Prostate too big to operate?

Ventura · Regular Joined: 19 Apr 2009 Posts: 20

Hey folks,

I'm back. Some quick back history about my Dad (65 yo in otherwise good health)...

01/08 - 3.5 PSA
10/08 - 3.3
01/09 - 4.5
02/09 - 5.3 (1 week before biopsy)
02/09 - Biopsy (4/12 cores +, gleason 3+3)
05/09 - 4.5 (1 week before biopsy)
05/09 - Biopsy* (Negative)
07/09 - 5.5 (1 week before biopsy)
07/09 - Biopsy* (1/12 cores +, gleason 3+3)

*repeat biopsies were done because there was some doubt as to the results of the first biopsy in 02/09 (incorrect patient name on the report)

Anyway...we consulted with various different docs about treatment options (surgeon recommended surgery, radiation oncologist recommended radiation, and med oncologist recommended watchful waiting). All diff as I expected but what gave me pause for concern was what the med oncologist said about the surgery option...he said absolutely not because my Dad's prostate what too big. Same went for seed implants for the same reason.

I mentioned this to the surgeon and he said the med oncologist was "full of #*$@" - so to speak.

Med Onc was from NY Pres and Surgeon was from MSK.

Who do I believe? We were all set to go the route of surgery but he was really adamant against it.

Anyone ever heard of a prostate being too big to remove???

Thanks in advance!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

I never heard of "too big to remove". Even a Da Vinci procedure can remove very large prostates (up to 200 cc) (see http://www.ucof.com/disciplinesofexcellence/robotic_prostatectomy/faqs.php ) and I bet open surgery can remove much larger ones.

As for seeds, yes. Size definitely matters.

Of course, the usual caveat applies--I'm not a doctor or in other way qualified to tell you what to do.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

johnT · Senior User Joined: 27 Apr 2009 Posts: 235

Since the biopsies are all over the place I would recommend a color doppler targeted biopsy before you make any decision. It could make a difference in your treatment choice.
I agree with Replicant, there should be no problem with Surgery for a large prostate.
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Ventura · Regular Joined: 19 Apr 2009 Posts: 20

Thanks for the reply!

Replicant - Thanks as always for your quick response. I had never heard of this issue either, so I figured I should ask.

JohnT (or anyone else) - In what way can the results of a color doppler targeted biopsy impact our decision? We're visiting with the surgeon on Friday and would love to ask him about this.

johnT · Senior User Joined: 27 Apr 2009 Posts: 235

Color doppler ultrasound is used to spot tumors in the prostate by looking at areas of increased blood flow combined with a powerful ultra sound. If a suspicious aea is seen a targeted biopsy is taken of the area, rarely more than a total of 6 samples. It is much better at seeing tumors in the transition zone (interior) than any other scan.

It can identify a tumor's agresssiveness by looking at the blood flow, as agressive tumors need more blood than indolant tumors. It can also identify the precise location of any tumor and give you a good idea of the probability of having a positive margin.

The machines are expensive, over $120k so most urologists don't have them. The skill of the operator is paramount in this scan. Interventional radiologists like Fred Lee in Rochester Mi or Duke Bahn in Ventura Ca are much better at it than others, both have done over 15,000 biopsies each so experience is the key.

The color doppler can also be used as a baseline for watchful waiting as future color dopplers scan will only result in a biospsy if there is a change.

I had 2 color doppler scans and both picked up a tumor that 12 biopsies with over 150 core samples and an endo rectal MRIS had missed. It accurately located the tumor and it's volume. It also indicated that a positive margin was very unlikey if I chose surgery. It also confirmed that a G6 tumor picked up in previous biopsy was in fact not a tumor but indolant clusters. A combidex MRI 3 months later also confirmed exactly what the color doppler showed.

I've talked to several Urolgists that think the color doppler is not effective. By the way, these are the same urologists that diagonsed my PSA of 40 as being BPH instead of a G4+3 large tumor.

JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

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