Just diagnosed...looking for suggestions on a surgeon in middle TN

How long is the wait list? You do not have to be in a hurry with those numbers.

My biopsy came back 3+4 in January and I had RALP in May.

More important to make the right treatment decision (for you!) and get to a top notch facility / practitioner than to get something done quickly.

OP said his diagnosis was 4+3 Gleason. I believe the ramifications of that are somewhat different than for a 3+4. Halbert will probably chime back in and clarify that better than I can and there will be others as well. Good luck with whatever you decide.

I looks like I misread your opening statement. G 4+3 is slightly higher grade than 3+4, so you definitely will need to do something. Even so, getting that second opinion is very important.

The frequent recommendation I give in here borrows from an old ad: go big or go home. In this context, it means go where the best people are that you can reasonably get to. You're in middle Tennessee, so going to San Francisco probably isn't going to happen. Vanderbilt, however, is a great facility, it's on the NCCN "centers of excellence" list--and that's where you need to be.

PC is incredibly common--something like 1 in 6 men will get diagnosed--but it's also very tricky to treat. Some surgeons will argue that prostatectomy is as challenging as brain surgery. So you want experience, lots of it. Same for radiation, you want a team that has treated many hundreds of patients.

Best of luck to you. Oh, by the way, when you come back, give us a little more info from your biopsy report (if you don't have the written report, get it--and get every piece of paper you can starting now). Your report should list out all the cores, their locations, and their pathology. Something like:

Right Medial, 10% involvement, gleason 4+3, and a line for each core. If you could copy that into your next response, we can help give a detailed interpretation.

If you want surgery, Joseph Smith at Vanderbilt did mine, and he is a vastly experienced surgeon who is also extremely widely published in the research world. He has done thousands of RPs and thousands of opens, and trained innumerable surgeons from across the country. That is, if he has not retired by now. I'm sure you have plenty of time for his waiting list, more time for you to research all options.

Kevin,

I see you've heard the classic "If you have radiation you can't have surgery later" line. Which is true. However, it implies something that isn't true: that if primary radiation isn't curative, there isn't anything else you can do. Which isn't true.

Reality is, the way we try to look at it is: What primary treatment is most likely to be curative with minimal side effects and can work for me, given variables like time off from work, distances involved, personal preferences, etc.

If you had indications, for example, that the PC had escaped the gland and was in your lymph nodes or bones, then surgery moves down the list, because it's less likely to be curative. On the other hand, if you want to make a single trip for treatment rather than multiple trips for radiation, then surgery moves up the list. And so on.

I'm a "surgery guy", and if you want to read my story, follow the link in my signature. I considered Vanderbilt, because at the time I was in southern Illinois, perhaps a 4 hr drive to Nashville. I opted for St. Louis (2 hr drive). The important thing is to get yourself to a highly ranked major center with lots of experience. That seems to be the best indicator of a good outcome that there is.

Actually, Joseph Smith at Vandy, who I referred to earlier, has written a paper on his experience doing surgery on patients who have already had radiation(RT). I think these surgeries were at least reasonably successful, but I can not remember the specifics. So it can be done. But, just as it is preferable, if you have to have RT, side effect(SE) wise, to have RT as a first/primary treatment BEFORE surgery has been done(aka salvage RT), it is preferable- if you have to have surgery, to have it first, before RT has been done.

Bottom line: take your time an figure out which treatment is best for you to start with. Because the SEs of either are potentially worse if you have to have them after you have already had the other. I personally would not pick my treatment thinking "oh well, if this does not work I can always have the other". I particular suggest you look at the relative cure rates of each treatment ( either very high for your stats ) and then look at the relative SEs of each as well as the likelihood of SEs and try and figure which you could best live with. Remember, there is no do over when it comes to undoing SEs. Though some SEs can be improved with further surgeries and such.

Thought I'd provide an update. I met with the Radiology Oncologist on Friday morning, and he was very encouraging. Net net of the discussion is that the PC has been caught early, and my chances of being "cured of my cancer" (his words) are very high with any treatment, radiation or surgery. I'm not a Pollyanna, but it was encouraging to hear this from a seasoned veteran after speaking with a very young urologist who performs 20 surgeries per year, for three years.

The RO said he's been treating PC for over 20 years, and has examined thousands of PC patients...he said the PSA scores are only 6.07, prostate is not enlarged, and digital exam does not reveal any density in the prostate. He is recommending the seed therapy over external beam, but only because he feels it will have lower SEs in my case...but either will result similar results.

I have an appointment with Dr. Joseph Smith at Vanderbilt two weeks from today, and looking forward to hearing what he has to say. Still on the fence in regards to which path to take. Part of me says that if both paths will have the same results, go with the one that will have the least SEs and is is least invasive. On the other hand...my question to the RO was "Which procedure will give me the greatest peace of mind when I lay in bed at night and wonder if there is any cancer left?" The RO answered that if my personality needs an answer to that question, go with the surgery...then repeated that either procedure will have similar results.

This forum has been a great resource! My other observation has been the shocking number of acquaintances who have already been through this! I am being contacted by dozens of friends and acquaintances offering to share their experience. Still researching...more to come after meeting with Dr. Smith in two weeks.

Hello Allen, I had a prostecomy in Knoxville 3 weeks ago by a Dr. Alan Shrewsberry from Tennessee Urolology located in Oak Ridge, Tn.
I highly recommend this Dr. The question about surgery vs. radiation is really quite simple.
If you have the surgery you can always have radiation later if needed. If you have radiation first you can not have surgery with expected good results.
I am healing very well and my score was also a 7.
I am 66 years o
D and my cancer was caught very early. Do your Research and don't be afraid. We are all here to give you support and share our experiences.

Kevin,
Sorry I missed your initial post. Regrets to have to welcome you to the club. Lots of good advice, experience, life journeys and support here. Earlier posts on that subject went on for a few pages! Just remember, we "aint got no" Doctors here on the forum.

My 2 cents is-though they told you you are just intermediate risk, some 4+3 with PSA 6, and I am far from experienced here, maybe I missed something, maybe someone could educate me, but I was wondering if the Dr. suggested an MRI or Cat Scan to see if any possible spread to your bones. I suppose that would be over treatment at this time,as it does not appear to be on the Dr's plans. So on second taught, maybe just dont worry about that now. Just wondering.

In any case make sure to go to the top of the page under the tab that reads Forum and Chat, there is a little rectangular search box. In that box type in the phrase"letters to the newly diagnosed .
I am quite sure that you will find some comfort and support there .
Wings of Eagles in So Cal