Robotic prostatectomy, now radiation? Outcomes?

SRVR said:

That's a mystery to me as
That's a mystery to me as well. I'd guess that those who are facing this scenario didn't know that cure rates of low grade tumors treated with surgery or radiation are about the same. So why put yourself through the pain, risks, and side effects of surgery if there's no evidence that it matters?

A radiologist won't send a patient to a surgeon prior to radiation treatment. Radiation kills cancer.

A urologist will only recommend radiation after surgery to correct a failure or cover anything he might have missed. Of course it improves cure rates, radiation kills cancer.

Even an expert surgeon could leave a drop of cancerous blood in the prostate bed after slicing out the gland. Radiation treatment solves problems surgeons create.

If you haven't had surgery yet, consult a radiation oncologist. Look at every alternative.

A pretty emphatic
A pretty emphatic condemnation about "a urologist" SRVR. Having practiced in the health care field for over 36 years, I would prefer to think our physicians are practicing to cure us rather than cover their backsides. My preference was surgery. My surgeon and my RT and my oncologist all worked together to gain the best result. It isn't over yet, as it never is with CA, but I am so glad I have faith in my team (not blind faith, by the way). You must have some pretty big worries in addition to your CA, if your trust is as you have indicated. And to think there is only one solution as in your last sentence is scary at best. It is good that you like the choice you made, but it is not necessarily best for everyone and every situation. JMHO.

SRVR said:

Sorry for all the drama
Sorry for all the drama there. I was commenting on and agreeing with Kongo regarding his "conundrum" remarks. He's dead on.

During my proton treatment I spent a lot of time with about 90 other men in treatment. About 20 of them were there for salvage treatment for surgery that had failed. One was done at Johns Hopkins, many were DaVinci patients.

Those who were there for salvage treatment were overwhelmingly disappointed that they had not consulted a radiologist prior to surgery. It's natural for the urologist that discovers our cancers to be confident they can cure it with surgery. Unfortunately many men stop looking for solutions past that and go through surgery with all it's side effects only to end up in worse shape.

If anyone on this forum is considering surgery, consult a radiologist first. Not for just conventional radiation or bracytherapy, but also for proton, cyberknife, and toma therapy.

Surgery, robotic or open, is highly practitioner dependent. Even the best surgeons don't get cancer out all the time. If you've decided to have surgery, check the track record of your surgeon. His level of experience is crucial to your long term survival.

Read Kongo's cyberkife testimony. It's motivating and encouraging. My proton treatment left me with no side effects and was completely painless. Don't settle for surgery because you haven't done any research. Have surgery because it's the best course of action for you.

Welcome to Drama Central
It’s natural for men who have chosen a particular method to treat their prostate cancer to be emotional and defensive about their choice and thank you for sharing your view of the advantages and outcomes of your proton therapy. Your story may well help a fellow victim of this disease to reach an informed decision about his own treatment. But like politics and religion, some feel that the only correct choice is the one they made and that everyone else is wrong; hence the drama. So develop a thick skin and keep making your points.

I completely agree with your views about independently seeking second opinions on how to treat the diagnosis our initial urologist delivers. The decision we make about treatment may well determine the length of our lives but will most certainly affect the quality of our life for however long we have left. Not to consider all the potential options available is, to me at least, foolish. Doing your research and consulting with different specialists doesn’t guarantee a life free of cancer or adverse side effects, but at least it should avoid the “if only I had known” syndrome that is possible for men who do not investigate alternatives.

I’m glad your proton treatments went so well and hope that you continue to enjoy a high quality of life

ob66 said:

