On January 23, Joe wrote:

(snip)

Welcome to the club no one wants to join.

My first recommendation is to take anecdotal stories from us with a
substantial grain of salt. Not that anyone would try to be misleading,
but because each man and his tumor are unique, however similar the
descriptions. What someone else has experienced may have little
resemblance to Joe's experience. However, with that caveat, anecdotes
can help to fill in the background -- so long as a treatment (tx)
decision is not made based upon such stories.

Second: go to the Prostate Cancer Research Institute's comprehensive
website at: http://prostate-cancer.org/index.html
and click on "Resources" then see the "Newly Diagnosed" link on the left
side of the page that will come up.

Third, buy and read _A Primer on Prostate Cancer_ subtitled "The
Empowered Patient's Guide" by oncologist and PCa specialist Stephen B.
Strum, MD and Donna Pogliano, PCa warrior. It could save much suffering.

That will do for the first steps in this journey.

BTW, I understand that, when an RP is performed on an obese patient, the
perineal approach is often selected. The perineum is the area between
the scrotum and the anus.

Further BTW, Dr. Strum writes that a CT scan is so insensitive that it
is usually a waste of time and money. Just recently, he posted the
following remark as part of his response to a request for info on
Patient to Physician (p2p):

"CT scanning to detect spread of PC to nodes is a very
INSENSITIVE technique & flipping a coin is about as good (and you can keep
the coin)."

Well, that's neither here nor there. The question before the house is: what to do? My answer is to study, learn and take charge of the case. The above recommendations are a good beginning.

Knowledge is Life.

We are here to help as best we can.

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"

The short answer:
You'll get plenty of feedback from patients, but that's called anecdotal
evidence -- a major oxymoron. What you need to make your decision is to
read, read, read ... such as PC books by Walsh, Scardino, Lange, Marks,
various cancer agencies, and others in the PC book section of your
bookstore, then the websites this group will recommend. The data and
knowledge from the books and sites is based on many thousands of patients,
thus FAR more valuable than what Horace did and loved and Cornelius did and
hated. Keep reading and asking here -- there are some extremely knowledgable
people here -- but do a LOT of more serious research, too. Read books by and
consult with oncologists in all three PC specialties, if possible (surgical,
radiation, and medical) to help balance their biases. This is the most
complex decision you've ever made until now; don't finalize it until you
have researched it for at least scores of hours. You will also need to
identify and analyze your own priorities, including such factors as sex,
urinary and/or bowel continence, time off work, physical configuration
(surgery can involve different strokes for different-sized folks), activity
level (increasing yours could add four vigorous years to your life, but some
treatments interfere with activity for years), and your personal
aversions -- or not -- to a long list of side effects. You will know when
you're ready to choose and act, because you will stop second-guessing
yourself with each new finding.

I.P. Freely

Joe,

I'm sure you'll get a bunch of replies, including a number of
different opinions.

My first recommendation would be to go on a serious diet.  Check
with your doctors to make sure there's no reason not to, but if you
were to schedule surgery today, it probably wouldn't take place for
30 days or more anyway (they've got to schedule an operating room,
doctor, anaesthesiologist, assistants, etc., and work around the
existing schedules for all those folks - none of whom are likely
to be sitting idle right now.)  That's enough time to lose some
serious weight.

You've already had two doctors express misgivings about
operating on you because of your weight.  Why not give
them, and especially yourself, a better chance by losing
as much of it as you can?  It will contribute to your overall
health anyway and now you have a real good reason beyond
just general principles to do it.

Now as to the choice of treatment, there are pros and cons
to all of them.  In my inexpert opinion, both surgery and
radiation have excellent chances of success with a low
PSA, low-risk Gleason such as yours - though the Gleason
can be misleading since it is very easy for labs to under-
estimate the actual Gleason score - mine was first said to
be 3+3 then was read by two more pathologists (same
set of biopsy slides) who said 3+4 and 4+3.

