Overwhelmed

Recently told I have prostate cancer.  I have to make a decision by Feb 6 as to what plan of action I should take.  So much info out there don't know what to do.  I think the doc wants to do the robot removal.

vapo61

What are you numbers? Being the PSA, Gleason, any scans done?, your age?

Why do you have to make a decision by Feb 6 ?

Calm down, take a breath and share all the information on your Prostate Cancer.

Hugs

Bud

vapo61,

Sorry to hear about your diagnosis. The whole thing is really unsettling and confusing at first, but you need to know and understand your pathology before you can understand your choices.

If they told you that you have prostate cancer, they must have done a biopsy. You need to know:

* What's your Gleason score?
* How many cores were positive?
* What percentage of each core was positive?
* Where were the positive cores located?
* What's the cancer stage?

Only when you know these things can you make an informed analysis of your choices. Your age factors into this too, but your choices might include:

* Robotic surgery
* open surgery
* Active surveillance, or watchful waiting
* Brachytherapy (radioactive seeds)
* Beam radiation
* Proton therapy
* and more...

Unless you know your numbers and you've at least considered the other alternatives, choosing between open or robotic surgery is like asking whether you should drive a Chevy or a Ford to the other side of the country. There are other ways to get there that are worth considering.

Finally, if you do decide on surgery, I'd suggest that the experience of the surgeon matters a lot more than whether you have open or robotic surgery. And any surgeon who rushes you into a quick decision with little information isn't serving your interest very well.

I suggest you get your pathology numbers and report back to us. Then we can have a more meaningful discussion about what you might consider doing.

Best of luck, and hang in there. They're very good at managing prostate cancer, and chances are you'll be fine. And there are a lot of very knowledgeable people here who will be happy to help you sort out your choices, but you can't approach this blindly. I look forward to hearing back from you.

Jonathan

Please don’t rush into a decision. Try to calm down; you will get through this and chances are really good that you’ll be fine. PCa is a slow growing cancer, so you have time to educate yourself and make informed decisions.

Get a second and maybe a third opinion. Consider talking with a radiation oncologist and a medical oncologist. Consider going to a major cancer center; many offer multi-discipline programs where you can schedule appointments with more than one specialist in one day. Travel if you need to. I can’t stress enough that the experience of the doctor doing whatever procedure you choose is paramount in your outcome. Ask what his numbers are. If he won’t say or is evasive – find someone else. You should also get a second opinion on your biopsy slides. A good book to start with is “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer.”

Sorry you have to be here, but I’m glad you found this forum. I’ve gotten a lot of information and encouragement from the people here on a patient to patient basis. They are very knowledgeable and caring.

Best of luck to you.

Had to run off and take a pet to the vet. Further blathering....

There are many treatment options and a non-treatment option. Unlike most of "modern medicine", they are all bad. There isn't (in my opinion) a good choice. Choosing the option that's least bad when considering all the intersections of what's important to you, where (stage, mostly) your disease is at, which side effects are going to upset you the most, your overall health, age and various other factors is the best we can do.

The fact that I chose X doesn't mean X is the best choice for you. The fact that someone else else had Y and thinks that Y is for you and Y is the best thing going and Y has no side effects whatever usually means that they are a paid shill for Y who hasn't even had PCa, much less treatment Y, and sometimes that they actually did have Y and got lucky - which doesn't mean that you will.

In early stages, most of the treatments will effectively end the cancer for a large proportion of cases. Choosing between them is then a matter of choosing possible side effects, and using a large BS detector (this place works quite well) to get past providers poo-poo-ing the possibility that there will be side effects. In almost all cases there will be side effects - many are temporary, some end up being permanent. What will actually happen to a particular patient (you) is unknowable - statistics don't predict any individual case, but they do tell what happens to populations, so you can asses your odds of various outcomes, while realizing that "92% have outcome G" does not mean you'll certainly have outcome G - you get G or you get H, and it's more likely that you'll get G - but H is not ruled out simply because it's 11 times less likely. You roll the dice and get what you get.

If you are old enough and your cancer is placid enough, doing nothing may be the right choice. Virtually all men get it. If it does not show up until late in life, it's quite likely that you'll die with it, but not of it. Not my situation, so that was not my choice.

Finally, if you do choose surgery, the surgeon is more important than which tool they are using. I met with 2 specialist robotic surgeons, and I actually ended up going with the one who had less operations - I felt that he had enough, and he was in a much more convenient location, and he only did one per day when operating. Sheer volume looked less appealing to me as the potential 2nd or 3rd operation of the day. the guy I used had also trained on the thing from the beginning of his career. Ultimately, you make a call based on whatever you make a call on - think of it as a job interview where you are the employer, not as lowly peon you meeting with great high-mucky-muck surgeon who deigns to see you. I'd take a good open surgeon over a bad robot surgeon (but I might also go looking for a better robot surgeon, based on my preferences.)

