What questions to ask. Any help appreciated.

Clevelandguy

Choices

Hi Nik,

Looks like you are doing your homework which will help your piece of mind knowing that you looked at all possibilities. If it was me I would also do a PET scan which is usually a little more definitive than a CAT scan for showing small cancerous growths.  Like I always say great doctors+great facilities=great results.  If you feel the need, second opinions are never a bad thing.

Dave 3+4

Old Salt

Are the cancerous lesions close to the edge of the prostate?

I hope that the doc pointed out, and that your Dad is aware, that there's a significant chance of (small, currently non-detectable) metastases with such a high PSA (24 ng/ml). Surgery won't solve that issue, but it can be addressed with radiation and hormone therapy later on. 

The radiation first, surgery later, issue is a red herring.

My warning may be futile because it seems your Dad has made up his mind and radiation therapies have long-term issues as well.

I wish him success.

Nik16

Exploring every option

Dave, I did inquire about a pet scan and both the urologist and oncologist reccomended the 3t mri. I believe they said the pet scan is more for recurrence. I will definitely do some more research on that per your recommendation, so thank you. 

Old salt,  I thought the same thing about the high PSA but both doctors weve seen so far felt his psa would be higher if it had spread. They did however point out there was no guarantee Until the surgery was complete, they get the path report, and he has follow up testing. At the appointment today my dad agreed to meet with a different surgeon and a radiation specialist at their cancer center. while my dads initial reaction was, get it out ASAP, now that things are slowing down and we have more details, he is inretested in learning about all of the alternative options. 

while I know nothing is guaranteed, I am just grateful he has a chance to explore options and is having doctors tell him there is a great possibility he can be cured. I know others in his situation havent always had that luxury. 

as always thank you all for your advice, support, and kind words!

nikki

VascodaGama

Use the Second Opinions to clear doubts

Hi again, 

Second opinions gives the patient confidence on the path to take, but these should be obtained from unbiased sources. I doubt that doctors at the same institution would suggest different approaches, going against the opinion of the prime doctor. I would advise you to consult specialists from a different institution. 

This time you have the chance to inquire on the small details regarding the data retrieved and knowledge you have acquired by now. You should be prepared with a list of questions confronting the opinions of the urologist. You should get information regarding the risks, side effects and procedures (before and after treatment), including counter measures in case of failure. You should take to the consultation copies of tests and exams, in particular the biopsy’s path-report and scans.

In my opinion, his doctor’s suggestion for surgery in a voluminous PCa case,  with 60% of gland involvement of Gleason rate 4, has the intent in debulking the source of the problem. Cure is ambiguous. You can inquire on the possibility of a multimodal (combination) treatment involving surgery plus radiation, or simply radiating the whole prostate and surrounding areas at once.

Can you share with us the copy of the biopsy report and CT scan?

https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/talking-with-doctor.html

Being part of a family with PCa history makes you too with high risk for breast cancer. These bandits share the same genes. You and your siblings need to be vigilant. 

Best,

VG 

 

lighterwood67

Good thoughts

I think in a lot of cases, the initial thought is to get it out (surgery).  You and your Dad keep doing your research.  Make sure he is comfortable with the path to cure.  I would stay focused on Quality of Life.  How does the path I choose impact what I do today?   And somehow you have to balance this with a path that will cure the cancer.  If you choose surgery, just a heads up, if they remove some of the pelvic lymph nodes for biopsy and they seal and clip.  Those surgical clips will be with you.  Another issue you may run into is around a year after RP I had to have an inguinal hernia repair.  The surgeon said this was probably the result of the RP.  The decision comes down to you folks.  Good luck on your journey.