Second Opinion Question

tikhon33

Hello again.

I went for my second opinion last week at Duke Medical in Durham North Carolina which, from what I understand is a top treatment center for prostate cancer and met with one of the teaching doctors/urology oncologists who has over 20 years experience and does 150 open radical prostectomies per year.

I also met with the medical oncologist and the radiology oncologists, but felt more comfortable with the urologist and am leaning towards surgery at this point due to the fact that I do not want hormone therapy.

Here's my numbers:

Staging: IIC-TIC N0M0

PSA: 3.93

Gleason Score: 4+3=7

PET Scan shows no metastesis and shows the cancer confined to the prostate.

I am still researching in an attempt to make an informed decision regarding what treatment is best for my situation, however there doesn't seem to be a lot of consensus among doctors and while I understand each case is different, it's frustrating to see so much disagreement since as patients, we seem to be the ones who are the ones at a disadvantage while trying to make an informed decision.

For example one of the books I've been reading is "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" and on page 211 he talks about how far radical prostectamies have advanced in the past decade and how that if you have a skilled surgeon, younger men should retain potent and few should have serious problems with urinary control and goes on to say that "...radical prostectomy is the most certain way to cure men with cancer confined to the prostate"

So far, so good, however, I'm reading another book by Dr. Mark Scholz called "The Key to Prostate Cancer: 30 Experts Explain 15 Stages of Prostate Cancer" and Dr. Sholz doesn't agree that surgery is the best option and that cure rates among radiation and surgery treatment modalities are similar over time, although he does say on page 44 of his book that if "...you are in a position fo consult one of the top prostate cancer surgeons who perform hundreds of these complex and challenging surgeries each year, or unless you are able to travel to a major medical center, surgery is a really bad option" (emphasis mine)

I'm assuming here but I think Duke Med is probably considered a major medical center and my doctor likely would fall under the category of a top prostate cancer surgeon, but not entirely sure how I would go about verifying this information.

Again, for those of us who have been given the awful diagnosis of prostate cancer, It feels like I'm drowing in a sea of conflicting opinions, data and information among the experts I'm looking to for answers regarding the best possible treatment options and it's troubling and stressful.

Sorry for the rant.

Anyway I think there are three questions here:

1. Has anyone been to Duke Med for treatment, and if so what was your experience?
2. How can one view a doctor's ratings and/or talk to patients that have been treated by a specific doctor?
3. Should I seek out a second opinion on the biopsy pathology report?

Thanks in advance..

doug

Old Salt

Most consider Dr Walsh's book outdated. While excellent on the surgical aspects, the book is not up to date on radiological approaches. The latter field has changed a lot over the last decade!

Doctor's ratings are not readily available. However, if you post here, or on another (prostate cancer) forum, others may chime in about their experiences with a certain doctor.

Second opinions on biopsy results and possible treatments are generally recommended.

Rob.Ski

You're not alone in the quest for the right doctor. I had been to a few Urologist before finding one I felt was the right one for my surgery. He did provide a study of outcomes for his surgeries. I'm not sure it's the norm for docs to have this info but, it is certainly a question worth asking. There are lots of statistics out there for outcomes of different treatments but, you really want to know the outcomes for your doc whether it's surgery or some other treatment.

Clevelandguy

Hi,

In my humble non medical opinion get the best doctors and the best facilities for the best possible results. From what I have read both surgery or radiation can provide equal curative results but there are no guarantees with either method. Where I live I can look at patient reviews either through google or the hospitals network site. My Internist strongly guided me to a specific doctor I guess based on his knowledge of the Urologist, so you could ask your Primary care doctor for referrals. When you’re all done it’s time to decide and then also accept the results. Second opinions are never a bad idea. Good luck…..

Dave 3+4

tikhon33

https://csn.cancer.org/discussion/comment/1710744#Comment_1710744

@Rob.Ski

Thanks for your response.

Why did you choose surgery over radiation and how do you rate your experience?

thanks again..

Old Salt

I second the idea to ask a 'neutral' (primary care) physician for input on which specialist to get. In my case, I got a referral to one of the guys in a big urology center and was told to only use him, not one of the others. He turned out to be great.

eonore

How long a course of hormone therapy was discussed by the RO?

Eric

centralPA

I get an aviation physical every year, and last year had to get a waiver for my PCa. Turns out my AME (doctor) had had prostate cancer a bunch of years ago. He had radiation. He’s an anesthesiologist, so he’s watched a lot of surgeries from the head down. :) I thought that was an interesting data point. He’s a quirky, highly opinionated dude.

tikhon33

https://csn.cancer.org/discussion/comment/1710762#Comment_1710762

6 months

Rob.Ski

https://csn.cancer.org/discussion/comment/1710747#Comment_1710747

I was 51 at time of treatment, otherwise healthy with no indication of metatasis. I had seen two different radiologist and 3 surgeons. Both radiologist suggested surgery so options are better if there is reccurence. If both surgery and radiation have similar success rates, they also have similar failure rates. If I was 70 and otherwise healthy, I'd probably done radiation. That was my thought process. I was worried about side effects like everyone else. Found what i thought was a great doc and went with it. There are people that chose surgery, had bad side effects and recommend to others not to do it. Others that had radiation, have recurrence and wish they had surgery. All you can do is gather as much info as you can and make the most informed decision. Find best doc and facility you can even if you have to travel for it.

Best of luck in your decision.