Just found this group, & glad to know you are there.
I am 68, considering RP in September, based on biopsy results of April 19, ordered due to PSA rate of rise (.7 in 2015, then .8, .9, 2.1, 2.5, 3.5, 4.1 in 2021). Since biopsy, I have met with my urologist and a robotic surgeon, and liked both a great deal.
1 - biopsy summary
2 - my situation
3 - questions. Your experience & advice appreciated!
1/ Biopsy summary
“We did find intermediate grade prostate cancer on the biopsies. The volume of cancer was low-moderate, so along with the normal PSA, we have good reason to think this is a very early detected prostate cancer. So early, the PSA is technically normal for your age still. The trigger for the biopsy was the rate of rise over time.
For a man your age, we almost always recommend surgery or radiation but of course, the man always has the final word on that. The reason is, this intermediate grade cancer can be aggressive but it takes many years for the cancer to be lethal. For you, there is a 99% chance that you will be alive in 10 years if you have surgery.
Your Prostate Cancer Risk Group: Intermediate
Pre-Treatment PSA: 4.1
Your Estimated Prostate Size: 17cc
Your PSA Density (corrects PSA for size of the prostate): 0.24
Gleason Grade (from most recent prostate biopsy pathology report):
Primary Gleason Grade: 3
Secondary Gleason Grade: 4
Biopsy Gleason Sum: 7
1997 Clinical Tumor Stage: T2a
Your Prostate Biopsy Pathology Summarized Information:
Number of Positive Biopsy Cores : 4
Number of Negative Biopsy Cores: 10
Biopsy Prostate zones and amount (mm length or % involvement) of cancer identified in each location:
Right Apex: OK Left Apex: OK
Right Mid: 5mm Left Mid: 5mm
Right Base: OK Left Base: 5mm
From Memorial Sloan Kettering Cancer Center Nomograms:
- Probability of cancer-specific survival after radical prostatectomy: This number shows, as a percentage, your probability of surviving prostate cancer for 10 years following radical prostatectomy. This probability means that for every 100 patients like you, 99 will survive prostate cancer and 1 will have died from prostate cancer
10 yrs: 99%
15 yrs: 99%
- Progression-free probability after radical prostatectomy:
This number shows, as a percentage, the probability that your serum PSA level will remain undetectable (less than 0.05 ng/mL) at 5 years and that prostate cancer will not progress or recur after radical prostatectomy. This probability means that for every 100 patients like you, 88 will remain disease-free 5 years after surgery and 12 will have a progression of disease within 5 years.
5 years: 88%
10 years: 80%
Extent of Disease Probability
Organ-confined disease: 65 %
This number shows, as a percentage, the probability that the cancer will be found to be confined to the prostate gland when the prostate is removed. Men diagnosed with this clinically localized, 'organ-confined' disease have a number of treatment options available.
What this result means
A low probability of organ-confined disease does not necessarily mean that surgery cannot cure the cancer. About 50% of patients who do not have organ-confined cancer have long-term freedom from recurrence following surgery. The probability of having organ-confined prostate cancer is not equal to the probability that surgery will provide long-term freedom from recurrence, because the cancer does not have to be organ-confined to be successfully treated with surgery.
Extracapsular extension: 33%
This number shows, as a percentage, the probability of 'extracapsular extension,' meaning the probability that the cancer extends through the capsule of the prostate into the surrounding tissue.
Lymph node involvement: 3%
This number shows, as a percentage, the probability that prostate cancer has spread to the pelvic lymph nodes.
Seminal vesicle invasion:2%
This number shows, as a percentage, the probability of 'seminal vesicle invasion,' which occurs when prostate cancer has spread into the seminal vesicles - glands attached to the prostate that help to produce semen. This number shows the probability that the cancer has spread to one or both seminal vesicles.
2/ My situation
About 20 years ago, I began having urinary problems — mainly frequent urgency with about 5 seconds warning, and rising to pee about once an hour at night. QoL plummeted. Eventually diagnosed as BPH (benign prostatic hyperplasia). Flomax was useless and made me dizzy. I had laser surgery in 2008, outpatient, catheterized a few days, no problem.
Improvement was significant but not dramatic. Tamsulosin helped some. Prior to surgery, urologist neglected to discuss high likelihood of retrograde ejaculation (semen squirts into bladder, is pissed out later). No more cum was disappointing (ok, shocking), but partners were understanding. So i’ve had 13 years to get used to no cum, limited erections, diminishing libido.
Some crucial changes happened 2-3 years ago. Frustrated with near-constant “gotta go - NOW” situation, I was referred to a new urologist, who suggested a different diagnosis — overactive bladder — and prescribed trospium.
It changed my life, literally overnight. One pill a day, and I can plan for my next piss. Now I go for hours without even thinking about having to pee. Hold it 15 or 20 minutes? No problem. Now I get up at night to pee once, or not at all. I LIKE my urologist. QoL skyrocketed.
He is also the one concerned about my steadily rising PSA. Recommended biopsy. Now recommending active treatment.
Two other key elements affect my consideration.
- i’ve been partnered for 20 years, and rowdy sex has been elusive for quite a while. No big deal: he’s my guy, laughter & affection abound, he’s the one I want to curl up with when the day is done. All good. Quite unexpectedly, we got to know a hot man half our age, who has now been living with us 3 years. He sounds impossible — handsome, smart, funny, excellent cook, does heavy lifting — and horny. Older chunky guys turn him on. But he is also totally mellow and understanding. It does wonders for the ego, at 68, to be drying off from the shower & have a guy, 34, spring instant boner when he sees me naked. Without searching or planning for such an arrangement, we’ve stumbled into a life that leaves all of us happy, encouraging, no issues. I don’t take that for granted. I have lucked out to he locked down in this pandemic with these 2 amazing men. As I’m facing treatment & associated further ED challenges, I have new “motivation” to want to hang on to (or reclaim) some sexual energies. So I want to pursue the choices that will give me the optimum balance between cancer-freedom and (eventual) sexual enjoyment.
- We maintain a non-habitational presence in the San Francisco Bay Area, are there a few weeks a year for medical care & stuff, but spend most of our lives in Mexico. More about that below.
— I want this cancer gone. And I want to make smart, informed decisions. If I understand correctly, scar tissue from my prostate laser surgery 13 years ago likely complicates radiation treatments, so surgery is preferred, yes?
— RP will likely be scheduled in late September. This appeals for several reasons: pandemic management progress (I am fully vaccinated), time to get more exercise, work on Kegels, generally improve health, learn more about all this. Suggestions?
— My docs tell me that after my robot-assisted surgery in Oakland, outpatient, I will likely have pain, discomfort, catheter up to 2 weeks. No heavy lifting, but I should be good to go by a month afterward. Does this ring true? One of my concerns — though I will be able to arrange local lodging for 6 weeks or so, some assistance from friends occasionally — mostly I will be on my own during recovery. The friend I’ll be staying with is 70, immuno-compromised (transplant), and my presence ideally should be to aid her rather than the reverse. Can I drive/shop/cook post-surgery? Am I missing anything? Do I need to rethink this?
I’ve spent several hours now reading through postings here. My feelings are all over the map: touched, encouraged, alarmed, confused. Thanks in advance for support, for information & suggestions & hope. I’m glad to have found you guys. — Gary