Picking Surgeons

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  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited February 2021 #22
    Rob.Ski said:

    My oncotype is 26.  

    My oncotype is 26.  

     

    What kind of PSA increases have you had over 12 years? 

    .

    Rob,

    In July 2013 my slides were evaluated by oncotype DX.   The GPS was 27 ( I think that that's the score that you are referring to. What that means for me is that according to oncotype DX I am a low risk patiient, likelihood of favorable pathology 74%, freedom from high grade disease 84%, freedom from non organ confined disease 80%....Oncotype DX uses rt-pcr to determine the expression of 17 genes in tumor tissue. Oncotype is calculated from the gene expression results and ranges from 0 to 100.

    The criteria for the Genomic test is based on a prospectively-designed validation study of biopsy tissue from 388 patients with localized prostate cancer meeting the NCCN Very Low, Low and Intermediate risk criteria.

    It  seems that your numbers are similar to mine...is that true?

    ....

    You ask about PSA increase.

    First let me say that the main information that I am interested in are my biopsy results, not the PSA's

    That said, my PSA, sometimes jumps up and down, but over time there is a gradual increase .. When I was first diagnosed around March 2009 my PSA was around 2.26/2.2.27. There has been a gradual increase over time. In February 2020 it is at 6.2 (Please note that you have to look at the trend of the PSA's since individual points fluctuate a great deal........By the way if you click my name at this site, I've documented my prostate cancer journey.

    I am open to answer any questions that you might have.

  • Clevelandguy
    Clevelandguy Member Posts: 783 Member
    Tv commercial

    Wow Amdenver, sounds like a TV commercial for a drug where everything under the sun is a possibility.  ?

    Dave 3+4

  • Rob.Ski
    Rob.Ski Member Posts: 88 Member
    edited February 2021 #24

    .

    Rob,

    In July 2013 my slides were evaluated by oncotype DX.   The GPS was 27 ( I think that that's the score that you are referring to. What that means for me is that according to oncotype DX I am a low risk patiient, likelihood of favorable pathology 74%, freedom from high grade disease 84%, freedom from non organ confined disease 80%....Oncotype DX uses rt-pcr to determine the expression of 17 genes in tumor tissue. Oncotype is calculated from the gene expression results and ranges from 0 to 100.

    The criteria for the Genomic test is based on a prospectively-designed validation study of biopsy tissue from 388 patients with localized prostate cancer meeting the NCCN Very Low, Low and Intermediate risk criteria.

    It  seems that your numbers are similar to mine...is that true?

    ....

    You ask about PSA increase.

    First let me say that the main information that I am interested in are my biopsy results, not the PSA's

    That said, my PSA, sometimes jumps up and down, but over time there is a gradual increase .. When I was first diagnosed around March 2009 my PSA was around 2.26/2.2.27. There has been a gradual increase over time. In February 2020 it is at 6.2 (Please note that you have to look at the trend of the PSA's since individual points fluctuate a great deal........By the way if you click my name at this site, I've documented my prostate cancer journey.

    I am open to answer any questions that you might have.

    PSA

    Seems like a lot of docs are interested in PSAs.  I'm aware it runs higher in some people.  Curious what led to your biopsy with PSA being low for your age.  Mine was 3.3 at age 49, now 4.6 18 months later.   Don't have my pathology handy but, one of the cores was 50%, others were lower.   

    Just got the Onocotype so, not real clear on what the data means but, it says The combination of GPS and clincal features predicts this patients risk is NCCN Favorable Intermediate.   Maybe it has to do with age difference? 

  • Rob.Ski
    Rob.Ski Member Posts: 88 Member
    edited February 2021 #25

    Choose wisely

    Hi,

    If you do choose surgery or radiation do your homework on the side effects.  Both surgery and radiation can have good results or sometimes not so good results.  Saying all surgery is bad or radiation is bad is an unfair generalized statement.  I had surgery and I am happy with the results, MK was not.  Other people on this form have had bad outcomes from radiation and others very good.  Each case is unique and to lump all surgery or all radiation as horrible is just not true.  It all depends on the amount and location of cancer in your Prostate and the facility's and doctors treating it.  Weigh the consequences and accept your choice in the future.  Don't let the naysayers shy you away from either treatment.  AS is another way to go if you choose that path, just consider what goes into AS and again learn to live with those parameters.

