Open Radical vs. Laparoscopic Prostatectomy
monwei05-22-2005, 07:43 PMAfter my biopsy result told me that I,age 49, had 1 cancer out of 12 samples, Gleason Score 3+3=6 with PSA 5.4, I am struggling to make decisions which prostatectomy surgery would be the best for me. I think I should separate two issues: Cancer recurrence control and post-operation recovery. To me, cancer recurrence control in the long run is the number 1 priority. And post-operation recovery is secondary. So far Laparoscopic seems to emphasize short stay of hospitalization, less pain, less blood loss. Although it claimed the cancer recurrence control is comparable with Open Radical, there is not enough public research data to support that due to the facts that Laparoscopic Prostatectomy is still new and prostate cancer is considered longer term recurrence. We may still need to wait a few years before we can collect enough data of Laparoscopic surgery and have the true randomizezed retrospective study.
By common sense, Laparoscopic would be much more difficult to operate than Open prostatectomy. Let me use the analogy. When you search a dark room, you can either open all windows ( Open) to find the things specifically and straightforward or you just use the flash light ( Laparoscopic) to search around (more time and possible damage ) to find the things. "Open" can also give you better feeling about things surrounding you. You can compare color, touch feeling in the vicinity area, to find any things unusual.
Unless the pathologists can guarantee befor the surgery commence that none of the cancers got spread out just based on biospy, Gleason, or PSA, then definently I would go to Laparoscopic. But, I do not think any pathologist can assure you that until the prostate get all removed and further analyzed. Since there is no randomized retrospective study on Open vs. Laparoscopic Prostatectomy, I borrowed the study of Colon cancer that indicated Open is better than Lap. It may not apply exactly to my case, it does reveal some insights of it in terms of logics and legistimate concerns.
Mon at LApositive4u05-23-2005, 01:19 AMMonwei-Whether you choose open radical or lap, the single most important variable is the skill & experience of the surgeon. That being said, open surgery has been around far longer with more surgeons doing it. The odds of finding a great surgeon are better with the open radical. That does not mean those doing lap surgery are no good.
Three years ago, age 46, I had 1 microscopic cancer out of 6 samples, Gleason score 3+3=6, PSA 4.6. Fewer samples but numbers similar to yours. At that time I had an open radical done because lap was just starting to enter the picture. I chose a surgeon who does several hundred a year & had several years of experience. To this day, it was one of the best decisions I've ever made. Recovery is now complete and PSA's remain undectable. Let us know what you decide.
Positive4U :)ItzMe205-23-2005, 09:32 AMHey Mon,
I have to echo positive's reply. My surgery 3 years ago at age 48 was an RRP by a very experienced surgeon at the top urology hospital. The laparo procedure was relatively new. I suspect you are right that the tactile and visual observations are important. The Johns Hopkins numbers I looked at for my age indicated that at 18 months out, potency was at 91% and continence was 98% (at their facility).
Many on this board are choosing the laparo procedure and I'm sure it has come a long way in the last three years. I have tried to find studies on potency and continence relative this technique, and am a little concerned that the numbers are somewhat lower or that the jury is still out.
Keep us informed and good luck with the decision!
ItzMe2monwei05-23-2005, 11:56 AMPositive4u and ItzMe2,
Thanks for your encouragement and really appreciate your wise insigts. I totally agreed that the selection of good and experienced doctors is the most important part of the process to have the best outcomes. The Nerves Spared was developed first at Johns Hopkins. No wonder they showed good resulsts. When I do research on the internet, I always check the source of information and their motivation, such as drug or equipment companies sponsored ? Is it commercial or factual ? Just be open-minded.
Currently I am contacting UCSF, San Francicco. Any one has comments about this institution ? ItzMe2, when you went to Johns Hopkins, did you live near there or out of state ? How you handled your travel ?
Thanks again
Mon at LAyvette014105-23-2005, 12:17 PMI need to echo my agreement with the others here. I too faced the same decision you do almost three years ago, I chose the radical surgury with one of the best uro's in the area.
