Talk Cancer

Question:

- Hide quoted text — Show quoted text – I’m scheduled for a Radical Perineal Prostatectomy on the 17th of Sept. The doc says cancer is localized and will not be removing lymph glands. Before I ask him why he is not going to even check them (laproscopicly) I would like your opinion about whether this is a good idea. Also, what about a bone scan? He’s not doing that either. I have great confidence in this doc and he comes highly recco. but I’d like this info before I ask him, so I’ll know how to react. my stats: PSA 2/95  3.1/98           NEG. DRE           free PSA 13%           Gleason 6 (highest of 5 positive, one neg biopsies) Thanks very much,Leon To summarize your staging/grading: T1c stage, grade Gleason 6, PSA 3 With this knowledge, the likelihood of bone metastasis is so low that a bone scan is not necessary.  In fact some studies have suggested that a bone scan is not needed if the PSA is below 10 (or some studies say 20…) The risk of lymph node involvement is also low (I don’t have the Partin tables in front of me, but I would guess a 1% chance or so is likely)  Therefore the extra cost/morbidity of the lymph node dissection in a case where that area would not be disturbed has been determined by your doctor to be unnecessary. I hope this helps.

Helps a lot…Thank you

Response:

– Hide quoted text — Show quoted text – I’m scheduled for a Radical Perineal Prostatectomy on the 17th of Sept. The doc says cancer is localized and will not be removing lymph glands. Before I ask him why he is not going to even check them (laproscopicly) I would like your opinion about whether this is a good idea. Also, what about a bone scan? He’s not doing that either. I have great confidence in this doc and he comes highly recco. but I’d like this info before I ask him, so I’ll know how to react. my stats: PSA 2/95  3.1/98           NEG. DRE           free PSA 13%           Gleason 6 (highest of 5 positive, one neg biopsies) Thanks very much,Leon

To summarize your staging/grading: T1c stage, grade Gleason 6, PSA 3 With this knowledge, the likelihood of bone metastasis is so low that a bone scan is not necessary.  In fact some studies have suggested that a bone scan is not needed if the PSA is below 10 (or some studies say 20…) The risk of lymph node involvement is also low (I don’t have the Partin tables in front of me, but I would guess a 1% chance or so is likely)  Therefore the extra cost/morbidity of the lymph node dissection in a case where that area would not be disturbed has been determined by your doctor to be unnecessary. I hope this helps. David L. Casey, MD Denton Urology Denton, Texas USA 209.170.56.239/den27072/ (soon to be http://www.dentonurology.com) This communication is intended to provide general information, and in no way is a substitute for face-to-face medical care. No implication of a doctor-patient relationship should be assumed by the reader. Sorry, but no questions or requests answered by private email.

Response:

I’m scheduled for a Radical Perineal Prostatectomy on the 17th of Sept. The doc says cancer is localized and will not be removing lymph glands. Before I ask him why he is not going to even check them (laproscopicly) I would like your opinion about whether this is a good idea. Also, what about a bone scan? He’s not doing that either. I have great confidence in this doc and he comes highly recco. but I’d like this info before I ask him, so I’ll know how to react. my stats: PSA 2/95  3.1/98           NEG. DRE           free PSA 13%           Gleason 6 (highest of 5 positive, one neg biopsies) Thanks very much,Leon

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