Can anyone recommend a Urologist At Vanderbilt, Nashville, TN

MissViv

My husband was just diagnosed with prostate cancer 2/02. 

He is 68 but turning 69 in early April.  He was diagnosed with colon cancer in Dec. '14 and had surgery to remove the cancer with no lymph node involvement and no chemo or radiation.  He was scheduled to have hernia surgery to repair some rather "ugly" protruding hernias in his abdomen from the colon surgery in January but this was postponed due to the prostate cancer.

His biopsy revealed a gleason score of 8 (4+4) in left mid 7% contained and left apex was "suspicious".

We have a consult with urologist here on 3/02 for CT Scan and MRI results.  We do have a copy of the MRI which was performed at the local hospital which looks good but will wait for the doctor.

We are leaning towards not have surgery due to his health and any complications that could arise and we would like to get a second opinion from Vanderbilt Dept. of Urology and wondered if anyone has had any experience with the doctors there.

We are also considering "watchful waiting".  Also interested in Cyberknife, which is done at Centennial Medical Center in Nashville, TN or Erlanger in Chattanooga, TN. 

Any comments would be appreciated.

 

 

Old Salt

Sorry that you have to join us

I am sorry that you and your husband are faced with a difficult scenario. Because of the complexity of the case, I am not qualified to even offer suggestions, but my gut feeling agrees with your position not to have surgery.

Active Surveillance is usually considered only for Gleason 6 and, in some cases, Gleason 3+4 patients. 'Watchful Waiting' is not the same as 'Active Surveillance' and isn't practiced any more under medical supervision, as far as I know.

SBRT (CyberKnife is just one version of an SBRT delivery system) could be an option. But again, I am really not qualified...

Max Former Hodgkins Stage 3

Yes

Miss Viv,

I agree with Old Salt on both counts: Your husband's age and apparantly extensive surgical proceedures should rule him out for surgery as a first choice, and a Gleason Score of 8 suggests a cancer strain too aggressive for Active Survellance.

Radiation therapy, fortunately, can likely be curative for him, with few or no side-effects.

Ask for an appointment with a Radiation Oncologist.

VascodaGama

Consulting a different specialist may be better

MissViv,

I wonder why you are looking for another urologist. Urologists rarely recommend a therapy other than their specialty, which is surgery. I would rather suggest that you look for a second opinion from a radiologist specialized in treating prostate cancer, and probably listen to the opinion, on what has been suggested, from an independent medical oncologist.

In any case, the image studies you refer typically do not detect cancer of small sizes (less than 1.0 cm) providing false negatives. I would try obtaining an image exam with more appropriate contrast agent or even a PET scan, for reliable diagnosis. Please read these links;

https://www.sciencedaily.com/releases/2016/01/160127132622.htm

https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/94377-clinical-and-multiparametric-mri-signatures-of-granulomatous-prostatitis.html

http://www.medscape.com/viewarticle/742986_3

In the past, several Gleason 8 patients have reported about recurrence. Gs8 is a particular type of cancer expressing only one pattern (Gleason rate 4) suggesting it to be from a voluminous consistent mass tumout. Different patterns in the same case (Ex; Gs 3+4) are guessed to be from spread tumours forming smaller masses, which may be easier to detect in image studies.
I cannot comment on a recommendable therapy but if you decide against surgery then I would recommend a combination radiotherapy approach (RT). Your husband could even investigate on RT clinical trials. These are safe, free of charge and well attended. Here is a link for you to read;

https://pcnrv.blogspot.pt/2016/08/sbrt-for-high-risk-prostate-cancer.html

Best wishes and luck.

VGama 

MissViv

Vanderbilt

My husband has decided to go for surgery.  We found a dr. at Vanderbilt Urology Clinic, Dr. Sam Chang.  Our first consult will be on 3/30/17.  We are taking the films from the CT, MRI and Bone Scan.  Is there anything else we need to do in preparation for this doctor visit?

Steelchuggin26

Get a copy of the biopsy

Get a copy of the biopsy report, psa result,  past medical history,  and bring a list of medications he may be taking.

Max Former Hodgkins Stage 3

MissViv said:

Vanderbilt

My husband has decided to go for surgery.  We found a dr. at Vanderbilt Urology Clinic, Dr. Sam Chang.  Our first consult will be on 3/30/17.  We are taking the films from the CT, MRI and Bone Scan.  Is there anything else we need to do in preparation for this doctor visit?

Congrats

Congratulations on having made a decision, MissViv.  By itself, this brings a sense of relief: the knowledge that you have a specifc plan, that you are insistent will work.  No doubt the two of you consulted with many experts.

You wrote, "my husband has decided to go with surgery."  One thing that would be helpful on the meeting on the 30th would be a mindset that says " we have decided on surgery."  Vanderbilt and its med school are among the best in the US, and lead the South in oncology, along with Duke and Emory. MD Anderson, being in Houston, is in a sense "southern" also.

