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Deciding between radical prostatectomy and radiation

Just been diagnosed with prostate cancer. PSA 4.0, Gleason 3+4=7,stage 2.
My urologist says surgery, my oncologist/radiologist says external beam radiation.
Are these people looking after themselves more than me?
Apparently my prostate is too large for brachytherapy.
Am currently terrified at the possible after effects of both.
Comments on the two forms of treatment as well as the afters would be appreciated.
Rob.

Re: Deciding between radical prostatectomy and radiation

Rob:
Making a treatment choice is a bit of a crap shoot. Most of us PCa warriors are aware that generally speaking urologists recommend surgery and radiologists recommend --well you know.
There is so much about you we don't know that may affect our response including your age, health,
marital status, PSA history, personal values etc. Rather than respond to your request for assistance with these sort of questions, let me suggest the following book by Bob Marckini: "You Can Beat Prostate Cancer..." His chapter on the advantages and disadvantages of several methods for treating PCa may be of particular interest to you. This book is readily available, an easy read and well worth its modest price. Although this book is nearly ten years old much of his information remains relevant.
With stage II PCa I suspect you feel considerable pressure to make your decision; even so reading Marckini's book may be time well spent.
Best wishes Don O.

Re: Deciding between radical prostatectomy and radiation

Rob; We have all been where you are right now and I don't know if anyone can honestly give you a definite answer as to what is best for you. Only you can decide that with the help of caregivers and your own research which you are doing by posting here. We have opinions and experiences to relate but know this is a crap shoot at best for anyone.
My layman's thoughts are this; Age can be a decision consideration. Younger age (sixty or less in this arena) seems to provide better results from surgery as far as side effect seriousness. "Youth" heals better and faster. Surgery gives immediate and factual results both with outcome evaluation and side effects. Surgery outcome to some degree is dependent upon surgeon skill, find an experienced one with good "reviews". Surgery leaves options for second "curative" treatment if it fails. Surgery is serious with in your face results but is tolerable to be sure. It does have a long healing period after as with most surgery. Physical examination of the gland after removal gives good indication of the anticipated success of the procedure in getting rid of the cancer and that is after all, the main goal here.
Radiation is far easier than surgery and is said to give equal results as surgery. Side effects are minimal at first but can surface much later on. Results are not as immediately conclusive as with surgery since PSA often takes a long time to reach a level point. No physical exam of the gland is possible. No second curative procedure is usually available after radiation if it fails.
There are an infinite number of things to consider and there are NO good choices. I have had both procedures and if you want, I would be very happy to exchange e-mails to answer any more specific questions you might have as you make your way through this. Just click on the (e-mail) sign at the bottom of the post here. Jon.

Re: Deciding between radical prostatectomy and radiation

Jon it sounds like you are a great authority on the subject having lived both procedures. I'm lucky in that I'm just Gleeson 6, but I know it's just a matter of time. So, if radiation fails to stop the cancer spread, removal is an option. I assume with that much time passing there is a greater chance of it spreading. We all hope for a PSA of -0- after surgery.

Rob, good luck with your journey.

Paul

Re: Deciding between radical prostatectomy and radiation

Paul; It appears by your post that you misunderstood about options after treatment.? Surgery is generally not considered a good option after radiation since it causes a lot of scar tissue that makes surgery very difficult. If having a second curative option is your choice, then surgery first is the way to go leaving radiation as a backup if the surgery fails. Jon.

Re: Deciding between radical prostatectomy and radiation

Jon, thank you for the clarification. I did not understand that at all. So even these fancy Protron, and IMART treatments cause scar tissue. With my Gleeson 6, the doc is just doing AS. I'm just a few weeks post diagnosis.
For those that choose radiation, if later decide on removal of the prostrate then a nerve sparing surgery become impossible, and perhaps not at all. Yikes!
Paul

Re: Deciding between radical prostatectomy and radiation

Rob,
Before making a decision, please get a second opinion from a doc not in your Urologists practice. Preferably from someplace like Bostwick Labs, Epstein at Johns Hopkins, MD Anderson.
That being said. My primary treatment was a radical prostatectomy da Vinci.
I have continence issues, I also have permanent ED. This is due to the nerves could not be spared.
Do you know how fast your PSA is rising? Waiting for another 1 or 2 PSA tests generally will not hurt. That way you can make a better informed decision.
If it is rapid and treatment is absolutely necessary, I personally would choose radiation. There are far fewer side effects, plus quality of life is much better with RT.

