Great hospital with many great surgeons. I'm in the NYC area as well,
and went with the chief at North Shore on Long Island.  Listen up..... this
is not a death sentence. It's just another of lifes adventures, this one not
as much fun as Vegas. You have plenty of time to make your descisions and
lots to learn, and this is the best place to do it. The actual surgery for
me was a piece of cake. No pain or discomfort to speak of. My guess is that
you'll die of a heart attack, or get hit by a blue haired ladies car in Boca
before PCa gets you.

Youc can't do any better than Slaon Kettering.

I thank Ron for asking such questions. It is this sort of thing that helps
one to organize and even to reconsider one's thoughts.

Having done so, and to the extent I'm capable, I'll respond as follows:

First: having a Gleason score compiled by an expert in the field gives the
patient information upon which he can rely when considering what course of
tx to pursue. AIUI, the Gleason score is the single most important datum in
the factual universe upon which the patient must rely when making his
choice of tx.

Second: what would "adsong" do upon receipt of the expert score. Who knows?
At least he would have a piece of information upon the accuracy of which he
could rely absolutely. FWIW, my second biopsy was examined by Bostwick
Labs, which reported something that the local yokels had not. But that's
another story for another time.

OTOH, as we all know to our regret, anything is possible with this
merciless killer. Where's the harm in learning the facts?

"What are the facts? Again and again and again -- what are the facts? Shun
wishful thinking, ignore divine revelation, forget 'what the stars
foretell,' avoid opinion, care not what the neighbors think, never mind the
unguessable 'verdict of history' -- what are the facts, and to how many
decimal places? You pilot always into an unknown future; facts are your
single clue. Get the facts!"
--Lazarus Long
(can anyone identify the source of this quotation? I'd offer a prize but
cannot afford more than maybe a cigar)

All that it can bear as we determine the biology of our tumor. So far, I
perceive that it can, thank Bog, bear a lot.

As for the bone scan, which I hope would be a QCT scan, I understand that
it would be appropriate as a baseline -- and later a crosscheck -- on bone
density *when the patient is beginning ADT.* That could carry us into a
discussion of bisphosphonates, which is I think beyond the scope of the
present discussion.

Which is, what should "adsong" do?

Who knows? So far as I can see, the only way to *know* is to do the tests.
And see above.

Know your enemy in this war. It is a merciless killer.

Regards,

Steve J

"If you know the enemy and know yourself, you need not fear the result of a
hundred battles. If you know yourself but not the enemy, for every victory
gained you will also suffer a defeat. If you know neither the enemy nor
yourself, you will succumb in every battle."
--Sun Tzu, "The Art of War"

Leonard wrote:

On pp 128-129 of the book, Dr. Strum clearly and honestly sets forth his
background in the field of androgen deprivation therapy. I must say that he
was honest about alerting his readers to any possible bias in his
recommendations. I will further say that this is far more respectable than
the failure of certain other authors to do the same.

And I see no evidence of "cherry picking" in Dr. Strum's book. What is
"cherry picking?" it is carefully choosing one's patients as those with the
better dx's so that one's stats look good. Helps to sell books, dontcha know.

I have read the book by another famous author/uro, and find that he devotes
something on the order of three times the pages to surgery (his specialty)
as he does to all other tx's, combined.

Haven't read this uro's book, so cannot comment.

Regards,

Steve J

"'MD' does not mean 'Medical Deity.'"
-- Stephen B. Strum, MD

Fred...I understand your anxiety completely.

I was very fearful when at 56 last November, I was diagnosed with Type 2
diabetes AND I had a PSA of 7.2 and a Gleason of 3+4=7

This group comforted me and taught me to do research and learn all that
I could.

I opted for RRP last March by Dr. Catalona at Northwestern Memorial
Hospital here in Chicago.

Things went well and the pathology report showed a Gleason of 3+3=6,
with clear margins and lymph nodes.

My first PSA was undectable.

At 4 months...I'm doing well with the incontinence (a pad every 24
hours) but no erections yet.

I waited until the other guys responded because they are the BEST.

Your numbers are good and things will go well.

Wishing you the very best.

Ron B.

Chicago

....

Welcome to the club.   First of all, the important thing is that
either rad or surgery will give you a really good chance at beating
this.  Better than 80%, maybe better than 90%.  

There's a strong sense of the "luck of the draw" and "no
guarentees in life."

As for side effects, I can only speak to Rad.  I went with 25 IMRT
sessions last September followed in a few weeks with 97
palladium-103 seeds.  This was at Dr. Dan Clarke's Inova Cancer
Center in Northern Virginia.

What surprise me were two things.  The absolute perfectionists at
Inova.  I have never seen such precision and attention to detail.

