Mayo Jacksonville - Opinion

bob33462
bob33462 Member Posts: 76
edited March 2016 in Prostate Cancer #1
Sorry - some of the below has previously been posted by me -

 

Biopsy 2/11/16 by a local Urologist

Results are in my profile below - above Urologist wanted radiation and ADT -

Subsequent CT and Bone Scans were negative.

Second opinion with Urologist at Cleveland Clinic Florida - Because of current voiding issues radiation would be very hard on me. DRE Clinical 3 per him.

Met with Cleveland Clinic surgeon who would do da Vinci with possible open abdominal adhesiolysis. ( 6 ft. tall, 258 lbs. and prior upper abdominal surgery)

Third opinion at Mayo Clinic, Jacksonville, FL - Met with surgeon who advised against surgery because of potential complications/infection because of weight and prior surgery to upper abdomen. If I wanted surgery he recommended a surgeon in South Carolina who does perineal surgery. Of course, the perineal surgery does not remove the lymph nodes. Not sure that Matters?
One thing the surgeon said was that because my prostate was so small, probably because of the Avodart, the biopsy results may be over stated.

Also, met with Radiation Oncologists at Mayo - they suggested Lupron with radiation. When I told them about voiding issues and what Cleveland urologist said they suggested possible TURP prior to radiation.

So here I am with a pending surgery at Cleveland Clinic scheduled for mid May, but based upon Mayo advice am really questioning that surgery because of potential complications.

However, I really want to avoid ADT, if at all possible. If I had radiation first without Lupron and that fails, salvage surgery, especially on me, would probably not happen.

My options as I see them.
1. Proceed with Cleveland surgery
2. Opt for perineal surgery
3. Do radiation without Lupron
4. Use Lupron with radiation to follow - ( my least favorite, but may be my best option)

Any suggestions for me based upon past experiences -

 

FYI - I am getting a third surgical opinion from University of Miami next week -

Thank you,
Bobby Mac

Age: 69, 69 at PC dx, PSA 6.7 Avodart (6.7 x 2.3 = 15.5)
3rd Biopsy: 2/16 13 of 14 Positive, 2-99%, 3 were 4+4
First two biopsies negative - one previous in 2008
Was being treated for BPH for 15 or so years -
No treatment as of 3/26/16

 

Comments

  • bob33462
    bob33462 Member Posts: 76
    #2
    Sylvester Surgery

    I met with Sylvester surgeon yesterday. He is willing to do either retropubic (open) or da Vinci surgery. He does feel that because of my prior abdominal surgery and weight he could run into problems with da Vinci.

    I feel I am better with open surgery as I don't want a da Vinci surgery aborted because of prior scarring.

    However, I am reading surgical margins are a bigger problem with open surgery.

    Any suggestions for me as I will have to make a decision on Wednesday.

    Thanks,
    Bobby Mac

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #3
    bob33462 said:

    Sylvester Surgery

    I met with Sylvester surgeon yesterday. He is willing to do either retropubic (open) or da Vinci surgery. He does feel that because of my prior abdominal surgery and weight he could run into problems with da Vinci.

    I feel I am better with open surgery as I don't want a da Vinci surgery aborted because of prior scarring.

    However, I am reading surgical margins are a bigger problem with open surgery.

    Any suggestions for me as I will have to make a decision on Wednesday.

    Thanks,
    Bobby Mac

    The importance of surgical

    The importance of surgical margins in prostate cancer.

    http://www.urotoday.com/index.php?option=com_content&view=article&id=87593:the-importance-of-surgical-margins-in-prostate-cancer&catid=1134:prostate-cancer&Itemid=2818&utm_source=newsletter_3449&utm_medium=email&utm_campaign=uroalerts-prostate-cancer-weekly

    Additonally more experienced surgeons , general have a smaller sugical margin, and some can in fact use MRI technology to control the margin. i consulted with one whose surgical margin was 0.06

    As far as the surgery, you want a surgeon who is most experienced and qualified; it can be robotic or open.

