Hi everyone. The quick stuff: I'm 73, diagnosed with prostate cancer about 3 weeks ago. From what my doc has told me, I fall somewhere in the low to moderate risk range. My gut feeling is not to fool around with this. At my age, I have no problem (well, mostly) with having my prostate removed. Can those of you who have gone that route tell me about long-term effects?
I'm at the beginning.: Hi everyone... - Prostate Cancer N...
I'm at the beginning.
Written by
Pierogi73
To view profiles and participate in discussions please or .
Read more about...
36 Replies
•
my OPINION from my experience
diagnosed stage 4 with mets almost 8 years ago. No option except ADT which has done well to keep the cancer mostly not there - but the side effects and physical and life changes have been a lot, a price I am willing to pay to stay alive. I am pretty sure, from what I know from discussions here and from what I have read, given the option, I would have gone with prostatectomy
However - be sure you get a second opinion
Best
PJD
A friend of mine did ADT in conjunction with radiation 11 years ago, and he is doing well. However, he isn't one to discuss sexual side-effects, etc. While, yes, I would miss that area of my life, the FloMax I've been on has already produced strange side-effects that I could do without.
as you said, you are at the beginning - I believe that you don't have to rush a decision. You should be able to understand the options that your Doctor gives you, get a second opinion, and have a feeling of being comfortable with your decisions. There is lots and lots of information and are lots and lots of variations of treatments - which is a good thing. You should get opinions and info from reliable sources and - if you trust your Medical Care givers, let them help with the decisions. If you do not trust your Med Care Givers, find some that you do trust.
and breath ...
for low to moderate risk, lots of options. Surgery, radiation, focal ablation or just active surveillance. Take your time. Get several opinions, talk it over with any significant other (they will also be affected). I had surgery but I was younger than you. I believe there is a tendency towards radiation or other options if your older than 70 as surgery takes longer to recover. But you may be fitter than most your age. Some people decide on the basis of side effects. For surgery there will likely be some ED and a small chance of incontinence (hint: if you go this route do lots of kegals). For radiation, some ED and small chance of urinary stricture and/or bowel impacts. But everyone is different.
It's way too soon to make a decision. You are still at the "Just cut it out" stage. That may change as you investigate more. Take your time and visit with a variety of specialists. You have plenty of time to decide:
prostatecancer.news/2016/08...
You are mistaken that prostatectomy is more curative than radiation. Also, the side effects of surgery, especially incontinence, may make your life miserable:
My anecdotal case is one example of a bad surgery outcome. I had Robot Assisted RP surgery 9 months ago, the surgeon was highly rated with a large number of surgeries and both nerves were spared. Here are side effects I still have after 9 months:
Urinary urge incontinence: need to go suddenly. Need a bathroom nearby.
Stress incontinence: Like a slowly dripping faucet. The leakage rate varies with activity level. I use a pad, but always feel damp, which makes life miserable. If I change the pad, I feel damp again 30 minutes later.
ED: Last sex with wife was 2 days before the surgery. Not possible anymore, but I have only tried CIALIS.
Irritable bowels: Need to go many times a day, sometimes suddenly. Need a bathroom nearby. This is supposed to be a rare side effect of radiation and not happen for surgery.
Irregular heart beat: This started after surgery and has not gone away.
Mild pain that comes and goes in the abdomen area. It feels like the pain is coming from something internal.
Obviously, I regret my decision every day of my life. In my opinion, the possibility of a long surgery making your heart problems worse should be a consideration for you.
You should probably follow the advice of more knowledgeable people on this site over mine. I did not know about this site and others before my surgery. I followed the recommendation of the RO and Urologist to go for surgery because “I was so young” (54). I failed to do more research, failed to take my time, and failed to get second opinions. Do not make those mistakes.
A couple books:
Invasion of the Prostate Snatchers
The Key to Prostate Cancer: 30 Experts Explain 15 States of Prostate Cancer
Website with great educational videos: pcri.org/
"Cut it out" used to be the widely used response. Not now. Take your time. Educate your self, talk with urologist, medical oncologist, and a radiation oncologist.
