Newly Diagnosed-Could use some advice re Lab findings
Gentlemen-
I have been trolling these boards recently after my first inclination I might have pCA. I must say I am impressed by the amount of unselfish, sincere help offered on these boards and the level of educated, well thought out responses offered by it's members. I hope to return the same at some point. I was hesitant to post prior to having some clinical data to report and now I have same.
I am a 64 y/o in reasonably good health. Smoked previously/ HPTN controlled with meds. My PCP has been watching my PSA over several years and suggested I see a Urologist when my level rose to 5.1 a few months ago. I had recently been experiencing some symptoms, urgency and less than ideal flow. My Urologist suggested a TURP due to my PSA velocity. The results of my TURP were as follows:
Right Medial Base: Benign
Right Medial Mid: Benign
Right Medial Apex: Adenocarcinoma, Gleason score 7 (3+4) involving approx 25% of the biopsy length
Right Lateral Base: Benign
Right Lateral Mid: High-grade prostatic intraepithelial neoplasia
Right Lateral Apex: Adenocarcinoma, Gleason score 6 (3+3) involving approx 15% of biopsy length
Left Medial Base: Adenocarcinoma, Gleason score 6 (3+3) involving approx 5% of biopsy length
Left Medial Mid: Benign
Left Medial Apex: Adenocarcinoma, Gleason score 6 (3+3) involving <5% of biopsy length
Left Lateral Base: Adenocarcinoma, Gleason score 6 (3+3) involving <5% of biopsy length
Left Lateral Mid: Benign
Left Lateral Apex: Benign
Subsequent the TURP during my follow-up with the urologist, we spent about an hour going over the TURP results and my new Dx of pCA. He placed me at an "Intermediate" risk due to the existence of the Gleason 7 ( he placed my DRE and PSA in the "low risk" catagory) and suggested an "MRI with 3D imaging" to furthur diagnose and check for possible extracapsular spread. He reviewd treatment options with me and felt I would be a good candidate for RP, however suggested I review/research all my options before deciding. He stated Both XRT and RP had a similar "cure rate" of 90-95% and mentioned RP to be the "Gold Standard". ( He's a surgeon.....) He did not try to force surgery over other tx options and offered referrals to other tx providers. He has performed "over 500" RP's and performs other DaVinci procedures on a frequent basis. ( including my wife)
About a week later I had a "MRI Prostate w/wo contrast w/ CAD and MPR"
Results:
PSA 5.2
Prostate Meas: 5.0x4.9x4.5 cm
Prostate Vol: 57.17 cc
PSA Density: 0.09
Prostate capsule intact
Lymph nodes: No suspicious or enlarged pelvic lymphadenopathy.
" There is no evidence for transcapsular extension or local regional disease"
End Report
(There is much more info in this MRI report however I am not sure what all is relevant, or not. So I have attempted to summarize. )
Subsequent the MRI, he met again with my wife and I. I had 2 pages of questions..........
He said my stage is "T1Gleason 7". If there is an error in this stage explanation, it is probably mine, as I still don't completly understand this staging system
Most of my questions were answered. He was very honest and forthcoming as far as I could tell. Again, he did not try to push me into a surgical remedy, however he did think I should make a decision within the next 3 months or so. BTW I asked if I could speak to prior patients. Another pt approx my age just happened to overhear our conversation and offered to talk to me. We spent an hour alone, in a closed room supplied by my doctor. he was 1 year post RP and he stated he would do it again. He was very frank about his experience, side effects, etc. I had all my questions answered by him. I felt I got an honest opinion.
I have scheduled an appt with another Urologist specializing in pCA here locally at the Moffit CA center this Wed. and an appt with an Oncologist at another facility this Thurs.
From my extensive reading on these boards describing pCA cases much more involved than mine, I remain cautiously optimistic. It is early on in my quest for answers, however I am currently considering either RP or CK.
I have a million questions, however at this late hour, the one that comes to mind is this: If PSA is produced only by the prostate, obviously PSA readings should be 0 post RP. How then, if RT irradiates and "kills" the entire prostate, can men have PSA readings post RT? Would that not indicate that ALL the prostate cells were not killed and those live cells could subsequently produce PSA, and furthur, become cancerous?? Another thing that stuck out to me was the prospect that recurrence after RP could be treated with radiation, however the reverse is not feasible.
