Making Decisions Regarding Surgery

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  • BRONX52
    BRONX52 Member Posts: 156
    #42
    bdhilton said:

    Thank you for your response
    Thank you for your response and it sounds like you had great advice and doctors…

    Yes that is what my surgeon (William Catalona) and my Urologist recommended adjuvant radiation in the first 90-120 days since I had a positive mid right margin, Right Seminal Vesicles involvement, Perineural Invasion on my pathology report based on initial studies showed that adjunct radiation with positives margins were showing better results…

    However, after I got my first PSA back at Zero in April I talk with my Urologist and he agreed with me that if he were me he would wait to see a rise in my PSA before I elect to have radiation because you are better off if you do not need it …so you are damned if you do and damned if you do not…but seriously it is a percent or so difference if you catch the rise under .02 between adjunct vs salvage…but the most interesting thing I have read in these studies is that if your margins were negative then this local radiation therapy is not going to help you…Anyway I still have about 35 days to think about this…I hate this PCa

    Prostatic Cancer Staging Summary:

    Tumor Type: Acinar with Focal Ductal Differentiation

    Gleason Score
    Primary + Secondary: 4+3=7
    Tertiary: Pattern 5

    Location Main Tumor: Prostatic Base
    Location Additional Tumor Nodules: Left Apex, Right Apex, Right Mid, Left Mid, and Left Base

    Extraprostatic Extension
    Focal (<2 Microscopic FOCI): N/A
    Established (Extensive): Present and Extensive

    Margins
    Apical Margin: Free of Tumor
    Bladder and Urethral: Free of Tumor
    Other Surgical Margins: Positive, right mid Prostate

    Seminal Vesicles: Positive for Carcinoma
    Location, If Involved: Right Seminal Vesicles

    Perineural Invasion: Present

    Lymphatic/Vascular Invasion: Not Identified

    Total Lymph Nodes: 2
    Number positive: 0
    Tumor Volume Approximately 18%
    Tumor (T): pT3b
    Metastasis (M): pMX
    Nodes (N): pN0

    Prostatic Cancer Staging Summary:

    Tumor Type: Acinar with Focal Ductal Differentiation

    Gleason Score
    Primary + Secondary: 4+3=7
    Tertiary: Pattern 5

    Location Main Tumor: Prostatic Base
    Location Additional Tumor Nodules: Left Apex, Right Apex, Right Mid, Left Mid, and Left Base

    Prostatic Cancer Staging Summary:

    Tumor Type: Acinar with Focal Ductal Differentiation

    Gleason Score
    Primary + Secondary: 4+3=7
    Tertiary: Pattern 5

    Location Main Tumor: Prostatic Base
    Location Additional Tumor Nodules: Left Apex, Right Apex, Right Mid, Left Mid, and Left Base

    Extraprostatic Extension
    Focal (<2 Microscopic FOCI): N/A
    Established (Extensive): Present and Extensive

    Margins
    Apical Margin: Free of Tumor
    Bladder and Urethral: Free of Tumor
    Other Surgical Margins: Positive, right mid Prostate

    Seminal Vesicles: Positive for Carcinoma
    Location, If Involved: Right Seminal Vesicles

    Perineural Invasion: Present

    Lymphatic/Vascular Invasion: Not Identified</p>

    TREATMENT
    SOUNDS LIKE YOU HAVE DONE YOUR HOMEWORK AND HAVE WHAT YOU NEED TO MAKE YOUR DECISION. NOW COMES THE HARD PART---DECIDING WHAT TO DO !! GOOD LUCK!!! I THINK IT IS FAIR TO SAY THAT WE ALL HATE THIS PC THING----SUCH A SMALL GLAND AND SO MANY TREATMENT OPTIONS---UGH !!!!
  • mrspjd
    mrspjd Member Posts: 694 Member
    #43
    Swingshiftworker said:

    I Agree!
    I haven't had any form of treatment yet, but I agree that the risks of surgery are so potentially debilitating that I'd only consider it as a LAST RESORT.

    I also think that the fact that the medical profession continues to promote surgery as the "gold standard" for the treatment of "young" men (like me) with early stage PCa (like me) is not only counter-intuitive (ie., it doesn't make sense) but is also borderline fraudulent, given proof that non-surgical treatments achieve equal results with such patients with fewer quality of life issues. I've stated this opinion here before and and I'm glad to hear from someone who has actually received the treatment who is willing to speak out against surgery as the "obvious" FIRST course of action.

    I'm not saying that surgery might not be necessary for some people, especially for those with more advanced cancers who are unlikely to be helped by less invasive procedures, but for early stage PCa patients, surgery is entirely unnecessary when there are other proven forms of radiation treatment that yield equal results without all of the negative quality of life risks that surgery presents -- namely prolonged incontinence (necessitating the wearing of pads and diapers) and ED (necessitating the use of ED drugs and penile injections) -- and, in the worst cases, the need for penile and/or urinary sphincter implants.

    So, I agree. If you are considering surgery to treat your cancer, think "LONG AND HARD BEFORE YOU PROCEED" because the "cure" of surgery can sometimes be much worse than the disease itself.

    RP surgery for advanced PCa NOT recommended
    In one of "swingshiftworker's" posts in this thread, he states: "I'm not saying that surgery might not be necessary for some people, especially for those with more advanced cancers who are unlikely to be helped by less invasive procedures..."