Today I am 100% happy and satisfied with the results. Take care and Good luck.ItzMe205-23-2005, 01:30 PMI live on the gulf coast and flew to Baltimore. Once was for the consultation, and again for surgery. My wife traveled with me. The return flight was fine. I had to walk the legnth of the plane a couple of times. We changed planes in Houston. I had a cart waiting for me and made it easier.
Three years later, I'm thinking "thank God that is behind me". I would do it again without hesitation.
ItzMe2monwei05-24-2005, 09:03 PMI got hold of UCSF. I make the first consultation with my surgen on June. At then time, I should be able to schedule the surgery.positive4u05-25-2005, 01:38 AMGood for you Mon! Choosing a course of therapy often improves one's perception of this whole ordeal. Keep in touch.
Positive4u :)All_Sevens05-25-2005, 11:54 PMMonwei, I've heard that UCSF is an excellent facility. Their urology department head, Peter Carroll, is a recognized expert in nerve-sparing RRP. His writings for patients are among the most helpful and understandable in the profession.John in CA05-26-2005, 10:45 AMMonwei,
The S.F. Bay area has loads of great surgical urologists! I am a huge proponent of the robotic nerve sparing procedure having just gone through it myself after months of research and discussions with guys who have selected every known option from traditional surgery, cryo, to HIFU. If you're interested in getting an opinion from a board certified and trained robotic uro doc, check this link (www.intuitivesurgical.com/patients/maps), click on California, and all the hospitals that have the robots will be displayed. You can then click on the specific hospital(s) closest to you and see which doctors are using the robot. From there it's very easy locating detailed information on a robotic surgeon and asking all the crucial questions e.g. number of procedures performed, success rate, hospital rates for staff infections & post-op blood clots, and the most important - patient references!
Good luck, keep checking your options and keep us posted on your progess!monwei05-26-2005, 11:18 PMPositive4U,
You are right. Once you set your course, the initial anxiety will be gone.
All Sevens,
Thanks for your information about Dr. Peter Carroll. Yes, Dr. Carroll will be my surgen.
I will share it when I am done with him.
John in CA,
Thanks for your research on the Robotic Laparoscopic and appropriate ways to dig information from these institutions.monwei06-24-2005, 06:40 PMI have been scheduled to have the surgery on June 27th next monday. Everything is set in motion. But then miracally, I got call this morning from my doctor of UCSF that the surgery should be cancelled because UCSF's pathologist reviwed the biopsy's slidse and got conclusion that there is no cancer which is different from another pathologist at LA who gave me the cancer opinion. They suggest I should re-do the biopsy for another 3 months at their place. It's kind of good news but it also confused me. Which side should I believe ?All_Sevens06-24-2005, 11:02 PMThat is confusing, but if you can't get two pathologists to agree on a positive diagnosis, it's best to hold off on surgery. False positives do occur, even though they are rare. It must be tough on you to be in this ambiguous situation, but it is much tougher on the men who did not find out that they were false positive until after their surgery.
I think your choices are to either send your slides to some place like Hopkins and get a third opinion, or to repeat the biopsy. If you want to do the first thing, you can call Johns Hopkins Urology Department on Monday-- they do the second opinion thing all the time, and their pathologists specialize in prostate cancer diagnosis. On the other hand, I would think that UCSF has a top notch pathology department. How about your first pathologist, do they handle a lot of prostate cancer cases?monwei06-25-2005, 12:44 AMHi ALL Sevens,
Thanks for your suggestion to get third opinion from Hoskins. I did not know the tract records of my first pathologist, Pathology Inc., at Torrance, CA. But I do know that UCSF handles 20 cases of prostate biopsy per day which is pretty good volume. UCSF called it "atypi" small acinar proliferation, suspicious but not dianostic for adenocarcinoma. It's kind of temporary relief, but I still need to work on it.GR8HARE06-25-2005, 10:48 AMMonwei,
Wow, sounds very much like a similar situation I had back in March where the "specialists" couldn't agree while looking at the same test results. It's nerve racking for sure, but this does give you the opportunity to step back, relax a bit, take your time doing research and in three months have the biopsy repeated at UCSF.
