New to the website....Diagnosed 11/07 in Stockton, Ca. Dr. Garbeff performed the biopsy. He took 20 samples and found 30% cancer in one of the samples from the lower right area. Gleason 3 + 4. PSA 2.6, which could be a supressed number because I've been on propecia (finisteride), for hair loss for at least 5 years. The bone scan was negative. The urologist/surgeon in Stockton, Dr. Garbeff, suggested RP and he does it the old fashioned way. My wife and I have always gone to the big city for important medical problems and have had great success in the past. I'm now dealing with UCSF. After speaking with the surgeon, Dr. Konetti, I was ready to have him do RP using the Da Vinci Robotic, which is the only way they do the procedure at UCSF. He asked if we had enough time to stay for an ultrasound which was performed by Dr. Shinohara who just happens to be one of the foremost authorities on brachytherapy. After making an appoinment and speaking to him I was ready to have him perform brachytherapy. My hesitation was that with RP they remove some lymph nodes in the proximity for pathology and with brachytherapy you just have to hope that the cancer hasn't gotten to them yet. Dr. Shinohara said that in his opinion all that I needed was brachytherapy and no external beam radiation. He said that he understood my concern and suggested that I speak to Dr. Speight, radiation oncology, in the basement of UCSF. She works hand-in-hand with Shinohara performing the brachytherapy procedure. She disagreed with Shinohara and said that I should have brachytherapy in a lower dose and then external beam radiation to the prostate and lymph nodes in the proximity of the prostate. I asked her to get together with her partner, Shinohara, and see if they could reach agreement. She said she would not only do that but would present my information to the "tumor board" for evaluation. That should take about 2 weeks, maybe until the first week of February, 2/08. Then possibly a 6 week waiting period before surgery. Is it true that statistics, as far as brachytherapy, can only give about 15 years of reliable data for longevity, because they haven't been doing it for any longer? Still weighing the options but I'm leaning toward just having brachytherapy with no external beam radiation. Any input would be greatly appreciated. Thanks.
[QUOTE=patrick1111;3408407]New to the website....Diagnosed 11/07 in Stockton, Ca. Dr. Garbeff performed the biopsy. He took 20 samples and found 30% cancer in one of the samples from the lower right area. Gleason 3 + 4. PSA 2.6, which could be a supressed number because I've been on propecia (finisteride), for hair loss for at least 5 years. The bone scan was negative. The urologist/surgeon in Stockton, Dr. Garbeff, suggested RP and he does it the old fashioned way. My wife and I have always gone to the big city for important medical problems and have had great success in the past. I'm now dealing with UCSF. After speaking with the surgeon, Dr. Konetti, I was ready to have him do RP using the Da Vinci Robotic, which is the only way they do the procedure at UCSF. He asked if we had enough time to stay for an ultrasound which was performed by Dr. Shinohara who just happens to be one of the foremost authorities on brachytherapy. After making an appoinment and speaking to him I was ready to have him perform brachytherapy. My hesitation was that with RP they remove some lymph nodes in the proximity for pathology and with brachytherapy you just have to hope that the cancer hasn't gotten to them yet. Dr. Shinohara said that in his opinion all that I needed was brachytherapy and no external beam radiation. He said that he understood my concern and suggested that I speak to Dr. Speight, radiation oncology, in the basement of UCSF. She works hand-in-hand with Shinohara performing the brachytherapy procedure. She disagreed with Shinohara and said that I should have brachytherapy in a lower dose and then external beam radiation to the prostate and lymph nodes in the proximity of the prostate. I asked her to get together with her partner, Shinohara, and see if they could reach agreement. She said she would not only do that but would present my information to the "tumor board" for evaluation. That should take about 2 weeks, maybe until the first week of February, 2/08. Then possibly a 6 week waiting period before surgery. Is it true that statistics, as far as brachytherapy, can only give about 15 years of reliable data for longevity, because they haven't been doing it for any longer? Still weighing the options but I'm leaning toward just having brachytherapy with no external beam radiation. Any input would be greatly appreciated. Thanks.
