Prostate Cancer

It looks like you are in caring hands and that you are properly preparing yourself for the surgery.

Wishing you a great outcome!

lighterwood67 said:

Thanks for the kind words of

Thanks for the kind words of encouragement.  The only probelm I was having was nocturia.  He did stage it at T1c.  "Stage T1c Gleason 4+3=7 adenocarcinoma of the prostate (anterior transition zone tumor, left TZ and apex). High volume anterior transition zone Gleason 4+3=7 adenocarcinoma of the prostate (unfavorable intermediate risk).Excellent surgical candidate. I believe that surgery is his best option given the fact that he has such a large volume of anterior tumor. Were he to have radiation, he would have to have combinedandrogen-deprivation therapy and I frankly believe surgery has less side effect long-term than a year or 2 of ADT plus external beam. I believe he can have bilaterally nerve-sparing because his tumor is anterior."  I will update .  Again, thanks. 

Surgical side effects are far more serious and longer lasting then you think.

If you would cut off and throw away one important part of your car, do you think car will work. For cars, you can buy new part and put it in and car will be functional again. 

That is not case with guys. Surgery is damaging guys important function to control micturation and hold urine where is supposed to be and erectile function which means continuation of QoL. Of curse, Cancer control is number one priority in the first place.

Why sacrifice QoL when other excellent means of controlling cancer are available.

once damage is done, it is irreparabl e and we have to lieve with our choices.

Sugggest that you speak with specialists for various treatment options to do your due diligence.

The side effects from surgery can be greater than other treatment options.

Many men at this site are treated with SBRT, that is accomplished in 5 days or less,  that have comparable outcome to surgery with less side effects. In the case of a more aggressive cancer 4+3, the perimeter of the treatment can be enlarged to treat area immediately outside the prostate.

https://prostatecancerinfolink.net/2016/01/06/nine-year-outcomes-after-treatment-with-sbrt/

Strongly recommend that you have additional image study which may show extracapsular extension, that is if the cancer has escaped the prostate; specifically a T3 MRI (uses the best magnet in clinical use). This information is imperative to your treatment decision.

lighterwood67 said:

Quality of Life

Quality of life and Quantity of Life were considerations in making a decision to have surgery that my wife and myself have made.  My surgeon told me about other choices, if you are talking about hormone; radiation, beam, chemo.  He told me that due to the size of my tumor, I would have to have the "Full Monty" of that kind of therapy.  The doctor that told me that is a graduate of Duke University; was over the Oncology (Urology) at Levine Cancer Institute; he has over a 1000 robotic guided prostate removals.  I have talked to a few people with prostate cancer.  One elected to go with the hormone/radiation treatment at age 60.  He is 62 now.  He is what is called Stage 4 and on chemo today.  Another one had his removed and appears to be doing fine. I am 67 years old.  I was in the military for 26 years went to 2 wars.  I moved my family 15 times in 26 years. I have been retired for 4 years. My QoL revolves around my wife, children, grandchildren, and camping. You make a good point with what you say and your analogy.  My friend who is in chemo now with Stage 4 prostate cancer told me if he had it to do over again he would have had it taken out.  So my friend, we have to roll the dice.  I realise the removal comes with permament side effects, on the sexual one, my wife is awfully hard to catch.  On the incontinence one, I am already having issues with that and nocturia.  You have a great day and thanks for posting.  

LW,

I was also 4+3 after biopsy, had RARP on 11/2/16 with pelvic lymph nodes dissection and bilateral nerve sparing according to my surgeon.

Fortunately, I was downgraded to 3+4 after surgery with Ca organ contained. Since surgery, my PSA is undetectable.

I recovered continence 99% by the end of 3 months post op. I still have stress incontinece with any physical activity but I learned to live with it. I am very active person who works 50 hrs / week, excercise 3-4 times a week, walk my dog every day 2 miles distance and officiate sport games every weekend. Still use pad in my compression shorts whenever running or officiate games.

I did not have luck in recovering of my sexual function. My sexual life is non existent after surgery and when loss of penile length of 2+ inches is added to my unfortunate recovery, I totaly regret having prostate taken out.

I am very confident, RT in my case would give me way better QoL after treatment. SE 10 years down the street would not impact me same way as it is now. Wanted to be in AS but urologist did not want to accept me because of 4+3. Don’t get me wrong; I am blessed to be cancer free and hope to stay forever free but on the other side, I think I could do way better with different treatment modality. And everything happened at age of 51.

God bless you and good luck with your surgery and even better recovery.

MK

Hi Lighter,

Sounds like you have done your homework and made your choice.  Just remember that both surgery & radiation of various forms all have side effects.  If there was one treatment that had no side effects we all would have chosen that one, but there is not.  Good point on the person you know on chemo.  The reason I chose surgery is because as long as the cancer was contained I felt my chance of re-occurance was better. by removing the gland.  Most radiation side effects come later on after treament where surgery has most side effects up front that get better over time plus, I did not want unintended parts of my body(bladder,colon) exposed to excess radiation.  Radiation can make cells mutate which does not sound good to me.  Your nocturia hopefully won't get any worse after surgery.  I would get up at night maybe 2-3 times per month to pee before surgery and now almost 4 years after surgery I still get up maybe 2-3 times per month.

Hope you have a good quick recovery so you can get back to "normal".  Sounds like you have any active life and good attitude which will aid in your recovery.

Dave 3+4

surgery is a localized treatment. With extracapsular extension, cancer outside the prostate surgery will not cure. Additional treatment radiation and or hormone will be necessary. The side effects of each treatment type is cummulative.

Did you have a bone scan?

 Recommend that you strongly consider radiation plus hormone, or hormone only. Surgery will be redundant( and in your case the nerve bundles will most likely be cut to cause ED).

Contact  a medical oncologist, the very best that you can find to lead your medical team. This person will not be biased, and will be the best person to administer any hormone treatment.

Lighterwood,

You are correct that during surgery the removed tissues are given to a pathologist to be studied, with preliminary results, before the surgeon closes.  Pathologist's findings are then given to the surgeon, who can then adjust exactly what he must do.  For instance, capsular escape would likely cause him to remove many more lymph nodes than otherwise would be necessary. Also, his "positive margins" (area of non-diseeased tissue around the tumor) would likely be expanded.

Reports of migration to the bladder or other areas would likely cause even more radical expansion of the proceedure.

After the surgery you will get a full assessment of the pathologist's report. I recommend requesting a paper copy of such for future reference.

Good luch,

max