I'm a newbie here

Max Former Hodgkins Stage 3

mikedayton62 said:

PSA history

I have had a PSA of 6 on two exams in the last 3 or so years. Both times the urologist put me on antibiotics. When I went to my GP for my annual physical in June, my PSA was 10, but I had not been celibate, so two weeks later the urologist tested it again. I was celibate for a week and was certain that my PSA would go back down, but was shocked when it came back at 12. DRE at GP and the urologist did not reveal anything. Both said it felt normal.

Sex and PSA

Mike,

A minor point perhaps, but worth mentioning: doctors differ on how much sex prior to a PSA draw will affect the results.

Some think it is significant, others think not. There are studies done to support both opinions.  My surgeon believes that the affect is very minor, and will not dramatically alter anything.  My GP is of the same opinion, and even told me once years ago that he felt my worry on the subject was "foundationless."

Half of all newly-diagnosed PCa patients have completely normal DREs. This makes sense, since a DRE only feels the back of the gland, leaving the other half unfelt.  With Stage II involvement, all of my DREs were totally normal.

Continuing to wish you an easy treatment experience and fast cure,

max

Clevelandguy

Surgery vs radiation

Hi,

I had my prostate removed two years ago via robotic surgery.  My doctor said it's always good to have a backup with that being radiation.  From what I was told the radiation makes it harder for the surgeon to remove the prostate after radiation tratments.  I have just a little stress leakage(one pad per day) and no ED(but it took took years for me to gain a good erection back).  I guess its up to you to decide after talking with your surgeon and radiologist.  Look around, ask questions, and get your doctors opinions.

Dave

3+4

Swingshiftworker

Clevelandguy said:

Surgery vs radiation

Hi,

I had my prostate removed two years ago via robotic surgery.  My doctor said it's always good to have a backup with that being radiation.  From what I was told the radiation makes it harder for the surgeon to remove the prostate after radiation tratments.  I have just a little stress leakage(one pad per day) and no ED(but it took took years for me to gain a good erection back).  I guess its up to you to decide after talking with your surgeon and radiologist.  Look around, ask questions, and get your doctors opinions.

Dave

3+4

Still irrelevant . . .

You DO NOT need to remove the prostate after a failed radiation treatment.  You can just hit it again w/radiation.   It is and has always been an irrelevant argument against the use of radiation to treatment PCa.

Clevelandguy

Surgery vs radiation

Hitting whats left of your prostate tissue with more radiation can only degrade everything in the whole treatment area(bladder, bowel, ect) .  Each person must make up there own mind on what threatment options to choose.  Some people will choose surgery, some will choose radiation.  If you look at all the message board posts you will find out about how successful the various types of treatment are.  I felt that surgery followed by radiaiton if needed was my best option cosidering my PCA and that it was all contained inside the prostate.  If its outside the prostate surgery may not be the best answer, you need to talk with your doctors(all doctors) to get your best treatment.  I can only speak from my experience, each person has their own path to follow.  This board did help me reviewing all of the various treatments for PCA vs long & short term side effects.

 

Dave

bob33462

TAKE YOUR TIME

Mike -

Please don't rush into a fast decision. Go and see more Urologists and Radiation Oncologists to get more opinions. Learn all you can about the disease.

As mentioned above you may be a good candidate for active survelliance. However, if you want to cure it, surgery and radiation have about the same outcomes.

I had surgery, but would have had radiation if not for my voiding issues.

Best wishes!

Bob

Old-timer

Hello again, Mike

I notice that you have taken part in an active discussion on this board with several people. I trust that this has been helpful and that things are going well with you. I now think it might be worthwhile for me to give you an outline of what has happnd during my 25-year sojourn with what Vasco calls "the bandit." Here it is:

 July 1991, at age 65: PSA 4.0, biopsy Gleason 3+4 = 7.0.

September 1991: radical prostatectomy.

December 1991 through 2003: PSA .0.

Early 2004: PSA 0.2. Then at 3-month intervals my PSA rose: 0.39, 0.61, 1.11.

Feb.-Mar. 2004. Radiation sessions (35).

