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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2006Meet with Surgeon on Wednesday
Hello All, Paul and I meet with a surgeon on Wednesday. He does the robotic surgery. I am not sure if the does RRP or only robotic. I would like to nail down the top questions I should not leave the office without knowing. Can you help me out? Also we meet with oncology radiologist on Thursday. Paul is reading Scardino's book but started from the beginning. I suggest he read about treatments first but he made up his own mind. Any advice would be appreciated. We are meeting with a Dr. Justin Lee of Urology Assoc, of North Texas. Anyone familiar with him? Thanks,Lisa I would confirm that he does indeed do open surgery as well. The doctor has probably done quite a few but I would ask just the same. All the robot gurus claim that if something goes wrong with the robot, they can open the patient up and continue in the normal fashion without any jeopardy to the patient. Dave Perry > Hello All, > [quoted text clipped - 10 lines] > > Thanks,Lisa Wow, good one. Thanks Dave. > I would confirm that he does indeed do open surgery as well. Paul and I meet with a surgeon on Wednesday. He does the robotic surgery. I am not sure if the does RRP or only robotic. I would like to nail down the top questions I should not leave the office without knowing. Can you help me out? Also we meet with oncology radiologist on Thursday. Any advice would be appreciated. Thanks,Lisa =====> the only comment that i can make is simply this. this is MY body and it has the cancer inside it....... now, i want certain goals afterwards. i understand that there are odds against these goals. but what can you tell me about YOUR surgery skill? what are YOUR numbers on men that you have operated on that have incontinence? that have erectile function afterwards? what is the avg age of the patient that you have operated on? this will give you some idea of what your outcome will be if you go with him or any other surgeon. rad people are different because of the delay of the time lapse between the treatment and the results from that treatment. hope this helps... ~ 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 > Hello All, > [quoted text clipped - 5 lines] > beginning. I suggest he read about treatments first but he made up his > own mind. Any advice would be appreciated. I concur with reading from the beginning. Lisa, I'm not sure if you are still shopping for a surgeon or just want to know what to ask the surgeon you have already chosen, and the questions will be a little different depending. If the latter, the main thing for me was to discuss the potential choice that may have to be made between erring on the side of PCa eradication and post-surgery QOL. Since this doc uses the robotic technique he is probably not of this ilk but some older surgeons may eschew even trying to save nerves if it is overly difficult or there is any hint of involvement. He just needs to know beforehand how you 2 feel about that. Cure is first and foremost but the surgeon does have some leeway even so. I wanted to make sure mine would do everything he could to save the nerves unless it was too risky to do so. On the other hand, w/ a PSA of 33 I wanted him to know that I wanted the surgery aborted if he got in and found extensive disease. Bill Denton RP 2/12/02 PSA .96 Memphis > Hello All, > [quoted text clipped - 10 lines] > > Thanks,Lisa Ask about the 3 N's: numbers, numbers, numbers. 1) how many surgeries has he done (not just assisted, etc.). 2) What is his rate of surgical margins? THis is a fancy way of asking how often is there ca left behind in addition to the other good suggestions already made. Also, I recommend that Paul read the parts of the Scardino books he needs to know about before the surgery. I don't think it's a good idea to read about everything that can go wrong in the future. But it depends on the person and you would know better... Leah Thank you to all of you. Your advice has been great! We don't know if this is the surgeon are not. I suppose after we talk to him we can evaluate. Paul and I seem to be handling this just fine but at the same time I have ulcers in my mouth which tells me on the surface all seems okay but at other levels I am stressed. I don't suppose anyone could not be stressed at this point. I know Paul's #'s look okay but I also know this will not be a cake walk. Major surgery always poses risk and while Paul is ready to get the cancer out, I don't know how ready he is for the SE that will change our life and his more importantly I know him and I imagine having ED problems is going to send him in to a depression. But, it is what it is. Thanks for your help. > Hello All, > > Paul and I meet with a surgeon on Wednesday. > > Thanks,Lisa Lisa, take a long weekend and get