Picking Surgeons

Hi,

You can inquire directly the center CTCA of your choice about their doctors past experiences in PCa surgeries, as well as obtain the contact of one patient with whom to talk.

I wonder why you have chosen surgery. What is your clinical stage?

Best of luck in your treatment. 

VG 

Yes, it seems to me that you are "picking blindly" and that is for sure not the best way in making decisions on therapies for prostate cancer that are linked to the prejudice of your quality of life.

In fact Gleason score 6 is the lowest aggressive that usually provides more than enough time to the patient to educate on the issue and consequences in therapies. What is taking you to such fast decision?

Young people in particular with long life expectancy may see their life style become absolute at such young age.

The PSA of 4.5 ng/ml is high but it doesn't indicate that the cancer is really aggressive. The PSA is a sensitive biomarker that easily shows variable upwards values if we had sex the night before drawing the blood sample for the test, or used a bike, etc.

You need to treat but do it coordinatly and timely.  Prostate cancer does not spread overnight. 

Best, 

VG 

Rob,

As Vasco suggested, you have ample time to fully research your options for therapies regarding your PCa.  Both surgery and radiation should be available options for you to consider, and both have their positive points and their negative points.  The fact that you are here, talking with PCa survivors, is a great first step.

Like most things in life, the greatest consistent results are generally achieved by those who have the most experience.  When considering doctors to work with you, the doctor's experience is one of the most important evaluation criteria to be aware of.  With the Internet and social media, there is more available data for you to review than ever before possible.  For example, when considering a prostatectomy, I suggest that you would like to see your chosen surgeon's experience to be above 1000 prostatectomies performed, preferably over 2000.  While the number of prostatectomies performed does not automatically guarantee you a successful prostatectomy by that surrgeon, your odds are greatly improved, and feedback/reviews on that surgeon should be more readily available for you to review.

Another very important aspect of selecting a medical prosessional to lead your therapies for your PCa, is your relationship with that medical professional.  You have to feel comfortable interacting with that person, and you have to devleop a mutual trust and respect for each other.  Sometimes, personalities clash, and you do not want to have any unnecessary distractions develop, while you are undergoing treatment therapies and the resulting follow-ups.  You are placing yourself in the hands of that medical professional, and you have to be totally comfortable with the selection.

I would suggest that you have a consultation with (1) a Medical Oncologist, (2) a surgeon who performs prostatectomies, and (3) a Radiation Oncologist.  Do your research first, and then prepare in advance a full list of questions for be discussed in each of these consultations.  I suggest that you obtain a Medical Oncologist as the leader of your medical team, and this Medical Oncologist can be with you throughout your PCa journey.  The Medical Oncologist has no vested interest in either prostatectomies or radiation therapies, and will give you advice and recommendations that are case specific to you and meet your requirements,  In addition, if hormone therapy is to be used at some point in your PCa journey, your Medical Oncologist will be your primary consultant in this area.  I have had a Medical Oncologiat as my medical team leader throughout my decade-long PCa journey.

Last, I am not a medical professional, and I am only offering you lay person suggestions. The medical team that you eventiually select will provide you with professional medical advice.

I wish you the best of outcomes on your PCa journey.

Rob,

I have not really researched CTCAs, but their general reputation among people I know in the oncology community is that they are "fair."   Neither great nor horrible.   Think C-Plus or B-Minus.  Think oncology marketing and convenience; they are The Target Store of Oncology.  They are not the best for rare or complex cases, but yours is neither, based upon what you have shared.  In general, a Stage 1 or Stage 2 case of PCa is relatively easy to eradicate via radiation or surgery;  an experienced, certified surgeon or oncologist in most cases will do nicely.  He or she will not need to be a world authority, not that there is anything wrong with that, except the price tag.  A good thing is that CTCA have radiation oncologists, so speaking to one of them for a consult should be easily arranged in-house.  I have heard that because they are a network, odd results are often shared online with experts who may be at other locations, but this is hearsay.