I was a Gleason 4/5 at age 65. Said "no way" to surgery because of the high potential for long term side effects and frankly, other treatments had a higher success rate. Had ADT for 18 months, external beam radiation, and brachytherapy. That was over 1.5 years ago. Had a blood draw checkup today. PSA steady and low.
I feel great. No urinary issues. Sex still good but need the Vitamin V 😀 Listen to your chosen professionals, but it's your decision.
I was a Gleason 8 and I had surgery with an experienced surgeon who had done over 2,000 surgeries 6 years ago. No incontinence and no ED. It’s like it never happened. Surgery is an effective cure no matter what others here say!
Look at where the advances have been over the last 10 years - all in radiotherapy. When I started my journey a year ago, I thought prostatectomy. I was told by the consultant that as I was a fit 73 I was a good case for it. Subsequent research showed that the risk of recurrence and side effects were all better with RT so I went down that route. I subsequently found a friend of a friend who had had a RP with the same consultant I saw and 2 years later had hip pain and found mets there, his PC is now incurable.
If you want to cut through the noise on these boards, always look at the advice Tall Allen gives.
Hello,
if you have the common type of prostate cancer (adenocarcinoma), which is highly likely, then you have a lot of time to make the decision. Such type is one of the slowest cancers. There's no rush.
At your age I would consider radiation therapy (RT) instead of surgery. Modern RT is very good at treating prostate cancer and has less side effects than surgery.
Surgery may be better when you also have other problems like BPH (Benign prostatic hyperplasia) or some other urinary problems. But surgery has more side effects.
I was 72 when I had RP, Gleason 7. Operation was successful as I’ve been cancer free since ,but I’ve experienced stress incontinence and ED.
I strongly suggest that you look into RT thoroughly before you decide on treatment . Your quality of life depends on it. Good luck!
I've had zero side effects from RP other than not being able to ejaculate. However, even with my success you can't deny the possibilities at your age of having those side effects. Mainly, incontinence. I'd get a consult with an RO/MO that deals with PC specific RT and see what they have to say. RP is major surgery and a lot of folks overlook that detail. I've been told by more than one drx they'd rather do open heart valve replacement surgery than remove a prostate and keep nerves intact. So with RP there's an added risk of a surgeon that really isn't that good. Where pretty much all RT systems are computer controlled. Good luck to ya!
No negative long-term effects. My RP was nine years ago, age 58. My post surgery continence was and continues excellent and I recovered adequate sexual function naturally.
Careful study of multiparametric MRI findings provided confidence my cancer had not spread to critical urinary track bits - a major cause of incontinence. All the best!
I was diagnosed with Gleason 6 prostate cancer at age 74. My father died of prostate cancer so I had a Decipher test which came back high risk. Since I was very fit, I was given all the options from AS to RT to RP. After getting comments from this forum and advice from my Urologist and RO, and talking with friends who had both treatments, I decided to treat it with radiation therapy. I thought the statistics were in favor of radiation at my age. You have to realize that during surgery, the prostate is not just cleanly removed as they have to extricate it from the uretha tube by sort of shredding it out. I also felt that radiation had really evolved over the last 10 years. I'm now 9 months after treatment ended. my PSA was 4.4 when diagnosed and after the 3 month checkup it was .79. My next 6 month is coming up so we'll see how that is. My side effects were only some mild fatigue during treatment and for a few months afterward. It was mild in that I was still able to exercise fairly intensely. I also starting taking flomax since my prostate swelled temporarily due to radiation treatments. Now, I don't have any ED and my nightly trips to the bathroom have decreased from even years ago. It's now only a few times a night. All in all the radiation treatments have so far not affected my quality of life. The decisions with prostate cancer are complex and each person has unique circumstances but I feel comfortable with my decision to treat it as soon as I could with radiation. My first reaction was to cut it out, but as I read more on this forum and did research it turned out to be more nuanced in terms of what was best. Good Luck to you on your journey.
Urologists do surgery; that's why they recommend surgery first. Get a second opinion from both a MO and an RO. Take 3-6 months to gather information and then decide. Your prognosis is excellent; so take a deep breath and relax about it.
