Dealing with IT!

[AlanO44]

Hi. 73 years old and I have been on Duodart for years but PSA rose to over 4. Recent biopsy showed Gleason 7 (3+4) on left lobe. Doc recommends keyhole surgery to totally remove prostate. Reading what you guys say makes sense but still scares me.

[cpcohen]

It would be useful to have your PSA history, and additional info on the biopsy results.

Has your doc told you of the likely side-effects of "keyhole surgery" ? He should have included long-term ED, and short-to-medium-term urinary incontinence. If he didn't mention them, maybe a new doc is a good idea.

Has he suggested radiation treatments as an alternative, and referred you for a consultation to someone who does them? (Radiation has its own side-effects; there's no free lunch, here).

Has he talked about the risks vs benefits of "active surveillance" -- that is, doing nothing for a while, and monitoring the tumor ? Depending on your biopsy results, that might be a reasonable thing to consider.

. Charles

PS -- it's late, and I might be grouchy. Do some research, before you decide which treatment (if any) to choose.

[AlanMeyer Moderator in reply to cpcohen]

Hello Alan,

I agree with everything Charles wrote.

Most urologists may be competent to perform a biopsy but aren't necessarily the best people to go to for treatment. Whether you decide on surgery or radiation, or anything else, you'll do best with a doctor that specializes in prostate cancer treatment. A typical urologist may do very few prostatectomies a year and not have the experience and knowledge to do the best job. Going to a prostate cancer specialist is like going to an endodontist for root canal or an oral surgeon for a dental implant. A general dentist is qualified to do those things but it's not what he does day in and day out and he hasn't seen or treated all the different kinds of cases that the real specialists have dealt with. Similarly, your primary care physician has more experience dealing with heart disease than most patients, but not as much as a cardiologist - and especially not as much as a cardiologist experienced in heart surgery.

Here's one place to find good specialists: cancer.gov/research/nci-rol...

Best of luck.

(Another) Alan

[AlanO44 in reply to AlanMeyer]

Hi Alan (& Charles)

Thanks for your comments. My problem with condition is where we live (Tenerife, Canary Islands). Choice of specialists and hospitals is not a luxury readily available.

My Urologist ( who has carried out over 600 prostate removal ops) has talked me through the key hole procedure and is not too optimistic about saving any nerves. Removes complete prostate and rejoins uretha to bladder

He also mentioned that if I was unsure about operation, then a course of Bicalutamide and Decapeptyl would contain the cancer in an ever decreasing prostate. But this would make the success of removal of prostate at a later date more difficult. The decision on whichever route to take has passed the wait and see stage and "make my mind up time" is here.

Any thoughts and comments gratefully received

Alan

[AlanMeyer Moderator in reply to AlanO44]

Alan,

Here are some thoughts to fold into your considerations.

1. How much do you like and trust this doctor?

Does he listen and give you thoughtful answers to your questions? Does he speak frankly about side effects and chances of failure, or does he brush off such questions and make it sound like you'll do just fine? Is he putting pressure on you to have the surgery? 600 prostatectomies sounds like a useful number (assuming it's true) but does he seem trustworthy to you?

2. Have you gotten a second opinion?

Cancer is a big deal. It is important to get a second opinion about treatment from another specialist and not just get everything from one doctor. I suggest getting a copy of the biopsy report and taking it with you to get at least one second opinion.

3. Have you checked out other options on Tenerife?

A Google search indicates that there are other urologists on the island, some of whom claim specialties in prostate cancer. There are also radiation oncologists on the island and they offer both external beam and brachytherapy options. Visiting one offers a chance to evaluate other doctors as well as to hear second opinions.

If you deal with a group practice, one thing you can do when you call is ask if they have a doctor who is particularly experienced and good at handling prostate cancer.

4. Is travel to another country practical for you?

If you have U.S., U.K, Canadian, or Spanish health insurance it may be that the biggest expense of treatment will be the travel to the country where you are insured. You may need to plan for at least a couple of trips, one for an initial examination and decision and a second for the procedure. If you get a procedure done in another country you should plan on staying there for a couple of weeks in case any follow up care is required. If you have relatives in a big city who could take you in you can probably find highly regarded treatment and not have to pay for a hotel.

I don't want to mislead you here. You may get treatment that's just as good on Tenerife that you would get anywhere else, so I ask the question mainly if you have serious doubts about the value of the options on Tenerife.

Best of luck.

Alan M.