While I can't speak to the brachytherapy as I chose the robotic RP (surgery 12/07) which apparently went well (time will of course tell), I was very impressed in general with Shinohara (who did a great job on my biopsy) and to a lesser extent Konetti who I consulted with before having choosing to have my robotic RP in Concord with Dr. Steven Taylor. The conventional wisdom is that the more robotics under the belt, the better. Konetti, while seemingly very sharp and personable has somewhere around 70 of the robotics under his belt, which is on the lower end of the experience spectrum. In fact, the head of the department there (Carrol?) hasn't done all that many and he's the most experienced on property. As I recall UCSF has only been doing the robotic for about two years now. The doctor I chose has been doing it for over five years and has at least 500 robotics. In my case I was a 5.0 PSA with the biopsy indicating mostly 3+3 and some 3+4. In the surgery he took 17 lymph nodes, the seminal vesicles, the bladders base resection margin and of course the gland itself and sent it all to pathology. The post surgical pathology indicated that the cancer was confined to the gland (all margins being clear), the lymphs and bladder resection and seminal vesicles clear as well...an obvious relief. However, as in some cases I was upgraded to 3+4 with a bit more tumor volume than the biopsy suggested. While from what I've read, the radiation therapy is as effective in stopping the cancer growth there is an element of mystery if you will as to if it spread, other than the follow-on PSA tests that everyone takes. For me, age (45) along with career reasons made surgery my only viable option. A month after catheter removal the incontinence has improved a lot, and I am beginning to tackle the impotence issues. While radiation spares you those little joys (up front at least) thus far on balance I am happier having gone with the surgical option. Unfortunately you can't ever be sure you did the right thing, so just do the best you can do.
[QUOTE=patrick1111;3408407]New to the website....Diagnosed 11/07 in Stockton, Ca. Dr. Garbeff performed the biopsy. He took 20 samples and found 30% cancer in one of the samples from the lower right area. Gleason 3 + 4. PSA 2.6, which could be a supressed number because I've been on propecia (finisteride), for hair loss for at least 5 years. The bone scan was negative. The urologist/surgeon in Stockton, Dr. Garbeff, suggested RP and he does it the old fashioned way. My wife and I have always gone to the big city for important medical problems and have had great success in the past. I'm now dealing with UCSF. After speaking with the surgeon, Dr. Konetti, I was ready to have him do RP using the Da Vinci Robotic, which is the only way they do the procedure at UCSF. He asked if we had enough time to stay for an ultrasound which was performed by Dr. Shinohara who just happens to be one of the foremost authorities on brachytherapy. After making an appoinment and speaking to him I was ready to have him perform brachytherapy. My hesitation was that with RP they remove some lymph nodes in the proximity for pathology and with brachytherapy you just have to hope that the cancer hasn't gotten to them yet. Dr. Shinohara said that in his opinion all that I needed was brachytherapy and no external beam radiation. He said that he understood my concern and suggested that I speak to Dr. Speight, radiation oncology, in the basement of UCSF. She works hand-in-hand with Shinohara performing the brachytherapy procedure. She disagreed with Shinohara and said that I should have brachytherapy in a lower dose and then external beam radiation to the prostate and lymph nodes in the proximity of the prostate. I asked her to get together with her partner, Shinohara, and see if they could reach agreement. She said she would not only do that but would present my information to the "tumor board" for evaluation. That should take about 2 weeks, maybe until the first week of February, 2/08. Then possibly a 6 week waiting period before surgery. Is it true that statistics, as far as brachytherapy, can only give about 15 years of reliable data for longevity, because they haven't been doing it for any longer? Still weighing the options but I'm leaning toward just having brachytherapy with no external beam radiation. Any input would be greatly appreciated. Thanks.
Maybe I missed it but did you mention your age?
:confused:
[COLOR="DarkGreen"]I'm interspersing some comments in green. I am a fellow survivor with no enrolled medical education, doing well since diagnosis in December 1999 with a challenging case, and was not eligible for the choices you have. Color me envious! :(
[QUOTE=patrick1111;3408407]New to the website....Diagnosed 11/07 in ... biopsy... took 20 samples and found 30% cancer in one of the samples from the lower right area. Gleason 3 + 4. PSA 2.6, which could be a supressed number because I've been on propecia (finisteride), for hair loss for at least 5 years. The bone scan was negative. ...ultrasound which was performed by Dr. Shinohara who just happens to be one of the foremost authorities on brachytherapy.
