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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2005Finally met with the surgeon
I just got back from a meeting with the surgeon. My age 56, T1c Gleason 3=4=7 Nothing felt on DRE I had decided on surgery (March 21st) and I went through the particulars with the staff. (cath, tubes, etc.) Then I met with Dr. Catalona the surgeon. Nobody ever mentioned the cores of the 12 biopsy needles before but he told me that there was 60% cancer in one lobe, little or none in the other. And he felt nothing on the DRE. He was very neutral although I was hoping for some optimism. Surgery was the best option for me but even then...if there were positive margins...or spreading...radiation would be the next step. That would depend on the pathology report of the removed prostate. He showed me in a drawing how he takes a "little extra" to try and get the cleanest removal. I asked if he could tell by sight and he said 'no', it was the path report that would tell the story. Then...if it had spread or there were positive margins...I could watch the PSA over the 4months of healing and then have radiation. I said that I wanted to be 'cured' and this was my best chance. I trusted him and agreed. I may have a few things wrong cuz I sat there like I was in front of a firing squad. My girlfriend was there too but it was all so surreal. It is snowing here in Chicago and the staff kept saying "ooh, look at the snow." I LIKE snow and I want to live so I couldn't see the attraction of the snow. :-) Then the doc also talked about doing one last night (he does a LOT) that looked normal to him and the path report showed that it had a lot of cancer. Honest... but this wasn't very reassuring. He's very skilled and I guess i had the hope that his expertise could help me alot. However...it struck me that as good as he could be...he couldn't control how much cancer was in there and where it had gone. If it DID spread (he thought maybe not) or had positive margins, we could consider radiation. IMRT. I've read much here and in books and know you need 6 1/2 weeks (42?) daily treatments. The side effects seemed harsh and I left...surgery scheduled...and fear in my eyes and heart. I guess this is normal. I'm writng while I can cuz it seems like when this hits me...I'll be numb. Intellectually...it's nothing I didn't already know but i guess I wanted to hear something better. I'm really not trying to dominate things...just tell my story...ask for advice and hear if others have had the same deal with. Reassurance is nice but maybe I expected too much from him. Thanks to everyone, Ron B. Chicago You didn't say, but you did hear the magic words "nerve sparing," didn't you? And will this be LRP or standard? jimhoney standard RRP age 52, cured, no significant aftereffects > I just got back from a meeting with the surgeon. > [quoted text clipped - 84 lines] > > Yes Jim, with Dr. Catalona "nerve sparing" is a priority. Though I am still more concerned about LIFE. It's a standard RP. Ron B. on 3/10/2005 2:04 PM Ron B said the following: > I just got back from a meeting with the surgeon. > > My age 56, T1c Gleason 3=4=7 Nothing felt on DRE Not much different than many of us here, Ron > Nobody ever mentioned the cores of the 12 biopsy needles before but he > told me that there was 60% cancer in one lobe, little or none in the > other. And he felt nothing on the DRE. Again, I doubt this surprises many here. The old analogy about trying to spear a basketball on a desert island comes to mind<g> Nothing palpable is good. > He was very neutral although I was hoping for some optimism. If he can't see the cancer when he has you on the operating table, how could he do much more than state your condition as factually as the tests allow? You're nervous and that's to be expected. As we've discussed off list, at this stage you can only do the best you can can. He can only do the best you can. While there are those that would argue that RRP is no longer necessarily the "gold standard" I suspect that even they would be hard pressed to say that for ridding oneself of PCa that the RRP is a bad first step. > Surgery was the best option for me but even then...if there were > positive margins...or spreading...radiation would be the next step. > That would depend on the pathology report of the removed prostate. > [quoted text clipped - 6 lines] > Then...if it had spread or there were positive margins...I could watch > the PSA over the 4months of healing and then have radiation. I was told (by Dr. Catalona) that if there was a rise in the PSA post op due to the positive margin I had, we'd start radiation in 6 months. As he's now suggested to you, we agreed on a watchful waiting and since I've had no PSA for almost five years (uh, that's five days and a wake up for me -- but who's counting?