    It's your body so you get to decide what to do, be careful of people with biased views as their wisdom is often clouded by that bias.

    Dave 3+4

     

     

     

    Trying to do the homework

    Trying to do the homework just don't feel that good about it.  

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited February 2021 #26
    Rob.Ski said:

    PSA

    Seems like a lot of docs are interested in PSAs.  I'm aware it runs higher in some people.  Curious what led to your biopsy with PSA being low for your age.  Mine was 3.3 at age 49, now 4.6 18 months later.   Don't have my pathology handy but, one of the cores was 50%, others were lower.   

    Just got the Onocotype so, not real clear on what the data means but, it says The combination of GPS and clincal features predicts this patients risk is NCCN Favorable Intermediate.   Maybe it has to do with age difference? 

    .

    Unique situation that led to my initial biopsy. I had a digital rectal exam. A lipoma was found in the cavity, not the prostate. Two different urologist decided to do a biopsy. I did not have knowledge at that time, so I agreed. I believe now that a biopsy was not called for at that time. 
    As far as the importance of PSA in my case. I have had a series of three dimensional fusion biopsies. My doc places greater importance to these versus the psa  

    I don't think that the oncotype resu refer to age, but you can research to make sure  

    Important to have your written records in your possession so you can bring to various specialists  

    It is highly recommended to have a second opinion on the slides of your pathology by a world class pathologist  Johathon Epstein of Johns Hopkins is recognized as world class and one of the best in the world  Simply contact your docs office and have them sent  All of your treatment is based on this  If insurance doesn't cover it would be about 250

     

     

     

  • Old Salt
    Old Salt Member Posts: 955 Member
    edited February 2021 #27
    amdenver said:

    Radical Prostatectomy: As a surgeon believes it

    Hi:

    Dave's right on about doing the home work.

    I'm in the situation of deciding which avenue to take. Had my meeting with the Uro about two weeks ago, in which he spent about 10 minutes on RP and how he does it, including answering some of the questions I had. Subsequently, I happened to look at his visit notes and found a LOT more there than had been covered in the actual meeting. Appears to me that this is the RP perspective that probably his internal legal has provided to him and he's copying pasting into each notes, i.e. their real view of RP and its subsequent after affects.

    Rob: Hopefully there'll be additional information for you in here:

    1) Radical surgery: nature of surgery discussed. If performed, radical prostatectomy was recommended via open retropubic or robotic assisted laparoscopic approach. Incisions , risks and benefits for both procedures were discussed. Hospital stay and recovery discussed. Post-operatively, patient would have a Foley catheter. Catheter would be removed 1-2 weeks after procedure. If both nerves spared, there is a 30-40% chance of post op erectile dysfunction. If one nerve spared, there is 50-70% chance of of post op erectile dysfunction. If both nerves have to be removed there is over 95-100% risk of post op erectile dysfunction. These percentages apply to 6-12 month post operatively after a period of healing. Post-operative treatments for impotence briefly discussed including PDE5 medications, vacuum pump device, penile injections, and penile prosthesis. The patient was informed of the possibility of leaving cancer behind in neurovascular bundle(s) even with good pre-operative prognostic factors. The general possibility of a positive margin (potential for residual cancer) was also discussed. Possible need for radiation therapy post operatively and delayed (10 years or more later) was discussed. The patient was informed that he is likely to have some degree of incontinence after surgery which may take up to two years to resolve. Up to 10% of patients have permanent incontinence (2 pads per day or more). The risk is less in younger patients. Treatments for post-operative incontinence (collagen injection, artificial sphincter, slings ) discussed. Patient informed that even patients with satisfactory urinary control report occasional dribbling with lifting, physical activity, or fatigue. Robotic assisted prostatectomy is another approach to removing the prostate. Other risks discussed included but not limited to positional injury, rectal/bowel injury necessitating diverting colostomy/ileostomy, ureteral injury including loss of kidney, penile shortening, lymphocele formation necessitating interventional radiology drain, permanent obturator nerve injury, prolonged foley catheter, need for interventional radiology procedures, need for prolonged drains, bladder neck contracture, incontinence, hernia formation at incision sites necessitating general surgery procedure, and all associated procedures.

    Best of Luck with your options !

    Wow

    Thanks for posting those (somewhat imaginary) 'notes'.

    Such a discussion with the patient would take at least 30 minutes!