[COLOR="darkgreen"]Those are good findings except for the Gleason, of course. Propecia is only one fifth as strong as finasteride, but it seems to me too that it is likely to have at least some of the same PSA suppression ability as finasteride. However, since finasteride suppresses PSA by about 50% (counteracting the cancer to an extent at the same time), I doubt Propecia would suppress the PSA by more than 50%. Therefore, it seems reasonable that your PSA without finasteride would not have been higher than about 5. I'm not familiar with the pathologists at UCSF, but I would have to think they are good.
After making an appoinment and speaking to him I was ready to have him perform brachytherapy. My hesitation was that with RP they remove some lymph nodes in the proximity for pathology and with brachytherapy you just have to hope that the cancer hasn't gotten to them yet. Dr. Shinohara said that in his opinion all that I needed was brachytherapy and no external beam radiation.... Dr. Speight, radiation oncology, ... works hand-in-hand with Shinohara performing the brachytherapy procedure. She disagreed with Shinohara and said that I should have brachytherapy in a lower dose and then external beam radiation to the prostate and lymph nodes in the proximity of the prostate...
[COLOR="darkgreen"]The Memorial Sloan Kettering Cancer Center (MSKCC)has prostate cancer nomograms that help guage the effectiveness of surgery, external beam radiation, brachytherapy, or a combination based on the case characteristics you input. The nomograms can help sort out the risks and benefits of different approaches, and you can get an idea how much the additional benefit of external beam in addition to brachy would be in view of the characteristics of your case. The nomograms do not ask about current propecia use or allow for an adjustment, so you could double your PSA to make that a "worst case" piece of data. The Prostate Cancer Research Institute's hard copy and online newsletter "PCRI Insights" (no charge) had an article about using the nomogram a couple of years ago by Dr. Mark Scholz. While the nomogram has been updated, the article would still be helpful.
About the value of surgical sampling of nodes: It certainly gives a lot of good information as CaptainBob pointed out. However, even such sampling is well short of 100% assurance, and there is an emerging alternative that appears to be superior, though hardly as convenient. Here's what Dr. Charles Myers, MD, has to say about surgical sampling in his book "Beating Prostate Cancer: Hormonal Therapy & Diet," page 38-39: "... Sometimes the [cancer] cells enter the lymph nodes immediately adjacent to the prostate gland or they pass through to lymph nodes at the back of the pelvis next to the sacrum. The lymph nodes in these two areas are those most commonly involved with prostate cancer. For reasons that are not entirely clear, it's more likely for prostate cancer cells to infiltrate the iliac nodes on the left side of the body, even if the cancer is on the right side of the prostate. If you're at high risk for lymph node spread because of a high Gleason grade, high PSA, or tumor size, many surgeons will biopsy your pelvic nodes before doing a radical prostatectomy. But they never sample nodes next to the sacrum because those are difficult to reach." I suspect that inability to access certain nodes goes for node sampling when the operation is carried through to completion.
There is an expensive scan that is not used for low and low/intermediate risk cases called the fusion ProstaScint scan. It is good at spotting spread to nodes. But because of the low risk unless the case characteristics indicate a more challenging case, insurance will not cover it for lower risk cases.
There is another emerging scan, much less expensive, I think, known by a number of names such as USPIO (Ultra small SuperParamagnetic Iron Oxide high resolution MRI), Combidex and Sinerem, but no US center has demonstrated mastery of it yet, and insurance coverage may be a problem. Dr. Jelle Barentjz, in Nijmegen, the Netherlands, has developed a high reputation for his expertise and scans many US patients. The scan appears to be excellent at identifying and locating lymph node metastases; it appears to be far more effective than surgery for this purpose and in fact to be highly reliable in determining the presence of cancer in nodes. The US FDA has published information on the evidence for using this scan. Unfortunately, that evidence is not clear cut yet. I attended the FDA hearing, and came away discouraged, but the theory sounded highly promising. At least one expert brachytherapy/IMRT doctor, Dr. Michael Dattoli of Sarasota, Florida, plugs the Combidex scan from the Netherlands directly into his treatment planning software and is a real fan. I suspect that Dr. Shinohara may also do that. If you ask and find out, please tell us. And I would really like to know what he thinks of Combidex. UCSF is a one of the world's leading institutions in cancer imaging, and Dr. Shinohara is a part of that. Of course, for you the Netherlands would be quite a trip and probably not cheap, so Combidex might not be an attractive option
would present my information to the "tumor board" for evaluation. That should take about 2 weeks, maybe until the first week of February, 2/08.
