Leaning towards radical prostatectomy

[gamma909]

I continue to do my research but also got additional feedback from my urological oncologist - my clinical stage T2b cancer (3+4, 2 cores out of 12) is showing up on the right side during biopsy but induration/nodules showing up on left side. He is fine with me getting additional opinions, including radiology, but is also encouraging me to get the prostate out and "see what's going on". I've noted in earlier posts that he is highly experienced and regarded. Any thoughts?

[harmoniken]

Kurt65

I had a removal in 1996. The first thing they did was give me belly shots to reduce the prostate size for easier removal, and presumably the cancer as well, then they proceeded to prep me...…...stop...…….they reduced the size of the tumour?? Isn't that what we are trying to do?

Why go any further? The PSA numbers drop, and you still have all your parts. No ED, no incontinence, sex is still possible...……….Knowing now what I didn't know then if they can reduce tumour size without removal that is where I should have gone.

I do not have a uro, or onco, never have had. 22 years out and my PSA last month was .017.

But I do have incontinence and ED whoopee...…….

harmoniken

[AlanMeyer Moderator in reply to harmoniken]

harmoniken,

I don't know what the "belly shots" were that you got, but I do know that there is no drug that is currently known to cure prostate cancer. Androgen deprivation drugs can reduce prostate size and PSA, but they eventually stop working, usually in a matter of a year or two and sometimes many years, but only very, very rarely for 22 years. Also, although they don't cause incontinence, they do cause impotence and loss of libido. If you're thinking that you made a mistake having your prostate removed I'd like to reassure you that didn't. The great majority of men live 10 years or more after an early diagnosis of PCa. But after 15 years they are dying off and after 20 the majority are dead. So you're doing well.

Kurt65,

I think it makes sense to get a second opinion from a good radiation oncologist. You're dealing with a potentially fatal illness and you want the best treatment you can get. Most insurance will certainly pay for it. Ask about how he would treat you, how the chances for a cure compare with those for surgery, and what side effects you should expect. However, having said that, I'll also say that surgery is a very good option. If the surgeon is experienced at performing radical prostatectomies and does a large number of them (not all urologists do many of this kind of operation), and if he seems competent and committed to healing his patients, he sounds like a good option.

Best of luck.

Alan

[gamma909 in reply to AlanMeyer]

Good advice - thanks.

[AlanMeyer Moderator in reply to gamma909]

I'll add one more thing that I should have said before. Although radiation and surgery have different side effects, neither one is side effect free. If a doctor tells you that almost all of his patients are free of side effects from his treatment, that counts to me as a negative for that doctor rather than a positive. You want a doctor you can trust.

For myself, I was treated with HDR brachytherapy + EBRT + Lupron. It worked and I have had no recurrence of the cancer, but I had short term side effects (difficulty urinating, frequent urination, rectal irritation, skin radiation burns, aggravated hemorrhoids) and long term effects (gradually increasing impotence.) My doctor told me in advance that I could expect some of that.

Alan

[Paulo1968 in reply to AlanMeyer]

Hi Alan,

Something you wrote made me wonder... you said that after 20 years of early diagnosis of PC most men are dead. Where do you take these statistics? On average men are diagnosed with PC when they are over 60, so it should be normal to be dead 20 years later, but what about the ones who still have 30 years of expected life?

Thanks for a feedback if you can.

Paulo

[AlanMeyer Moderator in reply to Paulo1968]

I got the information, or at least imagined that I got it, from the SEER (Surveillance, Epidemiology, and End Results) program of the U.S. National Cancer Institute. However, going back to it this morning I can't find any confirmation of my recollection. I don't know if I failed to find the tables I saw some years ago or whether the SEER program has published new, different, and more optimistic statistics, or whether my memory has betrayed me.

It seems obvious to me that the statistics have to be narrowly constructed in order to make any sense. If we say that a patient survived X years from his prostate cancer diagnosis, we have to know a lot more about what that diagnosis was before we can tell anything about the meaning of X years. What were his PSA, Stage, and Gleason scores? Was his disease local or metastatic at the time of diagnosis? If metatstatic, were the metastases nearby or distant?

We also need to know what treatment he had during the X years, if any. A man with local disease who had his prostate removed is likely to have a longer cancer specific survival than one who had no treatment. I think a lot of the published statistics are created for the purpose of figuring out whether and how much advances in diagnosis and treatment have contributed to life extension. So we might learn that men diagnosed in 1980 lived X years while men diagnosed in 2000 lived more than X years because they got more effective treatment. These statistics can help us track the advance of medicine.

