quijote's Journey with Adenocarcinoma, Prostate Cancer

My last physical examination revealed a high out of range PSA level of 5.3. Went to an Urologists who repeated the test with a value of 5.2. Also the DRE revealed a hard area in my prostate.He recommended a biopsy. I did some research to find the best doctor in the area, Went for second opinion at the Cleveland Clinic Florida in Weston. Doctor Shrivastava confirmed nodule in prostate. Stayed with the second doctor since I found that the first doctor still does biopsy with an older technique (finger needle). Doctor Shrvastava used ultrasound guided technique. Found out that I have T2b prostate cancer. Mostly on the left side of my prostate (5 out of 12 sections showed adenocarcinoma). Expected this to happen sometime in my life since my father and uncle both had prostate cancer. In addition two of my aunts (father side) also had breast cancer. I mention the breast cancer because an Oncology from Cleveland Clinic (the one I consulted for the clinical trial) mentioned that the BRCA2 gene is genetically associated with both types of cancer.

My doctor mentioned a clinical trial for which I could be a candidate. The clinical trial compares two groups. One group will receive chemo and hormones for a period of time then had radical prostatectomy the second group will only have the surgery. Base on my current status and the possible side effects decided not to participate in the trial. Basically based on the Kuttan model I have a 15% change that I need further treatment after surgery vs a 50% (or unknown change-depending how they randomized) of having the chemo and the hormones.

Unfortunately my health insurance is from a large hospital organization and gives reasonable benefits if I use their hospitals. The best doctor that I found is in other health system. My insurance is only going to cover only 25% after a $2000 deductible. I am in the South Florida are and I am planning to be treated at the Cleveland Clinic in Weston. Has any one being treated at this place? What about other places in South Florida?

I will be consulting a third doctor in at the Memorial Sloan-Kettering Cancer Center in NYC to discuss my whole case. After that consultation will make a final decision about surgery and where to have it done. I am in the South Florida are and I am planning to be treated at the Cleveland Clinic in Weston. Has any one being treated at this place? What about other places in South Florida?

I visited Dr. Laudone at the Memorial Sloan Kettering Cancer Center in NYC. Chose this place based on their reputation and their current research. Previous to my visit I arraged to send the pathololy slides and the CT and Bone scan images for evaluation. I discussed my case with Dr. Laudone and basically arrived at the same recommendation for treatment. Given my age and clinical stage Dr. Laudone considers that the radical prostatectomy is my best choice. I learned two things from this visit. First the pathologist at MSKCC downgraded my Gleason score to a 7 in some biopsy sections. In their opinion my cancer is not as aggressive as a Gleason 8 although is not all 7. This is consistent with the opinion of a pathologist friend in Florida which also evaluated the slides. Dr. Laudone mentioned that because of their high volume the pathologist at MSKCC do almost exclusively prostate biopsis. The fact that the Gleason score was downgraded does not have an impact in my treatment. The recommendation for surgery is still the same. The second learning was that they use an MRI technique (3TMRI) as part of the tools for surgery at MSKCC. I heard about this new technique before but I was not aware that it was actually being used as part of the surgery. I am going to learn more about this technique and its potential benefits. Apparently at MSKCC the 3TMRI images assist the surgeon to perform a more precised surgery. I am on a quest now to find out what are the benefits of using this technique. This could have an impact on where I do the surgery. I will also like to talk to my Doctor in Florida to find out his opinion about this technique and if it will provide him with useful information. I would be very interested to hear of anyone's experience at the MSKCC. Particularly if you had surgery or had the 3TMRI study done at MSKCC.