quijote's Journey with Adenocarcinoma, Prostate Cancer

Doctor Shrvastava used ultrasound guided technique for biopsy. Found out that I have T2b prostate cancer. Mostly on the left side of my prostate (5 out of 12 sections showed adenocarcinoma - all gleason 4 + 4). 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.

No other cancer found in imaging studies.

Had a bone scan an abdominal/pelvis CT. Results were negative.

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.

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. Recommended biopsy. Stayed with the second doctor since I found that the first doctor still does biopsy with an older technique (finger needle).

Consulted Dr Chen radiation oncologist. Discussed radiation treatment options including possible side effects. Need to learn more about Radiation vs Surgery to make a decision for treatment.

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.

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?

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?

Decided to have surgery at Cleveland Clinic Florida. Had robotic assisted laparoscopic prostatectomy with partial veil nerve sparring technique. Surgery went well with prompt recovery.

Adenocarcinoma Prostate Gleason 4 + 3, pT3, N0 (0 out of 19), negative surgical margins.

After surgery PSA went down to 0.

Had a bone scan an abdominal/pelvis CT. Results were negative.

Negative Bone Scan and CT after almost a year

Since after a year my PSA was still 0 and had minimal side effects, and my bone scan and CT scans were negative I decided to take care of an inguinal and an umbilical hernia. Went to see Dr Samuel Szomstein who assure me he has done this many times and should be simple surgery. Big mistake! He decided to try a new type of mesh for my umbilical hernia without my consent. At first the recovery was going well but 6 days after the surgery a sharp pain indicated that something was wrong. I called the office and went to see him inmediately. After examination he assured me that all was well despite my point that something must have change since I was doing fine and all of the sudden the pain started and there must be an assignable cause. He ignore my complaints and never mentioned that he used the experimental mesh. It turns out that it is most likely that he was trying it for the first tiem. Not only was this mesh later remove from Cleveland clinic usage but this mesh required a different procedure. Instead of doing a CT scan to rule out an obstruction due to meash adhesion, which would have been standard of care particularly because he knew that he had used something different than before, he sent me home. Needless to say I was back on the emergency room a few hours later with a serious bowel obstruction due to the adhesion of the mesh.

After CT scan confirming obstruction and naso stomach tube was placed to relieve the fluid accumulation Dr Samuel Szomstein had to do an emergency surgery to remove the mesh that he had implanted. Not only did he cause the problem but it also took over 6 month for the incision to heal with continuous suppuration. I also developed an enlarge testicle after this surgery possibly from some kind of fluid accumulation. Not only did Dr Szomstein kept secret that he used the experimental mesh for 6 month until after the incision was healed. Dr Szomstein is a very dishonest and unskilled doctor. It turns out that my complains to his boss Dr Rosenthal were ignored. I came to find out that perhaps the reason was because Dr Rosenthal was already fined but having done and incision in the wrong side of the body of a patient and he definitely wanted to stay out of trouble. I mentioned this experience here for various reasons. First because after a very successful prostate surgery Dr Szomseins mistake had tremendous impact on my quality of life. And secondly because I think that it is important that people know about unethical Doctors like Dr Samuel Szomstein.