    .....

     

    To be honest before the procedure, I don't understand why you are so set on surgery, not pursuing hormone and radiation, as was suggested here and at the healing well site. Of course be aware that we at these sites are lay people. Why not see a Medical Oncologist, for an impartial view of your situation..

    Best wishes to you.

  • bob33462
    bob33462 Member Posts: 76
    #4
    hopeful and optimistic said:

    The importance of surgical

    The importance of surgical margins in prostate cancer.

    http://www.urotoday.com/index.php?option=com_content&view=article&id=87593:the-importance-of-surgical-margins-in-prostate-cancer&catid=1134:prostate-cancer&Itemid=2818&utm_source=newsletter_3449&utm_medium=email&utm_campaign=uroalerts-prostate-cancer-weekly

    Additonally more experienced surgeons , general have a smaller sugical margin, and some can in fact use MRI technology to control the margin. i consulted with one whose surgical margin was 0.06

    As far as the surgery, you want a surgeon who is most experienced and qualified; it can be robotic or open.

    .....

     

    To be honest before the procedure, I don't understand why you are so set on surgery, not pursuing hormone and radiation, as was suggested here and at the healing well site. Of course be aware that we at these sites are lay people. Why not see a Medical Oncologist, for an impartial view of your situation..

    Best wishes to you.

    Surgeon Quality

    Hopeful, Thank you for the information.

    My surgeon is very experienced and one of the best in Florida - I feel extemely confident with him -

    Surgey will most likely end my voiding problems and I want the tumor out of my body.

     If I did radiaition first salvage surgery would most likely not be an option for me - also, no offense to anyone, but I just do not want to do ADT and it would be my last option.

    Thanks again!

     

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #5
    bob33462 said:

    Surgeon Quality

    Hopeful, Thank you for the information.

    My surgeon is very experienced and one of the best in Florida - I feel extemely confident with him -

    Surgey will most likely end my voiding problems and I want the tumor out of my body.

     If I did radiaition first salvage surgery would most likely not be an option for me - also, no offense to anyone, but I just do not want to do ADT and it would be my last option.

    Thanks again!

     

     

    .

    Of course I wish you the best with the choice that you made for you............that fits what is important to you...............I hope that everything goes smoothly for you, and there will be successful results.....please feel free to ask additional questions, and keep us posted

  • Swingshiftworker
    Swingshiftworker Member Posts: 1,017 Member
    #6
    bob33462 said:

    Surgeon Quality

    Hopeful, Thank you for the information.

    My surgeon is very experienced and one of the best in Florida - I feel extemely confident with him -

    Surgey will most likely end my voiding problems and I want the tumor out of my body.

     If I did radiaition first salvage surgery would most likely not be an option for me - also, no offense to anyone, but I just do not want to do ADT and it would be my last option.

    Thanks again!

     

     

    Your life, your choice . . .

    It's apparent that you've already made up your mind about what you want to do.   Good luck w/the choice you've made.

    I hope it goes well for you.

  • bob33462
    bob33462 Member Posts: 76
    #7
    hopeful and optimistic said:

    .

    Of course I wish you the best with the choice that you made for you............that fits what is important to you...............I hope that everything goes smoothly for you, and there will be successful results.....please feel free to ask additional questions, and keep us posted

    New Biopsy Results

    Took my slides to U of Miami Health Care and they got a Gleason 7 (4+3) as opposed to original lab who scored my Gleason 8. A little improvement ---

    Surgery on 4/20/16 at UMHC - final staging will follow -

     