If you do choose an RP, then please remember these things. You will no longer be able to father children. You will likely suffer from incontinence for awhile. And you may well suffer from ED. This is dependent on your frame of mind AND how extensive the surgery has to be. They won't know this until the surgeon gets in there and sees what he is up against. My surgeon had over 500 da Vinci procedures, he said average length of surgery was 3 hours. Mine was 5 hours due to the spread of my cancer.

Re: Deciding between radical prostatectomy and radiation

Rob -- i would not get in a rush to do anything right now--i was diagnosed with same gleason as your almost 15 yrs ago now and have done very little medically --hormone blockers off and on --i had a friend that was diagnosed less than a yr ago --went to Germany and had a so called expert on a certain surgery--his psa went to 0 and stayed that way less than 6 months -he had major problems with blood clotting off and on after less then 1 yr from diagnosis he through a blood clot and died-- he was 64 years old..with a gleason 7 your in no real danger for many yrs.. James

Re: Deciding between radical prostatectomy and radiation

Rob:
I was initially diagnosed 8 years ago (psa 4.1 GLeason 3+4) Because I was young(er) (56) then my onco recommended action - if I'd been older, he'd have suggested AS. I looked at all the possibilities and having just remarried, opted for ADT + HD Brachy + Low dose EBRT. All was good for 7 years, then my PSA started rising again.
With the benefit of hindsight, I would either have done nothing, or exactly the same thing. FOr me, RP was too drastic. As I've now got biomechanical recurrence I can still choose RP (though, as others have said, the side effects would be grim) or further radiation, or ADT, or something else (I'm investigating more novel immunotherapies).

Don't rush into treatment. Take your time, and when you do decide, commit to having NO REGRETS with the outcome! We make the best choice we can, for ourselves and for our loved ones. I was told I wad an 85% chance of being disease-free after 10 years. I almost made it, but I am grateful for those 7 years with no incontinence, reduced ED, and not thinking about PCa constantly!

Re: Deciding between radical prostatectomy and radiation

David:
While there are substantial differences in our PCa histories there are enough similarities that it may be mutually beneficial to correspond with one another. To get started have a look at my on-line journal; see http:/protondon.blogspot.com/ I suggest you begin with the entry titled "To My Family, Friends and Cyberspace Buddies".
If you agree a further exchange of ideas is indicated, we should probably switch over to e-mail rather than further clutter up Rod's thread.
Regards Don O.

Re: Deciding between radical prostatectomy and radiation

Hi Folks,
A little more background to myself beyond that in my opening post. I am 72, married, my wife is 70. I was in good health, reasonably fit, cycled regularly and had a routine exercise program.
Following my opening post I consulted various medicos and got various opinions. After much reading it became obvious that my wife and I would have to make our own decision. And so we decided that a radical prostatectomy would be the path we would follow. Our reasons were that because I was fit and healthy a total removal of the cancer could give me many more years of life, where radiotherapy might reduce those years, albeit possibly with a better quality of life in the shorter term. And of course because I was fit and healthy I would soon overcome the side effects of RP, wouldn't I?
So on Feb 14 (Valentines Day !!) I underwent surgery.
First the good news: the tumor was completely contained within the prostate, all the margins were clear as were the two lymph nodes taken and the seminal vesicle.
Then the not so good news. I suffered significant blood loss during the procedure neccessitating an iron infusion and then a blood transfusion. I then suffered three days of almost continual hiccups which almost became unbearable. After this I suffered severe constipation which took some time to rectify. In the end I was discharged from hospital on day nine, as opposed to day four which was the original plan.
Now recovering at home. The soreness is gradually declining, each day making a difference. Two issues have me concerned
. Firstly I have an acutely painful area of soreness in my right groin which I am told is due to nerve damage.
Secondly, the old bogey of incontinence. I realise it is early days yet so have to see what eventuates.
Would appreciate any comments from those who have trodden this path, especially the incontinence aspect and in particular the recovery time and what percentage of urinary control was ultimately achieved.
Rob.

Re: Deciding between radical prostatectomy and radiation

Rob--At your age in my Scientific background and a career of observation of every cancer known to man --at your age """If you could have just done nothing and you would almost assuredly died of old age and not prostate cancer"", i am sure you likely had a Gleason 6 or 7 as almost all men your age or older are diagnosed with a lower Gleason. We all have cancerous cells in our body and most people,s immune system will take care of cancerous tissue and pass it out through the elimination channels.. just because a man is diagnosed with prostate cancer does not mean he has to do anything medically or alternatively..