<g>) there's been no radiation therapy in my course of treatment. > I said that I wanted to be 'cured' and this was my best chance. > > I trusted him and agreed. FWIW, I too agree. > Then the doc also talked about doing one last night (he does a LOT) that > looked normal to him and the path report showed that it had a lot of > cancer. > > Honest... but this wasn't very reassuring. Give me honesty over false reassurance any time. > He's very skilled and I guess i had the hope that his expertise could > help me alot. He is and it will. > However...it struck me that as good as he could be...he couldn't control > how much cancer was in there and where it had gone. Yep, we've talked about this and it won't change. It is what it is. > If it DID spread (he thought maybe not) or had positive margins, we > could consider radiation. IF my uncle had a compressor mounted on his back he MIGHT pass as a refrigerator. Why not take this one day at a time. It's difficult enough to do in that fashion. Don't load all this crap on yourself at once. Repeat after me: We got it early! He's going to get it all! This is almost over! > I'm writng while I can cuz it seems like when this hits me...I'll be > numb. Grab a book, watch a good tv show tonight and settle in with a little Blanton's. Relax. > Intellectually...it's nothing I didn't already know but i guess I wanted > to hear something better. How about this? It's not from Dr. Catalona but he didn't tell you "Ron, I don't like what I felt. I think maybe we need to take another look at surgery. > I'm really not trying to dominate things...just tell my story...ask for > advice and hear if others have had the same deal with. We all have dealt with it. We'll perhaps not the ladies - least wise not in the same context. > Reassurance is nice but maybe I expected too much from him. In hindsight, I'd say that being accepted by him for the surgery would be/was reassuring for me. Ron B, The absolute worst part for me was waiting to be operated on. You are almost done with the worst part. My experience with RLRP (2/11/04)was good. There was very little pain. I felt like I had done about a 100 sit-ups. There was no nausea. I asked my doctor if I could go home the same evening. He convinced me to stay just in case there were problems with bleeding. I was up walking around a lot during my only night in the hospital. I didn't need or get any pain medicine, but the nurses asked me frequently if I wanted any. Getting the drains pulled out was painful but brief. I was a little sore on the trip home every time we went over a pothole. I was walking outside day 2. MY wife and I went out for breakfast day 3. I was driving day 4, able to walk 5 miles day 5, and went back to work day 6. (My job has no physical demands). Catheter out day 7. Back to weight lifting and running soon after that. As for scarring, the marks are hard to see even if you know where to look. I was able to have intercourse with pills at 5.5 months, and with nothing at 6.5 months. I'm still much better with drugs. Compared to pre-op when I was 100% erection wisw,, at almost 13 months I have about 70% with no drugs, about 85% with pills, and about 140% with shots. I've been dry since 8 weeks. Good luck Steve > on 3/10/2005 2:04 PM Ron B said the following: > > I just got back from a meeting with the surgeon. [quoted text clipped - 22 lines] > longer necessarily the "gold standard" I suspect that even they would be > hard pressed to say that for ridding oneself of PCa that the RRP is a > bad first step. > [quoted text clipped - 57 lines] > > Grab a book, watch a good tv show tonight and settle in with a little > Blanton's. Relax. > [quoted text clipped - 9 lines] > > We all have dealt with it. We'll perhaps not the ladies - least wise > not in the same context. > > > Reassurance is nice but maybe I expected too much from him. > > In hindsight, I'd say that being accepted by him for the surgery would > be/was reassuring for me. Sounds like you have done your evaluation. Go with it! I was 49 when dx'd/ Almost had radiation.....external beam. Went on to find other Dr.s and opinions. Surgery was the best for me! I had 7.00 PSA...after surgery it was 6.00 with lab results. I had positive DRE....one lobe felt hard..... I am 55 now......and for 5 years I have had less than 0.01 PSA I lost one set of nerves.....It took me 2 creative years.... To tell those one set of nerves to be all! Yes, I do get erection, and do not pee myself.... Viagra is a block buster. with a little bit, it goes a lonnnng way! So, since I did great with RP surgery...I suggest it to a person like yourself. I cannot give you outcomes...... Good wishes.... You are on the right track. John Loomis >I just got back from a meeting with the surgeon. > [quoted text clipped - 82 lines] > Ron B. > Chicago > I just got back from a meeting with the surgeon. > [quoted text clipped - 84 lines] > > ron, For what it is worth, I think you are going to do just fine. Ron, Now is the time to relax. You made your decision. That's the hardest part. Enjoy your life and try not to think about the upcoming procedure.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > I just got back from a meeting with the surgeon. > [quoted text clipped - 82 lines] > Ron B. > Chicago I second what's been said. Don't load it on yourself. Take it one step at a time. I'm relatively new to the group having had LRP 6 weeks (almost 7) ago. Path reports were very promising but won't know anything absolutely until the next PSA test in May. That's my next step and enough angst for now. I'm not worrying about anything else until that reading comes back. Incontinence improving daily. Dry overnights and most days, but can't go out with the boys and tip a few without being VERY careful. Sexual function is nill but I expected that. FYI: PSA 1.24 8/2003 age 60 PSA 12.4 10/2004, 15.7 two days later DRE 11/2004 negative Biopsy 12/2004 G7,T2b LRP 1/24/2005 nodes clear, negative margins. no SV involvement 2 days in hospital, on the beach in St Pete Fla in two weeks, back to work in three Loving Life!! Pops...Just trying to understand, if your 11/04 DRE was negative, how did your 12/04 staging come in at T2b instead of T1c?...Best wishes and good health, Ron |
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