[COLOR="darkgreen"]You are so fortunate to get this team approach at a leading institution! You gain not just from the consideration of your specific case, but the board approach helps keep the institution's doctors sharp and current with the state of the art.:)
Then possibly a 6 week waiting period before surgery. Is it true that statistics, as far as brachytherapy, can only give about 15 years of reliable data for longevity, because they haven't been doing it for any longer?
[COLOR="darkgreen"]Fifteen years of followup is actually quite good for any therapy, though of course we would like longer data. It used to be that five years of success was truly not enough to match up with surgery. But ten years of success looked pretty good. Now even surgeons coming to our support group tell us that surgery, brachy, and IMRT are pretty much equal in their effectiveness when the difficulty of the case is equal.:)
Still weighing the options but I'm leaning toward just having brachytherapy with no external beam radiation. Any input would be greatly appreciated. Thanks.
[COLOR="darkgreen"]Good luck, take care, and I hope you keep posting,
Captain Bob, I just returned from my visit with Dr. Taylor in Walnut Creek. I was very impressed with him. I'm now convinced that I'm making the right decision to have the robotic radical P. It took me a while to come to this decision and it's like others have been stating on this website, you have to be comfortable with your decision. It's very personal.
I discovered today, it's really a miracle that I ended up having a biopsy and let me tell you why. In the beginning, I went to my family physician because I had two instances of extreme urgency with incontinence. He ordered a PSA which came back 2.13. He told me that it was in the normal category but that my last PSA was 1.13. Keep in mind that I often lose track of time. He also told me that my last 1.13 PSA had been within the last year. Since then I have asked for my medical records and found out that the 1.13 PSA was in February of 2005. Anyway, he sent me to Dr. Garbeff, Maple Street Urology, in Stockton. Dr. Garbeff ordered another PSA and It came back 2.16. He peformed a digital examination and said that my prostate felt hard on the right side. He told me I needed a biopsy and performed one. He found cancer on the right side. 3+3 top right 10%, 3+3 middle 30%, and 3+4 bottom 40%. I'm only telling you this because Dr. Taylor seemed mystified as to why a biopsy was ordered at all. He wanted me to know how lucky I was that the cancer was found so early. He said that I have the prostate of a 20 year old. It's only 21 CC's in size, maybe small because of the 1 mg of propecia that I've been on for hair loss for 5 or more years. I hope that I'm not boring you and others with this information.
Getting back to Dr. Taylor. A very soft-spoken man. 300+ surgeries like you said. I tried to get him to rate himself as a surgeon on the robotic machine. He would only say that other surgeons rate him in the top 1%. He told me something that no other person has said. He said that there's a 10% chance that the cancer will return even if I have the RP but that it's my best chance for survival.
Dr. Taylor said that he can't really tell when he operates if a person will have trouble with incontinence or not. He said that he gives it a full year and then if a person is still having trouble with incontinence, he will surgically fix it. Up until this point I thought if a person had trouble with incontinence after surgery, he would just have to live with it. Also, of course he will do his best to leave the nerves that control erections alone. Do to ones anatomy, sometimes the nerves are plastered to the wall of the prostate which makes it extremely difficult to spare them. Sometimes there is space between the prostate and the nerves and that makes it easier to spare them. Often, when the cancer leaves the prostate it follows the path of least resistence which is along the nerves. One thing he stressed was that he wanted to be very careful not to leave any cancer behind.
I'm expecting a call from his scheduler Monday or Tuesday. He's not sure if February is completely booked at this point. I want to have surgery ASAP. I recently strained my back at work and am currently off. After seeing me walk, (I'm pulled down on one side), he told me that he wants my lower back to be completely healed before I have surgery because he's going to put me in some different bent positions to perform the surgery and he doesn't want to inflame my back.