  • Will Doran
    Will Doran Member Posts: 207 Member
    #8
    Robotic Surgery

    Bob,

    I, Like you, decided to go with the Robotic Surgery, because I wanted the "tumor" gone and out of my body. I am 6 ft 2 inches tall and weigh 210 lbs. I also had had  abdominal surgery.  I had a double abdominal hernia fixed, in the area of my navel.  There is mesh and 60+ titanium staples holding the mesh in place.  My surgeon and oncologists knew about this mesh before we decided on the Robotic Surgery.  My surgery was supposed to take about 2 1/2 hours to complete.  Because of the mesh, and other complications, my surgery took 5 1/2 hours.  They had trouble getting through the mesh with the robot for the big incision where they "passed" the tools in and out.  That incision goes right above the navel.  That wasn't the main "hold up" in the progress of the surgery.  Then Dr. M----- coudn't find the lymph nodes in my right groin, because of the muscle development I have from years of riding road bicycle.  He was finally able to maneuver the robot and located the lymph nodes and then had the robot do , as he described it, a mirror image and the robot guided Dr. M to the lymph nodes on my left side.  That made this entire ordeal much easier to accept.  The robot can and did offer a lot of help in getting through this process, and making my recovery much easier.  I was allowed to be back on a tread mill two days post surgery and was back on my Spinner Bike after 7 weeks.   My doctors used interior stitches and then closed the outer incisions (5 in total) with "glue".   

    Since all our cases are different, I can't assure you what your outcome will be.  But in my case, this was the best way to go in having this surgery, and I wouldn't do anything different, if I had to make this decision again.  If your doctor has a good reputation for doing this robotic assisted surgery and has done many of them, then you should be in good hands. 

    Best of luck, and best wishes for a speedy recovery

    Peace and God Bless

    Will

  • bob33462
    bob33462 Member Posts: 76
    #9
    Will Doran said:

    Robotic Surgery

    Bob,

    I, Like you, decided to go with the Robotic Surgery, because I wanted the "tumor" gone and out of my body. I am 6 ft 2 inches tall and weigh 210 lbs. I also had had  abdominal surgery.  I had a double abdominal hernia fixed, in the area of my navel.  There is mesh and 60+ titanium staples holding the mesh in place.  My surgeon and oncologists knew about this mesh before we decided on the Robotic Surgery.  My surgery was supposed to take about 2 1/2 hours to complete.  Because of the mesh, and other complications, my surgery took 5 1/2 hours.  They had trouble getting through the mesh with the robot for the big incision where they "passed" the tools in and out.  That incision goes right above the navel.  That wasn't the main "hold up" in the progress of the surgery.  Then Dr. M----- coudn't find the lymph nodes in my right groin, because of the muscle development I have from years of riding road bicycle.  He was finally able to maneuver the robot and located the lymph nodes and then had the robot do , as he described it, a mirror image and the robot guided Dr. M to the lymph nodes on my left side.  That made this entire ordeal much easier to accept.  The robot can and did offer a lot of help in getting through this process, and making my recovery much easier.  I was allowed to be back on a tread mill two days post surgery and was back on my Spinner Bike after 7 weeks.   My doctors used interior stitches and then closed the outer incisions (5 in total) with "glue".   

    Since all our cases are different, I can't assure you what your outcome will be.  But in my case, this was the best way to go in having this surgery, and I wouldn't do anything different, if I had to make this decision again.  If your doctor has a good reputation for doing this robotic assisted surgery and has done many of them, then you should be in good hands. 

    Best of luck, and best wishes for a speedy recovery

    Peace and God Bless

    Will

    Thanks Will

    Will, Thank you!

    I think my prior abdominal surgery is high enough to not be in the way. If not, they will go with open surgery in the groin area.

    I am anxious to learn of my final staging -----

    Bobby Mac

     

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,817 Member
    #10
    super

    Congratulations on your treatment decision, Bob. It seems making a decision on first-line therapy is at times the hardest part of the PCa experience !  Many other cancers, like lymnphoma or leukemia have no choices; it is "start chemo or die" in that other world.

    First-line therapy for moderate cases of PCa are virtually always performed by the doctor for curative effect; that is, you never want to see the disease again.  Oncologists today disavow the word "cure," but the terms "curative effect" or "palliative effect" are still standard nomenclature. throughout oncology. 

