Re: Prostate Surgeons or Radiation Oncologists in Seattle or Spokane, WA

September 26, 2010

Jim,

Suggest you don't pick the city of treatment first. There are a large

number of trade offs and even though you may end up being treated

locally you would be wise to at least examine all options. There is

also much

more to your decision than just picking a treatment (and a center)

especially if you are an "early detection" patient, as in that case

side

effect percentages start becoming very important. Also, if you are an

early

detection patient you may want to wait a number of months to a year to

see if your prostate cancer (PCa) is "slow

growing" This is hard for many of us to do since most have been taught

that the best way to beat cancer is to catch it early. However, it

appears that for the large majority of PCa patients a reasonable amount

of time can be taken to make sure we don't unnecessarily "jump from

the frying pan into the fire".

Individual good results are not worth much to help you to select a

treatment as

approved (10 year) U.S. treatments are estimated (see the "snapshot"

pages in

www.rcogpatients.com) to result in 46% to 87% of all

treated patients having no detectable PCa at 10 years. If you just

consider early detection PCa patients, those numbers are estimated to

range from 88% to 97%.

Average serious urinary, rectal and sexual side effects are much harder

to compare as only a few doctors/centers seem brave enough (or have the

funds) to accurately document their side effect percentages. However

some do, so based on that data: serious urinary side effects are

reported for approximately 1% to 8% of all patients; serious rectal

side effects are reported for approximately 0% to 1% of all patients;

and serious sexual side effects are reported for approximately 12% to

75% of all patients. So even though there is no silver PCa bullet

learning about your options could, on average, significantly improve in

your outcome.

Carl

JimV wrote:

I am facing the need for treatment. Would anybody be willing to

share their experience with physicians in Seattle or Spokane, WA? I'm

looking at all options, but I'm mainly thinking of open surgery,

robotic laparoscopic surgery, or seed implants.

Thanks for your help,

September 26, 2010

Jim, here's some advice from Dr. McHugh, a urologist who was diagnosed with PCA at age 52. This is how he made the decision on treatment:

It is excerpted from his book: The Decision: You biopsy shows Cancer, now what?

He writes a very interesting blog called Prostateb Diaries.

Mike

How I as a urologist made my â€œDecision.â€

Excerpt from â€ The Decisionâ€

How I made my decision

When I began the process of determining which treatment option was best for me, I had not yet formulated the â€œwho are youâ€ concept. However, I used it intuitively as I had when working through the options over the years with patients of mine. My general health was good; all options were open to me. Cure, ease of treatment, and time out of work concerns were the most important factors to me and vied for the most prominent role in my decision. The risk of impotence and incontinence associated with surgical removal did not worry me as much as the complications and unknown future complications of radiation therapy. Having performed hundreds of prostatectomies over the years and knowing how my patients have done with surgery gave me some degree of confidence about my favorable chances of retaining continence and potency. I also had confidence in the treatments necessary for the correction of these issues if they were to occur. In my

practice, the patients who did well with surgery usually did very well, without the unknowns and potential downside of radiation. The inability for those who chose radiation, and had problems, to do anything other than take medicines was a big factor in my decision. At the time of my diagnosis, I had some underlying early symptoms of an enlarged prostate, mild frequency and some decreased caliber of my urinary stream, and I knew that radiation would most probably worsen that. The fact that I was 52 played a role as well. I knew that my years at risk, figuring that I would most probably live into my 70s, would be over 20 years. This made me gravitate heavily toward what I felt was the most aggressive way to deal with the cancer. My path report was favorable in terms of Gleasonâ€™s score and volume, but my years at risk trumped this. The concern that cancer can return after radiation, not only because the cancer is outside the radiated field at the time

of treatment, but because of the potential inability of radiation to kill the cancer, played a role here. Reoccurrence of prostate cancer after radiation, if it happens, usually happens five to eight years after treatment. The potential for inadequate placement with seeds heightened my concerns regarding my years at risk because those were probably longer than the average time to reoccurrence with radiation. In the end, my decision was driven by my belief that my best chance for cure was with surgery.

Your "Decision" should be specific to you...not what the guy next door did.

Summary of my decision â€“ Now, you work through the â€œwho are you?â€ factors the same way, as I did, for your situation.

Subject: Prostate Surgeons or Radiation Oncologists in Seattle or Spokane, WATo: ProstateCancerSupport Date: Sunday, September 26, 2010, 4:33 PM

I am facing the need for treatment. Would anybody be willing to share their experience with physicians in Seattle or Spokane, WA? I'm looking at all options, but I'm mainly thinking of open surgery, robotic laparoscopic surgery, or seed implants. Thanks for your help,------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content

requires it

September 26, 2010

Dear Mike,

Thanks for sharing this information. It gives me added insights in how to make my decision. I'm very much indebted to you and the others who have responded to my posting.

Sincerely, Jim

Prostate Surgeons or Radiation Oncologists in Seattle or Spokane, WA

To: ProstateCancerSupport

Date: Sunday, September 26, 2010, 4:33 PM

I am facing the need for treatment. Would anybody be willing to share their experience with physicians in Seattle or Spokane, WA? I'm looking at all options, but I'm mainly thinking of open surgery, robotic laparoscopic surgery, or seed implants.

Thanks for your help,

------------------------------------

There are just two rules for this group

1 No Spam

2 Be kind to others

Please recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options.

Try to delete old material that is no longer applying when clicking reply

Try to change the title if the content

requires it

September 26, 2010

Dear Carl,

Thanks for sharing this information. It gives me added insights in how to make my decision. I'm very much indebted to you and the others who have responded to my posting. I was diagnosed in 2003 and have been doing the watchful waiting up to now. It looks like my cancer may be taking off, based on a big spike in PSA. But I'll certainly check out as many options as I can, consistent with the urgency of the problem. Thanks again!