If you read this newsgroup, you'll find people asking about this or
that side effect.  Inova gave me a timeline that spelled out when I
could expect what side effects and symptoms.  What to do about
them and they prescribed medication to take on that schedule.

The result was that when I needed help peeing or whatever, I not
only knew what to do, had it in hand, but had started taking the
meds a day before.

The 2nd surprise was that (and some of this was luck and some
of it was my age, 57, and relative good health) I really didn't
experience many side effects.

In the first month after seeding, I was pee'ing every hour or so and
getting up 3 or 4 times a night.  I was dribbling instead of hosing
down the comode.  But I was taking Decadron, followed by 6 months of
Flomax (3x a day at first, then a single pill as I improved), I was
also taking Aleve to help with urethral and prostate inflamation.

Along in there, I had 2 four month Lupron shots, that was worse than
the rad and seeding. I had many of the textbook Lupron side effects.

These include, hot flashes, joint pain, fatigue, muscle weakness,
irritibility, and I also blame the Lupron for some bad blood sugar
numbers.

I declined the 3rd Lupon shot. A few months after that, erections
(with Vitamin-V) returned.   5 months after the declined Lupron
shot, I was performing, ah, adequately without chemical assistance.
Not like when I was 20 or 30 of course but not bad for being 58.

External Rad is going to the center once a day, dropping your pants
and hopping on the robot table. You don't feel a thing, it's over in
5 minutes and you're on your way.

Towards the 3rd or 4th week, there are some gut symptoms, kinda like
you went to a chili and beer-fest in the bad part of town.

Seeding is like this.  They knock you out.  You wake up with a mess
between your legs.   When you manage to pee, they let you get
dressed and send you home.   I walked out of the recovery room as my
driver pulled up.  No courtesy wheelchair, just "see you in a few
days for the assessment."

For the next 6-12 hours, there's some blood in the urine, and you're
a little wobbly but that's it.

I have had no trouble pee'ing, starting and stopping work fine.  
It's not as easy as before but each month, the plumbing works
better.

Erections?  I figure it was the Lupron that took erections away for
a year. If it weren't for that, I'm guessing that I would have had
no problems.

The other plumbing is working too.  Not quite the same but nothing
to complain about.

The books say that post seeding you have dry orgasms, well, not
me. At seeding + 10 months, I'm still producing about a quarter
teaspoon or so. It looks funny though, almost clear.  I've heard of
others who are also still "wet".

The books say that orgasms are just as good as before, just
different.  They're right about the different but these are not as
good as before.

The important thing is that there is a good chance that I've beaten
the cancer.  Won't know for a few years and my last PSA was a .4 so
we'll see how it goes.

Whatever you choose will have a really good chance at curing you.  

Either choice has its drawbacks, side effects, and risk.  

I did well with Rad but my primary doc has a patient who went rad
and had big-time problems with peeing.  I pulled some reports off
"seedpods" and some seed-guys are catheterized for months and some
are permanently incontenant, just like some surgical patients.

I think the odds are better with rad but it's the luck of the draw.
No one will give you a guarentee.  

Hi Ken. Im really happy to hear that after 4 years  your PSA  is
undetectable!!!!. .
A couple of questions, if I may.
1:Did you have any symptoms from the  radiation?
2:If you wanted the sucker out of there as fast as possible,would that
not mean
you would  want the prostate outta there completely?It would seem from
what I
have heard, that if the  Cancer  was confined the prostate, removal  of
the organ
would  guarantee  no recurrence or "reawakening" of any cells within the
prostate?.
3:If a RPP were to be required at some time, would it be feasible in the
future?. I
heard that it is almost an impossibility with seeds... dont know about
radiation.

Thanks.
Fred.

PSA 5
Gleason 3+3.

Hi Ken:

My PSA was around 7. Yours was considerably higher. I considered
radiation as a first option because I would have liked to have most or
all of my parts intact as long as I possibly could. But after reading 4
or 5 books on PC as well as visiting 3 or 4 doctors I went with robotic
surgery. The path report was a T2c and 4+3, organ contained, neg
margins, both nerves spared. The clinical was T1c and 3+3. I was hoping
for the path to agree with the clinical report, but that did not happen.
So far my PSA readings have been < 0.1. I'm only out 8 months post op
though.
I'm glad that it worked out for you and your tests were undetectable. I
hope to say the same after 4 years (and longer) too!
The hard part of surgery, (hard?) is dealing with no erections and some
pain during climax, or what is supposed to be a climax. The doc says
that it takes time for things to revive. I'm curious as to how you are
doing in this area if I may ask?

B.A.