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Mayo Clinic - Florida Opinion

Some of the below I had already posted - Sorry for duplication

Biopsy 2/11/16 by a local Urologist

Results are in my profile below - above Urologist wanted radiation and ADT -

Subsequent CT and Bone Scans were negative.

Second opinion with Urologist at Cleveland Clinic Florida - Because of current voiding issues radiation would be very hard on me. DRE Clinical 3 per him.

Met with Cleveland Clinic surgeon who would do da Vinci with possible open abdominal adhesiolysis. ( 6 ft. tall, 258 lbs. and prior upper abdominal surgery)

Third opinion at Mayo Clinic, Jacksonville, FL - Met with surgeon who advised against surgery because of potential complications/infection because of weight and prior surgery to upper abdomen. If I wanted surgery he recommended a surgeon in South Carolina who does perineal surgery. Of course, the perineal surgery does not remove the lymph nodes. Not sure that Matters?
One thing the surgeon said was that because my prostate was so small, probably because of the Avodart, the biopsy results may be over stated.

Also, met with Radiation Oncologists at Mayo - they suggested Lupron with radiation. When I told them about voiding issues and what Cleveland urologist said they suggested possible TURP prior to radiation.

So here I am with a pending surgery at Cleveland Clinic scheduled for mid May, but based upon Mayo advice am really questioning that surgery because of potential complications.

However, I really want to avoid ADT, if at all possible. If I had radiation first without Lupron and that fails, salvage surgery, especially on me, would probably not happen.

My options as I see them.
1. Proceed with Cleveland surgery
2. Opt for perineal surgery
3. Do radiation without Lupron
4. Use Lupron with radiation to follow - ( my least favorite, but may be my best option)

Any suggestions for me based upon past experiences -

Thank you,
Bobby Mac
Age: 69, 69 at PC dx, PSA 6.7 Avodart (6.7 x 2.3 = 15.5)
3rd Biopsy: 2/16 13 of 14 Positive, 2-99%, 3 were 4+4
First two biopsies negative - one previous in 2008
Was being treated for BPH for 15 or so years -
No treatment as of 3/26/16

Re: Mayo Clinic - Florida Opinion

Bobby,

I would like to suggest the idea of a laser TURP followed by EBR + hormone therapy. I had a laser TURP and it worked well with very little discomfort.

Keep in mind that your #'s would indicate that your PC is likely outside the capsule and therefore surgery would not give you a cure, so you will probably need post RP radiation and or Hormone therapy.

If you want to consider this option you should run this by your Doc's before deciding. I am not a Doc.

Fred

Re: Mayo Clinic - Florida Opinion

Fred -

Thank you - laser sounds interesting-

Thanks,
Bobby Mac

Re: Mayo Clinic - Florida Opinion

Bobby:
It sounds as if you have done a fair amount of research and consulted a variety of specialists. Accordingly you may wish to explore the following two alternatives:
--Radiation (preceded by short term ADP?) at UFPTI in Jacksonville. The targeting capability of proton therapy may not aggravate your voiding issues.
--Chemotherapy. The Compassionate Oncology Medical Group specializes in the treatment of PCa and routinely employs chemo when indicted. This Group provides volumes of material online.
Best wishes Don O.

Re: Mayo Clinic - Florida Opinion

Don -

Not sure about Proton and High Risk disease?

I did inquire at Mayo about SBRT/Cyber Knife and Oncologist does not like its high dose of radiation.

Thanks,
Bobby Mac

Re: Mayo Clinic - Florida Opinion

Bobby:

Not sure about Proton and High Risk disease?
Nor am I. If they do not think you are a suitable candidate I doubt they will accept you for treatment. Let them be the judge?

Re: Mayo Clinic - Florida Opinion

Don Oberlin
Bobby:
It sounds as if you have done a fair amount of research and consulted a variety of specialists. Accordingly you may wish to explore the following two alternatives:
--Radiation (preceded by short term ADP?) at UFPTI in Jacksonville. The targeting capability of proton therapy may not aggravate your voiding issues.
--Chemotherapy. The Compassionate Oncology Medical Group specializes in the treatment of PCa and routinely employs chemo when indicted. This Group provides volumes of material online.
Best wishes Don O.



Bobby,
If you have been to Mayo in Florida then you are close enough to get an opinion at UF Health Proton Institute. You have time for more opinions.

Re: Mayo Clinic - Florida Opinion

I met with Sylvester surgeon yesterday. He is willing to do either retropubic (open) or da Vinci surgery. He does feel that because of my prior abdominal surgery and weight he could run into problems with da Vinci.

I feel I am better with open surgery as I don't want a da Vinci surgery aborted because of prior scarring.

However, I am reading surgical margins are a bigger problem with open surgery.

Any suggestions for me as I will have to make a decision on Wednesday.

Thanks,
Bobby Mac

Re: Mayo Clinic - Florida Opinion

Biopsy slides examined by U of Miami Health - Gleason 7 (4+3) as opposed to a Gleason 8 from the first lab.

I am having surgery with UMHC on 4/20/16.

True staging will follow surgery.

Bobby Mac

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