I have been recently diagnosed with PC.  I am 56 and otherwise in
excellent health.  Gleason is 6 (3+3), PSA is 2.8, the biopsy of 12
cores shows the right side with 60% to 70% cancer in the apex and mid,
and 20 to 30% in the base.  No cancer was found on the left side.  The
stage is T2a. The Partin tables show my profile has a probability of 40
to 50% penetration of the prostate.

The biopsy was done on Sept 8 and the consultation with my doctor on
Oct 2.  I have made the decision to have the RP which I hope to be
nerve sparing. The doctor that performed the biopsy only does a couple
of the RP surgeries per month, so I made an appointment with Dr Walsh
at Hopkins.  My appointment with Dr Walsh is Nov 3 (3 weeks from now)
and although I meet his profile as far as his schedulers are concerned,
there is no assurance he will take my case or not pass me off to one of
his associates.  Two other concerns I have is that if everything goes
right, I will not be able to have the surgery until mid December or
early Jan, which is 2 to 3 months from now.  Second, I am concerned
about how much of the surgery is done by Walsh rather than one of his
residents, lets face it, they have to learn somewhere and this is a
teaching hospital.  I also have concerns about the age of Walsh (70+)
and if he has continued to improve or even maintain his technique,
hence the need for residence to assist if not to learn.  He was a great
doctor, but has time passed him by as it does for all great ones as
younger doctors take his pioneering work to the next levels with the
lasted techniques.

I have also consulted a local uro where I live in suburban Washington
DC.  This doctor has performed about 1500 RPs and has a good
reputation.  So my quandary is do I go for the top doctor and hospital,
i.e. Walsh and Hopkins, or get this thing out of me ASAP in about 2
weeks with a local doctor of good stature.  I am concerned that the
right side nerve will be challenging to spare with the possible
penetration.  Walsh is the recognized expert at nerve sparing RPs.

I am concerned that by waiting for Walsh I may have to wait for another
2 to 3 months or even be referred to a 3rd or 4th doctor further
extending the surgery which leaves this cancer in my body to further
proliferate, especially if it has penetrated.  My primary question to
anyone who may care to opine on this is how time sensitive is my
decision in light of my high volume of cancer in the right side samples
and the 40 to 50% possibility of penetration according to the Partin
Tables.

I would truly appreciate any thoughts.

Phil