Rob.Ski said:

Thanks for the replies.  I

Thanks for the replies.  I have spoken with a radiologist at CTCA that was recommending surgery for my case when the time comes.  I would of have thought 500 was a lot of prostatectomies so, that's good gouge.  My general practitioner was kind of among similar opinion that PCa is common, most places should be able to deal with regular cases.  Of course, reading about SE, want the best chance of avoiding those.   That is why I'm here, trying to get some opinions on CTCA.

Thx

You mention that your Gleason is a 6. Many doctors consider a Gleason 6 a non cancer. You did not indicate the number of cores that were Gleason 6 or the involvement, that is the percent of the core(s) that are cancerous.  It may very well be that you are a candidate for active surveillance and you may be able to avoid the side effects of  active treatment. Can you provide more detail about your case?

Rob.Ski said:

Thanks for the replies.  I

Thanks for the replies.  I have spoken with a radiologist at CTCA that was recommending surgery for my case when the time comes.  I would of have thought 500 was a lot of prostatectomies so, that's good gouge.  My general practitioner was kind of among similar opinion that PCa is common, most places should be able to deal with regular cases.  Of course, reading about SE, want the best chance of avoiding those.   That is why I'm here, trying to get some opinions on CTCA.

Thx

Rob, your replies indicate that you are well inform and doing all of the right stuff.   It is interesting that a Radiation Oncologist recommend that you have surgery.  He must have had some reason for suggesting such.   When DaVinci was NEW-ish, it was common wisdon that '200' surgeries established proficiency, but of course, if a surgeon is Board CERTIFIED as a urologic surgeon, and on the DaVinci machine, then they have alread done a lot of surgeries as a resident or in training under some other doctor.   Five Hundred represents significant experience.  I have heard guys mention that their surgeon had done 2,000 or more, but as DR. Peter Scardino, former Chief of Surgery at Sloan Ketterin CC in NYC writes in his "The Prostate Book":  sheer number of surgeries is not the ultimate indicator of a surgeon's quality.   This is because, he says, some surgeons have little flaws in how they proceed, and then keep those habits throughout a career.  This is true of everyone in every profession, I suppose, but is an important thing to recall.  My surgeon is a a nationwide authority on PCa treatments (Residency at MD Anderson, and now leads or participates at national associaion meetings), and he is now up to around 1,300, and had done about 800 when I had my removal.

I would say that you are moving in all of the right directions. Also, many guys agonize forever over making the 'perfect' choice.   Almost always with PCa, there are legitimate options.  You will never make the 'perfect' decision.   The best most men can do is make an informed, clinically valid choice with a doctor they trust and have confidence in, and then move on.  When you decide, be happy with it and do not look back,

Hi Rob,

You can stay on AS for many months maybe years but you have to keep an eye via biopsies on your cancer.  Gleason 3 is a milder form than say 4 or 5 but it's still cancer.  If it was not cancer it would have been rated benign.  At a 3 you have plenty of time to decide on future treatments. If it was me I would want to know if the cancer was close to the edge(possible escape) or buried deep inside the Prostate.  All cancers whether a 3 or 5 still grow just at different rates.  Good luck........

Dave 3+4

Rob.Ski said:

My oncotype is 26.  

My oncotype is 26.  

 

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

Rob,

Why do any treatment when treatment is not necessary? Why treat something that is 99+% won't do any harm to you?
Surgery will drasticaly degrade your quality of life in many ways And for many years, very often it is lifelong.

I was pretty close to your age at diagnosis and RP surgery. Per TRUS biopsy, I was 4+3 with just 10-15% of cores involved.

No one wanted to accept me into AS because 4+3. RO did not want to do radiation because of 3 month prior I had TURP where I was incidentally diagnosed with prostate cancer 3+3 in transitional zone.

i had RP 4+ years ago. After RP I was downgraded to 3+4 in multiple locations and on both sides of prostate.

My QOL after RP is severely downgraded and I never recovered a bit of sexual function. I was suffering physically and mentally, my marriage ended in problems, my wife distanced her self etc.

Even in my case, I consider RP to be over treatment. 
AGE is no guarantee for good outcome, just excellent sell pitch used bu surgeons to get your business.

Good luck with whatever you choose.

MK

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