In the meantime, may I suggest you take this time to improve your diet, your physical conditioning and mental toughness (not that any of that is out of whack) so that on the chance that the PC diagnosis does come back ... you will be ready to face it square on.
It just very well may be that you are in the earliest stages of something "suspiciously" taking place in the prostate and the next three months may definitively prove to assist the docs to make the correct diagnosis without all the confusion. Personally, I would toss the first test results and do the wait & see routine for the next 3 months, in my ever so humble opinion. Please keep us informed and here's hoping that you get a clean bill of health the next time around! :angel: Best wishes!
Thom in VAmonwei06-27-2005, 08:50 PMHi GR8HARE,
you mentioned you got a similar situation. Would you explore and share a little bit about it, if you are willing to ? It seemed that you got surgery afterwards. Was it correct ? Did you get third opinion ? You are right that after mentally and physically being ready for the surgery, I am back to the initial stage of desire and anxiety again after the surgery got called off.GR8HARE06-29-2005, 09:17 AMMonwei,
After my initial PSA test came back with an elevated level of 4.8, my internist sent me directly to a urologist for a consult. After learning that I have a family history of PC, he did a 12 needle biopsy. The grid of the needle positions and results were as follows:
(G) - Benign
(A) - Benign
(D) - Suspicious
(J) - Benign
(H) - 50% malignancy, Gleason 3+3 = 6
(B) - 12% malignancy, Gleason 3+3 = 6
(E) - Benign
(K) - PIN, prostatic intraepithelial neoplasia
(I) - 44% malignancy, Gleason 3+3 = 6
(C) - 21% malignancy, Gleason 3+3 = 6
(F) - Benign
(L) - Benign
Based on this information, my original urologist advised that I could have surgery or radiation or seed implants, and recommended that I see an oncologist/radiation specialist. He said he felt an almost imperceptible nodule on the left side during the DRE and rated the tumor as a T2. He was also very upfront with me and advised that he has performed open prostatectomies in the past but there are more experienced doctors in our area that do the surgery fulltime. He made no recommendation as to treatment other that to say "I am a surgeon; I get paid to cut things out."
I took the biopsy slides to the appointment with the oncologist/radiologist doctor. He did a DRE on me as well and reclassified the tumor as a T3b, which is a drastic difference from the T2 diagnosis.
Next came the appointment with the robotic surgeon who reassured me that the tumor WAS NOT anything close to a T3b stage tumor and that his prognosis and opinion followed precisely the results of the biopsy. He spent nearly two & 1/2 hours with us answering our questions (of which we had many) and explaining the robotic procedure, advantages, drawbacks, etc.
So as you see, even the medical community can't come to the same conclusions when looking at the same information, let alone agree on a course of treatment. To be certain, of the diagnosis, the oncologist recommended an endorectal MRI. The robotic surgeon advised that it was useless as a diagnostic tool for capsule penetration and unnecessary for his purposes, but that it possibly could help ease my mind. The MRI was performed a week later and the diagnosis got even crazier at this point. The radiologist guy now said that the cancer HAD DEFINITELY penetrated the capsule even though all of the literature, other doctor opinions, biopsy report, etc. showed it had not. He was advising me at age 56, PSA of 4.8, Gleason score of 6, and a barely detectable nodule on a DRE that I have external beam radiation, followed up by seed implants. In his respected professional opinion, I WAS NOT a candidate for surgery.
The surgeon was equally as adamant that the radiation guy was full of BS, and I agreed!
