Radical Prostatectomy Question

I am waitng for a date from Dr. Patel in Orlando who has done oner 10.000 RPs. I am 76 and have a Gleeson 5 plus 3. I had to sign an ackbowledgfmant that I will no longer be able to fathwr children. So far my 2 chuldren in their 50's and wife who will be 75 in 3 weeks are taking thhis as well as can be expected.

icemantoo

Is your surgeon telling you your cancer has not escaped the prostate gland?  If the cancer has escaped the prostate gland, it is my understanding there is no need to remove the gland.  The treatment option is nuke (radiation).  In my opinion, if your primary concern is the loss of erectile function, I would say nuke it.  That is not saying that you will not experience ED.  Please understand that I am not a doctor.  Good luck on your journey.

JFG,

Welcome to the board. I think you doing well in investigating the details and consequences involving prostatectomies. You should only chose a treatment when totally confident that it will work as you would want or in your favor. This decision process is not easy because of the various modalities and the risks they involve. Survivors here can help you in understanding the facts but the surgeon that created your doubts is the best person to consult on the matter, as suggested by Steve above.

In any case, the decision on a treatment should have the ultimate goal of cure. It is not like using a bandaid to seal the wound. For such a reason one needs to know his clinical stage (the best one can get it), check what is most appropriate to his condition and then decide on the one that gives him the comfort to go ahead. The choice of a good physician to perform the therapy comes in the end of the above process. The outcome does not depend only on the skills of the doctor but on the capabilities of the treatment. And I question; is prostatectomy your best choice?

Regarding the nerve bundle serving the prostate and urinary sphincters, they interweave with each other. However, only the portions dissected will affect the tissues/muscles where they run. The local nerve network is not affected and, latter, the body’s natural system will try to repair the damage or substitute the signaling pathways via a separate bundle but it never gets to the same status. The finishing job depends on how much cutting is involved.

Accordingly, you comment above that the doctor wants to go wide; it means that he will not spare anything. Typically, a wide surgery includes dissecting the whole gland (+SV), a portion of the urethra, the nerves serving these tissues (the urethra sphincter will be affected but the bladder sphincter will be spared) and the localized lymph nodes. In the end they will vacuum the perineum cavity to avoid leaving behind cancerous cells. Surgeries done using robot have limits on the reach of the robot arms. Far places are not covered.

I wonder why the surgeon wants to go wide. Can you provide us with more details on your diagnosis?
Have you the results of image studies? What is your age? Did you get second opinions from other specialists?

Gleason 9 signifies high risk for existing metastases (it includes: extraprostatic extensions plus positive seminal vesicles plus lymph nodes and maybe bone involvement). If the case involves a biopsy with many positive cores then it is classified as voluminous in which cases lead doctors to recommend a combination of treatments with intent at cure; Such as; surgery plus radiotherapy or radiation plus hormonal treatment, etc. More therapies mean more risks and more side effects.
Typically surgery is chosen when the cancer is contained (whole within the gland). Risky cases for metastases are usually directed to radiotherapy. Nerve-sparing prostatectomies are only recommended for low risk cases.All cases require the patient to be fit so that age and other health issues matter in the choice.

Here are links with practical information;

https://www.healthline.com/human-body-maps/prostatic-plexus#1

https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/surgery/surgery-remove-your-prostate-gland

https://www.cancer.org/cancer/prostate-cancer/treating.html

 Best wishes and luck in your journey.

VGama

VascodaGama said:

Nerve bundles are not spared in Radical Prostatectomies

JFG,

Welcome to the board. I think you doing well in investigating the details and consequences involving prostatectomies. You should only chose a treatment when totally confident that it will work as you would want or in your favor. This decision process is not easy because of the various modalities and the risks they involve. Survivors here can help you in understanding the facts but the surgeon that created your doubts is the best person to consult on the matter, as suggested by Steve above.

In any case, the decision on a treatment should have the ultimate goal of cure. It is not like using a bandaid to seal the wound. For such a reason one needs to know his clinical stage (the best one can get it), check what is most appropriate to his condition and then decide on the one that gives him the comfort to go ahead. The choice of a good physician to perform the therapy comes in the end of the above process. The outcome does not depend only on the skills of the doctor but on the capabilities of the treatment. And I question; is prostatectomy your best choice?

Regarding the nerve bundle serving the prostate and urinary sphincters, they interweave with each other. However, only the portions dissected will affect the tissues/muscles where they run. The local nerve network is not affected and, latter, the body’s natural system will try to repair the damage or substitute the signaling pathways via a separate bundle but it never gets to the same status. The finishing job depends on how much cutting is involved.

Accordingly, you comment above that the doctor wants to go wide; it means that he will not spare anything. Typically, a wide surgery includes dissecting the whole gland (+SV), a portion of the urethra, the nerves serving these tissues (the urethra sphincter will be affected but the bladder sphincter will be spared) and the localized lymph nodes. In the end they will vacuum the perineum cavity to avoid leaving behind cancerous cells. Surgeries done using robot have limits on the reach of the robot arms. Far places are not covered.

I wonder why the surgeon wants to go wide. Can you provide us with more details on your diagnosis?
Have you the results of image studies? What is your age? Did you get second opinions from other specialists?

