Mri/Bones Clean/Surgery Scheduled/Consulted Surgeon

I wanted to give an update on my last post where I introduced my husband's recent diagnosis (gleason 6, cancer found in 1 of 15 cores, less than 5%, PSA 2.7 11 months ago, age 46, third biopsy in 12 months after repeated incidencies of PIN and atypical cells).

 His MRI and bone scans were normal, so that was great news. We met wtih Penn's DaVinci surgeon, David Lee, who we really liked. After our other urologist (also at Penn) we were hoping to find someone who was kinder and less patronizing in his demeanor. Dr. Lee fit the bill. We discussed his case and Lee described the differences between open and DaVinci and said that his stats and those of the best open surgeons (Walsh, Scarpino, etc) are really the same when it comes to continence and impotence issues) so that in the right hands both procedures are equally successful. However, the recovery time is really the biggest issue. Also, transfusion rates are much lower with DaVinci. Last year, men chose to go open 60% of the time and this year that stat has dropped to 40%--obviously due to more awareness of the benefits of this procedure. Again, he was careful to not paint an overly rosy picture and mainly referred to length of catheter wearing, recovery, pain etc. Since we don't have aceess to the top open surgeons and Dr. Lee is here, we do want to go DaVinci. However, his first available is in December. Interesting news is that he said it was perfectly find to wait for the surgery based on my husband's condition. He said that even if we waited a year or even 2, he would likely be curable based on the small amount of cancer he now has. However, with each passing year, the pelvic floor muscles get weaker so removal sooner is smart because the stronger your muscles when you have the surgery, the more quickly you will regain continence and erections (i think i understood that correctly--I might be wrong on the impotence part, just wishful thinking!). He anticipated my husband would need pads for 3 months and would start to have erections in 6 months and then perhaps the ability to have intercourse in a year. We didn't get into medications or other assistance. I think this may not be the case for us because my husband now needs some help with ED sometimes (we don't have  a clear understanding why) but maintaining an erection through intercourse is not always possible without Viagra. We didnt' discuss it with Dr. Lee on Friday. Just didn't seem the right time and my husband is kind of embarassed about it since there doesn't seem to be a clear physical explanation.

 Overall, we left the doctor feeling very very releived. We were very worried about the results of all the tests and hearing everything was normal (MRI and bones) and also getting reassurance from Dr. Lee that he believes he is an excellent candidate for a cure (they say if you go 10 years with no rise in PSA you are considered cured) was a wonderful feeling. So we now have a reprieve of sorts until December and are considering a trip just the two of us before surgery. It would be a financial splurge but perhaps something that would be good for us both. Did any of you folks do something similar?

Best to all.

Lesley 

I vehemently disagree with waiting that long in a man of 46 with a history of hight grade PIN (which is cancer ,by the way, just confined  to the ducts).  If your husband was 20 to 30 years older, perhaps that would not be as bad.  Young age is a negative prognostic sign, same as in breast cance with women and potentially indicates something may be different with regards to the natural history of the tumor.

The least that should be done is put him on ADT for the waiting period, but as above I would get treatment earlier.

He is a candidate for any of the available treatments from surgery, irradiation ext, or seeds so there is no need to wait.

On 7/29/2007 mediamom wrote:

I wanted to give an update on my last post where I introduced my husband's recent diagnosis (gleason 6, cancer found in 1 of 15 cores, less than 5%, PSA 2.7 11 months ago, age 46, third biopsy in 12 months after repeated incidencies of PIN and atypical cells).

 His MRI and bone scans were normal, so that was great news. We met wtih Penn's DaVinci surgeon, David Lee, who we really liked. After our other urologist (also at Penn) we were hoping to find someone who was kinder and less patronizing in his demeanor. Dr. Lee fit the bill. We discussed his case and Lee described the differences between open and DaVinci and said that his stats and those of the best open surgeons (Walsh, Scarpino, etc) are really the same when it comes to continence and impotence issues) so that in the right hands both procedures are equally successful. However, the recovery time is really the biggest issue. Also, transfusion rates are much lower with DaVinci. Last year, men chose to go open 60% of the time and this year that stat has dropped to 40%--obviously due to more awareness of the benefits of this procedure. Again, he was careful to not paint an overly rosy picture and mainly referred to length of catheter wearing, recovery, pain etc. Since we don't have aceess to the top open surgeons and Dr. Lee is here, we do want to go DaVinci. However, his first available is in December. Interesting news is that he said it was perfectly find to wait for the surgery based on my husband's condition. He said that even if we waited a year or even 2, he would likely be curable based on the small amount of cancer he now has. However, with each passing year, the pelvic floor muscles get weaker so removal sooner is smart because the stronger your muscles when you have the surgery, the more quickly you will regain continence and erections (i think i understood that correctly--I might be wrong on the impotence part, just wishful thinking!). He anticipated my husband would need pads for 3 months and would start to have erections in 6 months and then perhaps the ability to have intercourse in a year. We didn't get into medications or other assistance. I think this may not be the case for us because my husband now needs some help with ED sometimes (we don't have  a clear understanding why) but maintaining an erection through intercourse is not always possible without Viagra. We didnt' discuss it with Dr. Lee on Friday. Just didn't seem the right time and my husband is kind of embarassed about it since there doesn't seem to be a clear physical explanation.

 Overall, we left the doctor feeling very very releived. We were very worried about the results of all the tests and hearing everything was normal (MRI and bones) and also getting reassurance from Dr. Lee that he believes he is an excellent candidate for a cure (they say if you go 10 years with no rise in PSA you are considered cured) was a wonderful feeling. So we now have a reprieve of sorts until December and are considering a trip just the two of us before surgery. It would be a financial splurge but perhaps something that would be good for us both. Did any of you folks do something similar?

Best to all.

Lesley 

have you looked into hifu at all? The recovery time is much sooner than either type of RP. There are extensive websites hifuusa and hifu.ca. I had hifu performed a month ago in Toronto and flew home the next day. I am an electrician and went back to work in 2 and a halff weeks, half days though. It is worth looking into. The clinic in Toronto has been accepted ffor FDA study approval. Hifu, high intensity focused ultrasound has been done in Europe for almost 20 years and Canada for 5. Check it out. Good luck...max