Prostatectomy: To Gut or Not to Gut?

hopeful and optimistic said:

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I'm doing acgive surveillance, and looked into focal. By the way about a year ago, there was a major discussion at the ustoo discussion site among those who were interested in this treatment. A couple of docs who practice this procedure also posted. The thread was very long, and must be very very long now, but there are probably some tibits of information.

If I understand right, you had your procedure in bore, that is, I guess a computer program attached to the MRI machine...in real time, as opposed to MRI, then locking the results into a three dimension machine such as an Artemes (it is done both ways).

Although there are more powerful MRI's, the MRI with the T3 magnet is the most powerful in clinical use. I had several with the T3 magnet, and to be honest, sometimes nothing is found and other times the cancer is found in different spots.

Doug, I do think that focal is the treatment of the future as technology advances . I really do not know if it has or has not come of age yet. I understand that one can redo the procedure, or chose another active treatment without prejudice if things go south.

At any rate, I wish you the best

hey it’s Steve what exactly is focal where can I look it up ..the last surgeon I saw said I may even be a candidate fir focal therapy ...I have a final follow up on April 18 to discuss genetic test results and make a decision based on what this top surgeon at UCSF thinks he has been at it fir 32 years and I fully trust him thanks whether it be focal cyberknife brachytherapy or even surgery at this point 

 "I don't feel they once steered me in any direction but provided info and let me decide along with my wife."

I have often mentioned that I went through five urologists, six if you count the surgeon, for the very reason CG says... I could sense they were pushing me into something that was an advantage for them .(instead of giving me options to explore and choose from), including a TURP procedure because some urologists are qualified to do TURP but not Davinci RP. 

One urologist said I would have to have open surgery because my prostate was too large for nerve sparing robotic surgery. Wrong. Antibiotics curbed the infection enough to reduce the prostate size to 250cc and then 197cc at time of biopsy and surgery respectively.  ADT to reduce the prostate size was not necessary, though it was being pushed.

I dont like being pushed into any procedure until I know all the alternatives and effects.

I am not saying targeted radiation is not the solution for some guys, but my recurring prostatitis was caused by a Staphylococcus infection. It would have required the entire 200cc prostate to be targeted. Staph is one of the worst bacterial invasions to eradicate, and each time I went on antibiotics, it would only knock it down for a while, the prostate would shrink to about 200cc, and then i could get by with Flomax and Cialis... until the next flare up which meant a visit to the ER for another catheter. 

Since I was friends with a guy who had just had an RP that year and was already recovering from side effects, RP made a lot of sense for my case. Any targeted radiation would gave to kill the entire prostate without damaging surrounding tissue, and as big as my prostate was, it was pressing up against the colon, increasing the danger of proctitis.

Yes, maybe i could have shrunk the prostate further with ADT, and could have used hydrogel to protect the colon, or any number of other safeguards... but why? I had an experienced skilled surgeon available to remove the infected prostate and I wasnt going to sire any more children.

Yes, I may be an anomaly. I am not a Davinci salesman as suggested... all treatments should be on the table. People are just too quick to condemn RP when side effects are most likely caused by inexperienced  surgeons that don't have the peculiar talent to perform Davinci surgery.  That's why all treatments should be considered. If I didnt have a highly experienced surgeon available, maybe I would have opted for something else, i dont know.

I did not see a radiologist, my urologist gave me all the particulars of all treatments, including the good and bad possible outcomes. He himself wasn't the one to do Davinci, so he was not pressuring me into it. He could do a TURP but we both knew that was the least useful procedure, and after the biopsy it was off the table anyway.

If I had stayed with one of the high pressure guys that do TURPs, they would undoubtedly have pushed me into a TURP with antibiotics for the infection. It would gave been a five or six month  temporary fix but no solution. But the last urologist and I wanted the biopsy instead of a quick fix, and let me decide on the course  of treatment. 

I am the last  person to praise urologists after the conga line of urologists and GPs giving me DREs At least I won't have to deal with that inconvenience anymore, or Foley catheters, etc.

But one thing I will admit, no urologist or GP told me about the 1-2" shrink. That's why I keep bringing it up. Even my friend didnt say anything about it... maybe its not something he wanted to talk about or he didn't care about it.  I'm not going to ask him.

Magicsparkes said:

I'm Not Condemning Surgery

Hi Dave,

Allow me to apologize if I have said anything to insinuate or imply surgery is not a good and viable option for treating prostate cancer! If my comments come across that way, then blame it on my inability to correctly communicate. The truth is I had a very positive experience with how my cancer was treated and that is something I can never apologize about. Consequently, I'm in a good place and if I can do anything to help others get here, then just try to stop me. Still, that doesn't mean my experience is the only way or even the best way. I just want to offer my support in whatever way I can, but on that note, don't even begin to think I'm dismissing your experience or successful treatment! You know how the New England Pats win the Superbowl every year? Well, here in Seattle anyway, people get tired of the Pat's and Yankees winning all the time (yes, you can call us sore losers but there is something to be said about these spoiled winners). Hopefully, I'm not coming across like a spoiled winner with my laser ablation. Personally, I consider you all PCB's (prostate cancer brothers). Sadly, we're part of a family that keeps growing and we do not need anymore brother or sisters! If cancer can't be cured can't we at least give cancer Dad a vasectomy? 

Peace, 

Doug

I read your blog, and so happy for your outcome.  Your post and title have haunted me for several days though.  We are 9 weeks out from a successful robotic nerve sparing surgery in NYC.  My husband was not gutted.  His life/our future was saved.  He is one of the lucky ones that is experiencing a remarkable recovery with very minimal side affects at 9 weeks.  (BTW - Dr. Edhaie who was heading up the ablation study at MSK was his surgeon.  Can't say enough good things about our experience at MSK over the past 6 months).   The thought that he would be "gutted" never came to his mind.  Was he worried about side affects? - absolutely.  I cringe to think if he had read your title when researching his options -it would have been another mind game to get his emotions from the "edge of the cliff" mentality when looking at his treatment options.   When you have newly diagnosed men who are researching options to treat their prostate cancer, the wording of your post is wrong in so many ways.  I'm just throwing this out there as a thought as there are men with aggressive cancers and high gleason scores who do not have an option as you did.  My husband was actually on the road to ablation treatment until his pathology was reviewed by the top pathologists in the US.  We went from a Gleason 7 to a 9 in a matter of days.   With this site being used for research and discussion on prostate cancer treatments, have you thought about re-wording your post ?