I have to admit my ignorance here.  I have never heard of this diagnostic
procedure, pelvic MRI of lymph glands.  How does the oncologist know that
the lymph glands are involved?

jimhoney

you have our sympathies. (lori and curt).  Best wishes in whatever you
decide.
Curt got the "palliative" only prognosis from the only Onocologist that he
has seen. I am glad that you have been seeking more than one opinion.
hope things go well for you

1. To echo what someone else has already said ("I have never heard of
this diagnostic procedure, pelvic MRI of lymph glands.  How does the
oncologist know that the lymph glands are involved?"):
My surgeon said it is impossible to determine lymph node involvement
on the basis of a CT scan -- MAYBE (but it could be doubtful too) they
can see the lymph nodes on an MRI much better, but I was led to
believe you don't know about lymph node involvement until they cut you
open, remove some lymph nodes, and examine them under a microscope.
2. As I replied to your earlier post: "WOW - you REALLY need to get
another opinion on the MRIs!!
You should go to wherever you had the MRI done and get a copy of the
images in your hand and find yourself another pathologist and/or
oncologist to read them. ... have SOMEONE ELSE read the slides!"
I do not know where you live, but if not in a major metropolitan area
it might be worth traveling to Sloan Kettering or Johns Hopkins or
elsewhere. For example, you can lookup Sloan Kettering docs on their
web site and call (you can begin at
http://www.mskcc.org/mskcc/html/8616.cfm).

The effect of the drugs grows over time.

For the first couple of weeks after a Lupron injection there
is a "testosterone flare" that may actually make you more
interested in sex than before.  Then that tapers off.

I found that by around 6-8 weeks, my interest in sex
really tanked.  I was still capable of having sex, and I
did it, partly because I still wanted to try to satisfy my
wife, and partly because I feared a sort of "use it or
lose it" effect and I was hoping my interest would
come back in the future.  But the experience was more
psychological and less physical than it had been in
the past.

I'm not on Lupron now and, when the drug wore off,
my interest returned.  It was a real lesson in how the
things that you consider to be core parts of your
personality can be turned on and off by trace amounts
of chemicals.

   Alan

Gareth, I think your oncologist is assuming that PCa in lymph nodes
means that you are already systemic or probably are, and that no local
treatment is going to cure you. Of course, that may be a faulty
assumption and RT might knock it out before it has spread. I believe
you can have lymph nodes biopsied independently of surgery so you
might ask about that if that is going to make or break you. Also, even
if you have systemic disease, you also have local disease so local
treatment might give you a fairly lengthy "remission," especially w/
HT too. However, all of us amateur docs would need to know your PSA,
pathology, etc. to give better advice.

Bill Denton
RP 2/12/02
Memphis

Hi Gareth,

When my father, then 78 years old, was first diagnosed with PCa in 1998, we
brought him to the U.S. to see a doctor at the Memorial Hospital, in New
York City. But since we were unable to confirm the appointment before we
left from South America, we also arranged a visit to a cancer hospital in
Detroit. At the Memorial, the doctor said he should go straight to RT. Then,
maybe, to chemo. But since we had already booked the trip to Detroit, we
decided to get another opinion. In Detroit (sorry, but I forgot whe
hospital's name), my father was seen and examined by a doctor who, not
knowing about the previous opinion, said he should do hormone therapy only.

We had the luxury to be accompanied by my cousing, who, although from a
totally different medical field (he is a children's surgeon), is the kind of
doctor who keeps himself informed about everything, he will go to
international conferences every year etc. He didn't like the idea of hormone
therapy, which he labeled "sleeping with the enemy". It won't (try to) cure
the cancer, but only postpone its recurrence. He mentioned the Memorial
doctor opinion in favor of RT, and the doc from Detroit then said he would
convene other two doctors to give their opinion. The second doctor defended
the hormone therapy, citing my father's age and the likelyhood that he would
be dead anyway within the next several years that the hormone therapy would
supposedly last. A third doctor, a radiologist, came in and insisted that we
send my father to radiotherapy, citing his overall well-being apart from the
cancer itself, and his family history of longevity (my grandmother and her
sister lived to over 90, their only brother died much younger, but from a
liver disease).

The reality is, it seems, that doctors do disagree, based upon how they
interpret exams' results, how they consider several other health-related
recovery factors etc., but also because of differing views of medicine,
well-being and life.

My father didn't want to do the radiotherapy at first, given the conflicting
medical suggestions we received, but changed his mind when his PSA (back
then controled with hormone therapy in somewhere around below 5), started to
jump up. He did the RT and the cancer apparently went away, but only to
return, with metastasis, in 2002. But during his years he held a relatively
normal life -- eating regularly, walking around the house, stubbornly
driving his car, and even drinking his one or two shots of whiskey every
Sunday. This condition lasted untill late 2003, when his health started to
deteriorate.

My father is currently 85, with a PSA above 1,300, and being treated both
with hormone and chemotherapy. He is taken care of by a nurse and by my
mother -- who, like every other mother in the world, is the best mother in
the world! He now needs their help to get up, to go to the bath, to move
around the house and pretty much everything else ... except to talk to us
and to smile when he sees his children and grandchildren and when he hears
about his first great-grandchild, Maria, expected to be born in January
2005.

So, as you see, conflicting opinions are part of the game, doctors may know
a lot, but don't know everything. My suggestion is that you do hear a third
opinion and then take whathever seems to be the most optimistic and "you can
do it"-like of them.

I pray for you to get over this!

CB