July 2004: PSA 1.20. (Informed that radiation was not successful.)

October 2004 to June 2008. PSA see-sawed a bit while gradually rising to 20.4.

June 2008. Began hormone therapy.

September 2008 to October 2015. PSA undetectable <0.1.

September 2016. PSA 0.1. Urologist says this is detectable. but not a cause for concern. Check it again next year.

 I am 90, feeling good, remaining relatively active, and enjoying life.

 Good luck to you.

 Jerry (Old-timer)

mikedayton62

Old-timer said:

Hello again, Mike

I notice that you have taken part in an active discussion on this board with several people. I trust that this has been helpful and that things are going well with you. I now think it might be worthwhile for me to give you an outline of what has happnd during my 25-year sojourn with what Vasco calls "the bandit." Here it is:

 July 1991, at age 65: PSA 4.0, biopsy Gleason 3+4 = 7.0.

September 1991: radical prostatectomy.

December 1991 through 2003: PSA .0.

Early 2004: PSA 0.2. Then at 3-month intervals my PSA rose: 0.39, 0.61, 1.11.

Feb.-Mar. 2004. Radiation sessions (35).

July 2004: PSA 1.20. (Informed that radiation was not successful.)

October 2004 to June 2008. PSA see-sawed a bit while gradually rising to 20.4.

June 2008. Began hormone therapy.

September 2008 to October 2015. PSA undetectable <0.1.

September 2016. PSA 0.1. Urologist says this is detectable. but not a cause for concern. Check it again next year.

 I am 90, feeling good, remaining relatively active, and enjoying life.

 Good luck to you.

 Jerry (Old-timer)

Glad to hear that you are doing so well

And I am also glad to hear thet your recurrence responded to the hormone therapy. I think that my wife and I are both leaning toward the robot assisted laproscopic prostatectomy. I have read that RALP and brachytherapy have similar success rates, but for purely emotional reasons we both will feel better if the tumor is gone from my body. My urologist told me that his partner does all of the RALP's, and he has done a zillion of them. I also have a cousin who is a surgical nurse, and she told me if it were her husband, she would push for prostatectomy all the way. She told me she takes care of these patients every day and in general they do really well.

Old-timer

mikedayton62 said:

Glad to hear that you are doing so well

And I am also glad to hear thet your recurrence responded to the hormone therapy. I think that my wife and I are both leaning toward the robot assisted laproscopic prostatectomy. I have read that RALP and brachytherapy have similar success rates, but for purely emotional reasons we both will feel better if the tumor is gone from my body. My urologist told me that his partner does all of the RALP's, and he has done a zillion of them. I also have a cousin who is a surgical nurse, and she told me if it were her husband, she would push for prostatectomy all the way. She told me she takes care of these patients every day and in general they do really well.

I know little about "new" procedures

In 1991 my choice was prostatectomy or radiation. There was no discussion board and, frankly, I was ignorant about what I was up against. I knew I wanted the thing out. I chose surgery because the urologist had better bedside manners than the oncologist! Joking aside, I am satisfied with the choice I made. And I am exceedingly happy about the 25 years of good life I have enjoyed as a survivor.

You young folks have more options from which to choose. And with your "moderate" readings, you have ample time to study, discuss, analyze, and select. The journey is a challenge but bearable.

Personally, I claim that my life in old-age is richer as a result of having to cope with "the bandit."

Best of luck to you.

Old-timer (Jerry)

CowboyBob

Each PCa patient approaches

Each PCa patient approaches their treatment decisions from their own personal perspective. However, everytime I hear that someone is leaning toward surgery to "get the prostate cancer out of their body" I cringe.  The goal of radiation therapy is to remove the cancer from your body, just like surgery. They are equally effective in removing cancer confined to the prostate. So basing a decision for surgery with this rationale is illogical.

My father's course can be instructive. He had the same cut it out attitude. He underwent robotic assisted prostatectomy, required radiation anyway and is still dealing with the resultant incontinence and ED. 