Again, thanks for the information and I hope that I haven't bored anyone. I'm as stoked as I can be to have surgery. Thanks to all who contribute to this website. It would be my honor to help others as I have been helped.
[COLOR="DarkGreen"]Hi Patrick. I'll be glad to respond, in green again. Jim
[QUOTE=patrick1111;3421107]Captain Bob, I just returned from my visit with Dr. Taylor in Walnut Creek. I was very impressed with him. I'm now convinced that I'm making the right decision to have the robotic radical P. It took me a while to come to this decision and it's like others have been stating on this website, you have to be comfortable with your decision. It's very personal.
[COLOR="darkgreen"]You've done the right thing by giving several therapies a good look. I'm glad things have come together for you in your choice of robotic RP. :)
I discovered today, it's really a miracle that I ended up having a biopsy and let me tell you why. In the beginning, I went to my family physician because I had two instances of extreme urgency with incontinence. He ordered a PSA which came back 2.13. He told me that it was in the normal category but that my last PSA was 1.13. Keep in mind that I often lose track of time. He also told me that my last 1.13 PSA had been within the last year. Since then I have asked for my medical records and found out that the 1.13 PSA was in February of 2005.
[COLOR="darkgreen"]You have an added advantage going for you when you or your doctor look at the risk tables for successful RPs (or RTs) without recurrence: your PSA did not rise by more than 2.0 in the year prior to diagnosis. Based on the date of your diagnosis, I'm assuming your last PSA,2.13, and the repeat, 2.16, were done around October 2007, a few months ago, up fom 1.13 in February 2005, about 33 months earlier. That's a rise of just 1.0 in nearly three years. Dr. D'Amico and his teams have established that a rise of more than 2.0 in the year prior to diagnosis indicates higher risk than indicated just by the traditional PSA level, stage, Gleason Score, and that finding has been rapidly accepted. The reverse is also true: a lower than >2.0 rise, especially a much lower increase as in your case, indicates a lower risk than otherwise would be predicted. :) However, I haven't seen a single risk table or nomogram type formula that incorporates this new factor, which is not surprising since the papers were published just in 2004 and 2005.
Anyway, he sent me to Dr. Garbeff, Maple Street Urology, in Stockton. Dr. Garbeff ordered another PSA and It came back 2.16.
[COLOR="darkgreen"]That difference between 2.13 and 2.16 is extremely small and well within the 15% or so variation in PSA from test to test.
He peformed a digital examination and said that my prostate felt hard on the right side. He told me I needed a biopsy and performed one. He found cancer on the right side. 3+3 top right 10%, 3+3 middle 30%, and 3+4 bottom 40%. I'm only telling you this because Dr. Taylor seemed mystified as to why a biopsy was ordered at all. He wanted me to know how lucky I was that the cancer was found so early. He said that I have the prostate of a 20 year old. It's only 21 CC's in size, maybe small because of the 1 mg of propecia that I've been on for hair loss for 5 or more years.
[COLOR="darkgreen"]Finasteride typically shrinks the prostate by about a third, and does it fairly quickly - within a few months as I recall, certainly within a year. Although propecia is just one fifth the dose of finasteride, you have been on it for five years, and I agree it is probably the basis for your somewhat smaller than normal prostate.
I hope that I'm not boring you and others with this information.
[COLOR="darkgreen"]Nope!
Getting back to Dr. Taylor. A very soft-spoken man. 300+ surgeries like you said.
[COLOR="darkgreen"]I've read a paper indicating that there's a substantial difference in robotic surgical quality depending on whether the surgeon has performed fewer or more than 300 robotic surgeries. :)
I tried to get him to rate himself as a surgeon on the robotic machine. He would only say that other surgeons rate him in the top 1%. He told me something that no other person has said. He said that there's a 10% chance that the cancer will return even if I have the RP but that it's my best chance for survival.