out of Dodge! Find someplace where you two can be alone and talk, make love, talk some more, and make love again and again. I'm serious. Communication is so very important and getting away makes it easier to talk about fears and what is coming. It's also a good time to make some memories because you don't know when you're going to be able to have "normal" sex again and it will never be like it is now for the two of you. I don't think it matters if you pitch a tent in a National park or find a remove motel, or a B&B in the next town. Personally, I think some remote tropical island would be good. LOL Although this time of year you can often get some good deals on a beach house. Just get away and spend time together. Do not take the kids, do not go to your sister's house in Timbuktu, unless it's her weekend cabin in the mountains that she's not using! Just get out! You'll find it a great way to de-stress and it will be helpful to both of you. It's a time to hold hands, snuggle, and cry without the whole world watching. If you are like me, that rock you've always leaned on for support isn't really capable of having you lean on him. He needs to lean on you. And you're watching your cozy world shatter before your eyes. I didn't want to cry on him and add another burden to him yet sometimes I just fell apart anyway and the tears would just flow. Getting away really helped because when the weekend was over we both knew more about each other's fears and hopes then if we had stayed at home and done the normal weekend things. Getting away is important! It's also a good time to make the final decision on Tx and Dr. Bev > Thank you to all of you. Your advice has been great! We don't know if > this is the surgeon are not. I suppose after we talk to him we can [quoted text clipped - 13 lines] > > Paul and I meet with a surgeon on Wednesday. > > > Thanks,Lisa : Lisa, take a long weekend and get out of Dodge! Find someplace where you two : can be alone and talk, make love, talk some more, and make love again and [quoted text clipped - 22 lines] : on Tx and Dr. : Bev Mostly I just lurk here: my surgery, etc., long past and things have changed a lot since then; but I must say, P & L, you're getting the best advice from Bev that anyone could possibly give. If at all possible, take it. Ken Bland Thanks Bev, Thank you, I know you are right. We have a tripped planned for Las Vegas. Not really a quiet getaway. We do plan to spend a day driving in the desert...Hoover Dam, Lake Powell. When we booked the trip he said what about surgery and I told him we take the trip and schedule the surgery afterward. This was even before we knew the results of the biopsy, perhaps before biopsy. I knew we needed to get away from the normal..take a step outside. I think the biggest thing is stepping away from it. We seemed to have talked about it alot. We need to talk more but more than that we need to step away from this for a breather. Today, I feel, this just SUCKS! > Lisa, take a long weekend and get out of Dodge! > Lisa, take a long weekend and get out of Dodge! Find someplace where you two > can be alone and talk, make love, talk some more, and make love again and [quoted text clipped - 22 lines] > on Tx and Dr. > Bev This medicine never hurts (if it comes from the right source). Not long before husb's surgery we spoke to our and must have asked him something about sex because he replied: Why don't you two go home and [blank] all day for the next 2 weeks. I nearly fell out of my chair. When we left the office I asked J. "Did I hear right?" And he said, "yes, you did." I have to say I found this grossly offensive coming from from this dr we barely knew and the vulgar language didn't help either. Otherwise, great idea. Also, I wouldn't give up on sex never being the same ever again. In my case, it wasn't the same but in a lot of ways it was better. Leah Paul and Lisa, I will be following your progress as I too just last week was diagnosed with PC. So now I am diligently doing the homework on options. My wife will be making an appointment with another doctor for 2nd opinion (I am in the Dallas area). I hope to find another pathologist to review the slides and see what he/she thinks. Our first Uro says that here almost all doctors use the same pathologist to read the slides. I find that hard to believe, so iam going to find out who this person is and definitely find someone else to re-read the slides. If there is any URO lurking here, please post a reply and help me find names to look for. My understanding is that Gleason grading is so subjective that my numbers may vary ( i am 4+3, based on current initial consult). (snip) > My wife will be making an appointment with another doctor > for 2nd opinion (I am in the Dallas area). I hope to find another [quoted text clipped - 5 lines] > names to look for. > I am not a uro, but