When I responded to harmoniken I was thinking about men who had no treatment, other perhaps than hormone therapy, which it sounds like harmoniken had. I was also thinking of a friend who was diagnosed in 1996 with a PSA of 7.2, Gleason 3+4, and Stage T2b. He survived for some years, seeming to do very well with no treatment. When his PSA rose further and further to the point where his doctor told him that symptoms would begin soon, he went through three rounds of intermittent ADT. He died of PCa in 2014, 18 years after diagnosis.

It is true that many men have small and indolent cancers that are not likely to become dangerous. But it is also true that men diagnosed with dangerous cancers and who are not old enough to die of something else in the next 20 years, are likely to die of PCa.

Alan

[Paulo1968 in reply to AlanMeyer]

Thanks Alan, let’s hope new treatments can prolong beyond the more than x years as of the year 2018.

[ITCandy]

Treatment alternatives as in alternative treatments? Sounds scary. I agree you have time to research and determine what's best for you and you alone. Many have had their prostates removed and were cured and many had full blown mets two years after the operation. Not a choice I would want to have to make.

[Jeff85705]

I don't know your general health or age, but I opted for RALP after a similar biopsy (3+4 and Stage I pre-op), age 67 at the time. I was referred by my urologist to a clinical oncologist--prostate specialty, and then to a radiation oncologist. The clin concologist recommended in my case the RALP, the benefit being that you are rid of the cause of the cancer, the prostate can be examined during surgery by a pathologist to determine exact stage and spread--mine changed to Stage II--, and the surgeon can microscopically view the area around the prostate including lymph nodes, seminal vesicles and so forth. He said, "If I were in the same situation, I would take surgery." The rad oncologist said I was a candidate for external beam radiation, not brachytherapy due to the enlargement. I didn't want to go through weeks of radiation--dangerous in itself long-term--and still have the damned gland! Also, despite what you might hear from others, the side effects are similar for both treatments: ED (50/50) and some incontinence. Difference is immediate ED after surgery, that improves over time vs. gradual-onset ED following radiation. Or you may have little or no ED--or incontinence. Dribbling can continue, but in my case in 2 months after surgery I didn't need pads.

Anyway, bottom line: get your second and third opinions, do your due diligence of research from legit sources, avoiding "natural cures." Your doctors should have given you literature on your situation. I got "100 Questions and Answers About Prostate Cancer," a very good book, from my urologic surgeon.

Very best wishes on your journey!

[gamma909 in reply to Jeff85705]

Jeff-very helpful and we have similar circumstances. Age 65, 3+4, but T2b pre-op. I have confidence in my urological oncologist who proved information and a recommendation similar to yours and my thought process is also similar to yours. He encouraged me to get the rad oncologist opinion and I am still waiting for that appointment. I am glad to hear that your surgery went well and wish you continued good health.

[gamma909]

Thanks for the reply. I appreciate that there are many points of view on treatment and I respect everyone's opinion and the treatment decision they make. I have now read 4 books, numerous research articles, etc. There are those that tend to recommend aggressive treatment as well as those that tend to recommend conservative treatment. So, casting a wide net, getting lots of information, listening to other PCa stories, finding a doctor your trust are all important. Ultimately, it's an individual decision based on confidence rather than certainty. For me, the key test will be - "can I sleep at night knowing the decision that I've made".

[Dreamweaverman]

Hey Kurt, I have the same diagnosis. I am 51 and pretty healthy, and during my annual check-up, the doctor discovered a PSA level of 6.9, which led to a urologist, then a biopsy, then an MRI and now I am scheduled for surgery as all doctors and specialist I spoke to recommend that my prostate be removed because it is close to the edge of left side of my prostate. It seems all of this happen so quickly. Just a few weeks ago I was in the gym working out for 2 hours and now this.

[gamma909 in reply to Dreamweaverman]

Thanks for sharing - I wish you all the best and good health. From everything I've researched, the fact that you are healthy and work out will be a plus in terms of recovery. Also, if you have the discipline to work out, you should also be able to do whatever it takes to address side effects. I will meet radiation oncologist, see what his recommendation is, and then decide. In some ways, it will be a bit of relief to do all the research on treatment choices and focus research on optimal recovery.

[gamma909]

Thanks Bob - appreciate the support. My surgery is coming up in a few weeks and I, like many others who choose surgery, anxiously await the pathology report. Genomic testing indicated an aggressive form of cancer and the mpMRI showed possible ECE so it will be great to have the additional information after surgery. I wish you continued good health.