[COLOR="darkgreen"]Doctors trying to convey an idea of risk to their patients may not be adjusting estimates for the D'Amico work mentioned above. You could ask, though your doctor's 10% risk of recurrence essentially indicates a small risk of recurrence. Also, finasteride, which is generic Proscar, makes the PSA trend analysis used in the D'Amico studies more accurate since it decreases noise from Benign Prostatic Hypertrophy (BPH) - a fact established by research, and you have been on propecia, which is a lower dose of the same medication, for years before the 2005 PSA test and up to the present. That leads me to think that your PSA trend is probably even more reliable than it otherwise would be. I believe the calculator that Memorial Sloan Kettering Cancer Center features would give you a recurrence free survival estimate at 10 years of above 95% based on the inputs they specify (D'Amico < or >2.0 not included). The key is whether the cancer is confined, and though the one core with GS 7 cancer lowers the odds a fair amount for organ confined disease, Dr. Shinohara may have been able to virtually resolve that question.
Dr. Taylor said that he can't really tell when he operates if a person will have trouble with incontinence or not.
[COLOR="darkgreen"]Or impotence. As I understand it, the doctors can give you average odds for your situation, based on research, but each of us has a slightly different anatomy plus different cancer configurations that are not exactly known before the operation. Some surgeons track their own operations and can analyze them depending on the patient's case characteristics. That's ideal, but my impression is that usually it is the surgeons involved in publishing research that do that consitently.
He said that he gives it a full year and then if a person is still having trouble with incontinence, he will surgically fix it. Up until this point I thought if a person had trouble with incontinence after surgery, he would just have to live with it. Also, of course he will do his best to leave the nerves that control erections alone.
[COLOR="darkgreen"]What the doctor is saying matches what I have heard, but maybe the surgical veterans will comment here. My impression is that a lot can be done for most (but not all) patients.
Do to ones anatomy, sometimes the nerves are plastered to the wall of the prostate which makes it extremely difficult to spare them. Sometimes there is space between the prostate and the nerves and that makes it easier to spare them. Often, when the cancer leaves the prostate it follows the path of least resistence which is along the nerves. One thing he stressed was that he wanted to be very careful not to leave any cancer behind.
I'm expecting a call from his scheduler Monday or Tuesday. He's not sure if February is completely booked at this point. I want to have surgery ASAP. I recently strained my back at work and am currently off. After seeing me walk, (I'm pulled down on one side), he told me that he wants my lower back to be completely healed before I have surgery because he's going to put me in some different bent positions to perform the surgery and he doesn't want to inflame my back.
[COLOR="darkgreen"]I'm sure we all understand why you want the operation ASAP now that you have chosen a course; I know I would. But you appear to have a case of fairly slowly growing cancer, especially as indicated by that moderately long doubling time, and that gives you some scheduling leeway. :) In the meantime before the surgery, you could get knowledgeable and serious about a nutrition program for supporting cancer treatment and minimizing risk of recurrence, also throwing in the exercise you can comfortably do as well as trying to reduce stress. That would give you something you could actively do.
Again, thanks for the information and I hope that I haven't bored anyone. I'm as stoked as I can be to have surgery. Thanks to all who contribute to this website. It would be my honor to help others as I have been helped.
[COLOR="darkgreen"]That's what happens to us - after learning a lot and getting some help, we kind of want to pass it on to help the next guy. :)
[QUOTE=patrick1111;3421107]Captain Bob, I just returned from my visit with Dr. Taylor in Walnut Creek. I was very impressed with him. I'm now convinced that I'm making the right decision to have the robotic radical P. It took me a while to come to this decision and it's like others have been stating on this website, you have to be comfortable with your decision. It's very personal.
I discovered today, it's really a miracle that I ended up having a biopsy and let me tell you why. In the beginning, I went to my family physician because I had two instances of extreme urgency with incontinence. He ordered a PSA which came back 2.13. He told me that it was in the normal category but that my last PSA was 1.13. Keep in mind that I often lose track of time. He also told me that my last 1.13 PSA had been within the last year. Since then I have asked for my medical records and found out that the 1.13 PSA was in February of 2005. Anyway, he sent me to Dr. Garbeff, Maple Street Urology, in Stockton. Dr. Garbeff ordered another PSA and It came back 2.16. He peformed a digital examination and said that my prostate felt hard on the right side. He told me I needed a biopsy and performed one. He found cancer on the right side. 3+3 top right 10%, 3+3 middle 30%, and 3+4 bottom 40%. I'm only telling you this because Dr. Taylor seemed mystified as to why a biopsy was ordered at all. He wanted me to know how lucky I was that the cancer was found so early. He said that I have the prostate of a 20 year old. It's only 21 CC's in size, maybe small because of the 1 mg of propecia that I've been on for hair loss for 5 or more years. I hope that I'm not boring you and others with this information.
