Since it was caught early and lower grade, gave myself 'til end of 2020 to decide on a course of action. The most worrisome aspect of the testing was from the MRI, which noted the lesion "abuts capsule". That felt like a ticking clock.
Consulted with MSK surgeons and radiologist, as well as Dr. Tewari at Mt. Sinai. I settled on Dr. Eastham at MSK because, well because of a gut feeling, as well as quality of the re-hab program with Dr. Mulhall. I think Eastham, Tewari, and Coleman are all way up there in experience and number of procedures, so it comes down to going with your own instincts and rationalizations.
It's definitely a mix of feelings, as this procedure looms closer. I feel perfectly fine and am well aware of the potential side effects I am submitting to. Why would anyone do that? Well for me, I want all those cancer cells out of my body and this seems the most direct way to do it, plus it leaves open salvage treatment options.
With multiple small foci and the 1cm lesion where it is, I'm not a great candidate for focal therapy, and the docs I spoke with universally recommended surgery given my stats.
I respect everyone's personal decision process and wish all the best in their journey.
In return, good wishes accepted.
Jim
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Good luck. I had surgery with similar numbers (though there was a suggestion of EPE on pre-op MRI, which I believe would have made me unfavorable intermediate). Also at MSKCC; my surgeon was Touijer. I used to have a psychiatrist who used Eastham. I'm doing well at 2 yrs 3 months postop. Hey, given there was no EPE on postop path--I wonder who the radiologist was--maybe the same guy. I'll have to look that up.
Good luck!My husband went same path and is doing well close to 5 years out. He had his surgery with Tewari but went to MSK post surgery because of their aftercare. He has no incontinence and pretty good sexual function. Getting past the first few weeks was hard. PSA has remained at 0.1 for the last three years. But of course I still worry.
I am 73 y.o. with 50% (6/12) cores positive to higher than 80% G(4+3=7) Grade 3Unfavourable Intermediate Risk on March 2020.Had ADT (Lupron Depot 22.5 mg/12 weeks X 2 on May 2020 + Aug 2020 and VMAT-RT 3Gy X 20Fx on June 2020.
I also have a Lymphoma LNH Marginal Zone,
Chronic Renal Insufficensy,
Severed Pulmonary Emphysema and the cherry on top of the sunday, a
Severed Depression on Sertraline 100 mg.
Now my PSA is 0.03 µg/L and Testosterone <0.2nmol/L or <0.0577µg/L or <5.7684ng/dL.
I think you will be fine you have a good team once they remove it you will have a true grad of the cancer the surgery was not all that bad make sure you understand your pathology ,report ask questions had a positive margin and in six years later savage radiation
Thanks to all for taking the effort to leave an encouraging word--it meant a lot. This is an incredible community.
Surgery went well according to Dr. Eastham, sounds like nerve bundles fully preserved. Five days out is early in the recovery process but am doing well. Will report back a little ways down the road when I have more info regarding pathology and healing process. Best, Jim
Great news and that post pathology report which will be insightful. That Catheter was my worst experience, worse then anything else even surgery. After one week I cut that bubble off in the shower and everything just fell out. No need for a doctor visit. BTW, with this hunkered down pandemic I just kept the large big bag on and never changed.
After one week and getting that Catheter out life got better. The Incontinence lasted one week after and I donated all the diaper things to charity.
Give your self a few more weeks after that and work on your love life. I was surprised how it came back but its still not 100% after 4 months but the generic form of Viagra works great even at half dose. Your young so I bet you might experience the same.
In retrospect I actually thought that I should have my Prostate ripped out earlier. I am at a point where life is all but normal :-). The only hangover IMO is knowing that by my Hopkins Doc and others will tell you that I and now you have a 50/50 chance of the Cancer coming back. Even with clear margins and no signs of it etc, we still have a chance of reoccurrence.
Thanks for framing things in realistically positive light Murk. I'm glad you have maintained quality of life, and sounds like you still have more upside as you are only 4 months out. Who was your surgeon? I'm with you on the hang-over of potential recurrence, something to live with. Isn't that life? Things can change at any time, enjoy each day.
Cath to be self-removed tomorrow--man, I am ready.
Just take a day at a time, relax as you can and things should get quickly better. My Urologists is Dr. Christian Pavlovich, IMO a rock star at Hopkins. The staff there are also awesome, they so often get overlooked.