Gleason 9 signifies high risk for existing metastases (it includes: extraprostatic extensions plus positive seminal vesicles plus lymph nodes and maybe bone involvement). If the case involves a biopsy with many positive cores then it is classified as voluminous in which cases lead doctors to recommend a combination of treatments with intent at cure; Such as; surgery plus radiotherapy or radiation plus hormonal treatment, etc. More therapies mean more risks and more side effects.
Typically surgery is chosen when the cancer is contained (whole within the gland). Risky cases for metastases are usually directed to radiotherapy. Nerve-sparing prostatectomies are only recommended for low risk cases.All cases require the patient to be fit so that age and other health issues matter in the choice.

Here are links with practical information;

https://www.healthline.com/human-body-maps/prostatic-plexus#1

https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/surgery/surgery-remove-your-prostate-gland

https://www.cancer.org/cancer/prostate-cancer/treating.html

 

 Best wishes and luck in your journey.

VGama

     

 

but really do you think this man needs to hear all that reallyyyyyyy.like he isn’t worried enough .he most likely will have surgery and now he will be thinking about everything you told him .that dr is an expert ..I would rather lose an erection to have a chance at a cure . surgery  beck up radiation and hormone to be cured ..then do it ..you don’t know if radiation alone will work it’s all a guessing game ..you take it out u know for sure ....that alone is a great feeling ..that  I don’t have 

Steve1961 said:

Very informative

but really do you think this man needs to hear all that reallyyyyyyy.like he isn’t worried enough .he most likely will have surgery and now he will be thinking about everything you told him .that dr is an expert ..I would rather lose an erection to have a chance at a cure . surgery  beck up radiation and hormone to be cured ..then do it ..you don’t know if radiation alone will work it’s all a guessing game ..you take it out u know for sure ....that alone is a great feeling ..that  I don’t have 

Yes, folks need to know.  Just like you so vividly describe your treatment side effects.  I remember telling you about my journey and exchanging CSN-mail.  At the time, you wanted to know as much as possible from folks who have experienced radiation and surgery as treatments for PC.  Most of the folks on this site use it to tell their stories and so they do.  That is what this forum is about. Front line experiences with their prostate cancer treatments.  With that said, stay positive my friend with a common enemy.  My gut feeling is that you have better days coming.

lighterwood67 said:

Folks Need to Know

Yes, folks need to know.  Just like you so vividly describe your treatment side effects.  I remember telling you about my journey and exchanging CSN-mail.  At the time, you wanted to know as much as possible from folks who have experienced radiation and surgery as treatments for PC.  Most of the folks on this site use it to tell their stories and so they do.  That is what this forum is about. Front line experiences with their prostate cancer treatments.  With that said, stay positive my friend with a common enemy.  My gut feeling is that you have better days coming.

Hi all,

That is all.
We are saying that the gas is a bummer and it can hurt like hell but it will go away, the catheter is not a good experience but it will come out after a week or two, abdominal pains can get to you but mine were all gone after a few weeks.
But most patients come out of a RP cancer free, which has to be a winner.
Radiation can be OK as well.
At the end of the day this is cancer treatment it is not pulling a milk tooth that wants to fall out anyway.

Best wishes,

Georges

Hi JFG,

Sounds like from what your doctor said that the cancer might already be outside of your Prostate.  If it was me I would want to meet with a Radiation Oncologist and see if surgery or radiation is the best treament plan. I would want to look at both sides of the two major treatments(surgery vs radiation) to see which benefits your unique situation to get you the best results. Don’t be afraid the completely research your situation to come to a treatment plan that is right for you based on your diagnosis.

Dave 3+4

JFG2019 said:

I understand and accept that

I understand and accept that removing the prostate means loss of fertility.   I am just wondering if it is common or most of the time that nerve sparing robotic surgery results in loss of the left and/or right nerve bundle under the prostate that controls erections.

JFG,

'Go wide' sounds more like a football order to a receiver than medical terminology.  Undoubtedly it is lay parlance for some medical lingo that most are unfamiliar with.  IF I had RP, I would indeed go-wide in your circumstances.  While likely metastatic cases are usually recommended to R.T., one of the advanntages of RP is that when the gland is analyzed by pathology, they will very likely know if you need follow-on IMRT (radiation) for safety.

I have not seen this addressed in much detail here over the years, but high-dose RT essentially turns the gland into a charcoal briquette, and I do not see how a piece of charcoal would be more potent,sexually, than the removed gland.  I was fortunate to have full nerve sparing in my DaVinci, and have full potency today.  I know I was fortunate in this, and that not every man is.  

Regardless, so far your case sounds very managable with reason to hope for cure,

max

Treatment decisions are very individual so please consider everything.  Age is a factor, family history is a factor, bone scans are a factor, etc. etc.  (Even race may be a factor as some studies are beginning to find). So one case can't speak to another case but can help with the decision making process.  However, commonalities across cases can help with decision making.  Quality of life is a HUGE factor for the individual and differs for all.  Some things matter more than others for everyone and we can't judge or criticize where another person places value.  I think lighterwood67 comments about radiation if the cancer is outside the gland versus removal if limited to the gland is consistent with current treatment protocols for gleasons 7 or higher.  I agree with VascodaGama you should only choose a treatment you are comfortable with = quality of life.  Hope everything works out well.

You can follow my (Sept 2019) story at https://csn.cancer.org/node/320408