SRVR, you must
SRVR, you must understand that not everyone was waylaid by a urologist. One size fits not all. In my case I consulted with a urologist, a radiologist, and an oncologist before I made any decision. I did not want radiation as a first choice (rightfully, or wrongfully). I wanted the CA cut out of there. Period. It was and hopefully is cut out of there. My MDs however, have been very careful, and when my PSA (ultrasensitve) rose from 0.05 to 0.07 after 4 tests and ten months (a rise that many would say is within limits), these medical people decided I would best have RT. I did, and completed same in August.
To conclude, I do not see my daVinci surgery as a failure. I see my RT as an extension to further control the CA, and my usage of lupron plus diet (no meat, no dairy and as little sugar as possible) as being as proactive as I can. The only disagreement I have with your writings is the simplicity of your conclusions and treatment options. What is good for you is good. What is good for me is also good. I hope it remains that way for both of us. I was offended a bit, when you implied less than ethical reasons for treatment recommendations by MDs. I believe, as in all lines of work, there are bad apples, but to base premises in medicine on that, is scary at best and a stretch at worst.
Finally, I think Kongo's writings are the most excellent thing about this forum, other than the general sharing that goes on. But I think the conundrum of which he spoke related to not understanding why anyone would have surgery with the idea of having RT after. I did not approach it that way. It unfolded, unfortunately. But I am very good with where I am right now. Cheers, and Merry Christmas to all, and all the help I have received by tuning in here.

Correct
ob,

You're correct in summarizing the gist of my conundrum question seven months ago. Given the information available in the posts, I simply did not understand the reasoning of going for surgery with the expectation of quick follow-up with radiation...which I took to mean they had assumed the cancer had already escaped the prostate. It's not that I was necessarily against surgery, it's that I didn't see enough information to be able to look at it and say, "Oh, so that's why they're doing that..."

In my non professional opinion, choosing surgery is a preferable and effective option for many men depending on their pathology, personal choices, and long term expectations. Worldwide, it remains the most common treatment choice and the doctors who recommend it and practice it are, for the most part, not dummies. In most cases, it works out fine. Sometimes, like in your case, despite all our best expectations and studied investigations, sh*t happens which causes us to adjust our approach to treating prostate cancer.

As a result of my own journey and continuing study, I've learned that there are seldom any simple answers to these questions and that the "rules" about prostate cancer are ever changing and elusive. For example, in another forum today I read a post from a recently diagnosed man with PCa who had just completed DaVinci surgery and his advice to the world was essentially: "I had DaVinci and it worked for me therefore it will work for you. Don't worry about it." These types of statements make no sense at all to me and ignore the vast differences in our individual cancers, preferences, priorities, prognosis. I think if it works for you, then good. If it doesn't, you have our sympathies. Hopefully, men make their choices based on the type of rigorous analysis that you did but even then, you have to prepare for alternative outcomes.

Merry Christmas to you as well!

Kongo said:

Correct
ob,

You're correct in summarizing the gist of my conundrum question seven months ago. Given the information available in the posts, I simply did not understand the reasoning of going for surgery with the expectation of quick follow-up with radiation...which I took to mean they had assumed the cancer had already escaped the prostate. It's not that I was necessarily against surgery, it's that I didn't see enough information to be able to look at it and say, "Oh, so that's why they're doing that..."

In my non professional opinion, choosing surgery is a preferable and effective option for many men depending on their pathology, personal choices, and long term expectations. Worldwide, it remains the most common treatment choice and the doctors who recommend it and practice it are, for the most part, not dummies. In most cases, it works out fine. Sometimes, like in your case, despite all our best expectations and studied investigations, sh*t happens which causes us to adjust our approach to treating prostate cancer.

As a result of my own journey and continuing study, I've learned that there are seldom any simple answers to these questions and that the "rules" about prostate cancer are ever changing and elusive. For example, in another forum today I read a post from a recently diagnosed man with PCa who had just completed DaVinci surgery and his advice to the world was essentially: "I had DaVinci and it worked for me therefore it will work for you. Don't worry about it." These types of statements make no sense at all to me and ignore the vast differences in our individual cancers, preferences, priorities, prognosis. I think if it works for you, then good. If it doesn't, you have our sympathies. Hopefully, men make their choices based on the type of rigorous analysis that you did but even then, you have to prepare for alternative outcomes.

Merry Christmas to you as well!

Kongo, Interesting post and
Kongo, Interesting post and I enjoyed reading it.
Yes you are correct that many will make statements such as "I had such and such and it worked for me".

Education is key to fighting this but many do not want to bother with the education and go with what ever is recommended. There are so many variables to the equation, PSA, Gleason, spread, age, family history..... and the list goes on.

On my search I looked at every option in great detail. I'm sure that I would have had success even with other options but I was looking for a long term plan with my Gleason 7. When my father was diagnosed he had Gleason 6 and took a different plan of attack. He is 13 year survivor!

Best christmas wishes to all that fight cancer in any form.

Larry