The facts just didn’t match the scientific information available or the test results. The rest is history. I went with the science, the advanced technology (robotics) and most importantly, my gut feeling. Equally important was it left me with an option should the surgery not get all of the cancer. I couldn’t have asked for better results. The tumor was confined to the capsule, there were clean surgical margins and hence no involvement of the seminal vesicles or lymph nodes. Sorry about getting so long winded here, but like John in CA :wave: , the medical community just doesn’t get it sometimes when it comes to helping us with treatment decisions. Hope this helps.John in CA06-30-2005, 01:42 AMGR8HARE,
Right on! I can't agree with you more regarding everything you told Monwei reagarding getting the opinions and then following your gut feeling. Unless you're over 70, I say the ultra conservative route is the answer. My urologist told me flat out, as did many of the hundreds of articles I viewed on the Web, that if you have a life expectancy of over 10 years, then radiation, proton beam, chemo and even seeds sometimes, are "last ditch" procedures due to the potential nasty side effects 18 to 30 months down the road. I read a week after my robotic procedue in April, that somthing like 83% of men in a study from 2000 to 2003 who underwent radiation and in some cases, seed implantation by less than highly skilled "planters," experienced some form of rectal nerve damage from the radiation and many of those guys had some really severe and permanent problems with bowels and other perineum-type problems. If the surgery concluded with the fact that the cancer has in fact escaped the capsule, then there are many options left. If you radiate at the outset, and it's not 100% successful, then surgery is out from my research conclusions. :eek:
This just goes to prove that one must explore all the options possible that your time and patience will allow. PC is s-l-o-w growing and a few weeks, or in my case a few months, won't put you in the grave. This board helped me more than I can ever say! Between the postings and calling guys on the patient referral lists that I asked to be provided by each specialist I consulted, I was able to make the best decision for my particular case. I am at peace. Not one iota of "buyer's remorse."positive4u07-05-2005, 01:10 AMmonwei-take your time and do more consulting. I waited over 6 months to really research my options. This drove my wife nuts but she didn't say much. At 46 I needed to be sure. As John said, this cancer is slow growing. I agree to have your doctor forward your samples to a "center of excellence". I did & they reclassified my cancer from a 5 to a 6-all verified after the prostatectomy. It's your life and you are worth any extra precautions you take to safeguard it.
Positive4u :)data monger07-06-2005, 01:48 PMBy all means take your time. I was recently diagnosed wtih Prostate Ca. PSA of 4.4 and Gleason of 3+3. My initial discussion with th urologist gave the impression that time was of the essence. However a second opinion at a Comprehensive Cancer Center, by a prostate cancer specialist, said I had plenty of time to check out my options and make a decision. By all means go with a high volume surgeon and high volume hospital. I am going to go with a Lap procedure, based upon the discussion with the cancer specialist. One last piece of advice, go to a NCI designated cancer center for an opinion and or treatment.monwei07-08-2005, 10:48 PMMy third review of the biopsy slides at Johns Hopkins came back to me that it's benign in agreement with UCSF. Two pathologists, one from UCSF and one from Johns Hopkins both identified it's benign as opposed to one from local lab indentified it's malign. I got call from UCSF uro that I should schedule another biopsy within 3 to 6 months after my first biopsy. I decided to go to UCSF for that and already scheduled on August 19.
I am just curious that when some one said they went to seek second opinion, did they carry the biopsy slides to their second doctor who then would have another pathologist to have another look at the slides or just totally rely on the first pathologist report ? Most of the uro surgens can not read biopsy slides themselves and they all rely on pathologyst to tell them the results. So my experience is that getting top notch pathologist to second review your slides is probably more important than finding the uro surgen.GR8HARE07-14-2005, 09:05 AM. I am just curious that when some one (Thom) said they went to seek second opinion, did they carry the biopsy slides to their second doctor who then would have another pathologist to have another look at the slides or just totally rely on the first pathologist report ? ..... So my experience is that getting top notch pathologist to second review your slides is probably more important than finding the uro surgen.
Good question and excellent point monwei! I did take the original 12 needle biopsy slides with me when I got the radiologist/oncologist opinion and then again when I went to the robotic surgeon. It's a point I have been attempting to make throughout many of the threads here on the Boards. (The doctors sometimes don't agree even when they are looking at the same test information) My understanding of the science in classifying the core samples and determining the extent of any malignancy, ie: determining the Gleason scores, is fairly straight forward. Another important reason to have consults and testing done at one of the cancer centers of excellence. Their pathologists rate samples everyday --- it's their calling so to speak. At least in my case they didn't second guess the original pathologist report ... the Gleason scores never changed ... it was their interpretation of other subjective variables that made things so confusing and then (in my view) the ordering of an unnessary, uncomfortable and basically useless endorectal MRI further complicated matters.
