I recently received this from Prostate Cancer News: Basically, research indicating that the related side effects make radical prostatectomy counter-indicated for Gay Men. You can read the entire article here:
It would seem that given current treatments, radical prostatectomy is or should be counterindicated for all men.
Among its often unavoidable side effects are
(a) nerve damage, even when using so-called nerve-sparing techniques
(b) unacceptably high levels of incontinence
Whose life narrative has room for running around wearing diapers? Let alone spongy erections or the cessation of penetrative sex altogether?
Why exactly are these procedures still performed?
Oh yes, Urologists (the second-highest compensated specialty in the US), need a full pipeline of easy high-profit procedures to maintain themselves in the style to which they have been accustomed.
Now, no surgery is really easy, that's why that is where the money is in Medicine.
But a prostatectomy isn't exactly heart or brain surgery. Comparatively, it's quick, easy, and profitable. You can do more in a day.
That is why the Urologists, who are the prostate cancer gatekeepers keed directing patients toward their bread and butter procedure.
But that treatment's time, in my estimation, has come and gone. For all prostate cancer patients.
It didn't make sense to me when I chose my treatment 10 years ago. It makes even less sense today.
Am I missing anything here?
Written by
cesces
To view profiles and participate in discussions please or .
Burnett1948 My Urologist missed 6 mm in 2005 I was never told why. A MRI said my PC was inside the capsule. I wasn’t even told he missed the 6 mm. I had to wait until 2011 for another Urologist to read the pathology. I had asked my operating Urologist how did the Pathology go. He told me he didn’t take one. My question do Urologists miss cancer as as mine did in 2005 these days?
My thought precisely. I could understand if an enlarged prostate is causing blockage that there may be a place for RP. But beyond that, why would anyone choose a treatment as invasive as RP when most PCa can be treated with RT with the same level of survival and much less permanent SE.One stat that I would like to see and that I believe should be made available to every man contemplating RP is: How many men who have RP are permanently cured by that procedure alone? That number should not be difficult to come up with.
I've always wondered if all that slicing and dicing and poking and jabbing releases cancer in the system. I know they take steps to enclose the prostate but how could you really know that works. But that is just me talking. I'm sure urologists have a different point of view.
Then presumably you thought about this option when multitudinous biopsies were done to confirm the diagnosis, in the risk of releasing cancer. So many men died with undetectable PCA without biopsies and surgeries and they were and are important procedures to help with diagnosis. We move forwards all the time and there are roles for all of these procedures based upon the individual and his stage in this cancer.
And how does that relate to the subject matter of RP being out of date.
Not so out of date as blood letting, but still out of date.
That you may have been led into undergoing RP in the past is not justification that it is a good decision for others going forward.
Nor does that make me a bad person for me pointing that out to others... or you a good person for attempting to recruit company for, or justify your past decisions.
I propose that you consider that the world does not revolve around you and your past decisions... and that you stay on topic: New patients making new decisions with current information.
I once asked about all the clinical trials on the robot v open procedure but couldn’t get an answer. The NHS in the UK invested millions of tax payers money in the robots and training. I have never seen evidence of that investment being needed as a result of clinical trials showing significant improved outcomes over open surgery I have often wondered about that use of public money tbh
I don't think you're missing anything. There are so many options with fewer potential side effects, and lower risk that to me it makes no sense - unless there is something VERY special about the cancer - that justifies ripping someone open and cutting it out.
I've heard the argument about secondary cancers for radiation treatments - but the number is low - about 1-1.5% - about identical to DEATH on the operating table with an RP (which is really quite a significant side-effect) which runs to 1-1.5% from numbers I was able to track down (and not easily - it isn't like they want to report this..)
IMHO - The "get it out" syndrome is really rather sad - a panic reaction with long term side-effects.
Interesting - Dr. Eugene Kwon of Mayo Clinic shows some PSMA-PET scan images that show metastasized PCa - at the site of a robotic port used to do an RP. He states that this isn't a single incident where it seems obvious that the surgery "seeded" a recurrence of the PCa. To me that is just another reason why surgery is probably not a great idea for many men given the alternatives now available for treatment.
youtu.be/81iAzYV39Gw (if it isn't this one, look at the 2nd in the video series..)
While it’s true that modern radiation is preferred over surgery, my experience with surgery is well received. I had RP in 2010 at City of Hope outside of LA by Dr. David Josephson (currently at Tower Urology). I received nerve sparing surgery using the Da Vinci robotic technique. I can still maintain reaction with penetration and any urinary incontinence issues are extremely minor.
I am not suggesting surgery for any patient, but I am suggesting that in my particular case with Dr. Josephson I am very pleased.
I was talking the statistical risks over large populations.
If mine wasn't taken out, I'd be dead now....I'd rather piss myself and never get an erection than be rotting. You can't lump everything into one box,some travel a different path.
