Reasons for my decision: I made a decision based on my understanding, see below.
Radiation - no effect on urinary leakage, sexual function initially preserved but wanes for most, limited options for salvage - if cancer recurs treatment is palliative/non curative, long term radiation damage to bladder/bowel possible.
Surgery - impotent instantly and may not return at my age of 75 years, incontinence (usually temporary, but 5% of the time - long term), if cancer recurs - radiation is an option after surgery.
Histology report: Peripheral zone carcinoma — Gleason Grade 4+3=7, Grade 4 = 70%. No longer prostate confined. Specimen confined and did not extend to circumferential margins.
Continence recovery: have achieved dryness at night. Doing pelvic floor muscle endurance training every day.
Erectile function: deferred until after continence recovery.
Comments on improving progress of continence recovery are welcome.
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Hockeyforever
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From your bio I can tell that your pre-surgery PSA was low enough, so 4-5 weeks post RP you can have your initial PSA test. It will be most illuminating, one of the pros of surgery compared to irradiation. Since you were staged as high-risk, but IMO not in the higher tier of "high", monthly PSA tests after this to at least the second decimal place, will give you a far better picture on the possibility/time frame of recurrence compared to any nomogramme. Wishing you best of luck.
Regarding ED and penile rehabilitation, in addition the above, I have the following to offer from my own experience: The urologist who performed the RP, and the physician's assistant specializing in sexual function who works with him, recommended use of the VED daily beginning 8 weeks after surgery, in order to avoid loss of elasticity. Being fearful of loss of elasticity (which I believe is what made use of the VED somewhat painful the first week or so), and mindful that the VED is supposed to take the place of nocturnal erections, I have continued to use the VED at intervals of several days if we go that long between using TriMix.
Also, I’ve found that I can multi-task, shaving or flossing & brushing my teeth during VED therapy. That also helped alleviate my wife’s concern that I might be enjoying the VED therapy.
I bought a manual VED system from Encore via Amazon (scurry 2 Pack Collapsible... amazon.com/dp/B00RR5PVO6?re...) which has worked fairly well over the first ~16 months but then wore out. I bought a replacement pump unit that has lasted the ~20 months since then, but with less intensive use: I have been only releasing & re-imposing the vacuum twice each session instead of the 5-6 times previously which was per my understanding of the recommendations.
Beware of what the VED sales folks might try to push onto you: The medical group arranged for a session with a VED representative from Timm for their PTV and Osborn systems. She agreed that they would submit to my insurance the manual Osborn ErecAid Classic ($159), which appeared good enough for me. However, when their central sales rep finally followed up with me ~2 weeks later, she told me that the only device they would submit to insurance was the ~$299 system with battery-powered pump. I was especially irritated that their delay in replying to me was delaying start of its use, so I searched the web and Amazon and settled on the one described above and paid for it from my health savings account, expenditures being below the deductible limit for my high-deductible medical insurance anyway.
We are also using TriMix penile injections successfully. The recommended frequency for TriMix that I received is no more than 3 times per week, and also no more than once every 2 days. Of course, I don't enjoy the mild pain and discomfort from sticking a hypodermic needle into my dick, but for me that is a small price to pay for the ability to have intercourse. The monetary cost for me (central U.S.A.) amounts to ~7 USD/use, including the single-use syringe and needle. I have read that use of TriMix and similar entails risk of e.g. Peyronie's disease and possibly other side-effects, but I have no indication of any so far. Also, it seems like, due to e.g. scar tissue from the needle, there might be an ultimate limit to the number of injections that one could ultimately tolerate, which it seems likely to be associated with the risk of Peyrones syndrome. That is info from~3 years ago; I have been on the lookout for updated info but haven't actively searched since then.
I apologise for my late reply. Thanks for all the information on VEDs and penile injections. Your wife’s concern that you might be enjoying VED therapy was funny. The surgeon prescribed low dose viagra daily, commencing 2 weeks after surgery and continuing for 6 months. He said viagra will definitely reduce erectile dysfunction. I did some research and the theory is getting oxygenated blood into the penis reduces scar tissue and erectile dysfunction. I’ll ask about VEDs. I’m not a fan of penile injections (a coward). All the best.
The study directly compared the three approaches—surgery to remove tumors, radiation treatment, and monitoring. Most prostate cancer grows slowly, so it takes many years to look at the disease’s outcomes.
“There was no difference in prostate cancer mortality at 15 years between the groups,” Loeb said. And prostate cancer survival for all three groups was high—97 percent regardless of treatment approach. “That’s also very good news.”
