prostate cancer treatment question

I was 73 and diagnosed in 2019. Due to my wife's required care 24/7 elected to do radiation. For me bad choice. Overly aggressive radiologist toasted just about everything down there. Impotent and bowel incontinent. Cannot imagine a worse outcome.

I usually have a rule no optional medical treatments, I broke it and have paid the price.
 
I had my prostate removed in Jan. 2020. No PSA now, and can sleep thru the night. Bad thing is incontinence. I guess at almost 75, I can dream about it. The robot did the surgery, was introduced to hime just before being knocked out.
 
In 2009 had Gleason 8, three options:
1. radiation (I forget what type)
...Pro - no abdominal wound to heal or anesthesia
...Con - radiation burns tissue and after having it, later surgery if needed can't be done.

2. DaVinci robotic surgery
...Pro - small laparoscopic incisions, fast recovery, radiation and further surgery are later options if needed.
...Con - general anesthesia, can remove prostate and spare nerves controlling erection and continence, but the surgeon cannot get pathology samples of surrounding lymph glands for cancer spread check.

3. Radical prostatectomy
...Pro - Very thorough surgery, surgeon can biopsy surrounding tissue and lymph glands to check for spread, a skilled surgeon can spare erection and continence nerves while being sure of getting all cancer in the prostate area. Further surgery and radiation are open future options
...Con - general anesthesia, a 6 to 8 inch vertical wound in the abdomen with a longer recovery than DaVinci.

I chose the third one because I wanted the thorough look around, and I was in the hospital 6 days.
I did not get very good post op care from the urology floor and went home with a MRSA infection in the wound.
We got the infection cured and everything works as designed, my PSA is still zero 13 years later, and I'm glad I chose the path I took.
I still remember the feeling of relief that swept over me when my surgeon came to my bedside and said the pathology report read "clear margins, no lymph node involvement."
 
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attn: ameridaddy

Sir: Am glad your procedure went well. The DaVinci procedure/surgeon destroyed me. Doc DID cut the nerves controlling continence and erection and was literally pleased when the PSA did not lower sufficiently after the procedure: YOU NEED RADIATION!, he proclaimed. There followed eight weeks of radiation. I have suffered daily ever since, both from radiation after-effects and surgeon's poor treatment, and will continue to do so for the remainder of my life..

I would not recommend DaVinci to the OP.

Kaaskop49
Shield #5103
 
I won't recommend a treatment option. They all have advantages and disadvantages. They can all have poor outcomes. There are some guys that have great success with all of the methods. If I had a chance for a do over I'd make the same decision as before.

I was told the same as another poster, that if you get radiation first you can't get the surgery later. I had the DaVinci. Cancer in margins. That was 11 years ago. My PSA has been .02 to .03 for several years. That's low but not undetectable like I would like. Yes incontinence for a good while. Still get a little spot sometimes when straining like when lifting unless I remember to clench down first. It's not a problem other than it ticks me off. No pad needed. Otherwise I'm good. Impotence, yes, but there are solutions for that. Peak recovery does take awhile.

I had a friend die from prostate cancer last year. He didn't catch his in time.

My father has it too. That was a good 35 years ago. He went with radiation. The radiation burned him inside. He did eventually die from the prostate cancer but it did take over 20 years. I don't know if the radiation made him impotent. I didn't ask and he didn't volunteer. The radiation does cause impotence in a fair number of guys. If I'm as lucky I have at least 9 years left but hopefully more. God will decide.

Get the wife involved early. Make sure she is fully aware of what you and her will be dealing with. There are some pretty good online sources to help educate her. Counselling would be good for both of you. You will have impotence at least for awhile. Women tend to think any impotence reflects on them for some reason. You will be occupied with your own issues for a good while. Don't neglect the wife! Not all urologists are good with anything other than surgery or other urology physical issues. If he/she is weak in that department make sure to get help elsewhere.

Get a VED (vacuum erection device ) and start using it as soon as the doctor tells you it's OK. He can write a script for one so your insurance will cover it, if you get a medical grade version.

If you're at all prudish or have any pride prepare to have it stripped away by the medical professionals. Accept it and get used to it now.

