Met with a uro/surgeon at UH today (the "other" big hospital in Cleveland). He's the one that got this whole ball rolling when he ordered the MRI.

It was a good meeting.

His recommendation was surgery or brachy. He likes surgery as Plan A because it gives more options should we need a Plan B. This analogy was helpful so I'll share it. He said removing a prostate was like peeling one of those clementine oranges where the skin just falls off in one piece. Once a prostate undergoes radiation, you can still peel the orange, but it's like one of those oranges where you only get an inch or so off at a time, and it's not as clean or whole. You eventually get it peeled, but it's not easy

Two other things he said that carried weight with us. First, other surgeons might be doing the five incisions and the closings, but he'd be operating the console exclusively. The other thing came up while we were talking about nerve bundles and SEs. Steve said something about getting all the cancer being the first priority and the doctor's response was "no, my first priority is to keep you safe" and that would override everything. I would think that is every surgeon's first priority, but it was good to hear him say that.

This doctor was involved in an SBRT trial that started back in 2007. He thinks it's a good option for Steve to consider, but thought any type of external beam would be "overkill" and stood by his recommendation of surgery or brachy. He's aware we've got other irons in the fire and asked that we circle back with him no matter what we decide.

We are feeling a little more settled today. Still have a long ways to go before we are comfortable making a decision.

Have a great weekend everyone!

Suz (& Steve)

Though I ended up going with SBRT, I second Jim's recommendation to see Dr. Brian Moran at Chicago Prostate Center.

Don't let the fact that there's a Papadeux restaurant right down the street from him bias you.

I saw Dr. Moran twice. He's a straight shooter and does not pressure you. He did a joint phone consult with his peer Dr. Mac Roach at ICSF another renownded RO that a friend of mine on Inspire.com put me in contact with.

My ultimate choice after doing all the due diligence was Dr. Chris King at UCLA and SBRT

Suz,

My husband had his Brachytherapy performed by Dr. Jon Prescott at Lake West in Willoughby. He is someone that my husband's URO works with. He is a radiation oncologist that specializes in prostate cancer. it's been over 2 years now and it is all a thing of the past other than a PSA test every 6 months.

There are very good options for radiation locally in the Cleveland area.

Sharon

I'm glad you found a better surgeon to talk to this time. If you choose the surgery route it's good to know that you're comfortable with him and your chances for a cure with surgery are excellent.

Like some of the others, however, I don't fully agree with a couple of his comments. Surgery doesn't have more back-up options--it just has different back-up options. I also don't know why he says that SBRT is "overkill" since it's very similar to HDR brachy. (Although presumably he's referring to LDR brachy. Even then, I still don't get his comment.)

Most important, glad you're feeling more comfortable about where you are. Since most treatments will cure Steve I'd mainly keep your eye on potential SEs and which set you think you can best live with.

If you are able to go out of state, how far are you from Wheeling Hospital in West Virginia? Gregory Merrick there is among the top seed specialists in the world. In Detroit, you have Alvaro Martinez, who is one of the pioneers of HDR brachytherapy monotherapy.

- Allen

Suz, lots of top surgeons hand pick their cases. They tend to pick the ones that they think will enhance their reputations. Some pick 'easy' cases so they can guarantee a good outcome and makes their stats look better. Others seem to pick the challenging cases, so they can say, "hey, I did this one, and nobody else had the guts to try".

IMO, it's not that big a deal. Any surgeon at the CC that Dr. Klein would recommend will be top tier.

Suz, we're leaving tomorrow morning to head for home. Back to work Monday.

I had my surgery at a large teaching hospital (Barnes-Jewish in St. Louis/Washington University Med School), and I never asked if my surgeon was actually on the controls. For me, today, it barely would matter, because my outcome has been great.

Thing is, it's still the surgeon's name on the reports and so on. He's still the one who would be held to account if there was a problem.

The surgeon you choose does matter. MSK published data on their surgeons with the best at 11% positive margins, the worst at 37% and the average at 21%.

Surgery is no doubt a good option for many.

As is Brachytherapy.

I had HDR Brachy eight months ago and I'm doing great.

Dropping PSA, had sex with the wife 3x this week (so far), played basketball once (will again tomorrow) and worked out with my trainer and group Crossfit 3x. Hard, high heart rate workouts too. Now I'm on the front porch drinking a 'Monday Night Brewing' cold beer. They're an Atlamta craft beer maker, btw. This is a pic of me on their website FYI (at least my hand and lake)...

mondaynightbrewing.com/beers/nerd-alert/

I'm an Internet junkie or I probably wouldn't be around. I figure there are many successful HDR guys who've moved on.

Suz,

I notice that Dr Epstein suggested Tewari from Mt Sinai in NY. He did my RALP and my results were extraordinary. The issue of Positive Surgical Margins was the reason I chose him. His rate was about 2% which appeared to be as good as you can get. I did not want 10% or above. I was only going to do this once and I wanted the best chance I could get. I live in Florida and traveled to NY. I was dry from the moment the catheter was removed and had no additional issues with ED. My current PSA is undetectable.

Best of luck to you both!

Hi Suz,

No offense taken in the least!

I believe Klein only does open surgery if that matters to you. It didn't to me. One of the reasons, (primary) that I went with Klein is that he had performed thousands of surgeries vs the robotic CC Dr who I had scheduled a surgery date with but learned he had only performed a couple of hundred. I didn't take the time to investigate which robotic Dr's had performed more and what their outcomes had been. I cancelled and went with Klein.

All the best.

Samster

Hi samster - Glad no offense was taken! You are 4-1/2 years post-op and are one of those inspirational success stories. It is admirable that you continue to offer help and guidance to others on this forum. Thank you!

Suz

Just a quick thought. Does Steve have any current problems with BPH? If not, then I have no further thoughts regarding brachy. If he does, there seems to be more of a chance for radiation induced side effects in patients who had BPH issues prior to brachy or other radiation treatment. They may show up long after the procedure in those who currently exhibit signs of BPH. Just a thought.

Best of luck to both of you!