The results were published Saturday in the New England Journal of Medicine and presented at a European Association of Urology conference in Milan, Italy. Britain’s National Institute for Health and Care Research paid for the research.
Men diagnosed with localized prostate cancer shouldn’t panic or rush treatment decisions, said lead author Dr. Freddie Hamdy of the University of Oxford. Instead, they should “consider carefully the possible benefits and harms caused by the treatment options.”
Thanks for wishing me good luck and for your information.
Urologist A offered a prostatectomy at the end of March 23. Prostate cancer was diagnosed by biopsy in November 22 so I thought in 4.5 months there was a risk it may get outside my prostate. I found Urologist B who offered a prostatectomy at the beginning of March 23. I accepted the offer by urologist B and a post surgery histology report confirmed cancer was no longer confined inside the prostate and was confined inside the specimen. Sixteen years ago I lost one of my three daughters, at age 21 years, to acute lymphoblastic leukaemia (ALL), commonly known as childhood leukaemia. Treatment choice was either as a child with ALL or as an adult with ALL, the former treatment being more brutal (my choice of word as a layperson). The treating doctor chose the later. After 11 months of suffering my daughter died. The treating doctor said her cancer was very aggressive and nothing more could be done. I thought to myself would the outcome had been the same had my daughter been treated as a child with leukaemia (go hard) instead of as an adult with leukaemia. I didn’t know whether my prostate cancer would grow slowly or rapidly whether I had time to delay treatment (go slow) or not (go fast) while I used up time deciding on which treatment to choose. I decided to “go fast, go hard” treating my prostate cancer. I didn’t wait until the end of March 23 and the histology report seems to justify my decision to “go fast”. I decided on a prostatectomy. Time will tell whether I made a right or wrong decision to “go hard” but “go fast, go hard” were my decisions.
I don't think there are any "right" choices in treating prostate cancer. It's just a question of picking your poison and hoping for the best. Best of luck for future health! 🦊
Would be good if you had a dick trick...... You made your bed so just lie in it and live your life...
Watch hockey on t v and have your neck and eyes checked once a month. All kidding aside... I would like to offer my dearest condolences regarding your 21 year old daughter. That really is a sad and cruel part of life. May she be chilling out with her angel group.
Tons of us have made the choice of a RPD and are glad we did. I had mine in 2002 (non robotic) and I'm still kicking at 86 years old. NEVER ever look back at your decisions and say should I have..... You can't change the past... So keep posting here and no high sticking.....
p.s. If you have any Filipino friends ask them how they would broadcast a hockey game.
Thanks for your condolences and comments j-o-h-n. I play hockey on 2 afternoons per week for most of the year. I’m counting the weeks (4 to go) before I am allowed to play again. All the best for longevity and I hope you score a ton (in cricket that’s one hundred).
I had my RALP in 2018 and am very happy with my decision. 'Just received the results of my latest uPSA and it came back <0.006 so I am delighted. I'll share a few random thoughts, maybe one or two will be helpful.
After my RP my surgeon told me in no uncertain terms, "no lifting anything over ten pounds, no sex and no exercise other than walking for six weeks from the date of surgery." When my catheter was removed, I leaked like Niagara Falls the first day. I thought I was in trouble. But, I did my kegels as directed and after a couple of weeks I was down to 1-2 pads/day. By about the 6-7 week mark I was at least 99% dry, no thought of using a pad. Please do your kegels every day and be sure you are doing them properly. I did three sets of ten, holding each rep 3-4 seconds and I did them three times a day. I still try to do a good set every day...not getting any younger. I started using the VED 5-6 weeks after surgery and my Uro directed me to use it daily. I bought a medical grade one but mostly used inexpensive ones ($25) I found online for rehab. I believe it was very helpful. I also used some Sildenafil.
I wish you the absolute best of luck going forward!
I was told "from the date of surgery no lifting anything over 5 kg and no exercise except walking for six weeks." I’ll add “no sex” even though I’m not capable of sex at this time and am certain it will not change in the next 4 weeks. On continence: in 2 weeks I’ve gone from 1-2 pads/day to 0-1 pad/day. On kegel exercises: each day I’m doing 5 sets of consecutive 10, then rest for 10 seconds between each set; and 5 sets of hold for 30 seconds, then rest for 30 seconds between each set. I have a prescription for low dose Sildenafil daily which I’ll start tomorrow. No mention of VED so I’ll ask at my next appointment.
I wish you the absolute best of luck going forward!
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A reason to have both ?
Travel during RP recovery?
Introduction from PC newbie
EBRT or Surgery. 
Treatment - radiation vs. surgery