I'll try to answer any questions you have here or by PM.


I'll pray for you.
 
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When I was diagnosed I we discussed all of the procedures but I was given two options. Surgery or radiation.
I know two who had the surgery, one because bowel issues ruled out radiation and one because he could not take the time for the radiation. Three who had proton beam radiation and had good results.
I chose the proton radiation. Had it done at MDAnderson.
A few side affects from the radiation but nothing serious for me. Along with that some hormone treatment. With side affects. Ten months since the last hormone treatment and there starting to fade. Nothing serious, just aggravating.
There was a little fatigue after a few radiation treatments which was normal. However, I was able to drive myself to the treatments each weekday for 39 treatments. China Virus scare so no visitors allowed.
If you do chose radiation set your appointments early. Less chance of a machine breakdown. And treatments don't take long.
Good Luck.
 
I am sorry to hear of your news growr. I think the most important factors are, age and frequency and amount when you urinate. This should be the basis of the beginning of your research and options for a direction you take for treatment. The stage you are in, plays into this as well but you have to work around the first two things. There are mens health forums that you should referance to get you up to speed on everything. Side effects, options, recovery, pro's, con's and so on.
I am 64, stage 4- PSA was 44, biopsy readings were 5's, peed 50 times a day, couldn't sleep and now I'm seven months post radical prostectomy. I am still suffering but slowly getting better with PSA of 0. and urinate normal with no leakage.This can be easy for some and unforgiving for others. Some with few side effects, some with many.
Please do your home work my friend and best wishes.
 
Friday I was diagnosed with Unfavorable Intermediate Prostate Cancer....Yes, I was overwhelmed to say the least as I have NONE of the traditional symptoms.

The two main solutions seem to be removal, and radiation treatment. I also noticed some activity in the use of laser to treat the hot cells.

There were several other options that included Hi Frequency Ultra Sound, Cyro-genic treatment and something called Proton treatment. My Urologist nixed the Ultra sound and Cyro......don't remember as to why, will call and ask tomorrow.

So, my fellow forum members that have been afflicted with this type of diagnosis, what treatment course did you elect and why?

Randy


Randy, First off let me express my sympathy for you in your diagnosis.
At the ripe old age of 53 I was diagnosed with a highly virulent case of prostate cancer. I was fortunate in that my female physician noticed the odd feeling of my prostate and sent me into one of the best urologists in Spokane who after giving me a Gleason score of 9 out of 10 told me I had about a month to decide what avenue to go down. He told me I could freeze it, nuke it, watch and wait, etc. I asked him what he would do and he told me that he was a surgeon and had done hundreds of removals. The disadvantage of a prostatectomy is the inability to obtain a normal erection or truly anything approaching what I would call a pre-surgery erection. The advantage is that once it is removed and the cancer is retained within the prostate its game over for the cancer getting to you later. Prostate cancer specific antigens or PSA are often found through out the body once the cancer metastases' through out your system. It tends to settle in the bone or lymph glands, hence the reason guys that do not get an annual handshake with their doctor end up with a back ache that will not go away. I have lost three friends that way and it ain't pretty. If you radiate it or install radioactive seeds to essentially burn it out and your PSA comes back a surgeon cannot help you because everything in the area of your prostate has been cooked and a surgeon cannot identify good from bad tissue. Freezing produces similar results that a surgeon cannot rectify on a good success ratio.
I elected to have it removed and within a week was on the table, both cut ends of the prostate were clean and I was given a good chance for survival. I have survived eighteen years this past July with a 0.0 PSA, Life is Good...I lived to see my grandkids, etc. and enjoy my retirement. I ran into my original surgeon the other day and he welcomed me into his "Rose Garden". I asked him what that meant and he said that in the years of practice the odds of survival are not great for everybody and those that survive eight years or more are technically out of the woods as far as Prostate Cancer goes. He told me years ago that if Prostate Cancer does not kill a man by the time he is 72 something else will, often tripping over the cat to get up and pee a couple times a night, etc.
The new techniques are truly amazing, I was basically gutted like a fish eighteen years ago...felt like I had an axe swung up between my legs for a month or more. Nowadays they got this thing called a Divinci Machine that puts you on a table, turns you upside down and a robot removes the gland via three small holes. A friend of mine just went through that and went for a three mile walk within a couple days, no joke...he was up and on his feet the next day. I was on a catheter for three weeks, in the hospital for three days and sore for over a couple months, had to basically learn to walk again because of the pain.
I'd still do it over again over anything else...nearly everyone I know that did not have the gland removed is dead, I mean dead, game over and quite of few months of misery, taking female hormones, bloating, crying...no thanks. One of my buddies had his backbone disintegrate after going through all that ****, they were going to give him some kind of injected concrete to support his spine....no thanks. If your PSA is still below 25 get it removed, nuff said. If you want to talk, go ahead and PM me.
 
