for support and advice.

You have some phenominal folks here in the forum who can provide you with advice and guidance regarding your current situation and evaluation of options.  From a technical/clinical perspective, I am not one of them.

The advice currently on the table, however, is spot on.

1.  As strong as the urge may be to 'do' something 'now' to start your battle with the bandit, you do have some time available to you for research, consultation, and consideration of your options.

2.  Get as much information as you can, from as many sources as you can.    There is no magic answer that is available now, nor will there be coming out of your research, but your level of comfort regarding your eventual decision will grow as you accumulate and evaluate more infomation and gain the knowledge that is currently available.

3.  At the end of the day, the decision regaring your options is yours, and yours alone.  And, it is a very personal decision.

4.  Once you've made your decision, select the best and most experienced medical team that you can afford to perform your treatment of choice.  I understand that all medical professionals have to start out somewhere to build their experience portfolio, but it does not necessarily have to be on you.  Regarding robotic surgery, if that is your choice, find a surgeon who has performed at least 1000 of these procedures (mine had 2100+), as accumulated skill and experience really matters there.

From a patient experience perspective, I've had da Vinci robotic surgery, followed by an AMS 800 artificial sphincter implant (to restore my continence, lost through the surgery), followed by adjunct hormone/radiation therapy to hopefully kill off some remaining cancer cells in the prostate bed.  I'd be happy to share my experiences with any of these procedures with you at the appropriate time.

Good luck with your research, consultation, and eventual decision. 

To Josephg

Thank you for your kind offer to share your experience with da Vinci.

I will definitely keep you in mind.

I wish you the best with your ongoing treatments.

yankeefan

waiting for surgery

there is a minimum wait between a prostate biopsy and surgery.....6 weeks is probably as soon as one could do it.....my urologist also told me that surgery is no longer a viable option once you have radiation treatment...i've seen other (non doctors) on this site claim other wise, but I have never heard a real urologist say it.....if you don't trust your urologist get a second opinion...from another urologist, i.e. a real doctor....(i chose surgery for a number of reasons...but my surgeon was not my normal urologist...so my urologist had no stake in my decision.....) I was 68 when I had my surgery, so your not too old....the only real side effect for me is ed....it's been less than a year, so there may still be hope....you have to accept that as a potential side effect if you select surgery.....my urinary process works much better post surgery than prior to it....I was having negative side effects from a very enlarged prostate, which no longer present themselves....have you talked to a radiation specialist? if not, I recommend you doing so before you make your decision. for you, radiation may be the better route...most urologists will tell you that 5 years down the road the side effects are about the same.....radiation side effects don't kick in right away.....whereas, the surgical ones are there from the beginning, but ususally improve over time........get all the info you can and make your choice...best of luck

yankeefan

waiting for surgery

i forgot to mention that how well the surgery goes, if you should choose that route, will depend almost exclusively on the skill of your surgeon....if you go with the robotic method be sure your surgeon is an expert and has done many, many of them....(greater than 500 for sure)..and has a good track record....non robotic surgery demands skill too, so the same holds true for that option.....you want the very best surgeon you can get...even then things can go wrong....depending on how advanced your cancer is, whether it has visibly spread, etc.

donsantell

Waiting for surgery

Have you looked into Proton Beam Therapy?  I finished this treatment on 11/1/13 and am very happy with the results.  I have 0 side effects and it is a painless procedure.  There are 11 treatment centers around the country with more due to come on line soon.  I was treated in Jacksonville, FL at the University of Florida Proton Institute and would highly reccoment them.  If you go to their website, www.floridaproton.org, you will find much information about Proton Treatment.  It is the most exacting treatment using radiation you can receive.  If you email them they will send you, by overnight mail, a packet including a book by Bob Markini that you willf find very very informative and will answer many questions you may have.  The cure rate is the same or better than surgery and the rate of side effects, impedence, incontinentce, etc. is much lower. 

Usually your urologist will not reccomend Proton Beam Therapy as they are surgeons and cannot perform this.  The centers are very expensive to build and usually are done at Universities where they can get the funding to build these massive buildings required for the treatment.

My guess is you have not heard of this procedure but I would suggest before making up your mind look into it.

Don Santella