Thom in VA.data monger07-15-2005, 03:23 PMI took my slides with me for the second opinion. The cancer center urologist said he would not touch anyone without thier pathologist re-reading the biopsy slides.
By common sense, Laparoscopic would be much more difficult to operate than Open prostatectomy. Let me use the analogy. When you search a dark room, you can either open all windows ( Open) to find the things specifically and straightforward or you just use the flash light ( Laparoscopic) to search around (more time and possible damage ) to find the things. "Open" can also give you better feeling about things surrounding you. You can compare color, touch feeling in the vicinity area, to find any things unusual.
Unless the pathologists can guarantee befor the surgery commence that none of the cancers got spread out just based on biospy, Gleason, or PSA, then definently I would go to Laparoscopic. But, I do not think any pathologist can assure you that until the prostate get all removed and further analyzed. Since there is no randomized retrospective study on Open vs. Laparoscopic Prostatectomy, I borrowed the study of Colon cancer that indicated Open is better than Lap. It may not apply exactly to my case, it does reveal some insights of it in terms of logics and legistimate concerns.
Mon at LApositive4u05-23-2005, 01:19 AMMonwei-Whether you choose open radical or lap, the single most important variable is the skill & experience of the surgeon. That being said, open surgery has been around far longer with more surgeons doing it. The odds of finding a great surgeon are better with the open radical. That does not mean those doing lap surgery are no good.
Three years ago, age 46, I had 1 microscopic cancer out of 6 samples, Gleason score 3+3=6, PSA 4.6. Fewer samples but numbers similar to yours. At that time I had an open radical done because lap was just starting to enter the picture. I chose a surgeon who does several hundred a year & had several years of experience. To this day, it was one of the best decisions I've ever made. Recovery is now complete and PSA's remain undectable. Let us know what you decide.
Positive4U :)ItzMe205-23-2005, 09:32 AMHey Mon,
I have to echo positive's reply. My surgery 3 years ago at age 48 was an RRP by a very experienced surgeon at the top urology hospital. The laparo procedure was relatively new. I suspect you are right that the tactile and visual observations are important. The Johns Hopkins numbers I looked at for my age indicated that at 18 months out, potency was at 91% and continence was 98% (at their facility).
Many on this board are choosing the laparo procedure and I'm sure it has come a long way in the last three years. I have tried to find studies on potency and continence relative this technique, and am a little concerned that the numbers are somewhat lower or that the jury is still out.
Keep us informed and good luck with the decision!
ItzMe2monwei05-23-2005, 11:56 AMPositive4u and ItzMe2,
Thanks for your encouragement and really appreciate your wise insigts. I totally agreed that the selection of good and experienced doctors is the most important part of the process to have the best outcomes. The Nerves Spared was developed first at Johns Hopkins. No wonder they showed good resulsts. When I do research on the internet, I always check the source of information and their motivation, such as drug or equipment companies sponsored ? Is it commercial or factual ? Just be open-minded.
Currently I am contacting UCSF, San Francicco. Any one has comments about this institution ? ItzMe2, when you went to Johns Hopkins, did you live near there or out of state ? How you handled your travel ?
Thanks again
Mon at LAyvette014105-23-2005, 12:17 PMI need to echo my agreement with the others here. I too faced the same decision you do almost three years ago, I chose the radical surgury with one of the best uro's in the area.
Today I am 100% happy and satisfied with the results. Take care and Good luck.ItzMe205-23-2005, 01:30 PMI live on the gulf coast and flew to Baltimore. Once was for the consultation, and again for surgery. My wife traveled with me. The return flight was fine. I had to walk the legnth of the plane a couple of times. We changed planes in Houston. I had a cart waiting for me and made it easier.
Three years later, I'm thinking "thank God that is behind me". I would do it again without hesitation.