Hadn't planned on updating here so soon, but had blood drawn yesterday for PSA (which seemed kinda early). The results were already up on the MyMSK portal tonight so took a look...0.65. Felt like a gut punch, esp as post-op margins and lymph nodes were negative. Yet this looks like escape. Bone scan pathologist noted one possibly "suspicious" area on hip back in July and I should have directly asked Eastham about this pre-op.
On the other hand, nothing I can do about it this weekend other than other than continue to recover and get stronger.
Perhaps serum PSA is still washing out after 10 days and on its way down. Something to ask Dr. Eastham while waiting for next test. A PSA of .65 doesn't make sense given PROLARIS score, PSA <6, nomograms, post-surgical pathology.
Yeah my Doc said to wait 90 days after surgery for my first basic PSA Test, your body is still adapting. Then I can wait another 90 or go 120 days before next. I am doing 90 day treks, when i doubt I play offense!
Thanks Murk. Today they told me it was a scheduling mistake and they usually wait 6 weeks for residual PSA to clear. The nurse said given my case, they expect it to be undetectable. Wishing you the best, how great that you're at Hopkins.
PSA's halving time is published to be 3-3.5 days. At the 10th day after surgery, it should had decayed to roughly the 1/8 of the pre-op value. If this was 5.7, or so, 0.65 is well within what was expected.
MSK, Memorial Sloan Kettering has very high ratings so not sure what is happening to you but a second opinion could help your peace of mind. I just went for my second 90 day PSA test. I bet Tall Allen and other will recommend same maybe even when your pathology report comes have it sent for a second opinion.
When you say "Bone scan pathologist noted one possibly "suspicious" area on hip back in July" was this the full body scan? You could those results also sent out for second opinion. IMO the full body scans are not that detailed thus why they say we have a 50% chance of cancer reoccurrence. IMO don't fret, play offense talk to more people.
I hope others more informed and experienced then me chime in here.
Quick update now seven weeks out from surgery. Going to first post-op visit with Dr. Eastham tomorrow. Latest PSA is <.05, no continence issues, erection quality now gets to around 7/10 on 100mg of Sildenafil, trend is good. Very thankful for where I am at this point in recovery, and for the quality of treatment and care received from the MSK team.
The post-surgical pathology confirmed Gleason 3+4 with grade 4 being 10%, and tumor involved 10% of the prostate. Negative margins, no lymph node involvement, no ECE. The one new thing I saw on that report was "perineural invasion identified", and the staging went from T1c to T2. Guessing my odds for biochemical recurrence in coming years got a little bit worse? Will have to revisit the nomogram.
The operative report also noted "right accessory pudendal artery not preserved". Is this common? Googling that you get to read about redundant blood flow pathways into the penis and can blood vessels can be removed without a significant impact on functionality. Intend to further inquire about this area tomorrow with Eastham.
This paragraph has a few more intimate urological details, skip it if you like, but want to share so people can better make their own decisions about treatment and side effects. Months ago, I asked Dr. Eastham about the side effect of penis shrinkage during my initial consult with him, with my wild ass assumption being the urethra resection was the culprit. He waved that off an said basically its due to changes in blood flow. Maybe that's why my eye caught the "pudendal artery" notation in the report. I can verify current changes to flaccid size similar to what you might have after an intense workout when blood flood down there isn't a priority for the body. The little guy has been through some surgical (but hopefully well-managed) trauma. Hoping blood flow, as with nerve function, will improve over time, especially with rehab and lots of "attention", somewhat similar to skeletal muscle. As far as dry orgasm--check, but it's an still orgasm. Actually not completely dry, I might still emit pre-cum or urine, but the latter is minimal and seems controllable as I get more used to the nuances of this new functionality. Will update in a few months.
In the big scheme of things, I feel great that the cancer has been treated and I can get back to the gym, plan for the future, and worry about other things. I'm thankful this board exists and and for the good people here who share their knowledge and support.
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stricture surgery before radiation
Surgery coming up but I want SBRT
Surgery or Radiation? 
PATH REVIEW FROM MSK REREAD IDENTIFIES FOCAL\" EPE\" EXTRAPROSTATIC EXTENSION.