Every case is different every diagnosis is unique to the individual… consult with more than one Doctor… and if you don’t want surgery , don’t want radiation, don’t want ADT, then we are all free to make that decision for ourselves. I had an open RP in 2016, Salvage radiation in 2020. And I am alive and I feel great and PSA is undetectable.. but that’s me 🤷🏼♂️
What about high risk men......showing similar results with radiation, but only with 18 mo of our dreaded ADT and its side effects added to those from radiation. Surgery not requiring ADT! Complicating the picture is that apparently many fewer men have a salvage procedure with initial radiation treatment....... salvage surgery is seldom done, and salvage cryotherapy , HIFU, brachy also done in small numbers compared to salvage radiation after initial surgery. Perhaps men have more "salvage " ADT after initial radiation, but can ADT actually be considered as a potentially curative local salvage option...not my understanding.
I have been unable to uncover reliable studies addressing this question? Suggestions?
Can we really believe that radiation, even with ADT, is as successful, or more successful, locally as surgery? Fewer radiation patients have local salvage after radiation, and supposedly radiation +ADT patients have long-term results similar to surgery patients who have more local salvage (radiation). Radiation patients are guaranteed the SEs of ADT, surgery patients may avoid both ADT and radiation SEs. Confusing?
I'm totally confused about what point you're making. It's probably just me..
Surgery patients certainly aren't spared the torture of ADT. A good friend - had surgery, was good for about 3 years, recurrence happened, had salvage radiation - good for another 2 years. Had another recurrence - he's now on ADT for life. They've given up on curing him and are working on keeping him alive. As far as I know - no one claims ADT alone as "curative" - it's considered palliative when used after primary treatment. When used in combination with radiation, it's a component of a treatment regime that is targeted to be curative.
Large patient population studies... Yeah...But numbers always lie! If we always follow statistics, then we surrender our individuality and personal attention in our treatment decisions!
Then the statistics will dictate, that regardless of therapy chosen, there is always risk of side effects! Bar none! We don't always make decisions based upon side effect profiles, but the effectiveness of a therapy towards the diagnosis.
Mortality and Morbidity are two separate and distinct destinations in this game, and are usually mutually exclusive!
And you cannot exclude personal experience because of statistical performance...
The internet is a funny medium... People who do well aren't online looking for answers. So it's natural that online you find negativity in a great many things, statistically speaking of course!
There is benefit to patients, in the correct setting for the use of RP. The caveat is that the BEST results are received from the BEST doctors, ie, those with the most experience! Or we all wanting to, or ready to, exclude this phenomenon?
Maybe we should discuss how many patients just go along with their Urologist suggestions, don't educate themselves, don't seek 2nd opinions, etc., because they all have just as much negative impact on a patient's choices as does their treatment decisions.
Statistically in regard to CANCER, RT and RP patients have similar results with RT edging RP slightly, and RP actually then surpassing RT post 10 years. All in all, it IS an individual decision and an INDIVIDUAL choice, but one hopefully made with a good team and expert Oncologist's in your corner at a Major Cancer Hospital of Excellence that will provide a patient with the best probable outcomes. This data was correct in 18' when I made my decision, may be different now, lol.
I chose RP, even with my adverse features, ie, ECE, PNI, SVI, IDC-p, 90% of cores (6) 4+3... I chose to be aggressive and remove the mother load with the future in mind. A simple understanding that "when" (not if), I recurred, I would know that the cancer wasn't hiding somewhere in the Prostate. Well... It worked and it didn't... It worked because I removed my prostate and recovered all function (95%) on both fronts... But it didn't because I was persistent PSA and required immediate salvage therapy of ADT & RT. Again, an advantage because chosing RT first would have made the subsequent removal of my prostate problematic.
Anyways... We are all individuals, and need to focus our team providing care to us on that very point, because medicine today gets lost in the numbers and we lose ourselves in the fog of it all. The numbers are good, and we need them, no doubt, but they should not remove the individual from the equation!!!
RP is not always ‘quick, easy and profitable’ if done well, which it often is not. The skill of the surgeon is paramount in all surgeries, none more so than RP.
When you hear from a patient that their surgeon declared their disease curable via RP alone, when it had features that clearly made it not so, that is no good.
When that RP results in positive margins and a relatively high PSA post op, which subsequently begins rising quickly, that is also no good.
When the surgeon then tells the patient not to worry about it until PSA reaches 10 or even higher, this is old medicine, practiced by a doctor who is basically incompetent. It happens all the time.
You ARE missing something. I agree with all of your concerns regarding side effects of the surgery. I live with those every day. However, your argument discounts the great psychological benefit of have "the thing" cut out of oneself. Is it rational? Not very. But it is profoundly powerful.
Thank you. I saw this already. I am a gay man. I agree with the main points of the article. I suffer from the same losses. However, the alternative radiation therapy carries its own set of side effects, including ED and loss of ejaculate.
I think your analysis is problematic. You're assuming that physicians are motivated by profit rather than patient well-being. Sure, there are some that are but the vast majority of healthcare professionals deeply care about the well-being of their patients and take this responsibility seriously. The well-being of patients is drummed into the psyche of everyone who is in healthcare. It is at the core of training and ethics.