I welcome any/all opinions, advice or experiences.
Thank You.
Hopefully Optimistic
Comments
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I think that you have heard
I think that you have heard the talking points in favor of surgery, and now you need to consult with one or more radiation oncologists. Radiation turns most or all of the prostate into scar tissue. Some PSA will continue to be produced. I believe that it would be rare that a new prostate cancer would develop after RT. The long term efficacy of RP and RT are about the same, although there are differences in side effects.
If there is a recurrence after RT, there can be cryotherapy or salvage SBRT. There are options.
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I think we have legitimate a question that needs expert opinion
I also have been thinking about the difference in outcomes between RP and RT. Like ASAdvocate Ive been told that RP and RT have about the same success rate .
Could that really be ? I would think that radiation would radiate area's that are left behind by surgery ie prostate bed , therefore increasing your chances that cancer ( most likely not seen at the time of surgery ) would get treated thus lowering your risk of reoccurance. My cancer was found in the prostate bed left behind by surgery. Would radiation have addressed this ? not sure.
It would be good if this question was posed to a urologist surgeon and to a radiation oncologist. This could potentially help some new Pca patients make that difficult decision when faced with that choice...
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Choices To Consider
The following is a duplicate of one that I have posted in various threads on this forum to give men newly diagnosed w/lower risk prostate cancer (Gleason 6 or 7) an overview of the treatment options available to them.
Anyone newly diagnosed with prostate cancer rated Gleason 6 (and usually Gleason 7) has all treatment options available to him and, since this cncer is considered "low risk", he has time to decide which choice is best for him. So, the first thing a new prostate cancer patient should do is to do research on the available options before he actually has to make the decision regarding which treatment to choose.
The following is my response to other men who asked for similiar advice about the treatment choices avilable to them. It's a summary of the available treatment options and my personal opinion on the matter. You can, of course, ignore my opinion about which treatment choice I think is best. The overview of the choices is still otherwise valid.
. . . People here know me as an outspoken advocate for CK and against surgery of any kind. I was treated w/CK [7] years ago (Gleason 6 and PSA less than 10). You can troll the forum for my many comments on this point. Here are the highlights of the treatment options that you need to consider:
1) CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer. Accuracy at the sub-mm level in 360 degrees and can also account for organ/body movement on the fly during treatment. Nothing is better. Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding. Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.
2) IMRT is the most common form of external radiation now used. Available everythere. Much better accuracy than before but no where near as good as CK. So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding. Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed. I think some treatment protocols have been reduce to only 20 but I'm not sure. Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.
3) BT (brachytherapy). There are 2 types: high dose rate (HDR) and low dose rate (LDR). HDR involves the temporary placement of rradioactive seeds in the prostate. CK was modeled on HDR BT. LDR involves the permanent placement of radioactive seens in the prostate. 1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children. The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive. Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body. Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc. Both HDR and LDR require a precise plan for the placement of the seeds which is done manually. If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects. An overnight stay in the hospital is required for both. A catheter is inserted in your urethra so that you can pee. You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.
4) Surgery -- robotic or open. Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation. Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function). Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body due to the remove of the prostate which sits between the interior end of the penis and the bladder. Doctors almost NEVER tell prospective PCa surgical patients about this. A urologist actually had the to nerve to tell me it didn't even happen when I asked about it. Don't trust any urologist/surgeon who tells you otherwise. Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer. Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.
5) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer. You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer. Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it.
I personally could not live w/the need to constantly monitor the cancer in my body. Like most other men, I just wanted it delt with. Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted. I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected. Other men on this forum have reported similiar results.
So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment. The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.
Good luck!
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Not just internet folks with fuzzy credentialscontento said:I think we have legitimate a question that needs expert opinion
I also have been thinking about the difference in outcomes between RP and RT. Like ASAdvocate Ive been told that RP and RT have about the same success rate .
