Hello fellows and may I ask a few questions

Dear Philap:

I've gotta admit, I just don't get it with your tentative conclusions on your own case.  With 1% of 1 sample, a G6 and PSA of 3 you probably have the mildest case of PCa ever to show up on this forum.  Most of us would have killed for your stats...

To repeat an earlier comment from this thread and others, Dr. Peter Scardino, probably one of the best prostate surgeons ever, no longer recommends surgery as a first line treatment for men with low risk cancers.  Does you uro admit your cancer is low risk?

Anyway, one of our forum members, realziggy, has made what I think is an apt comment about low risk PCa patients who treat their cancers with surgery...that the treatment is for anxiety and not necessarily the cancer.  I would respectfully ask you to consider whether or not this is the situation with you...

Tudpock

Hi RickyD,

Of all the materials I reviewed while considering my course of action (and also consulting two surgeons, a radiation oncologist, and a general medical oncologist) the referenced study and article below from the New England Journal of Medicine was by far the most helpful to me.

 

The study followed 1200+ men and their partners for two years.  Interviews were conducted before surgery, and at 2, 6, 12, and 24 months.  Respondents were asked to guage their "degree of satisfaction" with "Changes in Quality of Life After Primary Care Treatment" in five areas, including Sexual Satisfaction and Urinary Incontinence.  The results are graphed out nicely in Figure 1 in the article referenced below;  you can keep clicking on Figure 1 it to get it to readable size.

 

I found the results more than interesting, and not that surprising from what I had learned anecdotally on this Board and other locations. 

 

For example, the men undergoing Prostatectomy were divided into Nerve-Sparing and Non- Nerve Sparing groups.  After two years, 40% of the Nerve-Sparing group reported they were sexually satisfied; only around 20% of the Non-sparing group reported satisfaction.  The two groups were much closer on satisfaction with urinary continenece, roughly 80% and 70% were satisfied.

 

My personal choices, because of my situation, came down to Non- Nerve Sparing Prostatectomy (one bundle)  or a combination of Radiotherapy + NHT (hormones) for six months.  Surprisingly (at least to me), the Radiotherapy + NHT group reported about the same level of sexual satisfaction as the Non- Nerve Sparing prostatactomy group (roughly 20%).  That helped tilt things for me towards surgery as I decided radiation had its own problems, and either way the sexual  recovery part was going to be a long shot.  Better to know before hand.

 

Well, here is the article.  I found, and still find, the data fascinating if not exactly what I would have liked.  I think the medical profession tends to downplay the effects a bit, especially the sexual recovery question.

 

Here is the artilce from March 2008, New England Journal of Medicne.  Best wishes as you consider your options.

 

http://content.nejm.org/cgi/content/full/358/12/1250

  

NewsPaper Lover

 

Age 66

PSA:  6.0  on 07/31/09 having risen from 4.2 on 12/02/08.  Free PSA 23.5%.Other PSA History: 4.3 on 05/01/08; 3.3 on 11/15/07; 3.1 on 05/20/07; 4.0 on 11/30/06; 3.40 on 09/01/05.

 

Biopsy:  09/04/09  13 snips;  two positive.  Right Mid  4+3 = 7 and 15% of the total volume.   Right Lateral Mid 4+3 = 7 and 20% of the total volume.

 

DaVinci robotic surgery:  11/05/09.  Post surgery pathology:  margins clean, no invasion of seminal vessels, no upgrade of the Gleason scores, no evidence of cancer outside the prostate capsule.

 

Cathether removed one week later:  11/12/09.   Stopped using pads on day three.  No pads or incontinence at night. 

 

I had the last surgical consult today. This was Dr. Jiminez (referred to as J below). His numbers have been added to the earlier table.
Number of operations performed: S: 200 F:1400 J: 200
% of patients "dry" within 12 months: S: 95% F: 99% J: 97%
% of patients "no ED and no drugs" within 12 months: S: 60% F: 75% J: 75%
J was extremely through in our discussion. He acknowledged the latest data showing RALP to have slightly worse stats than RRP, relative to incontinence and ED. As many have suggested, he stated that the experience and capability of the surgeon is the difference not the robotic assist. He further pointed out that the chairman at Vanderbilt (Dr. J. Smith ??) had long been a critic of RALP compared to RRP. He had done more than a thousand RRPs. Some years ago he switched to RALP and has since done more than a thousand of them. His stats indicate there is no difference between incontinence and ED with RRP or RALP using his own patients numbers. He is one of the top surgeons (apparently) and he now states his preference for RALP.
I was impressed with J. He is in same practice as F above. He stated, in his opinion, I would have an excellent outcome with RRP (performed by F) or RALP (performed by J). J suggested that maybe I should talk with Dr. J. Smith. It is only a 2 hour drive. I have a appointment with my PCP tomorrow and I will get his opinion. J had my file infront of him and told me the prostate size estimate was 28 grams. He indicated this was small and further reason to believe a good outcome. I will decide soon. Still learning. Still listening.
Happy New Year and many more to come for all.

I just found this statement by Dr. Joseph Smith at Vanderbilt. This is the Dr. J Smith that Dr. Jiminez referred.

"I almost exclusively do robotic prostatectomy now because I think that, despite this manuscript, there is clear evidence that it is comparable, in terms of continence, potency and tumor control,” said Dr. Joseph Smith, the chairman of urologic surgery at Vanderbilt University School of Medicine.

This is from the following article:  http://www.nytimes.com/2009/10/14/health/research/14prostate.html

If I would have been able to get RRP, Dr. Smith was the one I was gonna go to. But, sadly, due to the size of my prostate, I wasn't eligible. I do know that he is considered the dean of prostate surgery in the state by other doctors. Mine were really enthusistic about sending me to him. If you're gonna stay sorta local, I can't think of a better choice for the most expert practioner available, personally. 2 hours isn't a lot, in the vast scheme of perectnages of success, etc. Of course, in the end it's your decision, not mine....