Elective prostate removal

[Madbeach]

I’m a spouse of someone with recurrent prostate cancer and I was just thinking if I were a man, I would elect to have my prostate removed even before any signs of cancer, even if I had to take out a loan or mortgage my house. If insurance would pay for prostate removal before signs of cancer, sure would save money in the long run.

[Tall_Allen]

I guess there are women who prophylactically remove their breasts and uterus. I can sort of see why Angelina Jolie did it given he genomics. You are not a man and can't predict what you would do if you were. I did meet online one man in the UK who found a doctor to give him a prostatectomy without a diagnosis of PC. I thought he was insane, and needed psychiatric help.

[dentaltwin in reply to Tall_Allen]

There's always one. Hoping the "surgeon" isn't still practicing.

[Madbeach]

We live in Madeira Beach…..thus, Mad Beach.

[Hidden]

Kind of agree with the previous replies...removing a prostate is not the same as removing breasts..it's more equivalent to a hysterectomy.

With the lasting sexual disfunction that occurs.

[Madbeach]

No worries. Kidding around is a good thing….

[Bigdo58]

As the spouse here 'Mad', would you have liked sex young (if you met your spouse youngish) with a man with a quite likely much shorter penis and issues about becoming erect?

I don't know you, but don't think you would have enjoyed and maybe not have even stayed around. Again I don't know you, but that is a likely trajectory young. Also no children naturally (accepting 'sperm harvesting' exists today), not to say you have had them!

[maley2711]

I think permanent T loss is not a good thing for men...in more ways than just sexual. I don't know if T injections would overcome the natural loss?

[Hidden in reply to maley2711]

Prostate removal not testicles.

[maley2711 in reply to Hidden]

Big OOPS from me...it was late, and I'm old!! Yes, I actually had mentioned the same thng to my Doc......why not do it if it weren't for side effects.....especially for old men who are no longer so preoccupied with sexual life?

[Lettuce231]

When would you suggest we go for operation, immediately after we have fathered our children, or when the children have flown the nest and as a married couple you might have been able to enjoy that intimacy you once had before you became Mum and Dad. Or should I wait until retirement and then just prune roses for the rest of my life.

With respect I don't think that you have much idea of what removal does to a mans body.

As a side issue, my oncologist refused to remove my prostate, declaring that would be a last resort, but I guess at this stage it makes little difference, if I was you, which I'm not.

But that's just my opinion.

Phil

[Madbeach in reply to Lettuce231]

U r right. Being a female, I am clueless about prostate removal side effects. But for me, if I were a male, I can honestly say, I’d rather suffer those side effects than be diagnosed with cancer and have to take damn pills that are so toxic to ur system and receive radiation treatments, etc. just my opinion and from the responses, my opinion isn’t favorable.

[dentaltwin in reply to Madbeach]

Are you really going to remove every organ that MAY someday become cancerous? Because that's a pretty long list.

[Lettuce231 in reply to Madbeach]

Thanks for your reply, perhaps in the future an early forecast of the most likely guys to get this might help. But removing the prostate would be very extreme, I prefer the side effects of treatment to dying from cancer.

In my case the worry is that if the prostate is removed, the cancer will spread to other parts of the body, it's already beyond the prostate.

Just another thought, if you did remove the prostate in order to avoid this cancer and the long term side effects of treatment, could you at any point guarantee that the person wouldn't get another cancer ? So where do we stop.

Plenty of guys on here have been able to tailor their medical treatment to be less aggressive towards their personal health, I have too. We all live on a knife edge.

Regards.

Phil

[Cooolone]

Not sure how the conversation veered off from the OP who clearly stated her partner has recurrent cancer! Not what the conversation had gone to, removing the prostate absent diagnosis... Just sayin!

Although I am wondering if the OP was asking a question or making a statement? In any event, her husband has the right to choose his path, even if it is to his benefit or detriment! If you two are at odds, then maybe some other intervention may be helpful, like counseling or peer group participation.

Good Luck!

[Savoy in reply to Cooolone]

Sounds to me like a statement of exasperation. I think I can see her point

[Shorter]

While I don't necessarily recommend it, I totally get what Madbeach is saying. I had significant difficulties after my surgery that made me question whether or not I wanted to live. What I got was something I did not know was even a possibility.

I could get no help from the doctors where I live. In fact, everyone kept diagnosing my problem for something it was not, no matter how much I argued. I was told I didn't understand human anatomy by more than one person, and even on this forum. My surgeon tried to get my PCP to put me on an anti depressant.

One factor that made my problem worse was the size of my prostate. If I had had the surgery before the cancer there would have been less damage afterwards. There would still have been some of the normal side effects, such as more incontinence, loss of up to an inch of length, etc., but it would have not been as devastating. I could have still performed in the bedroom and had a "normal" life. I have adult children, so that was not even an issue. I had a recurrence in late 2019 which required radiation. That limited my options somewhat.