ItzMe2monwei05-24-2005, 09:03 PMI got hold of UCSF. I make the first consultation with my surgen on June. At then time, I should be able to schedule the surgery.positive4u05-25-2005, 01:38 AMGood for you Mon! Choosing a course of therapy often improves one's perception of this whole ordeal. Keep in touch.
Positive4u :)All_Sevens05-25-2005, 11:54 PMMonwei, I've heard that UCSF is an excellent facility. Their urology department head, Peter Carroll, is a recognized expert in nerve-sparing RRP. His writings for patients are among the most helpful and understandable in the profession.John in CA05-26-2005, 10:45 AMMonwei,
The S.F. Bay area has loads of great surgical urologists! I am a huge proponent of the robotic nerve sparing procedure having just gone through it myself after months of research and discussions with guys who have selected every known option from traditional surgery, cryo, to HIFU. If you're interested in getting an opinion from a board certified and trained robotic uro doc, check this link (www.intuitivesurgical.com/patients/maps), click on California, and all the hospitals that have the robots will be displayed. You can then click on the specific hospital(s) closest to you and see which doctors are using the robot. From there it's very easy locating detailed information on a robotic surgeon and asking all the crucial questions e.g. number of procedures performed, success rate, hospital rates for staff infections & post-op blood clots, and the most important - patient references!
Good luck, keep checking your options and keep us posted on your progess!monwei05-26-2005, 11:18 PMPositive4U,
You are right. Once you set your course, the initial anxiety will be gone.
All Sevens,
Thanks for your information about Dr. Peter Carroll. Yes, Dr. Carroll will be my surgen.
I will share it when I am done with him.
John in CA,
Thanks for your research on the Robotic Laparoscopic and appropriate ways to dig information from these institutions.monwei06-24-2005, 06:40 PMI have been scheduled to have the surgery on June 27th next monday. Everything is set in motion. But then miracally, I got call this morning from my doctor of UCSF that the surgery should be cancelled because UCSF's pathologist reviwed the biopsy's slidse and got conclusion that there is no cancer which is different from another pathologist at LA who gave me the cancer opinion. They suggest I should re-do the biopsy for another 3 months at their place. It's kind of good news but it also confused me. Which side should I believe ?All_Sevens06-24-2005, 11:02 PMThat is confusing, but if you can't get two pathologists to agree on a positive diagnosis, it's best to hold off on surgery. False positives do occur, even though they are rare. It must be tough on you to be in this ambiguous situation, but it is much tougher on the men who did not find out that they were false positive until after their surgery.
I think your choices are to either send your slides to some place like Hopkins and get a third opinion, or to repeat the biopsy. If you want to do the first thing, you can call Johns Hopkins Urology Department on Monday-- they do the second opinion thing all the time, and their pathologists specialize in prostate cancer diagnosis. On the other hand, I would think that UCSF has a top notch pathology department. How about your first pathologist, do they handle a lot of prostate cancer cases?monwei06-25-2005, 12:44 AMHi ALL Sevens,
Thanks for your suggestion to get third opinion from Hoskins. I did not know the tract records of my first pathologist, Pathology Inc., at Torrance, CA. But I do know that UCSF handles 20 cases of prostate biopsy per day which is pretty good volume. UCSF called it "atypi" small acinar proliferation, suspicious but not dianostic for adenocarcinoma. It's kind of temporary relief, but I still need to work on it.GR8HARE06-25-2005, 10:48 AMMonwei,
Wow, sounds very much like a similar situation I had back in March where the "specialists" couldn't agree while looking at the same test results. It's nerve racking for sure, but this does give you the opportunity to step back, relax a bit, take your time doing research and in three months have the biopsy repeated at UCSF.
In the meantime, may I suggest you take this time to improve your diet, your physical conditioning and mental toughness (not that any of that is out of whack) so that on the chance that the PC diagnosis does come back ... you will be ready to face it square on.