Getting back to Dr. Taylor. A very soft-spoken man. 300+ surgeries like you said. I tried to get him to rate himself as a surgeon on the robotic machine. He would only say that other surgeons rate him in the top 1%. He told me something that no other person has said. He said that there's a 10% chance that the cancer will return even if I have the RP but that it's my best chance for survival.
Dr. Taylor said that he can't really tell when he operates if a person will have trouble with incontinence or not. He said that he gives it a full year and then if a person is still having trouble with incontinence, he will surgically fix it. Up until this point I thought if a person had trouble with incontinence after surgery, he would just have to live with it. Also, of course he will do his best to leave the nerves that control erections alone. Do to ones anatomy, sometimes the nerves are plastered to the wall of the prostate which makes it extremely difficult to spare them. Sometimes there is space between the prostate and the nerves and that makes it easier to spare them. Often, when the cancer leaves the prostate it follows the path of least resistence which is along the nerves. One thing he stressed was that he wanted to be very careful not to leave any cancer behind.
I'm expecting a call from his scheduler Monday or Tuesday. He's not sure if February is completely booked at this point. I want to have surgery ASAP. I recently strained my back at work and am currently off. After seeing me walk, (I'm pulled down on one side), he told me that he wants my lower back to be completely healed before I have surgery because he's going to put me in some different bent positions to perform the surgery and he doesn't want to inflame my back.
Again, thanks for the information and I hope that I haven't bored anyone. I'm as stoked as I can be to have surgery. Thanks to all who contribute to this website. It would be my honor to help others as I have been helped.
Patrick:
You're welcome; I get the impression (based on a moderator remark at the end of your post) that you suggested talking/emailing me directly, which is apparently verboten ;) Feel free to ask me any questions here that you have. I was referred to Taylor by a couple of surgeons who don't know each other, and who later turned out to be Taylor's and my barber, who of course knows several guys in the Walnut Creek area who have gone through this thing. I found him to be (as you stated) very soft spoken, yet confident, articulate and very thorough. The initial consultation lasted over an hour where he laid out all my options including the radiation, hormone therapy and watchful waiting. Considering my age, profession and biopsy he certainly advocated RP, although he didn't push it. As I think I said, I interviewed Konetti at UCSF but wasn't comfortable with his robotic experience, or anyone there for that matter including the head of the department. As I also said, there is a Carol or Karol (sp?) down at San Ramon who has reputedly done over 1000 (according to people in a San Ramon support group). I'd suggest at least interviewing him as well...I didn't know about him before choosing Taylor, and certainly have no regrets with my choice. The surgery itself was a breeze, and other than my initial incontinence which has improved markedly and the impotence (just now beginning to deal with that with limited success) my appendix was a much bigger hassle.
I will say this however...
I think Taylor is first and foremost a superb surgeon, but he could have been a bit more forthcoming on the possible extent of the incontinence, and in particular, specifically the emotional impact of it. Or the fact that after the procedure your penis will shrink about the diameter of your soon-to-be-ex prostate. Given that few surgeons have actually endured the procedure and hence can't first hand grasp the impact of it all, some are clearly better than others in that department. Pursuant to that, I go out of my way to do research on my own and consult with other doctors without hesitation. For example I have met with two different docs lately regarding incontinence and impotence for a breadth of perspective. Both of them vigorously recommend Kegal exercises where Taylor pretty much dismisses them out of hand. Konetti pretty much dismissed perineural invasion as a player in my long term "cure" while Taylor respects, but certainly doesn't worry too much about it. Long story longer, I still truly believe that I picked an excellent surgeon, and apparently he did a very good job as evidenced by my pathology report. As for the after effects, I'm not inclined to blame Taylor, but simply accept that my situation and anatomy would have played out the same regardless of who did the surgery. It is what it is after all.