Please don't make any decision from an emotional standpoint. Get the facts. Take your time to understand the different options. There is no rush to make a decision at this point. And remember, that to a man with a hammer, a lot of things look like nails that need pounding. Urologists are going to tend to recommend surgery, rad oncologists radiation.

Clevelandguy

Surgery vs Rads

+1  Good post Tonycue

tonycue

CowboyBob said:

Each PCa patient approaches

Each PCa patient approaches their treatment decisions from their own personal perspective. However, everytime I hear that someone is leaning toward surgery to "get the prostate cancer out of their body" I cringe.  The goal of radiation therapy is to remove the cancer from your body, just like surgery. They are equally effective in removing cancer confined to the prostate. So basing a decision for surgery with this rationale is illogical.

My father's course can be instructive. He had the same cut it out attitude. He underwent robotic assisted prostatectomy, required radiation anyway and is still dealing with the resultant incontinence and ED. 

Please don't make any decision from an emotional standpoint. Get the facts. Take your time to understand the different options. There is no rush to make a decision at this point. And remember, that to a man with a hammer, a lot of things look like nails that need pounding. Urologists are going to tend to recommend surgery, rad oncologists radiation.

Surgery v Rads

 

 I read this thread with interest....I think that the surgery vs Radiation argument will just keep rolling on....I think it depends on your personality type as to which option you might favour (assuming you have the option)....Each comes with their own side effects and I'm sure that for every person who has a "horror story" with surgery, there'll be someone else who says it "was a breeze".....likewise with radiation...If you have a large prostate that is causing you grief anyway then the natural reaction would be to get rid of it with surgery....Surgery of course has incontinence and impotence issues, but Rads also have impotence issues (although usually later on) plus bowel incontinence. Plus there is always the old argument that you can have surgery before radiation but not Vice versa.....(although some will argue this is not the case). I'm sure you are aware that with surgery the subsequent PSA readings will at least give you an idea of how you are doing, whereas with radiation you can get the dreaded radiation "bounce" which can frighten the "bejesus" out of a person.....At the end of the day it is down to the individual to do as much homework as possible ....Fortunately in these days of the internet there is so much more info available to sufferers .....How on earth did people do their research 20 years ago??

tonycue

Question for Mike Dayton

Hi Mikedayton, noticed your post and thought I'd ask a question....I am awaiting results of a saturation template biopsy because of a "something" seen on a 3T MRI scan.....I was under the impression that any cancer that showed up on MRI had to be "clinically significant" ie G7 or above....could you give me more details re your G6 please....I'm currently sweating out a 2 week wait

     Thanks in advance

         Tony

hopeful and optimistic

tonycue said:

Question for Mike Dayton

Hi Mikedayton, noticed your post and thought I'd ask a question....I am awaiting results of a saturation template biopsy because of a "something" seen on a 3T MRI scan.....I was under the impression that any cancer that showed up on MRI had to be "clinically significant" ie G7 or above....could you give me more details re your G6 please....I'm currently sweating out a 2 week wait

     Thanks in advance

         Tony

3T scan

The suspicious tumor found can be non cancerous.

If cancer is found, it can be any Gleason level.

Also please note, not all radiologists contain enough expertise to read the MRI correctly.....so it is entirely possible that the radiologist who read your MRI did not read the MRI correctly..............

tonycue

3T Scans

Hi H&O,

I didn't mean to Hijack Mike Daytons thread, but he did state that he had been diagnosed G6 and that his tumour had shown up on MRI.....Since being told I had a suspicious PIRADS 4 lesion I have read the PIRADS protocol from cover to cover and was under the impression that only "clinically significant" cancer will show up on an MRI. I was interested in Mikes post for that reason (I'm just looking for a loophole here :-) )....I realise that scans can be ambiguous and that radiologists are only human, but after all as someone who is on AS you are staking your health  on their expertise, so I assume that you do have quite a bit of faith in scans and their interpretation

 regards.  Tony

hopeful and optimistic

tonycue said:

3T Scans

Hi H&O,

I didn't mean to Hijack Mike Daytons thread, but he did state that he had been diagnosed G6 and that his tumour had shown up on MRI.....Since being told I had a suspicious PIRADS 4 lesion I have read the PIRADS protocol from cover to cover and was under the impression that only "clinically significant" cancer will show up on an MRI. I was interested in Mikes post for that reason (I'm just looking for a loophole here :-) )....I realise that scans can be ambiguous and that radiologists are only human, but after all as someone who is on AS you are staking your health  on their expertise, so I assume that you do have quite a bit of faith in scans and their interpretation

 regards.  Tony

.

