Welcome to HW, sorry you need to be here.

It's a kick in the head isn't it? The shock will wear a little, but don't panic because the good news is that with your numbers you can expect a great outcome. You're very much in that 'curable' zone. There is even a good possibility that you can avoid treatment for a long time with an AS (active surveillance) program.

A second opinion is the best thing right now. I keep hearing folks talking about a Dr. Dattoli in your part of the world. Others will come by soon with other recommendations.

Surgery isn't your only option, the various radiation options might be better in your case. You'll want to talk to a good surgeon, and a radiation oncologist. Likely two ROs, one who does beams and one who does the brachy therapy (seed implants).

Check out the sticky threads at the top of the forum and start learning about this PC thing. It can get confusing fast. You've got a slow growing cancer so you've got time to make an informed decision - don't let anyone rush you.

Hang in there and keep us updated on your progress,
Andrew

We are also in Tampa. My husband was initially diagnosed after biopsy as T1C with Gleason 3+4. This was from a urologist that we have stopped seeing due to his lack of knowledge and compassion. We sent the biopsy slides to Johns Hopkins for a second opinion and they kept Gleason score the same but indicated higher percentage of cancer. So I do suggest a second opinion. We decided on laparoscopic robotic prostatectomy and got rave reviews from numerous friends/acquaintances/patients for Dr. Vipul Patel at Celebration/Florida Hospital in Orlando. He has done over 7000 of these surgeries to date. We were confident in his expertise and he did not disappoint. The surgery and subsequent recovery went very smoothly. Unfortunately my husband's cancer had progressed outside the prostate gland and he was categorized PT3B on pathology. We chose to have radiation (8 months after surgery to have full bladder control) and did this with Dr Fernandez at Moffitt in Tampa. Dr Fernandez was just as reassuring and knowledgeable and as much of an expert in his field as Dr Patel. Again, unfortunately radiation did not affect a cure and we were referred to Dr Zhang, a medical oncologist at Moffitt. Again, he seems to be at the top of his field but we wanted a second opinion on next therapy and consulted with Dr Slovin at Memorial Sloan Kettering. Found out she works closely with Dr Zhang so that all worked out to keep us in Tampa using the facilities of Moffitt. One suggestion I would make that our urologist did not suggest nor even tell us was an option is to have an MRI or some type of scan done to make sure cancer hadn't escaped the gland. Doubt it for you with Gleason 6 but knowing this in the beginning would probably have sent us to a different initial therapy such as seed radiation. Dattolli in Sarasota seems to be the expert in seed implantation but Fernandez at Moffitt does it frequently as well. Best of luck to you.

Hi Collins -

I'm sorry about your diagnosis, but you do have a LOT of good options. I hope you have read the sticky and have arranged for your biopsy slides to be re-read by Bostwick or Epstein as recommended there.

Of course the first option to consider is Active Surveillance (AS). That entails getting into a structured AS program and watching it closely. I've heard the Moffitt Center has an excellent AS program.

For surgery, you should only be considering Vipul Patel in Orlando. He's done more than anybody, and experience counts a LOT.

For SBRT, you have a great choice right there in Tampa - Debra Freeman. She's treated two online friends of mine with excellent results (full potency, no urinary or rectal SEs, and one even continues to ejaculate). To me there is no advantage to IMRT over SBRT, yet it is a lot more trouble and expense (5 treatments vs 40+ treatments), so I don't recommend IMRT for primary treatment (e.g., Dattoli) at all. For the same reason, I can't recommend proton, although UF Jacksonville is certainly a leader in it.

For LDR brachytherapy (seeds) you have John Sylvester in Lakewood Ranch. He is among the top 5 in the US. He was formerly part of the renowned Seattle group, and has more experience than almost anyone.

There might be an HDR brachy specialist in the Tampa area, but I don't personally know of any. I'd go with JNF's recommendation in Atlanta.

I recommend you visit with ALL of these doctors - even the IMRT and proton specialists. Remember that a specialist really knows his own field best, and you have to take with a grain of salt whatever he says about other specialties. Your diagnosis gives you plenty of time to make the appointments, gather information, and do the self-assessment that is critical. Don't rush this.

Welcome aboard Collins!!!!

