I was dx two weeks ago with adenocarcinoma of the Prostate. 4 of 12 biopsies came back positive on the rt side and one on the left was highly suspicious. My Gleason score is 7. Bone Scan and CT Scan came back normal late yesterday. My appt with the urologist is tomorrow morning and I want to be prepared. I live in a rural area of Middle Georgia and don't exactly now where I need to look for the best treatment. The Mayo clinic in Jacksonville, FL and Rochester, Minnesota keeps coming up on my searches as well as Sloan-Kettering in NY? I want a thourough second oppinion on a treatment method with the least long term sexual side effects. I am a very active father of three. My children are all very atheletic and I am very involved with them and their sports everyday. I just feel too young and healthy to have cancer but I know it doesn't work that way.
I would like to hear from you about your recommendations as fellow prostate cancer warriors on what you think is the best treatment centers and treatment methods.
The centers you named are all excellent. In fact, you can't go wrong with any National Comprehensive Cancer Network (NCCN) hospital. There are a few tertiary care centers of excellence that are not part of that group, including UCLA, USC, UF Jacksonville and the Cleveland Clinic, just to name a few. To complicate matters still further, many of the best doctors are not associated with major centers. Certain centers are known for certain specialties, such as Johns Hopkins for surgery and UW Seattle for LDR brachytherapy. You might want to narrow down your treatment preferences and then pick the right doctor at the right institution.
All of the following are appropriate for Gleason 7 and are about equally curative in the right hands:
Surgery (Robotic, Laparoscopic or Open)
LDR Brachytherapy (at certain specialty centers)
HDR Brachytherapy (not available everywhere)
CyberKnife (hypofractionated SBRT)
Pencil beam proton (not available everywhere)
CyberKnife (hypofractionated SBRT) is better in every respect to IMRT, based on the latest 5 year results. Pencil-beam proton is better in every respect to proton, based on very early results.
Having watched the results of whole gland ablative therapies, like cryo or HIFU, I would steer clear of those -- very low cure rates and high rates of side effects. I think they are only appropriate for focal or salvage therapy.
I should have mentioned that an advisable first step is to get a second opinion on your pathology report. There are some labs like Bostwick or Epstein's at Johns Hopkins that specialize in reading the biopsy results for PC only, and it can make a big difference.
You have already received some good advice. I'll add some thoughts.
Here is one excellent book to help get oriented: "Invasion of the Prostate Snatchers" (2010). There are oher good books, but this will answer some of your questions and is easy to read. An older book that is like an encyclopedia is "A Primer on Prostate Cancer" (Strum and Pogliano, rev.ed. 2005) This book hammers home the message that it is important to match the therapy to the individual patient's case, not take a broad brush approach and hope for the best.
Add MD Anderson in Texas to the ones Allen mentioned.
While I'm a long-time veteran of a challenging case of prostate cancer, an opportunity for curative therapy has opened for me, and I'm working through some similar issues. Like Allen, I have crossed HIFU off my list. There have been a number of international research studies, and the results are consistent: excellent results when success after HIFU is checked a year or two after therapy, but by the fifth year or so results are consistently well below success levels achieved with other therapies, and those discouraging success levels for HIFU seem to keep falling steadily lower as the years go by. On the other hand, some of us are still enthusiastic about HIFU.
A group of prominent physicians and researchers who concentrate on prostate cancer has produced an ongoing review of success levels of various kinds of therapy. The group is known as the Prostate Cancer Results Study Group. Based on their now published research, well-done brachytherapy (seeds) looks like an excellent choice for appropriate patients. Surgery is often an acceptable choice. Other forms of radiation, especially image guided (IG) intensity modulated radiation therapy (IMRT) also look strong. I'm personally trying to assess whether there is a true and substantial difference in success levels between well-done IG/IMRT and both seeds and the SBRT that Allen mentioned.
Thank you all for the suggestions. I have just returned from Johns Hopkins in Baltimore. I have decided to have an Open Radical Prostectomy. The Director of the Urology Department is going to perform the procedure. After speaking with him and two other local surgeons I feel like this is my best option for a cure. I had taken the past month to research and ask as many questions as I could. I couldn't have made it without the healthboards and all of your post. My wife found a great deal of support on another board years ago and highly recommended this site. My prayers are with all of you and I will post all of my details in a new thread.
I just went with da vinci radical prostatectomy..gleason 7, 6 of 12 cores positive and high volume. was able to spare nerves on right side and a week post-op, i have good sensation and some firmness...using a VED and taking cialis to keep blood flow moving to the nerves and to prevent penile scarring that would later block blood flow. Some incontinence, which is common, but generally goes away withing 6 months or so. For your surgery, I believe you are talking about Alan Partin...I had been invited to speak to him and felt he is an excellent choice for surgery, which was right for me being at T3A. (I did all the research on other options). He is considered an artist in this surgery and one of the best in the world at nerve sparing. I chose to go with a local doctor here in Cincinnati named Mark Delworth..a pioneer in the area on da vinci robotic surgery who performs 4-8 surgeries a week. I was told the skill of the surgeon is the single most important factor in regaing sexual function. I am satisfied with my choice and insurance-wise, it made sense, since Partin would have been out of network for me. Still, money isn't the main concern when you are looking at a life altering surgery! Good luck and God speed. I think you have made an excellent choice if surgery is right for you.