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Looking for NYC Doctor for Radical Prostatectomy

Posted , 11 users are following.

sharpcut
sharpcut

My name is Keith Nice to meet all of you I have read quite few of your comments and I am grateful for your responses to people in need ! I would like to ask you some questions if ok with you I hope ! ?  Here is my background 

I am 59 excellent physical shape  my PSA . 4.6 . My Father had prostate cancer but and had his prostrate removed and lived for many years after and died of  a series of strokes 

I had  12 biopsies done  on 6/5/18 . 8 out of 12 showed cancer involvement

Here is Pathology Report

Right Base Needle Biopsy

1.)Adenocarcinoma of Prostrate Gleason Score of 7 . (3+4) . involving 40 % of tissue 

comment:  Perineural Invasion is identified    (from what I can tell this is not good)

Right Mid Needle Biopsy

2.) .

Adenocarcinoma of Prostrate Gleason Score of 6 . (3+3) . involving 50 % of tissue 

comment  2 out of 4 cores involved by Tumor

High Grade Prostatic Intraepithelial neoplasia (HGPIN) is also present . ??

Right Apex Needle Biopsy

3.) 

Adenocarcinoma of Prostrate Gleason Score of 6 . (3+3) . involving 75 % of tissue 

Left Base Needle Biopsy

4.)  

Adenocarcinoma of Prostrate Gleason Score of 6 . (3+3) . involving less than 5 % of tissue 

Left Mid

Adenocarcinoma of Prostrate Gleason Score of 6 . (3+3) . involving less than 5 % of tissue    2 out of 4 cores involved by Tumor

comment  a rare atypical gland is seen in a third core .   ??

Left Apex  Needle Biopsy

6.)  

Adenocarcinoma of Prostrate Gleason Score of 6 . (3+3) . involving 10 % of tissue 

My questions are .   What does this mean ?  especially the comment  Perinueral invasion is identified ?   I am leaning towards Removing my Prostrate but do not have any leads for a qualified Surgeon in the NYC area 

Do you have any recommendations ??  Very Grateful for your help and input 

Thank You . Keith 

0 likes, 41 replies

41 Replies

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  • richard98806
    richard98806 sharpcut

    Posted

    Sloan Kettering is considered one of the best in the world.

    My urologist trained there and is an excellent surgeon. I live in Florida.

    John Hopkins is world class and I have used them for 2nd opinion on biopsy reports.

    Not sure why your contact is so negative on Sloan Kettering but you should delve further into his bias.

  • n-mac
    n-mac sharpcut

    Posted

    Where was this biopsy and diagnoses done? Are you considering being treated there?  If not, why not?

    Regardless, my very best advice is get yourself to MSKCC in NYC to have appointments with the following:

    Dr. Edhaie to overall see about AS, HIFU focal, or RALRP as viable options.  He performed my biopsy, and in the end gave me what I think turned out to be the best possible treatment opinion and advice in my specific case.  Every case and individual are different, so you'll need to journey deep on your own with the experts at MSKCC to get to your personal plan of action.

    Drs. Coleman, Laudone, or Eastham for RALRP.  IMO, any of them are a great choice.   Dr. Coleman performed my RALRP on 03/31/17, and like Dr. Edhaie is also IMO a leading expert in focal treatments. To say the least, now almost 15-months later, I'm a happy camper.  100% dry from the moment catheter removed at 7-days post surgery.  Sexual potency back to at or near 100% pre-surgery.  Had a dip @ 5 to 6 months post surgery, but persistence, determination, and Tadalafil (small doses) paid off.  Only missing part, and somewhat of a downside is the no more can spew the sauce, so to speak.  razz

    Dr. Zelefsky for all radiation related treatment options.  There are several available depending on the diagnosis specifics.

    Dr. John Mulhall for pre-treatment preparation, and post treatment male sexual health healing, recovery and maintenance.

    IMO, you're very fortunate to be located in the NYC area just because of the fact that MSKCC is a reasonably convenient alternative for your treatment and must hopefully a terrific out come.

    Wishing you the very best,

    n-mac

    • rocketman42
      rocketman42 n-mac

      Posted

      I totally agree and ironically I am sitting in the examination room, as I type this, waiting for my 18 month check-up with Dr Z.  

      I agree that you should do your due diligence and go wherever you feel confident. That said, I doubt you will find anyplace better in the world. 

      Good luck. 

    • sharpcut
      sharpcut n-mac

      Posted

      Wow   Thank You very much for sharing that . Grateful for your insight Will get an Opinion from SK
    • sharpcut
      sharpcut rocketman42

      Posted

      Thank You scott    Appreciate you taking the time  Very comforting !  will look at SK !  keith
  • n-mac
    n-mac sharpcut

    Posted

    Just want to say, your situation is spooky close to mine. I had just in the same month turned 60, was in very good  physical shape, my PSA had jumped to 4.4, and my Father had about 20-years ago been diagnosed with prostate cancer G8, but the cancer in his lung found at about the same time took him much ahead of when any PCa would have.  Per my local lab pathology, I was originally G=3+4 in 2 cores with a 3rd core having a small amount of G=4+3.  The findings of MSKCC pathology on the biopsy performed by Dr. Edhaie about 13-weeks later were a good deal more severe. Those findings showed the essentially same 3 mapped cores to all have G=4+3 with a much larger % of PCa in each, and PNI in one of them.  Looking back, I think that there is a great deal to be said for getting a 2nd opinion from the best cancer center that you can find, and stand convicted that I was truly blessed to have been lead to do so.

