Post RP: Finally elected for RP late... - Prostate Cancer N...

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Post RP

Atlantic77
Atlantic77

Finally elected for RP late January as was not possible for me to access SBRT unfortunately given my specs.

Now 2 months post RP, PSA <0.02ng/ml, no positive margins, no EPE, upgraded from a G3+4 (30%)=7 to G4(60%) +3=7 with 40% of the G4 described as cribriform. Lymph node dissection were all negative as were the SV. There was PNI found and the histology report indicates Grade 3.

Zero incontinence from the moment of catheter removal but increased urgency and frequency which has improved significantly since although nocturnal urgency can still arise.

Complete ED but signs of life stirring in the last few weeks although can be painful. Tried Cialis 5mg daily but found I was getting strange pains in my heart area so I stopped. I've been prescribed Aprostadil cream for the moment rather than injections so I'll see how that goes.

Anybody any information on the cribriform finding?

It appears to have negative prognostic value but if the RP got the whole tumor contained within the prostate gland it shouldn't be an issue, I hope.. oh yes, and the pathology report found a previously undetected G3+3=6 tumor on the other side of the prostate as well.

Hoping I got this sorted before the horse bolted..

9 Replies

Actually, drugs like Cialis (PDE-5 inhibitors) were recently proved to have less heart side effects than alprostadil. But individual cases may differ, of course.

jacc.org/doi/10.1016/j.jacc...

If Cialis caused problems, you might try Viagra or Levitra.

Good pathology report, and good continence result! Cribriform is now classified as a Gleason 4 pattern. If you have surgically removed it, it is gone.

Yes I tried Viagra and it does seem to be less troublesome although not very effective but that's not unexpected given the time required for healing post RP..

Did you have nerve-sparing surgery? Have you asked the surgeon if he managed to save them? If the nerves are left the erectile function usually returns.

Atlantic77
Atlantic77 in reply to Gemlin_

Yes it was a RALP and surgeon said both sides of nerves were spared but that they would need time to grow back as they were disturbed during surgery.

AlanMeyer
AlanMeyerModerator

Congratulations on a terrific outcome of your surgery. From what I've heard from other patients who have had surgery, "signs of life stirring" is a very positive sign. A friend of mine who had a prostatectomy at Johns Hopkins experienced "nothing" when looking at his fine looking naked wife but, over time, he had a complete return of erections. I also read a doctor's claim that his patients can continue to experience improvement for up to two years after surgery. By then, he said, they'll have already had whatever recovery they're going to get.

Knowing nothing about cribriform I looked it up and found this:

pubmed.ncbi.nlm.nih.gov/296...

Alan

Atlantic77
Atlantic77 in reply to AlanMeyer

Thank you Alan, that sounds hopeful.. Yes I saw that article about cribriform. If nothing else it makes me happy to have acted sooner rather than later.. although I did drag it out a bit...

I was a Gleason 8 ductal adenocarcinoma with focal positive margin of <2mm. 3 years out PSA remains <0.02!

Hope Springs eternal! My surgical cohort of four had same surgeon who performed same robotic procedure--- four different outcomes regarding urinary and potency issues. I got lucky and had wood the morning after the catheter was removed. My redneck girlfriend said God gave me an extra sex nerve.😀 good luck!

Hang in there on the ED.. no pun intended. It took me until six months to be able to achieve anything like an erection and that was with effort. At 12 months it was a real erection but again with effort and not long lasting. At 18 months I can get an erection with cuddling and often wake up with one. My doc notes that nerves heal very slowly. He prescribes Cialis 5mg for daily use to keep blood flowing down there and either Cialis 20mg or Viagra 50mg for use as needed the former lasting longer but being slower acting.

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