I have to ask...why don't people similarly indict radiation oncologists? After all, radiation also can leave men with ED, incontinence and so forth.
Yes, surgery sucks and has horrible side effects. It is not right for every person or every case. But surgery also saves lives. Also, gay men and straight men are far more alike than they are different. They are humans with penises and they want their penises to work, they want to be able to ejaculate, and they don't want to drip urine. Differentiating gay men and straight men here is another example of homophobia.
It is great that research continues and progress is made regarding the treatment of prostate cancer. I think everyone hopes for treatments that will leave men without the side effects many struggle with now. Perhaps that day is close at hand. But to suggest that surgery still exists due to the profit motive of surgeons is an egregious point of view.
Thanks for listening. I'm interested in responses but please make them kind...no hate or bashing.
What say you about the research being done ? It is being led by urologists. And it is developing non-surgical approaches. So, again, placing your comments in perspective, these researchers are "guild-busting" to take your perspective. Why not laud that rather than throwing this entire group of professionals under the bus?
I agree with your analysis… I never discussed my sexuality with my urologist prior nor post surgery. My prostate cancer had absolutely no bearing on decision making in the treatment process… the disease does not make those distinctions, neither did my surgeon
Interesting discussion. All eight cores of my biopsy revealed cancer. Gleason was 4 + 3. PSA 35. Urologist laid out the options, which were definitely not extensive. It was obvious that he was strongly suggesting that RP was the only ‘real’ option, so my wife and I readily agreed, knowing full well what that meant for our sex life. There would be no nerve sparing. Life or sex? In conjunction with my oncologist the plan also included radiation and ADT post surgical recovery. We had planned to give my ‘enemy’ a solid crack right from the start. What’s that old expression…..damn the torpedoes, full speed ahead. My urologist also strongly suggested that the cancer had most likely breached the prostate capsule. During the surgery, he determined that the cancer was also in my seminal vesicles so he removed them. The surgical pathology confirmed that was the case. After seven yrs I don’t seriously regret my decision for RP although some days I do ‘wonder’ what would have happened if I had just gone with radiation and ADT. My PSA is climbing quickly so I have to return to ADT. I suspect that without RP I might not be tapping out this message. Damn the torpedoes, full speed ahead.
I started my ADT two months after my RP and then started radiation two months after ADT started. While the radiation was over a two month period, my ADT went on for two years during which time my PSA was driven down to a nadir of 0.01. Ten months after my last of eight ADT injections my PSA began a slow climb from the nadir of 0.01. F\our yrs later my PSA is now 6.53 and I will be returning to ADT. So the question that hangs out in my situation is, "what was the impact of the radiation tx, other than landing me in the hospital for 10 days with internal radiation burns?" The answer is that we don't really know for sure, however, because my PSA began to rise after the ADT drug wore off one could speculate that the radiation may not have played a significant role....rather it was the ADT that had a much larger impact. A PSMA PETscan 18 months ago revealed a single tumour/lesion in the location of where my right seminal vesicle used to be. Did the radiation miss that? All very speculative. Would I do it again?? Probably.
@MGBman - I'd really strongly suggest watching the videos I referenced from Dr. Kwon (above). He talks about cases basically the same as yours where after recurrence for a targeted spot - treatment resulted in no evidence of disease.
You don't mention how long ago your radiation treatment was done - but if it's more than 5 years - there are much better treatments (including and besides radiation) available now with less of a chance of causing side-effects. It's also possible (maybe) that you can avoid having the torture of ADT.
Hello Don. Thank you for your response. I watched the videos and they are most excellent! Dr. Kwon is a very effective speaker. As to your question, my radiation was summer 2015. As such I have had ample time to do some research so I am familiar with a number of things. I have investigated HIFU, cryotherapy, surgery, SBRT, needle directed brachytherapy, etc. Unfortunately, and for various reasons, all have been ruled out by my onco and uro. It is frustrating, but as I live in Canada, we have some medical constraints that may not exist in other countries. As Dr. Kwon said, “doctors are busy” thus SOC is the easiest path, so in my case I will be back on ADT shortly with 2nd generation drugs, chemo and Lu-177 in the future (latter not yet approved in Canada).
The problem is one of confronting reality, We may be faced with two rotten choices… die of prostate cancer and its affects on the body or live without sex… ( in many cases)
I don't see anything in your history as to your chosen path. I see multitudinous posts about other options and all of them seem focused on spreading doubt in the choices of others or make people struggling with a life threatening disease feel as if there is only one path i.e. yours. You have a bellicosity that I feel outweighs your qualifications, and everyone's path is different and there are proven scientific approaches to prostate cancer and all of us, as thinking, responsible adults will take these paths. I have faith in my urologist as well as my MO and find this site a wonderful resource from many contributors.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
New member - requesting advice for next steps - rising PSA following radical prostatectomy - decipher test score considerations
Dealing with expected incontinence after robot assisted laparoscopic radical prostatectomy
Salvage Prostatectomy
