Deciding on treatment

Hi,

Usually with external beam radiation you can only hit the area so many times and your done.  With surgery then you have the option to do radiation as a secondary treatment.  And again if radiation fails you can’t go back for more radiation.  I chose surgery as a first option and radiation if I need it later on.  I am totally recovered with the ED and wear a light pad as a security blanket. My occasional drip or two leak is very manageable for me, but that’s me. Which treatment to choose is always a “spirited “ discussion on this form but the choice is up to you.

You need to look at your test results, talk with your Urologist & Oncologist & family members based on the facts to give you the best chance for a robust recovery.  We can tell you our experiences but your choice is up to you.

Dave 3+4

Two points:

1). There are no prostate size limits if you choose high dose brachytherapy. It does not involves seeds, requires two sessions, and has very impressive results. It has been used since the 1980’s.

2) Do not be mislead by the pro-surgery talking point about “two bites of the apple”.

Sure, surgery is difficult after radiation, but, so what? Did you know that cryotherapy , HIFU, FLA, HDR-BT, and SBRT are proven salvage treatments in the event of primary radiation treatment? Now, Protons are also being tested for salvage therapy.

You stated that genetic testing was "as positive as genetic testing can be." If it was Oncotype DX testing, what were the GPS scores?  If they were less than 20, then there's very little chance of your cancer ever metastasizing.  At this point, why roll the dice on possible side effects of surgery, particularly at your age and sexual activity.  The one good thing about AS is that it is a totally reversable decision at any time.  Also, with each passing year, more and more treatment alternatives become available.  As for the yearly biopsys, I would look for a different urologist, and and if they are painful, DEFINITELY find a different one.  I had my 3rd. biopsy YESTERDAY and it was essentially painless except for about an hour's worth of mild discomfort in the perianal area afterward.

lighterwood67 said:

Spectre

Here is what is happening as far as penile shrinkage post RP.  After the prostate is removed, the part of the urethra at the very top of the penis (it’s called the membranous urethra) retracts into the pelvis, MRIs showed. Anatomically, the tissue surrounding the urethra as it travels from the bladder through the (now-removed) prostate to the tip of the penis, the membranous urethra, and the penis itself act as a single integrated structure. As a result, the shaft of the penis gets pulled up into the pelvis, too. “Slight vertical repositioning of the membranous urethra after [prostate surgery] causes changes in [penis length] over time,” the researchers wrote.

But over the next 12 months the tension in the connective tissues that hold the pelvic organs in place loosens, they explained, allowing the membranous urethra to return to its original, lower position. The penis follows.

https://www.statnews.com/2017/02/13/penis-shrinkage-prostate-cancer/

 

I wish this was true.  I don’t think I am alone in losing a significant amount of length.  I am now a year and a half post surgery and no length has returned.

eonore said:

Penis length

I wish this was true.  I don’t think I am alone in losing a significant amount of length.  I am now a year and a half post surgery and no length has returned.

"For their study, physicians at Kanazawa University School of Medicine in Japan followed 102 men who had undergone radical prostatectomy — surgery to remove the prostate — as part of cancer treatment. Using a ruler, they measured the length of each patient’s stretched penis (considered a proxy for an erect one) at room temperature while the men were lying down, before the operation and again eight times over the next two years.

Penis length was shortest 10 days after surgery, having lost an average 0.8 inch from before the operation. The larger the size of the prostate, the greater the shrinkage. But penis length “gradually recovered,” Dr. Atsushi Mizokami, a prostate cancer specialist, and his colleagues reported, until it was “not significantly different from [the] preoperative” length."

No two of us are alike.  If you say there is shrinkage and many others have also.  I personally believe you.  And folks leaning towards surgery should definitely take that as another side effect.

 Hi,

Had my robotic surgery almost five years ago and I don’t realize any difference in length.  Of course I was never that concerned about my length.  As long as my cancer is gone I don‘t care if a I lost any length.  My size is between my wife  & I and she has not complained about it.  I have always been a private person so I don’t go walking around locker rooms with my member on display.  You guys keep talking about this like its a big problem, yeah maybe if your a porn star.  A loss of an inch or two and no cancer is not a bad trade off in my book.  My friend once told me use it or loose it so maybe the lost length is coming from not having the blood engorge the penis to expand the tissue?

Dave 3+4

Clevelandguy said:

Length

 Hi,

Had my robotic surgery almost five years ago and I don’t realize any difference in length.  Of course I was never that concerned about my length.  As long as my cancer is gone I don‘t care if a I lost any length.  My size is between my wife  & I and she has not complained about it.  I have always been a private person so I don’t go walking around locker rooms with my member on display.  You guys keep talking about this like its a big problem, yeah maybe if your a porn star.  A loss of an inch or two and no cancer is not a bad trade off in my book.  My friend once told me use it or loose it so maybe the lost length is coming from not having the blood engorge the penis to expand the tissue?

Dave 3+4

”You guys keep talking about this like its a big problem, yeah maybe if your a porn star. ”

Since you are lucky enough not to have suffered this problem, I don’t know why you feel the need to belittle those who have.  In any thread where I have mentioned my loss of length, I have never complained about it.  I have merely stated it as a potential side effect, one that is not always mentioned by medical staff.  I will also add that, without going into specifics, having a shortened penis has caused some bathroom hygiene problems that didn’t exist before the surgery.  You may want to try being less judgmental.

Eric

Clevelandguy said:

Length

Eonore,

Not trying to belittle anyone,  I would glady give up length if I knew it would get rid of my cancer.  It seems like some people here use it as a downgrade to having surgery but I don’t think it’s that big of a problem.  If my doctor would have told me I might be a little shorter I would have been OK with that.  I might even be a little shorter but its not noticeable to me.  I guess after fathering two children and having an understanding wife it would not be anywhere near a bad point for having surgery in my opinion.   We all have different views and opinions and that’s what makes the world go round.  Not being judgmental, just giving my view point on some of the side effects from a person who has experienced surgery. In dealing with cancer I feel that the length issue is very minor compared to getting rid of your cancer and hopefully living on for years, to other men it might be a huge reason not to have surgery. We’re all different.

Dave 3+4

No problem Dave.  Like you, my primary goal is getting rid of cancer.  Even had I known about the loss of length before surgery, I still would have gone through with it.  However, I am 67, in a totally committed long term relationship of 35 years.  It isn’t that big a deal to me.  On the other hand, if I was younger, single and in the dating market, who knows.

Eric

The thing with prostate cancer is that there are several ways to treat it and each treatment comes with its own set of side effects. And unless you have a particularly difficult or aggressive cancer, they all have very similar success rates. It's worth taking the time to get all the facts; there are no do-overs.