Could that really be ? I would think that radiation would radiate area's that are left behind by surgery ie prostate bed , therefore increasing your chances that cancer ( most likely not seen at the time of surgery ) would get treated thus lowering your risk of reoccurance. My cancer was found in the prostate bed left behind by surgery. Would radiation have addressed this ? not sure.
It would be good if this question was posed to a urologist surgeon and to a radiation oncologist. This could potentially help some new Pca patients make that difficult decision when faced with that choice...
An expert panel from the AUA did state that radiation and surgery are both recommended for intermediate risk patients with localized cancer.
https://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)
Please scroll down to 9 for low-risk patients and to 16 for intermediate risk patients
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Get second opinions on collected data before any conclusion
I wonder if you did TURP. The data you share above seems more to be from a TRUS (trans-rectal ultrasound guided) biopsy involving the template of 12 needles. Of those 5 are positive meaning a voluminous case of cancer. The 57cc makes it to believe that hyperplasia exists which could be the cause of the "less than ideal flow" of urine. Calculi are ruled out by the CAD and MPR technique. I would think that the urgency is due to an inflammation or nodule pressing upwards against the walls of the bladder. Surely the cancer found in both lobes at the base could cause the symptom.
It was good for you to inquire with one of your doctor's patient but by rule no one case is equal to another. His status could have been different which surely would not assure an equal surgery outcome. The radiologist's comment "There is no evidence for transcapsular extension or local regional disease" suggests a contained case but I think it better you get a second opinion on the interpretation of the MRI because of the extent of the cancer found in the biopsy (both lobes positive in the apex and base). Gleason score 7 is for intermediate risk for metastases. I would suggest you to get a PET PSMA exam to have a better conclusion on the diagnosis. Please note that if cancer is not totally contained both; RP and CK would not assure you cure.
Welcome to the board and to this friendship club of which no one wants to become a member.
Best wishes,
VGama
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Study, Study, Study
Hi,
Make sure you do your homework and this will give you the knowledge & piece of mine that you made the right choice. Both surgery & radiation each have their own side effects. Good doctors & good facilites are a must when you decide on your treament, I can't say that enough. It's your body, your choice what ever the outcome is. Might sound kind of basic but it is just that. Swingshift has a good review except for the surgery part, lots of scare tactics that are not quite true. Once you decide what path to go there are several people that can guide you the rest of the way. Good luck....................
Dave 3+4
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Thank You
Thank you all for your comments and suggestions. I have appts with another surgeon and an Oncologist Wed and Thurs of this week. Will post more after those appts.
D.
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What's your clinical stage?
HopefullyOptimistic,
I received your mail. I think it better for you that we keep exchanging views in this your thread as many guys may provide their opinions. Your posts will also be helpful to those reading but not participating.
You mail me the following;
“….I understand that based on the amount of cores out of 12 (BTW, it was a TRUS, not a TURP, i misspoke). Alternately, I hoped that I was on the "low end" of Intermediate as most of the Ca found was Gleason 6 and only one area of G7. This hope obviously refers to the chances of spread and the amount of time I have to make a decision on Tx. Please correct me if my thinking is inaccurate or overly hopeful. You mentioned a second opinion on the MRI. I assume this would be done by another radiologist? I'm being seen @ Moffit Ca center here in Tampa in the next couple of days and will inquire there. Will also inquire re PET scan. Would appreciate any additional thoughts/opinions you might offer.”
Firstly I want to tell you that Moffitt CC is a research center involved in all types of cancer (including clinical trials for PCa matters). Their facilities are modern and filled with the latest equipments and investigational team of physicians. They do not follow the others. They suggest and impose the rules. It is a trustful place where you surely can get answers on your questions and doubts.
https://moffitt.org/tests-treatments/tests/radiology-diagnostic-imaging/
Regarding the image exams (I have suggested above) you can discuss the matter with their radiologists, requesting a second look on the MRI film and at the same time inquiring about the PET exam. Your PSA of 5.2 ng/ml should warrant a positive result which ever radiotracer is used but my suggestion is for you to have the 68Ga PSMA PET scan or the PET 18F Flurocholine. If they are not using these radiopharmaceuticals or not doing the PSMA technique, at least they can guide you to other clinics doing it. The traditional 18F-FDG PET/CT exam is not the best for you for the low Gleason rates presented in your cancer and the Axumin is not specific in PCa at certain areas. Please refer to my comment in here: https://csn.cancer.org/comment/1604475#comment-1604475
The above scan in combination with the MRI results will be more appropriate to identify any localized extra capsular extensions. Other nuclear exams I would request in this opportunity would be a simple bone densitometry test to check bone health (the bandit loves weak bone).
