Checking out 4 recommended prostate surgeons.

My 74 year-old brother las an aggressive non-metastatic prostate cancer. doctors want him to have surgery stat. He has been given names of 4 top surgeons:
1. Malcom Root, Moffitt Center inn Tampa
2. Julio Pow-Sang, Florida
3. Michael Blum, Univ of Chicago
4. Airlock Shrivastava, Cleveland Clinic, Ft Lauderdale, FL
Do you have any recommendations Or doubts about these surgeons?

Hi Allen,
Thanks for getting back fast.
we know about Dr Patel.
No mets. Looking at RA w/robotics &a laparoscopy. Depends heavily on surgeon's experience & skill.
What IMRT,
IMRT + brachytherapy boost+ ADT?

I can't comment on the specific surgeons you mentioned, but do agree with your comment that having an experienced and skilled surgeon with many, many robotic surgeries under his/her belt is very important.

Re your question about IMRT/brachy/ADT, that's the combination I had for my aggressive cancer. It combines external radiation (IMRT) with internal radiation (brachytherapy) and a drug therapy to temporarily repress testosterone (ADT). To Allen's point, the combo has very good success with aggressive cancer as it targets a wider area than just the prostate. Localized spread (not mets) can be a greater issue with an aggressive cancer. (For the record, I'm doing quite well with the combo therapy and there are several other success stories of similar guys here on this board.)

I'm not trying to upset the apple cart if you're already set on surgery...but if you haven't talked to an experienced radiation oncologist that specializes in this combo, it could be worth your brother's time. And hopefully some others can respond to your question about the specific surgeons yo asked about.

Regardless of the path you choose, good luck to your brother and it's great that you're advocating for him!

Does the fact that he is 74 limit some treatment options?

Also, Curly Girl...sorry you have to be here, but as Jim said, some info on your brother would help us....

Most notably, how did they diagnose that it was an "aggressive" cancer?

To Ken's point, it was the famous prostate surgeon at Johns Hopkins, Patrick Walsh, that would not operate on anyone over age 70 unless they brought both patients to the consult. Walsh developed the nerve sparing techniques that are the standard today and generally regarded as the pre-eminent prostate surgeon of our time. Prostate surgery is difficult and many surgeons use 70 as a maximum age.

You should investigate the various radiotherapy options that are as good or better than surgery for cancer control and generally have less significant side effects. The Datolli Center in Sarasota is where I would start in Florida. They are prostate cancer specialists and are always using and developing cutting edge methods and technology.

As TallAllen pointed out, don't rely on a surgeon to tell you about radiation therapy, that is out of the surgeon's league. Go to the specific specialist for the information.

I'm glad your brother has landed on a treatment option. There are several of us here that had the "triple play" of brachytherapy, IMRT and HT, myself included. Three years out, I'm doing quite well in terms of SEs--nothing really to mention and (knock on wood) so far my PSA has been low and steady. I hope JNF also weighs in as he was another high-risk patient that had the same treatment and he's several years ahead of me.

In both our cases, we had high-dose radiation (HDR) brachytherapy, which is different from "seeds" or low-dose radiation (LDR) brachytherapy, which is more common. But lots of guys here have had LDR brachy and have done great. Hopefully some of them will also weigh in.

Good luck to your brother--I think he made an excellent treatment choice for aggressive PC.

Curlygirl,

The one with the temporary implants is called "high dose rate (HDR) brachytherapy." The one where they leave the seeds inside permanently is called "low dose rate (LDR) brachytherapy (or "seeds")." They are both excellent choices when combined with external beam radiation and hormone therapy.

Because survival rates are so long after treatment of even high risk prostate cancer, they usually look at a different measure of how successful a radiation treatment was. They look to see whether PSA increased significantly (more than 2 points) after going down first. That's called "biochemical" progression-free survival, recurrence-free survival, relapse-free survival, freedom from failure, disease-free survival or no evidence of disease (depending on the study).

As you can see in the top part of the following article about HDR therapy, the HDR brachy "boost" led to 5-year biochemical relapse-free survival ranging from 67% to 97% with acceptably low rates of long-term toxicity. (HDR brachy monotherapy and SBRT monotherapy are experimental therapies for high risk cases):

HDRBT in treatment of high-risk prostate cancer

The LDR brachy boost was compared to external beam only therapy in a randomized comparison last year. The 7-year progression-free survival was 83% in that study, so very similar to the HDR brachy boost. Long term urinary toxicity was somewhat higher than the HDR boost therapy, but the two weren't compared directly.

EBRT + LDRBT boost provides superior cancer control compared to EBRT alone

When these studies speak of "late term grade 3 urinary toxicity" for these kinds of treatments, they are mostly referring to urethral strictures (closing up of the urethra from the swelling and scar tissue) that required surgical intervention (like a stent or TURP). That occurred in 1%-7% of the men in the HDR boost studies and up to 19% of the men in the LDR boost study. The opposite problem, urinary incontinence, is a rare side effect with primary radiation therapy of any kind.

Acute side effects like urinary frequency/retention, urgency, and burning are common within the first 3 months after these treatments, but they usually pass quickly, and medications can help make it more comfortable in the interim.

- Allen