Post Edited (RandomPseudoNym) : 1/29/2012 2:47:27 PM (GMT-7)

Hi,

You have gotten some excellent recommendations from many

HW members.

The key is not to be rushed into a surgical procedure you may not

want or even need.

Please send all available data on your PCa diagnosis for HW members to review, which will enable them to give you much more educated recommendations.

Also, seek a second Urologist's opinion at the very least and take the time to speak with a Radiation Oncologist and Medical Oncologist in order to determine the best way to manage your Prostate Cancer.

Also, Watchful Waiting and/or Active Surveillance may or may not

be an option depending on you age, PSA, Gleason Score, etc.

At the end of  the day, the final decision is yours alone after you have weighed the pros and cons of each Treatment Option.

Another source of great support I have found is the UsToo Prostate

Cancer Support Group. It has been a source of great comfort to me for almost 8 years now. UsToo is an International Organization for

Prostate Cancer Survivors and holds monthly meetings.

You get to personally meet with fellow members and share experiences relating to your Prostate Cancer.

I am currently Co-Chairman of the UsToo Group at Hackensack

University Medical Center in New Jersey and have spoken with many men recently diagnosed with Prostate Cancer.

This is a completely Volunteer Group with no Membership Fees, etc.

If this sounds interesting you can go to www.ustoo.org to find a Chapter near you.

Best of luck.

Bob 

   

You've received fantastic advice. If you are a fairly low Gleason score (eg. 6) and being pressured to make a decision by Feb 6 then you should find another urologist ASAP. I would suggest visiting the Yana website and listening to some of Dr. Myer's video logs. They have (along with this forum) have been a great source of help to me.

http://www.yananow.org/
http://askdrmyers.wordpress.com

By the way to answer your original question, if I decided to go for treatment I would pick the best surgeon possible and the choice between open or robotic would be secondary.

that was a good start, you have 2 of 12 cores positive. it would really help to know what the Gleason score was on this last biopsy report, you should have a copy, and if you don't, go back to the doctor and ask for your copy. It may or may not have the staging estimate, which would be important to know as well.

we are here for you, eage to help, and to answer any questions that may come up. the suggestion to read the walsh book "surviving prostate cancer", is a good starting point in your education, pretty well covers most treatment choices and options, and would serve as a good primer for you.

the most important thing right now, is not to be pushed into something, until you have had the chance to educate yourself on your situation, and what all your true options really are.

david in sc

Hi Vapo, so sorry you have to be here but this is the place to be as you begin your journey.

You do not mention where you live or what is available in your area for treating PC. My URO is a partner in the largest Urologist practice in Alabama. They have open and robotic surgeons, radiation oncologist and medical oncologists on their staff and practice in several area hospitals. They also have specialist in post treatment continence and ED which is almost as important as the treatment.

After my biopsy last April my URO told me I had Gleason 7 PC in 2 of the cores and that this was a moderate aggressive cancer, but I still had plenty of time to make a smart treatment decision. He is a robotic surgeon but we covered all of my options and offered me the chance to meet for any second opinions that I needed both within and out side their practice. I felt so comfortable with his non pushy approach that I chose to have RALP with him. Even after that decision he wanted to wait 2 months before surgery which I spent doing research on him and his URO group.  I even asked my GP who,  I trust with my life, who he would use if he was in my situation and he told me no question he would use my URO. I also asked him about experience and he had done over 700 robotic surgeries and averaged about 3 per week. Their group had done over 6000 surgeries.

No matter which treatment or type of surgery you choose I can say the key is choosing a doctor who has experience in that treatment first and who you feel comfortable with second. If you go the surgery route ask how many surgeries your URO has personally done over all and the last year.  From my experience in this forum and from other sources you want a surgeon who has done a minimum of 500 surgeries and does at least 2 per week.

Good luck and remember one thing from this forum; the only right treatment decision is the one you will make as you are the one who will live with that decision.

Terry The Water Guy

vapo61: everyone is giving you great advice. With that said, I cannot really add any more info since they have already covered all the bases. I will be following this thread because I want to see why your doctor wanted you to make a decision so quickly. That sent my BS detectors off big time. One piece of advice I will give is to get a copy of all relevant medical records regarding you PC. I started that as soon as I was diagnosed. I have a copy of earlier PSA tests, the two pathology reports one before RP and the one after RP, RP surgery report, and lab reports like blood tests and urine cultures. I keep all of that info in a notebook and I will keep it up to date for the rest of my life.