here is a list of specialist labs who do second opinion Gleason grading: Bostwick Laboratories, David Bostwick [800] 214-6628 Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162 (Dr. Epstein does not do ploidy analysis) Dianon Laboratories 1 [800] 328-2666 (select 5 for client services) David Grignon (Michigan) 313-745-2520 Jon Oppenheimer (Tennessee) [888] 868-7522 UroCor, Inc. 1 [800] 411-1839 I understand that the cost is about $350 for the basic Gleason grading, with additional charges for additional services. I also understand that the cost is covered by Medicare and insurance. It is necessary to have the original slides and paraffin block, or recuts, sent to the lab. They can give instructions. Unless the patient is in some benighted jurisdiction, those specimens are HIS, not the medic's, not the lab's. I don't know about the others, but Bostwick does have a website that outlines all their services. See, http://www.bostwicklaboratories.com/default.htm They did a study on the specimens from my second biopsy and reported some verrry interesting information that was omitted from the local lab's report. (snip) Regards, Steve J "Empowerment: taking responsibility for and authority over one's own outcomes based on education and knowledge of the consequences and contingencies involved in one's own decisions. This focus provides the uplifting energy that can sustain in the face of crisis." --Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled "The Empowered Patient's Guide." > Paul and Lisa, I will be following your progress as I too just last > week was diagnosed with PC. So now I am diligently doing the homework [quoted text clipped - 9 lines] > My understanding is that Gleason grading is so subjective that my > numbers may vary ( i am 4+3, based on current initial consult). Several men here arranged to send their slides to Hopkins or other centers for evaluations. I'm not sure just how you go about doing that, but I think you can find some references by searching the newsgroup with Google groups. Also, ask your doctors whether another pathologist would come up with an estimate enough different to make a difference in which treatment you would choose. >> iam going to find out who >> this person is and definitely find someone else to re-read the slides. >> If there is any URO lurking here, please post a reply and help me find >> names to look for. > Also, ask your doctors whether another pathologist would come up with an > estimate enough different to make a difference in which treatment you > would choose. Many uros send their slides to Bostwick labs, long accepted as the gold standard of PC grading. While Leonard's question is generally valid, there are differences in the statistics between adjacent Gleason grades which may affect your decision. But the grade often turns out to be higher than the biopsy shows upon post-op pathology anyway, simply because the latter examines the entire prostate, not just core samples, so Bostwick vs a city-wide Dallas lab may be just splitting unnecessary hairs. I.P. I would think about going down to Houston to MD Anderson, I went there for a second opinion and they have a first class Urology department. They do everything, Radiation and all forms of surgery, LRP, RRP and Robotic. I am from Dallas originally and live in Denver now. I had my RRP done here at the University of Colorado June 13th of this year, but I strongly considered MD Anderson. They will require your pathology and they will also do a complete work up, blood, DRE, path evaluation and consultation with several doctors if you like. > Paul and Lisa, I will be following your progress as I too just last > week was diagnosed with PC. So now I am diligently doing the homework [quoted text clipped - 9 lines] > My understanding is that Gleason grading is so subjective that my > numbers may vary ( i am 4+3, based on current initial consult). > I had my RRP done here at the University of Colorado June 13th of this > year, Hi, Mike. How was your first post-op PSA?  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 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, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum PSA @50 1.7, @51 2.1, @52 2.3 PSA 1/06 @53 5.8 Biopsy 2/06 G6 (3+3) T1c RRP 6/13/06 G6 (3+3) T2a Neg Margins PSA 7/25/06 <.01 Contenence @ 12 Weeks >> I had my RRP done here at the University of Colorado June 13th of this >> year, > > Hi, Mike. How was your first post-op PSA? > PSA @50 1.7, @51 2.1, @52 2.3 > PSA 1/06 @53 5.8 > Biopsy 2/06 G6 (3+3) T1c > RRP 6/13/06 G6 (3+3) T2a Neg Margins > PSA 7/25/06 <.01 > Contenence @ 12 Weeks Looks good, Mike! SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 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, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum |
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