I would definitely ask the surgeon about the herniated area and existing scar tissue from his colon surgeries.  He might want a general surgeon in the room during the surgery if hernia repair is warranted -- I would ask about those issues for certain.  The gland will be analyzed immediately, before he is even closed in surgery.  The results of that patholgy will guide any further treatments than might be indicated then.

You are obviously a highly thoughtful and supportive spouse....these pronouns can be subtle.

Bless the surgeon and the results. Bless everyone involved, which very much means you as well. 

I have always said: My cancers were harder for my wife than for me. I mean that literally: the experiences, treatments, recovery, where harder for my wife than me. Yes, I felt the pain, the weakness.  But she had to take care of everything while I was down-and-out.  Do relaxation activities for yourself.  Do not ignore your own well-being.

max

MissViv

MissViv said:

Vanderbilt

My husband has decided to go for surgery.  We found a dr. at Vanderbilt Urology Clinic, Dr. Sam Chang.  Our first consult will be on 3/30/17.  We are taking the films from the CT, MRI and Bone Scan.  Is there anything else we need to do in preparation for this doctor visit?

Yes, I have a copy of the

Yes, I have a copy of the biopsy with PSA to take also.  Vanderbilt sent us a patient questionare to fill out and it has a place for all former surgeries and medications.  Also, a release form for any doctors records that they might need.

MissViv

Max Former Hodgkins Stage 3 said:

Congrats

Congratulations on having made a decision, MissViv.  By itself, this brings a sense of relief: the knowledge that you have a specifc plan, that you are insistent will work.  No doubt the two of you consulted with many experts.

You wrote, "my husband has decided to go with surgery."  One thing that would be helpful on the meeting on the 30th would be a mindset that says " we have decided on surgery."  Vanderbilt and its med school are among the best in the US, and lead the South in oncology, along with Duke and Emory. MD Anderson, being in Houston, is in a sense "southern" also.

I would definitely ask the surgeon about the herniated area and existing scar tissue from his colon surgeries.  He might want a general surgeon in the room during the surgery if hernia repair is warranted -- I would ask about those issues for certain.  The gland will be analyzed immediately, before he is even closed in surgery.  The results of that patholgy will guide any further treatments than might be indicated then.

You are obviously a highly thoughtful and supportive spouse....these pronouns can be subtle.

Bless the surgeon and the results. Bless everyone involved, which very much means you as well. 

I have always said: My cancers were harder for my wife than for me. I mean that literally: the experiences, treatments, recovery, where harder for my wife than me. Yes, I felt the pain, the weakness.  But she had to take care of everything while I was down-and-out.  Do relaxation activities for yourself.  Do not ignore your own well-being.

max

Thank you for the kind words.

Thank you for the kind words.  I am the one doing all the research & reading and then I pass on to him.  He (we)  is a little "freaked out" right now with all the complications that can happen.  I think we are in the right hands with Vanderbilt.  The surgeon is a oncologist surgeon and should be able to answer all of our questions.

The ED does not concern me as much as the incontenience, I just really don't want that for him and hope it will be temporary.  We are going to ask the surgeon about the tumor placement and nerve damage.

Mark58

MissViv said:

Thank you for the kind words.

Thank you for the kind words.  I am the one doing all the research & reading and then I pass on to him.  He (we)  is a little "freaked out" right now with all the complications that can happen.  I think we are in the right hands with Vanderbilt.  The surgeon is a oncologist surgeon and should be able to answer all of our questions.

The ED does not concern me as much as the incontenience, I just really don't want that for him and hope it will be temporary.  We are going to ask the surgeon about the tumor placement and nerve damage.

Vanderbilt Urologic Surgery

They have been treating me for 13 years. Dr. Smith (Dept Chairman at that time) was my surgeon, and took care of me for 9 years. I am now seeing Dr. Moses (Oncologist) in Urology. I love my nurses and practitioners. This has been a long road. I've gone thru radiation, harmones and every other drug they came up with. Am I satisfied with Vanderbilt?? Yes I am!! I drive 50 miles one-way just fpr a blood test. I'll answer any and all of your questions. Best of luck with your journey down this bumpy road. Maybe yours will not be as bumpy as mine has been.

MissViv

Mark58 said:

Vanderbilt Urologic Surgery

They have been treating me for 13 years. Dr. Smith (Dept Chairman at that time) was my surgeon, and took care of me for 9 years. I am now seeing Dr. Moses (Oncologist) in Urology. I love my nurses and practitioners. This has been a long road. I've gone thru radiation, harmones and every other drug they came up with. Am I satisfied with Vanderbilt?? Yes I am!! I drive 50 miles one-way just fpr a blood test. I'll answer any and all of your questions. Best of luck with your journey down this bumpy road. Maybe yours will not be as bumpy as mine has been.

Thank you for your comments

Thank you for your comments about Vanderbilt.  I feel confident that we are going to the right place.  It is about 80 miles from our hometown.

We made an appointment with Dr. Sam Chang.  We only had three that were approved by his insurance and Dr. Smith was not one of them.  He seems very qualified.  Graduated from Princeton and medical training at Vanderbilt. 

Our first appointment is 3/30/17.