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[jimmyNYC]

Hi - I am a 47 year old gay man with stage 1 prostate cancer. After separate consults with both a surgeon and a radiation specialist I am more confused than ever as to which route to take. The surgeon made it seem like that was absolutely the way to go. The radiation doctor was much more balanced and also as a gay man pointed out concerns to me on both sides that I should consider (none of which were explained by the surgeon or my urologist nor addressed in any of the literature I have read). I had been less concerned about the potential for erectile dysfunction as a "bottom". The radiation doctor pointed out that came with its own set of concerns. For surgery he pointed out that you are removing the prostate, which is a big part of what makes anal intercourse pleasurable (something of course I knew but hadn't connected). And for radiation (beam or seed) he said the area would be weakened and that anal intercourse should be avoided completely for 9 to 12 months to minimize side effects like rectal bleeding. On a more medical front, the surgeon warned that after surgery if cancer comes back around the area it can then be treated with radiation but that the reverse is not always true: meaning if I do radiation first and cancer comes back surgery is not always a safe option because of the impact of radiation - leaving extreme hormone treatments as the only option. If anyone has any thoughts, feedback or experiences about any of these I would greatly appreciate it. Best ~ jim

[Tall_Allen]

What the surgeon told you is "truthy" but not true. Salvage surgery is not the optimum salvage choice after radiation failure. Better choices are salvage focal brachytherapy, salvage focal ablation, or whole gland SBRT - all of which work, while not increasing side effects to the extent that salvage surgery might. I assume you have "low risk" prostate cancer (stage is just one risk factor). In that case, your odds of a lasting cure with either surgery or radiation is over 97% - so why would salvage even be a decisive factor?

If you are low risk, you are also a great candidate for active surveillance. Contrary to what you may have heard, active surveillance is an excellent choice for younger men:

pcnrv.blogspot.com/2016/08/...

About half of low risk men on active surveillance NEVER progress.

As far as sexual side effects of treatment, surgery side effects include erectile dysfunction, penile shrinkage, climacturia, Peyronie's, anorgasmia, and dysorgasmia. And of course, loss of sensation from prostate stimulation. Radiation doesn't affect the nerves, but may cause erectile dysfunction from scar tissue in the blood vessels - less of a concern in a man your age, but certainly a possibility. SBRT and HDR brachytherapy have the lowest reported rates of erectile dysfunction - 20-30%, but less in men your age. Loss of cum is certain with surgery, probable after radiation.

Take your time. There is really no rush for you to make this decision.

[Vitruviusman in reply to Tall_Allen]

tall Alan you're absolutely correct in what you say

[NEPA]

I don't have any advice for you as you are the only person that can make this important decision. I can, however, share my story and that may be helpful. Basically I was in your position (but 10 years older) about two months ago. Surgery seemed to be my best option. So I made an appointment with Dr. Lee at the University of Pennsylvania.

Before my prostate was removed my urologist found G6 cancer in 2 of 12 samples. After surgery my Gleason score was increased to a 3+4=7 and 10-25% of my prostate was involved.

While the surgery wasn't fun, it wasn't as bad as I expected. I'm now 18days post surgery and I'm getting erections! Also, my bladder control is almost normal.

Yes... sex is going to be a new and different experience... but I look forward to giving my little guy a test in about a month. As for bottoming... I'll likely wait 6weeks or 2 months, just to be sure everything is well healed.

Good luck with whatever you choose!

[Vitruviusman]

Jim call me on phone. Let me clarify some points. Sent my phon e to your email

[jakre]

Hi Jim- I had a very similar experience with the surgeon but he gave me a ton of literature to read and also explained to me that if I went to radiation route and it did not work or the cancer came back that surgery was very risky and no guarantees. Therefore, I opted for the surgery. I sure hope all goes well with you and if you do go the radiation route it works.

[Darryl Partner]

I see you are in ny. Next Monday is gay men and prostate cancer group. Http://Malecare.org/nyc

[jimmyNYC in reply to Darryl]

Thanks so much -- I will be there!!

[jimmyNYC]

Thank you to everyone who has provided their thoughts -- it is appreciated!