I do wish you the best.

James

Re: Deciding between radical prostatectomy and radiation

To Mr. Nolen and those inclined to be of the his opinion of the seriousness of prostate cancer, and anyone just looking for guidance from this site;

I hesitate to write these words but feel I must for the benefit of giving another view on the subject. I do not wish to be argumentative, so please take this in a constructive way. I am only a victim of cancer and its treatment and certainly no expert on cancer. I too was skeptical of the seriousness of this cancer when first diagnosed. I procrastinated for a year before making the decision to treat. That was another year this cancer had to mature in me and very well may have given it the head start it needed to get ahead of the point where it could be eliminated. I have never believed that I will die from this cancer and still don't but - I do know it kills and I want to make sure I don't give it a free rein to claim me as one of the unlucky few who do die from it. I am VERY skeptical of miracle cure concoctions, special diets, and yes - the ability of our immune system to fight this disease. If the immune system could cure this, none of us would be here writing about this subject. We would all be cancer free. Most of us will not die from this but who among us - when face to face with this decision - is willing to gamble our life that we won't be the one who does in the end? I have witnessed the end result of choosing not to treat this disease and it IS NOT pretty!! The case I site here had a few years of freedom and a good quality life but then things started going downhill. It was a slow process and the last two years of his life, and those lives around him, were filled with suffering and hopelessness. He gambled and lost. I don't know what his final thoughts were but mine would have been kicking myself all the way to the grave that I hadn't at least given it a fight. Be careful of listening too much to statistics. They are just numbers and odds and very seldom have much bearing on individual cases - especially with this very unpredictable disease. I could certainly still die from this cancer - or not. I may not have died from it had I never found out I had it. No one can say. I do know I hate what treatment has done to me - treatment is never an easy choice but I feel it is the right choice over gambling with a death that you might be able to avoid. When someone says 70 plus is too old to worry about treating, they are thinking you only have a few years left anyway so why bother. I plan to be around yet well into my nineties so you see, it is all about which direction you look at it from. Treatment comes with huge sacrifices but not treating is much like playing Russian roulette. Best to all! Jon.

Re: Deciding between radical prostatectomy and radiation

Hi Folks,
About time I updated on my progress.
Have just had my six month check up. Best news is my PSA is still undetectable.
I am feeling well and am back to a very similar lifestyle to pre surgery. I do find I fatigue easier than before, but my surgeon suggests that will continue to lmprove
for another six months.
Continence is good without being perfect, still have the occasional unpredictable dribble, with the unpredictability being the worst aspect. I have not worn a pad for weeks, so that gives some indication of where I am at. While of course I would like better, I am reasonably satisfied with my progress in this regard.
ED is another matter.I remain totally impotent. So far I have tried Viagra, Ciallis, and Levitra without any success. Now working my way up the dosage scale of Caverject, up to 15 now with only a trace of an erection. Most frustrating.
I would be grateful for any comments, particularly in regard to ED.
Cheers to all,
Rob.

Re: Deciding between radical prostatectomy and radiation

Rob: Congratulations on an excellent PSA six-months out! I had my prostate removed @ age 59 in mid-February 2018 and was completely continent by late May, so 3-1/2 months with a pad, though barely needed one after 3-months. Was in active surveillance for two years leading to the surgery. After a second (prostate specific) biopsy and confirmation that I did have grade 7 (PSA never worse than 6.5) I had the removal. Seconded-guessed surgery vs. radiation several times. Opted for what I felt was a better chance at a complete cure.

Had some nerve infiltration, so only had partial nerve sparing, but no other signs of a spread to lymph glands or outside the gland margins. Needless to say, I am completely impotent, at least this early on, but have pretty good orgasms even in the flaccid state...and dealing with some shortening after the rearrangement of plumbing. An OK trade-off vs. the terrible stress I was having leading up to the surgery. I had a clinical PSA of zero at the first test...very happy at this point.

I must be in the minority, judging from blogs, but I have completely rejected aftercare with the drugs etc...don't feel like dealing with the treatment or potential side effects. With a wife in menopause, and intercourse being painful, it's like what's the point and I'm not about to let her use Estrogen products with her family's history of cancer. We are still sexually active in other ways. I'm content the way things are and glad to be be six-feet above ground. I can see how many men, especially younger ones, can be frustrated by the functional changes.

I wish you continued improvement in your health and stability with that PSA.

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