    RP surgery is especially NOT indicated in advanced/high risk PCa (some T3b's and most all T4 clinical stage PCa) and if a doctor has recommended RP for those stages, it's time to get some other opinions, change doctors and start doing your homework!
  • griff 1
    griff 1 Member Posts: 114
    #44
    randy_in_indy said:

    pwright613
    I have to agree with BD....You offer nothing but negative about surgery yet you still have not told your whole story..when the rest of your story may be the cause of the outcome...what was your pre-surgery stats....how experienced was your doctor - How many da vinci's did he perform...if you say less than 300 or even 400 there is a huge learning curve on that which I am sorry you did not research out prior to choosing? See now, I am just assuming that...look how stupid that makes me look. However, those two things alone you fail to comment back to multiple inquires...based on that I guess no one has any reason to believe what you post - simple logic. It's pretty presumptious of you to say surgery IS a bad choice....when what you should have said was, "Surgery with who I choose and for me was a bad choice." Sorry I call it like I see...always have and always will ...life is too short. You can read many stories...on here and in factual books of successful surgeries with prostate cancer...I was one.

    Randy in Indy

    negative post
    i do feel bad for you pw613 having complications and such on your surgery, but like they all say whats good for one might not be for the other. i hope you pull out of this and have a good life.
  • griff 1
    griff 1 Member Posts: 114
    #45
    DanKCMO said:

    No doubt the original post
    No doubt the original post was made out of frustration and disappointment. I hope he comes back and fills us in more. And I hope his situation turns around and goes in a more positive direction.

    I appreciate the follow up posts too. Although I don't expect (or even want) every post to be an inspirational 'feel good' account of things, with my surgery three weeks away the first post kind of upset me.

    Dan

    dan
    i to am going for surgery in 3 weeks, it was scary reading that post, hopefully he is doing better. are you going for open or davinci? i did want to go da vinci route now i have read a few things and the open sounds just as good. griff
  • griff 1
    griff 1 Member Posts: 114
    #46
    07SHNNAC7081522 said:

    Wow...Making Decisions Regarding Surgery
    That's a pretty bold statement. I have seen (it seems like one million posts...) and I don't get this sentiment. I've tried to rationalize with this understanding and come to terms (and respect...) the decisions that many of us make. When you state that surgery is a bad decision...you arbitrarily are making a statement that I've made a bad decision. My decision was prostatectomy via Da Vinci. Worked best for me and my situation...trust...I did tons of research. ALL alternatives have their drawbacks. It is my belief that our jobs here are to help those that are uninformed become educated to make the well-informed decision. I was diagnosed in March 2010...Age 40 (...yes my jaw hit the floor on the diagnosis...utter disbelief...), PSA 2.2, Free PSA 10.3, positive biopsy (5/12 cores), right mid; 2 of 2 cores- 3+4 (13% of needle core tissue), right base; 1 of 3 core - 3+3 (7% of needle core tissue), and left mid; 2 of 2 cores - (2% of needle core tissue) - Pathological Report - Gleason 7, Clinical staging - T1C. Consultations stemmed from providers performing Proton Therapy, Radiation Therapy, Cryotherapy...from Miami Florida to New York City. All consultations resulted in this for my own well-being - I could have chosen ANY treatment, but if I elected removal as a second choice...there would have been no turning back to use it as an option later on. Surgery was performed 29 Apr...I was home on the 30...the following week on wednesday (7 days later...) the catheter out...life is good. As expected, I am experiencing incontinence, but each day it gets better and better...don't know about the ED yet... but currently "the man" appears responsive. (...Who wants to get with the "get down" a week after surgery anyway...) I continue to get better each day...(The day after the surgery...I walked for 1 1/2 miles....., I taught my 5 year old how to ride his bike the day after...) With the way things are going...i'm optimistic that this will be a success story. My only challenge initially...finding someone (the best) to perform the surgery and advocate my well-being for the best outcome. I was told...find someone who has done over 1000 of them...personally I don't think this is realistic. Da Vinci was approved for use in 2001...do the math...every hospital doesn't have one (a robot) with surgeon(s) who can perform over 100-120 a year (2-3 times a week)...divide that up between a couple of oncologists...those numbers go down pretty significantly. I think a realistic number for greatness regarding proficiency is around the 500 area. The only guy I know that has done 4/5x that many is Dr Samadi up in New York (and he's good...)...he's got over 2400 touches...I don't know how, but he has. My doctor had performed over 450...and had participated in over 900. He was realistic and explained ALL the facts. When it got right down to it...the radiation oncologist had a great sell, the proton therapy oncologist had a great sell...everyone advocated why their product was the best...and they are all good. I simply got back to the basics on what had been proven for total eradication. This is me though...I KNOW I made a well informed decision...one which was carefully thought out based on 6 or 7 consultations based on my own personal situation...I understand everyone is different...

    wow
    i am glad to see a post that is positive in what he decided to do. it will help me in thinking my decision was the right one my doctor has done 600 of the da vinci surgeries, yes i think you are right in saying 500 is realistic. my doc is also very up front in saying the surgery is not easy and it can be bad for some. i guess what comes comes. good luck.

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