I chose a radical surgery in Kansas City that most men would not even consider to fix my problem. I don't think the surgeons in Kansas City really believed my problem was what I told them until they opened me up. While I was in recovery one of them came out and told my wife they had never seen anyone before with what I had and that my diagnosis was correct. The surgeon told my wife that what I asked them to do was probably the only way possible to fix it.

This cancer is a beast and can cause you to give up things you can only have nightmares about. Would it make sense for some men to do it ahead of time? In my case I think it would have.

Mike

[OldVet]

But get ready for incontinence ALL THE TIME! Wish I never had it done.

[Jvaughan0]

Based on today's science, my answer is no. There is nothing elective about prostate removal. Although preventive analogies with other surgeries exist and may be valid, prostate removal causes physical changes that can be profounding damning to the male psyche in ways beyond any shallow perception of machismo.

[noahware]

I think if we ever find ways to predict well in advance 1) which men are highly likely to get PC, and 2) which men with PC are highly unlikely to get cure/remission, then many men might opt for preemptive surgery.

But most younger men, without any benefit of hindsight or such ability to predict PC likelihoods for themselves, will weigh their odds and choose to stay intact. It might be different if there was no risk of incontinence, impotence or infection.

[Union98]

I realize not everyone has the side effects of long lasting incontinence or sexual dysfunction but to take that chance when there is no way to know if it would ever be needed is not something I would ever support. I'm happy my husband did not have to have his removed as ADT side effects are bad enough . . . Personally I do not do any preventive health screening but I'm weird in that way.

[jimreilly]

I understand the logic involved here, but the significant side effects of RP (I've been there) would prevent almost all men from making such a decision. After all, for most of us men, our brains are in our penis (just joking guys, it's only part of our brain) and we hesitate to do anything that would cloud our thinking if we don't have to. Seriously, I would have considered radiation more thoroughly before I went ahead if I had had this site to help me...

[dentaltwin in reply to jimreilly]

There is an old Yiddish expression--something to the effect of "when the penis rises, the brain gets buried".

[Howard53545]

1 in 6 men get prostate cancer!

[maley2711 in reply to Howard53545]

1 in 40 die of it..that is the conundrum? 8 men are treated so that 1 actually has a longer life....all this went into USPTF thinking about PSA tests. I have learned that what I read early in my research could not be more true...the problem is overtreatment of so many men, while undertreating many others!!! At least AS is finally being recognized by more Docs!!

[RonnyBaby]

Frankly, totally illogical and a dangerous sentiment if you were MY spouse .....

[Watertower]

What's critically missing here is a clear notion of what me mean by prostatectomy. The operation suitable for prevention is quite different from what is typically needed for a man already with the disease. For him, we have to cast a wide surgical net, trying to catch every last cell.

But for prevention, suppose we get just 90% of the glandular cells inside the capsule, leaving everything outside (think nerve bundles, sphincter. etc.) largely untouched. Doesn't this reduce the chances of serious cancer ever starting? (Naively, by 90%?)

Does anyone here no what's the maximum fraction that could be cleaned out this way? What's the maximum possible by TURP?

[Timberjack69]

I had it done but you need to take into account the possibility off erectile dysfunction and/or incontinence to varying degrees. Good luck

[Cooolone]

What's really missed is the fact that despite all we supposedly know, we really don't know at all...

So cutting things out doesn't mean the cancer hasn't already seeded somewhere, and is just moving along it's merry way, waiting for some day to reveal itself! Especially with Prostate Cancer, known to be one of the slowest of the cancers except for a small percentage of patients! You could remove the prostate, sure, but the cancer cells having already made a home elsewhere and years later appear.

As a prophylactic, I don't see the benefit when considering the potential side effects, and I suffered barely none! With 1 in 6 men getting PCa and considering if your father or uncle having it predisposes you to a 75% chance of getting it yourself, this type of methodology would result in everyone having their prostate removed like tonsils were at one time! Lmao... the Horror!!!

Even when you have PCa, the decision to feed the Prostate Snatchers is not one made lightly, there are so many factors to consider, it isn't a one size fits all shoe! The side effects are well noted and not everyone can get access to those magicians that perform magic and their patients do very well (experience wins).

Many "MANY" patients do well with primary treatments other than surgery after diagnosis, some 2/3 actually... And they don't have issues later. When you factor in the average age of diagnosis vs life expectancy, sometimes patients forego treatment at all and do well too. The adage is dying "with" PCa, but not from it!

So why would just at the chance of having it, maybe, possibly, and maybe having it not so bad because it was caught early, or low risk... How this could cause one to take it out!... Ehhhhh... Just NO! I had a basil Cell Skin lesion removed... Do I remove them all (moles)?

Tried to wrap my head around this paradigm (remove without diagnosis) and no matter what angle I approach it with, it doesn't ring any bells! You cannot use your situation and retrospectively apply a what if and create artificial results from assumptions of what the outcome might be.

Good Luck!