I was 73 and diagnosed in 2019. Due to my wife's required care 24/7 elected to do radiation. For me bad choice. Overly aggressive radiologist toasted just about everything down there. Impotent and bowel incontinent. Cannot imagine a worse outcome.

I usually have a rule no optional medical treatments, I broke it and have paid the price.


Buddy, My heart goes out to you...best of luck to you and if I were a religious guy I would send a few up for you.
 
My PSA rate jumped up to around 8 at age 80. Biopsy said 18% cancer in prostate Docs said best I go into "Waiting" phase. At age 84 PSA rose to 12 and biopsy showed 44% cancer. Docs said they did not do surgical removal of prostate after age 80 and suggested Cyberknife radiation. Did that. Now 9yrs later, age 93 , PSA has been unmeasurable. Prostate's fried and cancer's gone. Side effects minimum, no problem peeing and erections good as assisted with injections. Docs think I'll make it to 100 !
 
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I had a radical prostatectomy in 2002 before they used the robot. PSA zero since then. I'm glad I had the surgery. Walking 2 miles most mornings cured some stress incontinence I developed after 17 years. Here's what I know for sure:

1. There are always surprises. (In diagnosis, outcome, or quality of life)
2. Prostate cancer can kill you. The biopsy/diagnosis is not always 100%
accurate. Even doctors minimize prostate cancer compared to diabetes
for example, but it's a serious problem requiring serious treatment.
3. Your doctor cannot guarantee an outcome.
4. Salvage surgery is named that for a reason. Better to have it initially
than to need it later.
5. Prostate cancer does not affect your shooting ability, and rotator cuff
surgery recovery is worse.

Edit…..if you have a brother, have him get a psa test.

Best of luck.
 
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Gleason score of 8. Fully 1/2 the prostate was cancerous but it was still contained within the prostate. I'm too heavy for the robotic surgery so I had no other choice but to have a radical prostatectomy. Never regretted it. PSA has been 0 since then. I'm a 10 year survivor.
 
Diagnosed last Sep and opted for the radiation instead of the other options. My urologist said no way in hades would he recommend proton therapy. Since I was 73 he said surgery also was not recommended. I had a Lupron injection in Nov before the procedure and then had the 2nd and last one in May. That lupron injection will kick your butt! I took 28 radiation treatments in Dec and Jan and PSA is really low and has stayed that way. Impotence, at least for me, did not happen so the wife and I are both happy with the results.
 
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Friday I was diagnosed with Unfavorable Intermediate Prostate Cancer....Yes, I was overwhelmed to say the least as I have NONE of the traditional symptoms.

The two main solutions seem to be removal, and radiation treatment. I also noticed some activity in the use of laser to treat the hot cells.

There were several other options that included Hi Frequency Ultra Sound, Cyro-genic treatment and something called Proton treatment. My Urologist nixed the Ultra sound and Cyro......don't remember as to why, will call and ask tomorrow.

So, my fellow forum members that have been afflicted with this type of diagnosis, what treatment course did you elect and why?

Randy
My grandfather died from prostate cancer. My father had it treated with radiation and died from other causes. Both of my brothers had radical a robotic prostatectomy and so did I. I was 58 at the time. Seventeen years later I am still here. You have more options than ever now but why fool with it. Take it out and live on...
 
Every case of prostate cancer is different. That is why there is no single best treatment. I would suggest you get a second opinion just for your own peace of mind. Consider MD Anderson in Houston.
 
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