hi wes - overall rule of thumb on treatments,,,,,,

if still gland contained - remove by surgery
if has positive margins - either surgery or radiation.

as a rule, there is an order in the treatments.........

if you have surgery, and if you were to have recurrence of pca, then you
can have radiation for a second chance of a cure.

if you have radiation, and if you were to have recurrence of pca, then
you normally can not have surgery and would have to procedure to the
next step of treatment, which would be hormone therapy.

general comments.........

at age 37, given your gleason and stage, you might want to look at
surgery with nerve sparing.  gives the best of both worlds.  they got
the surgery down pretty pat and the results have been very good now.

by the same way, they are improving on the radiation treatments too.  

bottom line - what you feel comfortable with.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

If you choose surgery, then given your age and assuming that your
future sexual performance is important to you, I'd suggest either
Sloan-Kettering or Baylor Prostate Center.  At both places they do
(or, at least, used to) a simultaneous nerve transplant from the lower
leg to compensate for the nerves they sever during surgery.  It's not
a guarantee, but supposed to make at least some difference.

At your age you will most likely be recommended to receive nerve sparing RP.
Also, if you haven't sired all the kids you've planned on, you probably want
to bank some of your sperm.

That said, I had Dr. Peter Scardino, the chief of urology at Memorial Sloane
Kettering Cancer Center in NYC do my surgery last year.  I was 47.  A year
later I'm doing quite well.  I highly recommend him.

Sandy K.

Wes,

If you're in the area, I wouls almost certainly look up Walsh.  He's the
king of surgeons, at least wherein name-recognition is concerned.  However,
there are many surgeons who have done nerve sparing operations since Walsh
perfected it.  And they are now all over the U.S.

Search for a surgeon who has done a lot of them and then find out from him
how many of them are still limp.

If you are planning to visit M.D. Anderson in Houston I would recommend that
you start with Dr. Richard J. Babaian in the Urology department.

At your age, the great majority of specialists would recommend surgery.
   Also, at your age, you stand an excellent chance of avoiding side
effects, but you should find the most skilled surgeon you can.  My guess
is that the very best surgeons would be interested because your case is
pretty exceptional.  Wlash at Hopkins, Scardino at Sloan Kettering, and
Catalona at Northwestern Memorial in chicago come to mind.

You shouls also discuss saving some sperm in case you want to father
children in the future.

Good luck.

At your age, and assuming that you're
in good health, the best path surgery,
PERIOD!

Surgery is the gold standard, so you'll still
have other options left if that does stop the
cancer.

I would go to  JH and forget the rest.  BTW,
Patrick Walsh specializes in younger men
like yourself, my doctor told me that!

Tom Welch, 60 years old
Surgery, followed by radiation
PSA less than 0.1

At your age surgery is probably the way to go and you have a few
options to choose from.  No matter what you pick, you will want the
most experienced person you can find to do the surgery and I would ask
each person you talk to the same questions so you can compare answers
and see what seems most favorable to you.  Be sure to ask about the
advantages/disadvantages of the most common forms of surgery.  These
are:

RRP - Retropubic Radical Prostatectomy, the gold standard.  It's what
all the long-standing surgical gurus perform.  As compared to the
laparoscopic approach, open surgery goes faster and the doctor can feel
things with his fingers.  However, there is usually more blood loss and
of course there is a large abdominal scar requiring a bit more recovery
time.
LRP - Laparascopic Radical Prostatectomy is fairly new ( last 7+ years
or so) but there are many surgeons who have performed hundreds of them
so finding an experienced surgeon should not be a problem.  A
disadvantage is it does take longer so more time under anesthesia.
Advantages include:  Your stomach is pumped full of gas so that the
increased pressure helps to close off blood vessels, hence less blood
loss.  The field of view is magnified about 15 times and projected onto
a TV monitor so the surgeon has a better view of things due to both
magnification and less blood sloshing around.
RLRP - Same as LRP except with the aid of a robotic device.  With LRP
the doctor is standing over the patient manipulating the tools by hand
while watching what's happening on a TV monitor placed a couple of feet
away.  With the RLRP, the doctor is sitting a few feet away
manipulating levers and wheels while looking at a monitor, and the
tools are operated indirectly through the robotic device.  One drawback
to the robot, it takes up to an hour to set it up while the patient is
under anesthesia so the patient is typically "under" that much longer
over standard LRP.

One word of caution that each of the doctors I consulted told me
independently - two at Stanford, two at Kaiser Permanente, and one
independent surgeon.  There are a few doctors out there who feel that
in order to promote their careers they have to advertise that they are
on the cutting edge of new technology and use the robot devices as
advertising ploys to attact business.  So, it is possible to get a
doctor who might have graduated at the bottom of his class yet has
plenty of experience with the robot.  This of course would be an
exception, but just be aware of the hype that's out there.  Also, if
you go the laparoscopic route, make sure the doctor also has performed
plenty of open surgeries just in case he has to open you up if
something goes wrong.  All that said, I went the non-robot laparoscopic
route with a doctor who had performed many hundreds of open surgeries,
40 RLRPs using a robot that a nearby medical facility had purchased and
another 125 LRPs.  He had long stopped using the robot because he felt
he could do the surgery better and faster without it.  That said, I am
two years out from surgery still wearing a pad/day and little Willie
stirring but not awake.  So, you take your chances no matter who/what
you go with.  I'm sure even Drs. Walsh/Catalona shudder at a few bad
outcomes and would love to do them over again.  So, once more, go with
the best and most experienced you can find because you want the stats
in your favor, and once it's done, never say "Gee, if only---".  All
three surgical methods have essentially the same outcome statistics
with regard to positive margins, recurrence, etc..  That makes the
choice of method tougher (gee, which one?) but also easier (it doesn't
make a whole lot of difference.)

Finally, if you are near or visit a medical center you might be able to
use their medical library.  If so, go to the urology section and read,
read, read.  The more informed you are, the better.

Dave Perry

(snip)

I've been following this thread, and note that Wes is being practically
shoved in the direction of surgery by almost all of the folks who have
responded to him.

I'll say this: none, absolutely *none* of the people who recommend
surgery to Wes have the slightest idea of the details of his medical
history and might be influencing him to select a tx that is inappropriate
for him. This is dangerous. It reminds me of a fellow I've encountered
who operates a large PCa site on which he frequently gives medical advice,
which he is unqualified to do, and even runs an ersatz P2P service.

IOW, the folks I'm complaining about have little or no medical training,
same as me, and seem unaware that having had the surgery does not
make one an expert in the field of RP. No more than does having a baby
make a woman a qualified obstetrician. Nor does having had failed cryo
and salvage IMRT make me an expert in those fields.

We can certainly tell one another about our experiences and what, if
anything, we would do differently; and we can pass along information
we have garnered elsewhere. But that is as far as we should go.

I earnestly recommend that we here refrain from recommending anything
more to the new guys than that they study their disease and ask lots of
questions, and*only then* with the advice of their medic select the tx that
is best for them. The choice is theirs, and we can best serve their
interests
by pointing them in the direction of sources of information.

//Rant over. I will now tuck away my soapbox and scuttle for cover.....

Regards,

Steve J

"You must pay for conformity. All goes well as long as you run with
conformists. But you, who are honest men in other particulars, know
that there is alive somewhere a man whose honesty reaches to this
point also: that he shall not kneel to false gods, and, on the day when
you meet him, you sink into the class of counterfeits."
--Ralph Waldo Emerson