It just very well may be that you are in the earliest stages of something "suspiciously" taking place in the prostate and the next three months may definitively prove to assist the docs to make the correct diagnosis without all the confusion. Personally, I would toss the first test results and do the wait & see routine for the next 3 months, in my ever so humble opinion. Please keep us informed and here's hoping that you get a clean bill of health the next time around! :angel: Best wishes!
Thom in VAmonwei06-27-2005, 08:50 PMHi GR8HARE,
you mentioned you got a similar situation. Would you explore and share a little bit about it, if you are willing to ? It seemed that you got surgery afterwards. Was it correct ? Did you get third opinion ? You are right that after mentally and physically being ready for the surgery, I am back to the initial stage of desire and anxiety again after the surgery got called off.GR8HARE06-29-2005, 09:17 AMMonwei,
After my initial PSA test came back with an elevated level of 4.8, my internist sent me directly to a urologist for a consult. After learning that I have a family history of PC, he did a 12 needle biopsy. The grid of the needle positions and results were as follows:
(G) - Benign
(A) - Benign
(D) - Suspicious
(J) - Benign
(H) - 50% malignancy, Gleason 3+3 = 6
(B) - 12% malignancy, Gleason 3+3 = 6
(E) - Benign
(K) - PIN, prostatic intraepithelial neoplasia
(I) - 44% malignancy, Gleason 3+3 = 6
(C) - 21% malignancy, Gleason 3+3 = 6
(F) - Benign
(L) - Benign
Based on this information, my original urologist advised that I could have surgery or radiation or seed implants, and recommended that I see an oncologist/radiation specialist. He said he felt an almost imperceptible nodule on the left side during the DRE and rated the tumor as a T2. He was also very upfront with me and advised that he has performed open prostatectomies in the past but there are more experienced doctors in our area that do the surgery fulltime. He made no recommendation as to treatment other that to say "I am a surgeon; I get paid to cut things out."
I took the biopsy slides to the appointment with the oncologist/radiologist doctor. He did a DRE on me as well and reclassified the tumor as a T3b, which is a drastic difference from the T2 diagnosis.
Next came the appointment with the robotic surgeon who reassured me that the tumor WAS NOT anything close to a T3b stage tumor and that his prognosis and opinion followed precisely the results of the biopsy. He spent nearly two & 1/2 hours with us answering our questions (of which we had many) and explaining the robotic procedure, advantages, drawbacks, etc.
So as you see, even the medical community can't come to the same conclusions when looking at the same information, let alone agree on a course of treatment. To be certain, of the diagnosis, the oncologist recommended an endorectal MRI. The robotic surgeon advised that it was useless as a diagnostic tool for capsule penetration and unnecessary for his purposes, but that it possibly could help ease my mind. The MRI was performed a week later and the diagnosis got even crazier at this point. The radiologist guy now said that the cancer HAD DEFINITELY penetrated the capsule even though all of the literature, other doctor opinions, biopsy report, etc. showed it had not. He was advising me at age 56, PSA of 4.8, Gleason score of 6, and a barely detectable nodule on a DRE that I have external beam radiation, followed up by seed implants. In his respected professional opinion, I WAS NOT a candidate for surgery.
The surgeon was equally as adamant that the radiation guy was full of BS, and I agreed!
