Questions for Dr Eastham Sloan Kettering Consult

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Hi   Thank You for all the wonderful comments helps me sort things out !

I have an appointment with Dr Eastham  At Sloan Kettering this Monday   I am told his robotic assisted laparoscopic prostatectomy takes 4 Hours which is 2x the time my local Urologist said the same operation would take so I am hoping he is more thorough !! Wondering what other questions are important to ask ? I  know he is Dept Chair so He does 4 operations a week . 2 Tuesdays 2 Thursdays  Not sure if this surgeon is the right one for me Some Dept Heads are there for a reason better at Politics  than surgery    Any input is welcome .  Thank You .  Keith

I am 59 excellent physical shape  my PSA . 4.6 . My Father had prostate cancer at 70  and had his prostrate removed and lived for many years after

I had  12 biopsies done  on 6/5/18 . 8 out of 12 showed cancer involvement . Gleason 7

 

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  • Posted

    You may want to ask how many robotic prostatectomies this surgeon has had and in how many years and make sure you are totally knowledgeable about the side effects after surgery so you are not surprised do not let him sugar coat it
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  • Posted

    I would ask why you are considering surgery with such a low PSA reading. Over what time period have you been having PSA tests? Have you had a biopsy and what were the results? What other treatment options have you considered? Have you looked at the side effects of surgery? Cheers Richard
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  • Posted

    I am also concerned about why you are considering a prostatectomy. At Gleeson grade 7 you have a moderate grade. My grade was up from 4.4 last year to 6.4 this year, so I had an MRI, which showed a lump. It is 4/3 and two friends had 3/4. However, we are all having treatment and we have all researched a great deal. None of us is doing what you are and it is usually used for more extreme cases. One having Brachytherapy and two of us are having Proton Therapy.

    I did a great deal of reading and the side effects of each were of key importance. Have you considered them all? Even if you have a nerve saving prostatectomy, which is never a guaranteed operation, you may lose much or all of your impotence.

    What I also was reminded about was that each specialist will guide you towards their own speciality, which they will feel is best for you. 

    Good luck but if I was you, I would read up a great deal more. Call Prostate Cancer UK or Cancer Research uk. You will get info about methods but its your decision, in the end.

     

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  • Posted

    Thank you for your comments  !  Very Helpful . My PSA was rising 4.3 .   1/18/18 .   4.6  4/18/18 .   Local Urologist said my prostrate was small so thats why PSA was not higher .  

    BIOPSY REPORT FROM DR EPSTEIN . John Hopkins

    I had 12 biopsies done on 6/5/18 . 8 out of 12 showed cancer involvement . Gleason 7

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

    comment: Perineural Invasion is identified 

    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

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    • Posted

      How are things going with you? Have you made a decision on treatment. Your PSA and Gleason scores are low enough that it seems like other treatments may work for you. I was diagnosed with adenocarcinoma over 2 years ago. PSA was 5.6 up from 4.0. My urologist / oncologist told me about several treatment options available to me. He directed me to a few websites where I could plug in my numbers to see what options were available and the success rates for each. I looked at and considered a few treatments, then found information about Brachytherapy which is low dose radiation seed implants. There are actually two types of Brachytherapy - low dose seed implants, and high dose implants where the seeds are inserted, left in for a length of time, then removed. I think that procedure is repeated 2 or 3 times in the span of a couple of days or so. I had the low dose seed implants which was done as an outpatient procedure. It took 45 minutes. A one time treatment. As with all treatments, there are side effects to deal with, this treatment seems to have few side effects and the side effects that I did have were tolerable. I am at the 2 year plus point since I had the procedure and at this point it is like nothing ever happened. I have seen the doctor every 6 months for a PSA check and a DRE. My PSA now is at 0.14. I will see him again next month. He told me that I will probably only need to see him once a year after this visit. Before you commit to surgery, check all options available to you. As someone else in this discussion said, most doctors will recommend to you what ever their specialty is... and if it is surgery, that is their recommendation. What ever you decide on, make sure that doctor has performed that procedure many times successfully. Good luck to you.
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  • Posted

    Now I realise that you are in the States. I am in the UK so saw 2 different specialists (consultants). One was Radio therapy and the other a Surgeon. You have moderate grade and a treatment would be an option. I had choices even though it is the NHS, which as you may know, is available to all. I chose Proton therapy, which is only available privately, so is costly. It's more available in the USA. Anyway, that is what the Patient site is for. Quite rare to have surgery so early, or would be here.

    Good luck!

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  • Posted

    Hmm. A troublesome PSA is one that doubles in a year or less.

    Your annual PSA was 4.3 and 3 mths later is 4.6

    Annually this is a rise 27%

    Really another PSA reading is needed to determine the change in PSA.

    "Cancers" < 3+4 are not worth bothering about.

    The worry in your post is not the 3+4 but the mention of the PNI. This means cancer cells are at the extremity

    of the prostate and may scoot away and cause problems in the future.

    If I were you, if needed, I would consider surgery in favour of radiation or hormone treatment.

    But I would wait for another PSA before going under the knife.

    And if that PSA was south of 4.92, I would reconsider any treatment in the short term

    because such a reading indicates the cancer is climbing at a rate of <27%

     

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  • Posted

    Hi Sharpcut

    One course of action is to telephone around and ask for peoples’ comments.  If you ask politely many will tell you over the phone things they would not say in an email. 

    Have you tried calling Prostate Cancer UK and other charities?

    May I ask what made you decide to go  for prostate removal instead of various treatments available?

    I may be facing the same situation and I would be grateful to learn from your experiences. 

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    • Posted

      Hi Mike .     After meeting with Dr Eastham  MSK . He told me that the problem with Radiation is It would be hard to get an accurate and reliable PSA  reading as well as the difficulty if cancer returns Surgery is much more challenging after radiation  He said most patients my age opt to remove the prostrate  ????   I understand surgeons prefer surgery    What do you think ?  I just read Charles 61038 seed implant choice and it sounded like it was very successful   !   Any ideas ??   So hard to get comfortable !   

      Thank you .  Keith

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    • Posted

      hi Sharpcut

      Sorry for late reply. Best to seek and obtain widest advice for your specific condition. i heard one leading surgeon say if i had attended certain NHS hospitals they would have recommended i have my prostate removed whereas my London based private urologist surgeons advised that my prostate cancer with Gleeson score of 3+4 is local and contained in the prostate and is highly amenable to HIFU ie high frequency ultrasound treatment which i will have next month

      So research and seeking widest opinions is always a good thing despite the temptation to not want to hear too much about it all Best of luck. Mike

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    • Posted

      I agree Mike. I had hormone treatment followed by four weeks of RT treatment. for a Gleason score of 7. two years ago. Psa has been stable at atmost zero at each test. When I was diagnosed with prostrate cancer my immediate reaction was to have the prostrate removed but at age 75 this was not considered to be the best solution. Surgery comes with its own risks of course such as the likely problem of getting erections later on.

      Cheers Richard

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