New Member - I'm worried too....

After reading a number of posts I'm wondering if I made the right decision?

I'm right on the border of low and intermediate risk so I opted for the Davinci RRP now scheduled for January 27th 2015. Doc said the stats are about 80% that no additional cancer treatment will be needed but won't know until the surgery / pathology results.

I'm young relatively speaking, a little overweight but in good health, taking no meds, no symptoms, no ED or incontinence issues whatsoever at this point. Is surgery the right path?


Thanks for your thoughts.

PSA Level 9.75
Biopsy 10/23/14
Gleason 7 (3+4)
Cores 2 of 12
Positive 7%
Negative DRE
Staged T1c
Age 54
BMI 26
BP 115/75

Welcome to HW, sorry you need to be here.

Yes, second guessing our treatment choice is kind of a thing we all do. I did for a long after treatment.

Surgery is a good way to go - works well for a lot of guys and with your stats, I'd say you'd be fine with that. Having said that, have you look into radiation - especially brachy seeds? You'd likely be fine with that too.

And there is the problem with guys like us - almost any of the treatments will do the same job with about the same side effects.

Bottom line, I'd say, stay the course and get 'er done,

Andrew

Thanks for your replies and information. It's great not to feel so alone with this.

Radiation will follow surgery only if the pathology and post surgical PSA levels warrant it. about an 80% chance I won't need anything additional.

From your posts I plan to speak with someone from the radiation treatment side of things.

Find yourself a good RO (radiation oncologist) and have a consult. At the least you owe it to yourself to get the information.

and I'd put money down that you'll likely only need the one treatment.
Andrew

Gray,

You have time to talk to other doctors before your surgery. Surgery is a good treatment for your disease and you will probably do fine. No need to have doubts about your decision. It's in the bank. You're going to be OK.

But, you have some time and you may be able to trade up if you find something even better. If your surgeon hasn't done hundreds, if not thousands of these operations you might talk to another more-experienced surgeon. Studies have shown that the experience of the surgeon makes a big difference in the results. And of course you should talk to doctors who do radiation. Be sure to talk to someone who does Brachytherapy. For extra credit talk to someone about SBRT radiation (Cyberknife, etc.) which can also be a good choice for young guys worried about side effects.

If you do change your mind, try to give your surgeon three weeks notice at least. Most surgeons are busy enough that with that sort of notice they can just pull someone from their waiting list and not miss a payday.

One thing you will notice here on the forum is that you can usually guess what treatment a member will recommend by looking at his signature to see what sort of treatment he himself has had. Before a man will let someone cut on his man bits -- or zap them with radiation, or freeze them, or poison them -- he is usually hard to convince and he tends to stay convinced. It's all good information, but you will get different information from different guys. By this measure I ought to be a cheerleader for surgery (my primary treatment) and I am... sort of. But you should talk to all the doctors you can.

I am not convinced that the SE profile is "better" with radiation.
It is true that with surgery, the SE are immediate: incontinence and ED are the main ones. For me, I totally regained my continence in a few weeks. ED for me is still problematical although I have recovered a lot in that area.

For radiation, the SE sneak up on you. There can be serious bowel and urinary issues and I think they can worsen. Having had bowel issues, this possibility is a major concern to me (a lot more than some partial ED)

Perhaps the radiation advocates can debunk that comment. I do know if you are younger, that is often a reason given for doing surgery.

When I was dx. 5 years ago, I carefully studied my options and visited with surgical and radiation experts. I was healthy otherwise and did surgery. Well, I failed surgery and failed the salvage radiation. I then did HT and it worked great. I had an HT vacation but now the PSA is climbing and I am looking at resuming HT. However, in the interim I went to Mayo Clinic (earlier this month) and had the super duper newer Choline CT PET Scan, which is only done there. It found ONE solitary node. So, all of a sudden, after using up my two curative bullets, I now have another curative possibility (maybe a 30% chance, which was about the same chance I had with the salvage radiation). But, here is my point:

I am once again looking at surgical and radiation options regarding the lymph nodes. It is almost like a do-over. This second time around, for whatever reason, I am leaning towards radiation. Even choosing radiation, I need to look at SBRT and IMRT. The latter seems to be the usual, but some HW friends are really advocating SBRT and they have cited assorted studies. So, I will be making a decision in 2014. I suspect this time it will be radiation. Go figure, huh!