    Best Regards,

    n-mac.

  • barney34567
    barney34567 sharpcut

    Posted

    Hi Keith,

    A few things come to mind:

    1. Gleason 3+3 is not really a cancer. In the absence of familial history of PCa, no highly experienced physician would suggest surgery.

    2. Given you have history, then surgery may be indicated.

    3. As your cancer is low (3+4=7 is the lowest you can get), you should research the choices available, including:

    surgery (robot assisted or not)

    radiation

    hormone

    HIFU etc

    4. Was the biopsy performed by an experienced surgeon?

    5. Was the MRI read by someone with a lot of prostate reading experience?

    6. I live in Australia and my research (two years ago) indicated that MSK is the place to go. If you decide to go. It is to be preferred to the #2 place which is the Anderson Cancer Center in TX.

    5. Pernieural invasion changes things somewhat. Writing as a 50yo who was Dx'd with 4+5=9 (and had RARP) with PNI seen at biopsy. It means that a simple cancer (where no PNI is present) can most likely be removed in total by a skilled surgeon. But if PNI is present, that leaves open the good chance that some cancer cells may have escaped the prostate gland and while the gland has been removed,  some cancer (invisible to the surgeon's eye) may remain in your body which will be detectable via bloodwork.

    6. In your shoes I would research for a while. Even if you decide on treatment, a 3+4 is no excuse to hit the "panic button".

    Best wishes.

    • sharpcut
      sharpcut barney34567

      Posted

      Barney .        Biopsy was performed by a local surgeon with good credentials I live 40 miles north of Manhattan  He wants to do the MRI today but I am thinking of waiting until I get a consult at MSK . Insurance probably will not pay for two MRI's  Very Grateful for your post . Wow !  Puts me more at ease And gives me more positive energy  THANK YOU !   keith

    • rocketman42
      rocketman42 sharpcut

      Posted

      Keith -

      It's always best to have tests done by the facility/doctor who is potentially treating you. Makes it much easier than having to bring the test results to show them. Also, the quality and interpretation of an MRI is going to be optimal at a place like MSK.

      If you think you will be going to MSK then I suggest waiting and letting them order any additional tests they want. It will make your life much easier going forward.

      Good luck.

    • sharpcut
      sharpcut rocketman42

      Posted

      Scott .    . Great Advice I postponed MRI  and will get down at MSK .   Thank You  will update as tests are done . Now waiting for Epstein JH . to review slides of biopsy .   Grateful for Everyone here helping me !!   keith
    • n-mac
      n-mac sharpcut

      Posted

      Hi Sharpcut,

      Now that is new information.  Your local urologist/surgeon performed an biopsy prior to having an MRI done?  Wow, because I think that sounds extremely not good.  As far as I know, state of the art diagnosis calls for first doing a 3T MRI, and then using that MRI result to guide the biopsy.  I'm pretty sure that is at the very least the testing/diagnosis sequence that you'll likely receive at MSKCC, which means that you'll end up with the benefit of another far more accurate biopsy to better show the state of your prostate.

      I also agree with scotth42 that both the quality of the MRI taken, and it's analysis will be top notch at MSKCC.  I explained in an earlier post how that was the case when it came to my biopsy, but did not mention that it was MSKCC radiology that concluded a high probability of ECE from the same MRI media analyzed by my local lab who erroneously concluded no ECE present.  Turned out that MSKCC was spot on. Fortunately, the surgical pathology showed that although the cancer had made it in one area to the outer capsule, all all surgical margins were negative.  Whew!  The point is that here again, a 2nd opinion from a top notch treatment center was far more realistic and accurate, and therefore very helpful to me in making my final decision on treatment option.

      Just my 2-cents:

      When it comes to your local specialist, if it were me, I'd vote with my feet, and run, don't walk, and don't ever look back.  Keep well in mind that medicine is a practice, and not some sort of universal perfect algorithm, nor mathematical theorem or equation founded on a 100% absolute, deterministic, and infallible, proof.  As such, mileage (i.e. quality) will vary depending on the practicing provider.

      One more thing, if you do ultimately receive treatment at MSKCC, and especially if your reasonably satisfied with the outcome, never hesitate to give back by spreading the word to others, and always to the extent that you're financially blessed, never forget to include MSKCC (a total non-profit) and the American Cancer Society in your yearly giving back plan!  wink

      If you live more than a 45 minute commute from MSKCC, then you likely meet the ACS' criteria to provide you with great accommodations at its Hope Lodge in NYC.  You'd need to have your assigned MSKCC social case worker make the reservation, and do so at least 1-month in advance to best assure availability.

      Cheers,

      n-mac.

    • n-mac
      n-mac sharpcut

      Posted

      Most welcome sharpcut.  Don't hesitate to keep us posted here as things develop.

      Best,

      n-mac.

    • barney34567
      barney34567 sharpcut

      Posted

      I have been busy the last week so have not followed up this discussion.

      With imaging, the key is to have it performed by a leader in his or her field ie

      someone who specialises in reading prostate images.

      The films and the report should be accepted by all urological surgeons.

      But a biopsy performed by one Dr may not be accepted by another.

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