I am treated at a high volume center of excellence, where the radiologists are experts and follow the correct protocol for interpretation. Many times at other locations, the radiologist do not follow the correct protocol.

tonycue

mikedayton62 said:

MRI vs Gleason score

I believe that the MRI and the Gleason score indicate two different things. The MRI can see the size of a tumor, but the Gleason score is actually an estimate of how aggressive the cancer is, how quickly it will spread, and how aggressive the treatment plan should be. So in my case it appears that I have an 8mm tumor (from the MRI) comprised of cancer cells that were rated Gleason 6 under the microscope (from the biopsy), meaning that it is slow growing, giving my wife and me time to make a treatment decision. With a tumor that appears to be wholly contained in the prostate, and a Gleason 6, it is highly likely that no cancer cells have made their way out of the prostate yet. In addition to this, there are a number of other things factoring into our decision between Brachytherapy and Robot Assisted Laproscopic Prostatectomy:

1. We have ruled out AS due to my age and relatively good health.

1a. My PSA has doubled since last year (6 to 12). This is another factor that leads us to rule out AS.

2. The argument is still out as to which treatment has better long term non-recurrence results. Based on what I have found, this ranges from a draw to a slight advantage for the Brachytherapy.

3. Immediate side effects are probably worse for the RALP, but long term are worse for the Brachytherapy.

3a. I recently spoke to a friend who is still recovering from open prostatectomy. He is very pleased with the result.

4. Should we opt for RALP, the urologist who will perform the procedure has done it many hundreds, if not thousands of times, thus improving the chances of a positive outcome with regard to side effects.

5. Emotional concerns - definitely a large factor in our decision, because I will be living as a cancer survivor, and I want a few unknowns as possible into the future, and I would like to live those years with my wife at my side, not suffering from her own fears. With the RALP, the side effects will be immediately apparent, but also very likely treatable, and the only real unknown going forward is the chance of my PSA going up again later on. Given my numbers, this probability is quite low, but should this happen, there will be treatment options. With the brachtherapy, however, there could be side effects that might not show up for a number of years. Because of this, both of us are leaning toward RALP.

We are awaiting one final piece of advice before making our decision. Through the health plan provided by my employer, we have a service called Expert Medical Opinion. With this program, three separate doctors look at my records and give a report. Once we have their opinions, we will proceed with our chosen treatment.

Sorry for getting long winded, but I hope I was able to at least partially answer your question.

MRI Etc

hi Mike, thank you for replying, feel free to be as "long winded" as you wish.....Some of my posts have been small novels.....I have a small lesion which has shown up on 3TMRI hence my question....My first TRUS biopsy came up negative, so now I've just had a template biopsy....

whatever route you choose I wish you well

 Best wishes.  Tony

Max Former Hodgkins Stage 3

One Thought

Mike,

You posted a very clear and well-written summation of where your decision-making process is at. You are in the ponder and decide moment now, awaiting the review panel's comments.

I would question only one statement that you made, and that regards Brachytherapy.

Dr. Peter Scardino, Chief of Surgery at Sloan-Kettering CC in NYC, in his 2010 edition of his The Prostate Book, writes that Brachytherapy is not suited (per uriological conventions) for a man with either of the following: (1) A single Gleason hit of above a 4 (or composite Gleason over 6) or (2) a PSA of 10 or above. He does not specify a vector limit, but your doubling rate is significant.  For these same reasons, A/S would indeed be a bad choice, so you were correct for eliminating that as an option.  Interestingly, Dr. Scardino preferrs open surgery over DaVinci, for reasons that he discusses elsewhere in the book. He does not "dislike" DaVinci I would note.