To my mind, the main determinant of success is not the
choice of radiation vs. surgery, or LRP vs. RRP, but the
choice of doctor.  You want a very careful, very
experienced doctor who has treated many cases of PCa
and who gives you a sense of confidence in his or her
skill, expertise, and commitment.  Grind-em-through-the-mill
practitioners who run the patients in and out while thinking
about their next Florida golfing vacation are the last guys
you need to be looking for that last centigram of diseased
prostate tissue inside a deep, dark and bloody incision in
your abdomen.

As for side-effects, incontinence is much less common with
radiation than surgery, but is still possible.  The opposite
problem, difficulty urinating, is much more common with
radiation because the x-rays inflame the prostate tissue and
it swells around and closes the urerthra.  The chances for
impotence are often said to be about the same with both
treatments.  However, skillful surgeons and radiation
oncologists will have better results with fewer side-effects
of any type than quick draw artists.  You can improve their
chances for success by losing weight and making their
jobs easier.

Most men your age in this newsgroup seem to have chosen
surgery and can give you good reasons why - including the
one you mentioned (radiation as a followup is possible, but
not vice versa.)  I personally went for radiation.  Although
many will disagree with me, my personal opinion is that
both treatments work pretty well with small advantages for
each depending on the particular cancer.  I liked radiation
because I thought the dangers and side effects were less,
though it's hard to say for sure if that's true.  If I were you, I
would ask to see a rad onc too.

As for the two surgeons you mentioned, from what you said,
it sounds like both are experienced and you need to consider
which, if either, is the one your gut tells you is really going
to go all out to heal you.  I like that the first guy said he would
biopsy the lymph nodes even if there is only a small chance
of learning anything critical.  But on the other hand, the
second guy knows a hell of a lot more than I do and maybe
he's right that it's not worth doing.

Best of luck with your decision and your treatment.

   Alan

Joe,
Sorry to hear of your  misfortune. I was 50 when I got the bad news 2
years ago. It was devastating!  I'm doing great now.
I had a Robotic Laparoscopic RP in February of 2004. The surgeon was
Dr.Joseph Wagner. He has done hundreds of robotic procedures. I'm very
pleased with him. You could look at the Hartford Hospital's website
www.harthosp.org for information about the procedure. They have a video
of one of the operations that you can watch on your computer, and the
doctors explain everything. I went there and I am very happy with my
results. The operation took about 3 hours, but seemed like seconds to
me. I was able to go home 20 hours later, and back to work day 6. Now I
never leak, and a most of my erection ability has returned. The worst
part was waiting between the diagnosis and the surgery. Only you can
decide what is best for you. Take your time and read all you can. Most
of the guys here did that, and we came to different conclusions. Most
sound happy with their decisions, and you probably will be too.

My PCa stuff is:
age 50 PSA 4.5
Bx showed High Grade PIN
5 months later PSA 5.6
repeat Bx 1/12 cores <1mm gleason 3+3=6 stage T1c
RLRP 2-11-04 at age 50
Favorable path, 5 small foci of 3+3, organ contained
Post op PSAs  <0.1
Steve U

Welcome, Joe.  Sorry about your diagnosis.

It is true that with your age and low dx numbers (4.2, T1c and 6), you have
the whole array of treatment from which to choose.  Most surgeons would
recommend surgery and most radiologists radiation.  There is still not
enough data to show that radiation does as well as surgery.  But, nor is
there enough to show that it does not.

I would think that if an LRP specialist is hesitant, then that would seem to
be your answer regarding LRP.

I was 6'6" and 300 pounds when I did RRP.  I had no problem at all, though I
don't know if my surgeon did.

   Just to add.... this may be the event in your life to get you to lose
the weight.  Doesn't sound like you're surgery is in any hurry. On a strict
diet and exercise plan, you may be able to lose as much as 50 lbs in a
couple of short months.  Believe it or not, you may have a greater chance of
dying from a related overweight illness than your PCa after surgery. Think
about it?

I like this online book for add'l info:
http://www.cancer.prostate-help.org/download/leahy.pdf