Mel

Graytech,

You are about six years older than I am and your PSA was about 2x mine; but the Gleason is the same so we're very similar.

I've studied this quite a bit for the month, and I'm not saying I've got it all right..... But, and I think I should be able to say this without anyone getting mad because I haven't had any procedure yet.

I don't see why in the world anyone wouldn't give serious thought and consideration to the brachytherapy or Cyberknife. I too was set on surgery after my initial diagnoses and talk with my urologist (surgeon).

Surgeons specialize in surgery so they obviously genuinely believe that's the best method of treating cancer; and the same with radiation oncologists.

I'm a stock broker so I think the best way to save for retirement is with stocks, but real estate investors disagree with me. It doesn't mean either of us isn't genuine in our beliefs.

I'd study up on the cure rates, side effects, etc. on all treatments. Seek out cases where men have troubles with surgery, brachytherapy, radiation, etc.

And remember, a lot of guys have successful treatments and move on from here and live their lives so it's not a full representation of all treatments.

I'm choosing HDR brachytherapy. Unless I've missed something, I have yet to find anyone whose treatment failed. There could be some, and I'd certainly like to know of them, but just haven't read or heard yet.

Either way, you should be fine in my opinion. Keep us posted.

Super max,

I'm no expert for sure, but I think SBRT is a great treatment option as well.

I'm not "afraid" of any type of surgery, cutting, etc. per se, but I am a little fearful of the radiation machine shooting beams from outside my body. Not too much, and I believe SBRT to be highly accurate, but the 'internal' radiation theory I liked better.

My doctor, Peter Rossi, is head of brachytherapy at Winship Cancer in Atlanta (Emory and St. Joseph's). He trained at Wake Forest and has been at Emory since 2006. Three urologists I've spoken with ranked him high.

Dr. Demanes is the man for sure. I was initially willing to go anywhere in the world, anytime; but the more I researched and consulted (even with a couple of men here), I decided I can get A rated care in Atlanta and have the convenience of being down the road.

The SBRT certainly has an advantage of being less invasive, and he went over that with me as an option. My urologist who did the biopsy, if y'all remember, tried to scare me into surgery I think but he finally chilled out a little. He talked about a beam coming down through other organs, etc. so that might still be in the back of my mind.

Dewayne said...
I'm not "afraid" of any type of surgery, cutting, etc. per se, but I am a little fearful of the radiation machine shooting beams from outside my body. Not too much, and I believe SBRT to be highly accurate, but the 'internal' radiation theory I liked better.

You and I think alike re: the radiation source. As an engineer it makes some intuitive sense to have the radiation originating as close as possible to the intended target.

You might like this HDR article if you haven't already read it: www.sciencedirect.com/science/article/pii/S1538472114005054

Keep us posted.

Mel, that IMRT vs SBRT question for your situation is way above my pay grade. However, I will be very interested in the answer as you break new ground.

Jim

Graytech,
In my case, it came down to what I feared most. I was fortunate enough to have treatment options, and I feared side effects more than the disease itself. I studied like all of us do, and I was fortunate to work with a large group of 'retirees' who had experienced pc. Most of them had had surgery. All were obviously alive, but none had the results that I wanted concerning their sex lives. That was my main reason for choosing brachy, and I am grateful every day that I did.
Best to you whatever you choose.

Graytech, we are going through the exact same issue and decision making process as I'm sure you know. And our biopsy results are not the same but very similar.
Your biopsy was 2 weeks before mine, and your surgery is scheduled 3 weeks after mine.
I'm curious to know, if there was any conversation regarding the wait time between your diagnosis and your surgery.

I don't want to take away from this thread focusing on YOUR specific situation, so if you would prefer to have the conversation off line feel free to email me, my email address is in my profile.