The book is available as regular-stock at Barnes and Noble, and any good library would have a copy.  The relevant pages are 345-357, and it gives an excellent summation of BT generally, if you do choose it.  What I liked about the book is that it lays out every modern treatment technique, and lists pros and cons for each.  Except for a few new drugs and some tweeking of Imaging technologies that have come on market since 2010, it is up-to-date.  And those drugs all pertain to HT and Stage IV treatments, which are irrelevant in your case.

I regard the remainder of your critique to be essentially perfect:  It is a toss-up (given your particulars) between RT and surgery as regards cure; open and robotic surgery, as regards cure, are also identical;  cure rate between IGRT and Cyberknife are identical.  And as you noted: side-effects post-surgery are immediate; side-effects post-radiation are usually less than in surgery, and delayed in manifesting.

max

DaVinci, Dec, 2014

mikedayton62

I've chosen the surgery

After many long talks with my wife, with doctors, and with friends, I have elected to pursue the Robot Assisted Laproscopic Prostatectomy. I have a consultation appointment with Dr. T. Brian Willard at Carolina Urology Partners, West Columbia SC. He will be the surgeon performing my RALP.

Does anyone here have any experience with Dr. Willard? I'd love to hear about it. He has a 4.4 of 5 star rating on healthgrades.com (https://www.healthgrades.com/physician/dr-thomas-willard-ydwx4) and his office tells me he has been doing RALP for five years, and has done hundreds of them.

 

Thank you in advance.

Will Doran

Best of Luck

Mike,

Congratulatiosn on making your decision.  It's tough, I know.  Best of luck for all the sucess in the world and God Speed to you doctors. I pray that you will have the sucess that I have had, to this point, by having the Robotic Surgery.

Love, Peace and God Bless

Will

Max Former Hodgkins Stage 3

mikedayton62 said:

I've chosen the surgery

After many long talks with my wife, with doctors, and with friends, I have elected to pursue the Robot Assisted Laproscopic Prostatectomy. I have a consultation appointment with Dr. T. Brian Willard at Carolina Urology Partners, West Columbia SC. He will be the surgeon performing my RALP.

Does anyone here have any experience with Dr. Willard? I'd love to hear about it. He has a 4.4 of 5 star rating on healthgrades.com (https://www.healthgrades.com/physician/dr-thomas-willard-ydwx4) and his office tells me he has been doing RALP for five years, and has done hundreds of them.

 

Thank you in advance.

Mike,

Congrats on making a decision after much discussion, meeting numerous doctors, and reflection with your wife.  I hope it serves you very well.

I live just up I-26 from you in the SC Upstate area, not far below the NC line.

You already know this, but ensure that the surgeon plans erectile nerve sparing,and removes the seminal vesciles.   Both of these proceedures are virtually universal today in the US, when possible.

I found the pain in the recovery room to be worse than I anticipated, and I had bladder spasms, which made my bladder feel full, despite a cath in place. The N.P. said this was an uncommon side effect, but treatable with anti-spasmotic drugs. That sensation only lasted a few hours at most. I was walking the next mornng, and went home after only one night in the hospital.

You will wear a cath and bag for about one week afterward.  Any hint at an erection will take a minimum of a few months, although I have read accounts about spontaneous sex a few months later, I found them unbelievable and so outside the normal range as to ignore them.  TRIMIX, a self injection, had me having sex about three or four months later, and within a few months of that, Cialias worked well.  Today I do not even use Cialias at all, and things are working well.  But do expect some "down time" -- no pun intended.

I wore an adult diaper after the cath was removed for two days, and a pad/liner for a few months beyond that, which on average, was pretty fast continence.  I received Kegel exercise instructions prior to surgery, which are very helpful. Men have two urinary spincters at birth; the RP will remove one of these, leaving only the other.  I do not mean to submit "TMI," ("Too much information") but I know these are the real-life questions that guys have.

There are no perfect choices, just several very good ones.  Bless your progress and the pathologist's report following surgery,

max