You surely can be hopeful for a low grade case because Gleason rate 3 could very well be a lower 2 (AUA stopped using this grade since 2005 upgrading it to 3), which would reduce your risks. But the finding of the rate 4 commands your case in any interpretation of your status. The biopsy does not analyze the whole gland tissues in 12 needles. It identifies and locates cancerous cells. Unfortunately the finding leads to think for the worse. Grades of 4 could exist but have been missed. The risk for metastases is therefore higher and it should be given more particular attention.
I wonder why you worry about the “time” you have to make a decision. Without a due clinical stage nothing should be decided. You are just following the proper steps after diagnosis. Nothing is at loss by spending time in investigations. Cancer does not spread overnight.
Your quality of life is at risk. You should involve the opinion of your family in your final decision as they will also be affected by the situation. Do things coordinately and timely.
Best wishes,
VGama
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HopefullyOptimistic......great name!
Determining Gleason scores are subjective.......there is a difference among pathologists and facilities.....suggest that you receive a second opinion on your pathology from a world class pathology center........johns hopkins is a excellent choice....at that time request information on how much of the 3+4=7, if the expert pathologist concurrs is a Gleason 4.
If you have to pay out of pocket the cost will be approximately 200, worthwhile since the results if the pathology is most important in determing treatment choice.
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Take Your Time
Hello HopefullyOptimistic
You have already received good advice and have also taken some good first steps with your testing. FYI I had Johns Hopkins perform a second opinion of my biopsy slides in mid February this year and it cost me $250 out of pocket straight cost as I had no insurance help on the charge. It took me a couple of calls but my doctor ended up taking care of it all. As Hopeful suggests I think it is a good idea as part of your studies. Other than that I streuously suggest that you take your time and talk to as many medical sources as you can. Except for the fact I had no symptoms of any sort like urgency or flow my diagnosis was not far from yours. I went about 9 months from initial biopsy to initiation of my chosen treatment along the way gathering enough information to feell confident in that length of delay. Good luck and I'm sure you will make the right decision for you but by all means study and talk to docs until you're blue in the face. Best regards.
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Gentlemen-
Since my last post, I have seen an additional surgeon and a RO. I saw the surgeon at Moffitt Ca Center in Tampa. A center that is well known and highly regarded, one of the best in the country, I am told. This particular surgeon has performed "about 1400 DaVinci procedures specifically for PCA" he states. Additionally, he was doing prostate work via Lap and also open procedures prior to robotics for many years. Personally, I feel this Doc has probably seen almost every prostate presentation known to man secondary his extensive experience. ( my opinion, not his statement ) Unfortunately, I forgot to ask hom about his +Margin %'s. I also forgot to ask him about penile shortening secondary surgery and am somewhat concerned about it as I am a "Shorty" to begin with and can't afford to lose 2", for both vanity and functional reasons. I don't want to have to tie a string around my pecker to pull out when I want to pee...... Moffitt will be providing a second opinion on both the pathology and the MRI. He does not feel a need for a PET scan based on the MRI and his eval of my case. He said he is able to see the problem areas on the current 3D MRI. He says they are not able to do "path while on the table" and I don't know if this is industry norm or a result of facility abilities. My Urologist who first diagnosed my Ca and performed my TRUS states he has done approx 500 DaVinci's for PCa and coincidentally, trained at Moffitt. He generally down-played the penile shortening thing, mentioning a figure of "1-1 1/2 cm's."