I am another Floridian from near W Palm Beach. There are many of us here from Florida on the forum so you are not alone. Others will probably chime in shortly

As the others have said investigate all your options and choose what treatment best suits you. With a Gleason 6 all options are on the table. Do get a second opinion on your slides. After my surgery it was discovered that I was a Gleason 3+4=7 instead of a Gleason 6. You only get to do this once so do your due diligence.

It does feel like you have been punched in the stomach and you are coming up for air after hearing the "C" word directed at you.

I had my surgery by Dr Vipul Patel in Celebration, Florida 5 minutes from Disney World which would be a quick drive for you in Tampa Bay. As Tall Allen said, no one has done more than Dr. Patel. As of February this year he has done 8,500 Da Vinci Robotic surgeries. He is a very caring, knowledgeable and personable man.

My email is available by clicking on the envelope under my name in the margin on the left.
<------------------------ or just click on my name, BIG MAC to the left if you need any info from me on Dr. Patel.

Good luck, these first few weeks are stressful but once you make your decision, a load seems to be lifted off your shoulders.

Bill from Florida

JNF will hopefully be along soon. If not, send him an email . If you put "JNF" and "HDR brachy" in the search bar and find any of his posts and click on his name, his email will come up. He had HDR brachy combo therapy (used on higher risk cases), but his RO is expert at HDR brachy monotherapy as well.

Allen, with all due respect for your vast knowledge and contributions, this member has seven positive cores.

I would think that would rule him out of most active surveillance programs, without even discussing bilateral involvement.

InTheShop said...
Welcome to HW, sorry you need to be here.

It's a kick in the head isn't it? The shock will wear a little, but don't panic because the good news is that with your numbers you can expect a great outcome. You're very much in that 'curable' zone. There is even a good possibility that you can avoid treatment for a long time with an AS (active surveillance) program.

A second opinion is the best thing right now. I keep hearing folks talking about a Dr. Dattoli in your part of the world. Others will come by soon with other recommendations.

Surgery isn't your only option, the various radiation options might be better in your case. You'll want to talk to a good surgeon, and a radiation oncologist. Likely two ROs, one who does beams and one who does the brachy therapy (seed implants).

Check out the sticky threads at the top of the forum and start learning about this PC thing. It can get confusing fast. You've got a slow growing cancer so you've got time to make an informed decision - don't let anyone rush you.

Hang in there and keep us updated on your progress,
Andrew

All of that! Many G6s die in old age of the more normal things that kill us all, rather than PC, even if they do NOTHING! Autopsies (in places where PSA testing is not normally done) show that a whole bunch- maybe a majority- of age 60+ men who die of various causes had PC and did not even know it. Finally, no matter what treatment you choose, there is an extremely high chance that you will be cured.

So main thing: take a deep breath, slow down, an start researching which treatment, if any, is best for you. Do NOT be rushed into surgery or any other treatment by anyone. And if you still decide you prefer surgery, find a very experienced surgeon- thousands of prostatectomies would be best- even if you have to travel. IMO.

EDIT: It is true that you could have something worse than a G6 in there. Just like it was true before you ever had the PSA tests or Bx. For an older man, you never really know what is growing in there. But OTOH, the only thing you actually know- that you didn't know a few months ago- is that you have a G6, a low risk result. You might even consider a 2nd opinion on those slides to make sure they are not even lower than G6.
EDIT: do you have the volume/percentage from your Bx?

Post Edited (BillyBob@388) : 8/12/2015 7:04:51 AM (GMT-6)

Hi Collins,

As others have stated, you have many options. It is a short drive to Sarasota and I think that it would be worthwhile to have a consult with Dr. Dattoli. He uses a combination treatment that has been proven effective and has treated thousands from all over the world. I traveled from Michigan for treatment and have been happy with the results.

Hi LupronJim ..The out pouring of support from this forum has been incredible and i tell ya...I'm feeling uplifted already from that gloom and doom of last two weeks. The idea of physically meeting members on this forum sounds good and i'm gonna research GFMPH presto!! Good luck on your continued recovery

collins

Hello Susan
Thank so much for sharing your husband's inspirational story with me. It goes a long way to strengthen my resolve in dealing with this dreadful disease. Yes...Dr. Zhang has been mentioned quite a few times and his is currently on my short list. Thanks again!!

Collins

Wow..Thank you for sharing your journey. All the different PC treatment experiences on this forum is so invaluable and i thank God for you'all

Collins