    Around 50% of all men in the US today choose surgery for this, and around 50% choose radiation, sometimes with HT added.  Curative outcomes are very nearly identical for both approaches.  (Advanced PCa cancers are different, and surgery becomes a less reasonable or effective option in those cases.)  I had surgical removal 15 months ago, and am satisfied with the results.   Expect to be impotent, in nearly all cases, for at least six months.  At nearly 60, that was not problematic for me.  A year or longer impotent is not uncommon....  Continence returned for me rapidly; I wore diapers only two days after the cath was removed, but a pad or liner for a few months beyond that.

    One thing my worrisome nature found appealing about surgical removal is that the same day you know exactly what was going on in the gland and surrounding tissues. When it is put under a microscope by a pathologist, all questions come to an end.  No waiting for a PSA nadir, etc.  If surgery discovers that things were worse than anticipated, radiation can be started soon after the incision is healed. 

    Uriological stricture is generally a recommendation for surgery rather than radiation, although a good radiation oncologist can often work around this.

    What to do is ultimately a flip of the coin, a Hershey Bar with almonds, or without.  All approaches have proponents, and fortunately all usually work pretty well.

    Good luck,

    max

  • bob33462
    bob33462 Member Posts: 76
    #11
    Max Former Hodgkins Stage 3 said:

    super

    Congratulations on your treatment decision, Bob. It seems making a decision on first-line therapy is at times the hardest part of the PCa experience !  Many other cancers, like lymnphoma or leukemia have no choices; it is "start chemo or die" in that other world.

    First-line therapy for moderate cases of PCa are virtually always performed by the doctor for curative effect; that is, you never want to see the disease again.  Oncologists today disavow the word "cure," but the terms "curative effect" or "palliative effect" are still standard nomenclature. throughout oncology. 

    Around 50% of all men in the US today choose surgery for this, and around 50% choose radiation, sometimes with HT added.  Curative outcomes are very nearly identical for both approaches.  (Advanced PCa cancers are different, and surgery becomes a less reasonable or effective option in those cases.)  I had surgical removal 15 months ago, and am satisfied with the results.   Expect to be impotent, in nearly all cases, for at least six months.  At nearly 60, that was not problematic for me.  A year or longer impotent is not uncommon....  Continence returned for me rapidly; I wore diapers only two days after the cath was removed, but a pad or liner for a few months beyond that.

    One thing my worrisome nature found appealing about surgical removal is that the same day you know exactly what was going on in the gland and surrounding tissues. When it is put under a microscope by a pathologist, all questions come to an end.  No waiting for a PSA nadir, etc.  If surgery discovers that things were worse than anticipated, radiation can be started soon after the incision is healed. 

    Uriological stricture is generally a recommendation for surgery rather than radiation, although a good radiation oncologist can often work around this.

    What to do is ultimately a flip of the coin, a Hershey Bar with almonds, or without.  All approaches have proponents, and fortunately all usually work pretty well.

    Good luck,

    max

    Thanks

    Max - Thank yiou---

    Bobby

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #12
    bob33462 said:

    Thanks

    Max - Thank yiou---

    Bobby

    Lower risk Gleason rating. Just wonderful

    That was great news about the lower risk Gleason rating. It makes things easy and provides peace of mind. Gleason 7 is intermediate while Gleason 8 is of high risk.

    Best wishes for a successful outcome from the surgery.

    VG 

  • bob33462
    bob33462 Member Posts: 76
    #13
    VascodaGama said:

    Lower risk Gleason rating. Just wonderful

    That was great news about the lower risk Gleason rating. It makes things easy and provides peace of mind. Gleason 7 is intermediate while Gleason 8 is of high risk.

    Best wishes for a successful outcome from the surgery.

    VG 

    Thank you

    Thanks, Vasco - I will find out the true staging in 10 days ---

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