The RO I saw was referred by my Urologist. He performs "Smart Beam IMRT" via something called a "Rapid Arc" machine. 42 weeks 5 days a week, sessions of approx 10-15 mins followed by Hormone Therapy. He's a Young guy, I forgot to ask how many procedures HE had performed as I initially did'nt think this mattered in RT as much as in RP. I now realize I may have been mistaken. He was very straight forward with me, stated he would spend as much time with me as I wanted, unlike, I felt, the surgeons. We spoke for over an hour until I quite literally, ran out of questions and could not think of anything else to ask. ( Unfortunately, my understanding of RT is rudimentary as best ). He stated they do some "extracapsular irradiaton" usually, irradiate the seminal ves, but not the lymph nodes as there is not evidence of need on the lymph nodes. We discussed side effects which he stated usually start "around the halfway mark of the 42 tx's until approx 1 month post tx completion. He mentioned burning urination, diarhhea, ED, incresed frequency, etc. which he felt all would resolve post tx completion. He explained that he prefers the longer, less radiation approach as it gives the healthy cells left over a better chance to recuperate. And yes, although they irradiate the ENTIRE prostate, there will be some live, healthy cells left. He said cancerous cells do not have the ability to regenerate post radiation. I asked about the left over healthy cells turning cancerous and he stated this normally takes a very long time, if ever, a time frame that would probably eclipse my life expectancy. I asked him briefly about CK and his concern was the very high amout of radiation used in a brief time period and the possibility of subsequent tissue damage.
I must say, my Urologist and this RO both stated that I would probably be served equally by either of these approaches. I also must say that I originally was planning on having surgery and just living with the consequences/side effects as this was better than the alternative of mets. After speaking with this RO I am made aware of the possibility of a tx with fewer side effects up front, however an unknown amout of side effects later on. While I do not relish the risks encountered with surgery at my age, the side effects, possibly long term, I do not want to rule out what may be a viable solution just because I am too much of a woos to undergo it. Alternately, I don't want to short change myself by electing a procedure that might be easier in the short run only to hurt myself in the long run. I don't mean to infer a leaning toward surgery, I am simply trying to voice my thought process. ( one I'm sure ya'll have heard a million times ). As I'm sure many newbies have asked before me, I would like to hear from as many of you as would be willing to help about RP vs RT. Let me have it, full strength. If there are any links, stickies you feel I might benefti from please direct me. I respect the opinions of all and will consider all with the same attitude. On my end, I will continue to educate myself.
In the interest of full disclosure, I must say that I will be posting this and other posts to other forums in the hope of getting as many opinions/help as i can.
Thanks,
D.
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.
D,
research about treatment decision is important, but see what the second opinion of the pathology will reveal before determining what is best for you.
SBRT of which CK is one platform of many that delivers can be a very viable choice of an active treatment, however it is possible that the aggressive and quantity of your Gleason may be downgraded and you might be eligible for Active Surveillance which is preferable..
Here is a study about SBRT which requires only 4 or 5 treatments versus 40 for your study. Notice that the results are comparable to surgery, and appear to be better than long term IMRT and has less side effects. (suggest that you speak with a radiation oncologist that does SBRT.
https://prostatecancerinfolink.net/2016/01/06/nine-year-outcomes-after-treatment-with-sbrt/
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Old Salt-Old Salt said:Some issues (Dec 1 post)
About IMRT, HopefullyOptimistic wrote:
42 weeks 5 days a week, sessions of approx 10-15 mins followed by Hormone Therapy.
That can't be correct; the usual IMRT protocol is around 40 sessions.
Also note:
1. There are studies showing that a shorter IMRT protocol (20 sessions at higher intensity) has good outcomes. Rad Oncologists don't like to mention this as they get paid per session.
2. The Rad Oncologist that you spoke to is not up-to-date on SBRT/CyberKnife and wants you to spend your money in HIS place.
Old Salt-
Good catch. You're right. I misspoke. 42 sessions of 10-15 mins ea is what I meant. I've gotten so many numbers, acronyms, and data lately my head is spinning. I continue to research and try to educate myself on RT. Thank you.
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ChoicesHopefullyOptimistic said:Old Salt-
Old Salt-
Good catch. You're right. I misspoke. 42 sessions of 10-15 mins ea is what I meant. I've gotten so many numbers, acronyms, and data lately my head is spinning. I continue to research and try to educate myself on RT. Thank you.