Years ago well to be exact it was 66 years ago I received my required summer reading list of 10 books prior to my freshman year of a college preparatory high school. The opening sentence/paragraph to one of those books has stayed with me all those years. “It was the best of times; it was the worst of times; it was the winter of despair; it was the Spring of hope ….”
My buddy and I entered this journey at exactly the same time with exactly the same diagnosis. He went to Mayo; I went to our local hospital. He was a “cut it out” guy; I was let’s make this as easy and as reasonable as possible to perhaps cure the cancer with minimum side effects. I am done with my treatment and going to the gym every day and driving my sports cars; he has now had RP and salvage radiation and is still suffering side effects of ADT.
The dichotomy goes on so research and make the best choice for you; Do not look back; there are no do overs.
The hidden question is do you know the novel behind my story?
You should post your biopsy results here because that will give a clearer picture. For example, if all the tumors are Gleason 6 (3+3) and you are over 70 years old, you have a wealth of options. No need to rush -- pump the brakes and set up meetings with both a surgeon and a radiation oncologist.
Man at your age ( unless you’re having problems) .I wouldn’t do anything…. How long do you think you’re gonna live anyway? What I’ve learned is that you’ll be miserable with leaking urine the rest of your life and there’s multiple complications that can result from surgery, such as having to wear a catheter for the rest of your life, leaking urine from where they hooked your urethra back together, which calls for another surgery to fix that. Remember too, that it’s the slowest growing cancer there is. Good luck.
My best advice is to get yourself into a Prostate Cancer (PCa) support group. I facilitate a couple in the SF Bay Area through the Cancer Support Community (CSC). We have groups around the country that you can find through the national office web site. You will learn a lot quickly rather than waiting for a long series of Dr. appts. This was really helpful for me. Another great resource, beyond this site, is the Prostate Cancer Research Institute (PCRI) which has an on-line staging guide to help you figure out all the medical mumbo-jumbo and sort through choices of various treatments or possible Active Surveillance. You are not alone. Find a group - many are on line, or hybrid in-person on line like ours at CSC.
The thing I'm finding very difficult is keeping in mind that we are all individuals who are likely to have somewhat different experiences with any treatment. But more and more, I realize that to a certain extent, medicine is a crap shoot, a game of probabilities. For example, 17 years ago when I was in my 50s, I came very close to a major heart attack. ( I was lucky enough to have unmistakeable symptoms with a 90% blockage.) I got three stents and life went on. But filed away was the fact that my heart disease had not gone away; it will be with me through the end. Last summer, I learned one of my stents was blocking up; I now have a stent within a stent. I had made up my mind that someday, heart disease would be the end of me. But then came the diagnosis of diabetes. I've lost weight and gotten that under control, but I've been told it will worsen as I age. Now, here comes the Big C. This one bugs me because I have seen some prolonged agonized outcomes of this disease. And while I know prostate cancer is not like an inflamed appendix, my mind wants to approach it as such. You don't need it, it could kill you, get it out! But unlike an appendix, removing it before it poisons your system is not how this works. That is very hard to wrap my mind around because I don't want it to be true. Ironically, my Mom also suffered from heart disease for decades, but it was cancer (that had supposedly been removed) that did her in. I'm sensing you do your homework, make an educated choice, and then hope for the best outcome.
I was diagnosed 6 years ago at 66, intermediate/favorable. Had RP. Was incontinent for maybe 3 months, improved. Still have to pee more frequently, but only mild annoyance. ED is significant but not absolute.
I don't regret my decision to have surgery, but I DO regret not consulting with a radiation oncologist first.
I had gradually worsening mitral regurgitation over many years, finally had robotic repair in March. My cardiac history did not interfere with my RP 6 years ago; neither did my prostate history interfere with my heart surgery.
You are concerned with side effects but RP surgery is the most invasive option with the highest risk of nasty side effects. Incontinence would be at the top of that list. After TURP surgery 10 years prior to my diagnosis I was told that RP wasn't an option, which was fine with me. I was steered toward external beam radiation but chose a different option.
