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Third SBRT Opinion Worth It?
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Me:
Age 50, Gleason 7 (3 + 4), 0.56 intermediate risk, 6/12 cores, PSA 6.68, PSMA showed no metastasis to lymph nodes or bones, cystoscopy showed no obvious issues.
My dilemma:
The surgeon who did my biopsy recommended treatment (RP or RT), as did two separate ROs, all local to me in Louisville, KY. I'm leaning ever so slightly towards radiation but it's not a done deal.
The first RO suggested a 9-week course and the second RO recommended a 4-week course, both with 6 mos. testosterone blocker. Both ROs recommended against SBRT/Cyberknife due to existing issues (frequent urination, weak stream). Before seeing the second RO, the urologist at that center suggested that I might be a candidate for Cyberknife. Based on that, I decided to initiate a visit to MD Anderson for a tie-breaker, mainly thinking the MR-Linac might be an even better option than Cyberknife.
Now that both ROs here have frowned on SBRT, I'm not sure about traveling to Houston. I don't think it would be feasible for me to get a 'regular' course of treatment (RT or RP) there, but I guess it might be worth having them tell me for sure MR-Linac is not a good option.
I'm open to wisdom, experience, and informed opinions. Thanks.
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I'm still going to MD Anderson on Monday but I did meet with another local urologist (surgeon) today and he strongly recommended RP based on my existing urinary issues. This is the first of the four urologists and two ROs I've seen who has recommended a particular treatment and he answered my growing list of questions satisfactorily, many of them before I even asked.
A nurse practitioner from another office had worked with him in the past and recommended him for RP. At the time I filed it away in memory and didn't think much about it until @survivor5280 shared a link to the Intuitive website and I discovered that his 2-3,000 Da Vinci surgeries are the most of anyone within 150 miles or so. There is another doctor about 3.5 hours away with 8-9,000 Da Vinci surgeries and I have an appointment with him on April 10th. Unless something drastic happens at MD Anderson (I'm open to it), I'm thinking I'll do RP here in Louisville or in Columbus.
https://www.intuitive.com/en-us/physician-locator
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2 ReactionsSounds like you're making progress every day! It feels good to be moving forward! Let us know what you find at MDA!
Best wishes!
The team at MD Anderson not only recommended RP, but the ROs said they wouldn't perform RT on me with my current urinary issues. A bit nerve-wracking, but this type of clarity is what I was hoping for by coming down here.
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2 ReactionsWow, RO’s not pushing radiation…it’s nice to hear that a team can work together for the good of the patient and not the hospital.
@psychometric, I'm guessing you might have been hoping for RT, but are somewhat relieved to have clarity on how to move forward!
A couple of questions, if you don't mind sharing:
How did you like MDA?
Did the RO's share what their IPSS score choking point was for urinary issues?
Did you schedule?
Best wishes!
GSD
Yes, definitely relieved although somewhat anxious about incontinence outcomes. The two most experienced surgeons I've seen (plus the ROs at MD Anderson) have recommended surgery. Although I was holding out some hope for MR-Linac RT, it would have made an already unclear situation even murkier if they'd recommended that.
My experience at MD Anderson was really good. After the the various assistants and nurses took vitals and verified my records, I met with one of their Urologic Oncology Fellows first. After an unwanted (probably both ways) prostate exam, she prepped me that they were going to recommend RT. She also mentioned that Dr. John Ward - the surgeon I met with - is the best she's ever seen, including her residency at Mayo Jacksonville.
That was confidence inspiring, although Dr. Ward didn't really need the assistance. He was great - no rush, explained everything, answered all my questions. They would do an MRI a few days before the surgery. I asked about urethropexy - he performs a Retzius-sparing/hood technique with a Foley catheter for 10 days. He's found better short term incontinence outcomes with that combo. I'd stay overnight in the hospital, and then able to return home the following day after discharge. Patient self-removal of the catheter is common (probably due to travel - I didn't ask). Interestingly, he doesn't remove lymph nodes - says the risks outweigh any benefits. Post-RP PSA > 0.1 is the trigger for more treatment.
I did schedule the surgery for June 25th to lock in the date, but I have one more appointment with a surgeon in Columbus, OH next week (he has 8-9k Da Vinci surgeries). Unless something unexpectedly odd happens at the initial appointment, I think it's going to come down to the logistics I feel most comfortable with between Houston and Columbus.
No threshold from the ROs - maybe case-dependent?
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1 Reaction@psychometric, I know it's good to be moving forward! It sounds like you would be in good hands with either surgeon. Thank you for sharing your account of your experience at MDA. Please keep us informed as you move forward. You're in my prayers and your great outcome will lift everyone's spirit!
GSD
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