The facts just didn’t match the scientific information available or the test results. The rest is history. I went with the science, the advanced technology (robotics) and most importantly, my gut feeling. Equally important was it left me with an option should the surgery not get all of the cancer. I couldn’t have asked for better results. The tumor was confined to the capsule, there were clean surgical margins and hence no involvement of the seminal vesicles or lymph nodes. Sorry about getting so long winded here, but like John in CA :wave: , the medical community just doesn’t get it sometimes when it comes to helping us with treatment decisions. Hope this helps.John in CA06-30-2005, 01:42 AMGR8HARE,
Right on! I can't agree with you more regarding everything you told Monwei reagarding getting the opinions and then following your gut feeling. Unless you're over 70, I say the ultra conservative route is the answer. My urologist told me flat out, as did many of the hundreds of articles I viewed on the Web, that if you have a life expectancy of over 10 years, then radiation, proton beam, chemo and even seeds sometimes, are "last ditch" procedures due to the potential nasty side effects 18 to 30 months down the road. I read a week after my robotic procedue in April, that somthing like 83% of men in a study from 2000 to 2003 who underwent radiation and in some cases, seed implantation by less than highly skilled "planters," experienced some form of rectal nerve damage from the radiation and many of those guys had some really severe and permanent problems with bowels and other perineum-type problems. If the surgery concluded with the fact that the cancer has in fact escaped the capsule, then there are many options left. If you radiate at the outset, and it's not 100% successful, then surgery is out from my research conclusions. :eek:
This just goes to prove that one must explore all the options possible that your time and patience will allow. PC is s-l-o-w growing and a few weeks, or in my case a few months, won't put you in the grave. This board helped me more than I can ever say! Between the postings and calling guys on the patient referral lists that I asked to be provided by each specialist I consulted, I was able to make the best decision for my particular case. I am at peace. Not one iota of "buyer's remorse."positive4u07-05-2005, 01:10 AMmonwei-take your time and do more consulting. I waited over 6 months to really research my options. This drove my wife nuts but she didn't say much. At 46 I needed to be sure. As John said, this cancer is slow growing. I agree to have your doctor forward your samples to a "center of excellence". I did & they reclassified my cancer from a 5 to a 6-all verified after the prostatectomy. It's your life and you are worth any extra precautions you take to safeguard it.
Positive4u :)data monger07-06-2005, 01:48 PMBy all means take your time. I was recently diagnosed wtih Prostate Ca. PSA of 4.4 and Gleason of 3+3. My initial discussion with th urologist gave the impression that time was of the essence. However a second opinion at a Comprehensive Cancer Center, by a prostate cancer specialist, said I had plenty of time to check out my options and make a decision. By all means go with a high volume surgeon and high volume hospital. I am going to go with a Lap procedure, based upon the discussion with the cancer specialist. One last piece of advice, go to a NCI designated cancer center for an opinion and or treatment.monwei07-08-2005, 10:48 PMMy third review of the biopsy slides at Johns Hopkins came back to me that it's benign in agreement with UCSF. Two pathologists, one from UCSF and one from Johns Hopkins both identified it's benign as opposed to one from local lab indentified it's malign. I got call from UCSF uro that I should schedule another biopsy within 3 to 6 months after my first biopsy. I decided to go to UCSF for that and already scheduled on August 19.
I am just curious that when some one said they went to seek second opinion, did they carry the biopsy slides to their second doctor who then would have another pathologist to have another look at the slides or just totally rely on the first pathologist report ? Most of the uro surgens can not read biopsy slides themselves and they all rely on pathologyst to tell them the results. So my experience is that getting top notch pathologist to second review your slides is probably more important than finding the uro surgen.GR8HARE07-14-2005, 09:05 AM. I am just curious that when some one (Thom) said they went to seek second opinion, did they carry the biopsy slides to their second doctor who then would have another pathologist to have another look at the slides or just totally rely on the first pathologist report ? ..... So my experience is that getting top notch pathologist to second review your slides is probably more important than finding the uro surgen.
Good question and excellent point monwei! I did take the original 12 needle biopsy slides with me when I got the radiologist/oncologist opinion and then again when I went to the robotic surgeon. It's a point I have been attempting to make throughout many of the threads here on the Boards. (The doctors sometimes don't agree even when they are looking at the same test information) My understanding of the science in classifying the core samples and determining the extent of any malignancy, ie: determining the Gleason scores, is fairly straight forward. Another important reason to have consults and testing done at one of the cancer centers of excellence. Their pathologists rate samples everyday --- it's their calling so to speak. At least in my case they didn't second guess the original pathologist report ... the Gleason scores never changed ... it was their interpretation of other subjective variables that made things so confusing and then (in my view) the ordering of an unnessary, uncomfortable and basically useless endorectal MRI further complicated matters.
Thom in VA.data monger07-15-2005, 03:23 PMI took my slides with me for the second opinion. The cancer center urologist said he would not touch anyone without thier pathologist re-reading the biopsy slides.