location of tumor too close to urethra, Dr. refuses surgery.

[-db123_]

my tumor runs from apex or 6 o’clock to 1 o’clock and Doctor refuses surgery for fear of negative margin.

Looking for another competent surgeon.

Anyone had this problem and surgery later?

[cesanon]

Radiation???? Sbrt radiation?

Didn't the doc recommend radiation?

[NanoMRI]

Because my tumor was at apex surgery was recommended to me over various radiation/focal treatments; multiple rad docs told me, based on mpMRI findings, they did not see sufficient margins for their methods - the precision of RP was my best choice to minimize chance for incontinence. Approaching ten years later and continence remains great and erectile function good enough.

MDA Houston offered me RP but I found urology department not open to shared decision making and too production line for my taste so I went elsewhere. Six years ago I approached them on salvage extended pelvic lymph node surgery using the frozen section pathology method - they declined and pushed STAMPEDE protocol. I declined them and again went elsewhere.

Note I will be at MDA Houston next week regarding my just found metastatic melanoma.

In my experiences we face so many disparities with this beast. Perhaps you are well beyond information such as this - but thought I would share. diagnostichistopathology.co...

All the best!

[j-o-h-n]

Greetings -db123, Good Idea to add data to your bio file. It helps you and helps us too. All info is voluntary. Thank you!!!

Good Luck, Good Health and Good Humor.

j-o-h-n

[cujoe]

-db123_ - If you wanted a second opinion or answers to specific questions about the treatment path you should consider, you might start by trying to contact the two authors of the paper linked by NanoMRI. Here are links to their contact info (email addresses included):

1 -Emily Chan MD PhD, Assistant Professor, Department of Pathology, University of California San Francisco, San Francisco, CA, USA. Conflicts of interest: none declared

cancer.ucsf.edu/people/chan...

2 -Jane K Nguyen MD PhD, Staff Pathologist, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA. Conflicts of interest: none declared

pathologyoutlines.com/direc...

* * *

The advantages often cited by patients for surgery are:

1. Ability to surgically remove any cancer that is visible during the surgery. Esp. valuable for non-organ-confined disease. (Atho' when that state is determined, surgery will often not be offered at some treatment centers.)

2. Removal of the primary source of cancer, the prostate itself which is often referred to as the "Mothership".

3. Minimal chance for any damage to surrounding organs and tissues. (When done by a skilled and experienced surgeon.)

And for RT:

1. Assuming clear, wide margins from treated areas, less physically invasive and "usually" less SEs (at least in the short-term).

2. Depending on number of treatment sessions, much less physically demanding - no surgical recovery period and without risks from anesthesia/antibiotic disruption of immune function/microbiome.

In both cases, the outcomes are dependent on the skill of the RO or surgeon, esp. with respect to short, long-term, or late SEs like incontinence and ED. Decide on a treatment approach and find the most skilled professional available to you and get it done.

Last time I saw numbers, the OS for both are near-identical.

Good Luck whatever treatment you decide to use.

Stay Safe & Well, Ciao - cujoe

[Cancer2x]

Like most things in life, there exists a range of skill sets. In surgery, a General Surgeon will no want to attempt a “microsurgery”, which requires additional training and experience. His fear is not for you, but him.

I humbly suggest finding a different surgeon, possibly trained in Microsurgery or Reconstructive Surgery with an interest or specialty in pelvic surgeries.

Good luck! But do something.