You are concerned with side effects but RP surgery is the most invasive option with the highest risk of nasty side effects. Incontinence would be at the top of that list. After TURP surgery 10 years prior to my diagnosis I was told that RP wasn't an option, which was fine with me. I was steered toward external beam radiation but chose a different option. Anyway, welcome to the club none of us were thrilled to join.
i had the proton radiation. I opted out of surgery at my doctors direction due to other issues. You can read about all the options on line. Good luck. I will answer any questions i can for you but i did not have surgery. .
It's not mentioned here very often, but one significant change after a prostatectomy is the occurrence of "dry orgasms," where there is no ejaculation due to the removal of the prostate and seminal vesicles. Unfortunately, though, radiation treatments can also result in a similar outcome. 🦊
I'm already experiencing those on FloMax, coupled with the most bizarre addition – delayed ejaculation. Seriously, it's a flow of semen 20-30 minutes after orgasm. Can't say I'd miss that.
My husband had an RO at U of Washington by Dr Ellis 23 years ago. No incontinence, no impotence except while on Anti-androgen therapy. He only did that for 9 months starting about 3 months after surgery. He had 18 years of remission without additional therapy. We were both pleased with the outcomes. Dr Ellis was prepared to do a seral nerve graft (from his foot) if he couldn’t do nerve sparing surgery and fortunately didn’t need it. He was 59yo when he was diagnosed and was lymph node positive at the time of surgery.
Do careful due diligence when vetting a surgeon. The more they do, the better they get. Good luck to you.
As Allen said, you need to carefully weigh your options.
If you decide to go forward with surgery, I CANNOT overstate vetting the surgeon you use very carefully. I am an outlier, but my surgery went very wrong, and I had 2 people who swore by my surgeon. It was lifechanging for me.
I have had radiation 3 times now, and mostly they were bumps in the road. That said, my cancer was very aggressive and continues to grow. My cancer came back 20 months after surgery and then about 3 years after salvage radiation. I have not had testosterone for almost 5 years. Since I am replying, obviously I am still alive, but physically and mentally very different.
Hi Pierogi73.My husband was in near identical situation in age & risk. The initial consultation with the oncologist was pushing him down surgery direction, but he took his time, explored every option & went with LD brachytherapy. He didn't have an enlarged prostate & had 75 seeds. That was in Jan 2023. He was given the all clear in August this year. He has very little after effects (an occasional feeling of urgency when he wants to pee but controllable, ie. it's just a feeling). Absolutely nothing else. When we pushed the oncologist at initial consultation (because he said surgery would mean it's all done & dusted) about why follow up radiation may be necessary he admitted "because we don't always get it all". He's been told that if the (very rare) occasion of a new cancer we're to arise he could have top up brachytherapy. He agrees with TallAllen that the breakthroughs in modern treatments & techniques mean that surgery for PCa is no longer the go to treatment it once was. You're in the USA. We understand that brachytherapy isn't always pushed over there as it doesn't yield the profits for the professionals that surgery does.
Make sure you get good info on ALL the options. And... all the best!
My urologist has mentioned brachytherapy, both LD or HD. Really, I have to say that he is not pushing surgery; in fact, he did say it is often unwarranted. It's just hard for me not to look at prostate cancer as something I want to distance myself from, as in "Remove it!" But I live with heart disease, diabetes, high blood pressure, and the like, and should know that there are ways of minimizing risks in other ways. I guess I'm looking for quick and complete, but no option can guarantee that.
Not what you're looking for?
You may also like...
Where I'm at so far....
After a high PSA test result (26.2), an abnormal DRE and an MRI that was PIRADS-5 (high risk of...
I'm new here...
My prostate is very enlarged and I have to get up several times in the night to go to the bathroom....
I'm new here. I've been diagnosed with prostate cancer.
About a week ago, I went to NIH to have a MRI-directed targeted biopsy of my prostate. It was done...
Sperm at last
after getting radiotherapy everything still worked but with pain and no ejaculation but after...
I'm new here
I'm nearly 69, Gleason 7 (3+4), PSA 10.3, prostate normal size, the cancer appears to be isolated...
Hello, I'm new here
Newly Diagnosed high risk PCa at age 52
Best place to get a MP MRI if I am paying the bill?
NY Proton Center and Cyberknife at NYU Langone. 