Hopefully,
You are about where I was in choosing treatment in late 2014. IMRT and the slightly more updated IGRT are both "fractionated" RTs, and are almost always a good choice. (IGRT has better guidance, and is about as accurate in delivery as CK.) Interestingly, the Head of RT at my cancer center, which also has Varian Truebeam (essentially identical to Cyberknife, but a differing brand; both are SBRT) said that he preferrs to use IGRT over Varian/CK for reasons that he mentioned (too complex to relate here). His statement was NOT a matter of price or availability of the machine, since they had and used both machines.
I struggled with the dilemma of choosing between RP and RT, but eventually chose DaVinci, and have been highly pleased since. RP WILL leave you impotent for usually around 4 months or more, but I never saw that as an issue. The notorious lifetime impotence stories one hears at times are uncommon but worth listening to.
I did not want radiation because as a former advanced lymphoma patient with tons of chemo, radiation increases the chances of relapsing with leukemia years later. I know that such a worry makes me one-of-a-kind here. I didn't want a piece of irradiated charcoal left in me either. I do not advocate one way or another.
You are well on track to making a good decision. I had to just take a few weeks away from studying this and go with my gut. I was so impressed with the surgeon that his overall pitch won me over. He never denigrated or spoke down regarding RT either. Your surgeon or Radiation oncologist will still own their yachts and summer villas, regardless of what any one individual chooses.
Stepping back and just deciding whom you most believe may assist you in a final decision also. Most cancers do not have a variety of essentially equally curative choices, the way PCa does.
max
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Some issues (Dec 1 post)
About IMRT, HopefullyOptimistic wrote:
42 weeks 5 days a week, sessions of approx 10-15 mins followed by Hormone Therapy.
That can't be correct; the usual IMRT protocol is around 40 sessions.
Also note:
1. There are studies showing that a shorter IMRT protocol (20 sessions at higher intensity) has good outcomes. Rad Oncologists don't like to mention this as they get paid per session.
2. The Rad Oncologist that you spoke to is not up-to-date on SBRT/CyberKnife and wants you to spend your money in HIS place.
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Have you sought a second
Have you sought a second opinion from a top rated urology hospitail. If you decide to go with surgery then you can have radiation if needed.
If radiation first its hard to go back and do anything if you have additional problems. Age and Health are big componets in surgery. I was diagnosed with 3+3=6
T2a tumor in October and have talked to friends of mine that have had both treatments. Also been to Vanderbilt and talked to Doctor there that has performed thousands
of robotic since 1993. Take your time and do what you feel is best for you. Im still exploring my options with active survellance and robotic. Good Luck
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Sorry that I have to point this out again1005tanner said:Have you sought a second
Have you sought a second opinion from a top rated urology hospitail. If you decide to go with surgery then you can have radiation if needed.
If radiation first its hard to go back and do anything if you have additional problems. Age and Health are big componets in surgery. I was diagnosed with 3+3=6
T2a tumor in October and have talked to friends of mine that have had both treatments. Also been to Vanderbilt and talked to Doctor there that has performed thousands
of robotic since 1993. Take your time and do what you feel is best for you. Im still exploring my options with active survellance and robotic. Good Luck
The idea that there are no options after failure of primary radiation just isn't true, but this misconception is hard to get rid of, apparently. And not logic!
In very simple terms:
Surgery first and if this fails, (salvage) radiation will be required
So why not start out with radiation?
There are cases, where surgery is the better choice, but this is NOT generally true.
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tannner
Do not know the details of your case, but if simply monitoring the disease is available, why have a radical treatment that can change the quality of the rest of your life. Active surveillance for low aggresive . low volume disease is the preferred treatment.
You may wish to start a thread about your situation, so you can receive inputs
Best
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Another TURP
If this is another case where RP will be performed after TURP, I would be extremely cautious in going with surgery.
In my case, RARP after TURP did not produce good outcome for me but surgeon disagree with TURP affecting RP outcome especially regardless sexual function recovery.
Do not become another victim of this 2 surgery combined.
MK
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