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44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?
Prostate Cancer | Last Active: Apr 7 9:21am | Replies (172)Comment receiving replies
Just got back from my Urologist. Had another shot of Degarelix (80mg).
He is pleased with the response of my body to the Degarelix initial shot and now we are down to the straight line: RARP.
Option 1:
Head to a private clinic, in north Germany, about 2 hours flight, where they MAY be able to do SOME nerve sparring. This option involves a $2500 out of pocket for the surgery and care afterwards, plus the costs of the trip. So about $4K out of pocket.
Here I will get RARP with a Da Vinci system. The post-OP treatment (RT and ADT) will however be done in my city at the local hospital urology clinic.
Option 2:
Get the RARP at the local hospital. Also with a Da Vinci system. Here they will not attempt to do a nerve-sparring procedure. The procedure will be covered by my insurance and I am about 15 minutes drive from home. The hospital stay is expected to be 3-4 days. Post-OP treatment (RT and ADT) will also be done here.
Some food for thought over the weekend and then it is decision time.
To all a good weekend.
Be positive and stay strong.
Replies to "Just got back from my Urologist. Had another shot of Degarelix (80mg). He is pleased with..."
Congratulations on the results thus far.
Appreciating that economics are large factor in any decision, I can only offer that in terms of prostatectomy surgical expertise, there is no real comparison between the surgical team at Martini Klinik and Heidelberg, and I intend this comment to be respectful to the expertise at Heidelberg which is comparable to any center of excellence in the US.
Why do I believe this?
First the statistics. Across and average of 2900 patients that receive prostatectomies at Martini Klinik every year, including patients with all Gleason levels and ages greater than 75 years old, their average for full continence is 90.3% within 12 months and this statistic is only below 95% because they treat some of the most challenging surgical cases worldwide, their post op potency rate is 81.0% within 18 months and this is only lower due to many older patients they treat. My experience with patients that have been treated at Martini Klinik, including a recent 76 year old, is they were fully continent immediately and regained full potency with 9 months ( the recent 76 year old amazingly was full continent and potent immediately). Obviously not all patients have these results.
No many surgeons will show these statistics. The top three surgeons speak at the major US conferences on their latest surgical techniques to improve continence and potency. The top surgeon is considered to be the world expert on the single “arm” DaVinci, which has been demonstrated to significantly reduce recovery time.
Many of the techniques they use are challenging for a surgeon, unless you have the skill and the learning cycles they demand of their team and this is the reason that many of the top prostatectomy surgeons in the US have visited the Martini Klinik.
For those that choose surgery, I always recommend to get the best surgeon that can show their patients post op statistics on continence and potency. While Martini Klinik is recognized worldwide for their expertise, measurement processes, and openness with patients, you can also find surgeons in the US, Asia, and Europe who have the expertise and results, but not most.
Because of some of the European based PCa support forums in which I also participate, I may have more exposure to patients that have been treated at Martini Klinik and others centers within Europe, but the Mayo Connect forum also includes some patients that have been treated at Martini Klinik. As well as at least one that have been treated at Heidelberg.
My personal experience with some surgeons within Europe is that they attempt to understate the expertise at Martini Klinik as being “a factory.” After having toured Martini Klinik a few times, participated in many conferences that included their surgeons, and communicated with many, many patients across the world who were treated at Martini Klinik, my response to these surgeons is always that if Martini Klinik is a factory, my opinion is that it is the most finely tuned, innovative, and technology leading factory in the world:-)
Lastly, as well as I view Martini Klinik for prostatectomies, my opinion is that there are better European and Germnay centers for radiation therapies and I believe there are better centers for GU oncology expertise, which includes Heidelberg.
For some reason, I missed this message. I wonder what you decided to do.
Good to hear the shot is working. Did your testosterone drop way down?
At your age, the nerve sparing procedure is definitely more desirable.
Was there a problem with the location of the tumors that makes nerve sparing iffy? Is the doctor real experienced in doing nerve Sparing at the option one hospital?
What happened with the surgery?
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@dinu
It’s really too bad you’ve had to come out of Pocket for the PET scan and now considering it for the surgery.
There is a big difference between nerve sparing, and non-nerve sparing. You will probably never get an erection again, on your own, if you don’t get the nerves spared. You could get an implant put in, which will give you an erection and works quite well people say. The other option is using Injections of bimix or Trimix, Which work for almost everyone, but would be no fun for somebody as young as you to have to do it for so long. The thing is, you are pretty young. I would imagine that getting an erection for the rest of your life, or for at least the next 15 or 20 years would be very important. You could check out the cost of getting the implant that would resolve the problem and then you can get a cheaper surgery. The implant is covered by insurance here in the USA.