Keep me posted, so to speak while evading moderation :D
[QUOTE=patrick1111;3421107]Captain Bob, I just returned from my visit with Dr. Taylor in Walnut Creek. I was very impressed with him. I'm now convinced that I'm making the right decision to have the robotic radical P. It took me a while to come to this decision and it's like others have been stating on this website, you have to be comfortable with your decision. It's very personal.
I discovered today, it's really a miracle that I ended up having a biopsy and let me tell you why. In the beginning, I went to my family physician because I had two instances of extreme urgency with incontinence. He ordered a PSA which came back 2.13. He told me that it was in the normal category but that my last PSA was 1.13. Keep in mind that I often lose track of time. He also told me that my last 1.13 PSA had been within the last year. Since then I have asked for my medical records and found out that the 1.13 PSA was in February of 2005. Anyway, he sent me to Dr. Garbeff, Maple Street Urology, in Stockton. Dr. Garbeff ordered another PSA and It came back 2.16. He peformed a digital examination and said that my prostate felt hard on the right side. He told me I needed a biopsy and performed one. He found cancer on the right side. 3+3 top right 10%, 3+3 middle 30%, and 3+4 bottom 40%. I'm only telling you this because Dr. Taylor seemed mystified as to why a biopsy was ordered at all. He wanted me to know how lucky I was that the cancer was found so early. He said that I have the prostate of a 20 year old. It's only 21 CC's in size, maybe small because of the 1 mg of propecia that I've been on for hair loss for 5 or more years. I hope that I'm not boring you and others with this information.
Getting back to Dr. Taylor. A very soft-spoken man. 300+ surgeries like you said. I tried to get him to rate himself as a surgeon on the robotic machine. He would only say that other surgeons rate him in the top 1%. He told me something that no other person has said. He said that there's a 10% chance that the cancer will return even if I have the RP but that it's my best chance for survival.
Dr. Taylor said that he can't really tell when he operates if a person will have trouble with incontinence or not. He said that he gives it a full year and then if a person is still having trouble with incontinence, he will surgically fix it. Up until this point I thought if a person had trouble with incontinence after surgery, he would just have to live with it. Also, of course he will do his best to leave the nerves that control erections alone. Do to ones anatomy, sometimes the nerves are plastered to the wall of the prostate which makes it extremely difficult to spare them. Sometimes there is space between the prostate and the nerves and that makes it easier to spare them. Often, when the cancer leaves the prostate it follows the path of least resistence which is along the nerves. One thing he stressed was that he wanted to be very careful not to leave any cancer behind.
I'm expecting a call from his scheduler Monday or Tuesday. He's not sure if February is completely booked at this point. I want to have surgery ASAP. I recently strained my back at work and am currently off. After seeing me walk, (I'm pulled down on one side), he told me that he wants my lower back to be completely healed before I have surgery because he's going to put me in some different bent positions to perform the surgery and he doesn't want to inflame my back.
Again, thanks for the information and I hope that I haven't bored anyone. I'm as stoked as I can be to have surgery. Thanks to all who contribute to this website. It would be my honor to help others as I have been helped.
Patrick:
Slightly off-topic, but something I think I should mention...
It is possible your back pain is a result of the obvious stress you're under as a result of your diagnosis. My wife a few years ago was under a lot of emotional stress that manifested itself in chronic, intense neck pain. She went to several specialists, had x-rays, scans, accu-puncture and physical therapy all to no avail. Then someone recommended a book titled "Healing Back Pain" (don't recall the author). Its premise is that while clearly there are genuine physical causes for back and neck injuries/pain, many such pains are a result of psychological and emotional stressors that manifest themselves in the back and neck. In her case, it was a miraculous and complete recovery and to boot it made her a happier, better adjusted person. Hey...you may well have injured yourself, but at least consider all the possible causes, as if it is indeed psychological as opposed to physical it could hold you back from the surgery. Of course I was out of it for the surgery, but I didn't know that I was rolled around during the process. I do have to reiterate how little physical discomfort I experienced following the surgery. The mental impact of the whole affair was far, far worse.
