Scheduled for Surgery - What can I expect?

What did the MRI show and any other scans you may have had?

IMHO, you really should investigate other options. There are various radiation therapies that could be used for a case like yours. I recommend consulting with radiation therapy specialists, not your urologist about these. Typically, urologists like to recommend surgery because that's what they do.

You have time to do this! Then decide whether surgery is the best option for you.

PS: I am by no means against surgery for a young(er) person, but I do hope that patients consider all reasonable options.

Did you consult with a radiologist at all?

Talking with two urologists who specialize in surgery, and having them both recommend surgery…

I recommend reading “Invasion of the Prostate Snatchers” by Dr. Mark Scholz. Here’s the google preview. Not saying surgery isn’t ideal, just think you should do some more info gathering.

https://books.google.com/books/about/Invasion_of_the_Prostate_Snatchers.html?id=v77jDwAAQBAJ&printsec=frontcover&source=kp_read_button&hl=en&newbks=1&newbks_redir=0&gboemv=1#v=onepage&q&f=false

I'm 51 and had surgery last Feb. I was diagnosed with Gleason 3+3 originally and did active surveillance for almost a year. Had a second biopsy 10 months later that was still 3+3 but, volumes were 100% & 70% in 2 of the 6 positive cores, PSA was around 4.7. This was pushing the AS boundaries with the high volumes. The doc running the AS said she didn't have patients my age with the high volumes although, didn't say I needed to quit AS. Got another PSA 6 months later and was over 5. Felt like it was time. I chose surgery. Both radiologists I spoke to suggested surgery for the same reasons you mentioned. Better options if there is recurrence.

Surgery was pretty smooth, 1 night in hospital. Not too bad a recovery, catheter is annoying but, tolerable. Pathology after surgery was 3+4. First PSA after surgery was undetectable. Pretty much continent after catheter removal and sexually active (with help of vitamin V). Feel I was pretty lucky escaping side effects.

If you haven't talked to a radiologist, you probably should. Get as much info as you can to make the best decision for yourself. Everyone is different, not all outcomes are the same.

Hi,

Do you remember what your Gleason score was? If it was 3+3 with low volumes you have time to study the big three, Active surveillance, surgery, or radiation. Just make sure that you keep in mind that all three can have side effects from chances of infections to ED or urine leakage. I also would talk to a Oncologist/Urologist maybe even from a different hospital network. I had surgery with about the same results of Rob.Ski in 2014 and I am still undetectable. Don’t mean to confuse but there have been bad surgeries and radiation treatment results so there are no guarantees, choose wisely. It’s really your choice after consulting with your family and doctor team. Great doctors +great facilities = great results, I have included a link to get you started.

Dave 3+4

If you are "just" Gleason 3+3 and 4% in 1 of 12 biopsy samples (I assume) then you have a lot of time to really sort out and explore your options. Some things to consider:

• Get a 2nd opinion on your biopsy from John Hopkins University or other center of excellence. This is easy to do and will give you a warm and fuzzy if they concur with the original assessment. https://pathology.jhu.edu/patient-care/second-opinions
• Get your positive biopsy sample genomically tested with the Decipher test or similar (Prolaris), to get a refined estimate of probability of metastasis. https://decipherbio.com/
• Visit with a radiation oncologist and learn about potential radiation treatments and outcomes, which include SBRT, IMRT, Proton Therapy, LDR brachytherapy, and HDR brachytherapy. If you are unfamiliar with any or all of those terms, you really haven't done your homework.
• What is your PSA density? This is the ratio of PSA to the size of your prostate, which you should know from the MRI. This will help tell you if you are Low Risk or Very Low Risk
• READ - https://www.nccn.org/guidelines/recently-published-guidelines , https://www.healingwell.com/community/default.aspx?f=35 , http://www.pctrf.org/

I get that you are probably freaked out at the thought of cancer percolating in your prostate, been there and doing that myself. You want it out yesterday. I worry that you don't fully understand the decision space.

Are you up to date on probability of ED and urinary incontinence from RALP? Shortening of penis? Peyronie's disease? Similarly for radiation treatments? Time frames?

With nothing popping up on your MRI, and I assume nothing felt on the digital rectal exam, based on what you've told us you likely fall into the Very Low Risk category for prostate cancer. As per the NCCN guidelines, Active Surveillance is the preferred treatment path currently for that category, with surgery and radiation secondarily recommended. This could allow you to watch and monitor while the treatment techniques continue to bound forward, and your urologist continues to hone his surgery skills.

Greetings. I'm also looking at options, though my bone scan results have to be sorted out first. My father had the robotic prostatectomy about 20 years ago (he's 84 now). He is satisfied with the results. He is pretty much continent at this point, though he wears a pad for minor, occasional leakage. He did say he's unable to have an erection without some sort of intervention. His PSA has only just been detectable this year at about 0.3. One of his younger brothers had (I think) a traditional prostatectomy about 15 years ago in his early 60s. He said his surgery was more involved because the tumor affected his bladder. He's not continent at all, nor does he have any sexual function. He's not happy about the results, but thankful to be alive. His PSA is virtually undetectable.

Carluvrj, Follow the advice given here. I wish I had. I had about 20 years on you when I had my biopsy. I didn't know anything just relied on my URO. Didn't get a second opinion, didn't know about CSN, didn't consult with a radiologist, oncologist, nada! My mindset was, "I don't want cancer in me. I want it out now! I want it out now." While my PSA 4 years post surgery is still virtually undetectable (<.01), nothing below the waist works as it did before except for the urine part. It goes all the time.

Carl, full speed ahead on getting educated.

It's mostly up to you to do it. Doctors just don’t have the time to share everything they know about prostate cancer. Even if you spend a full hour or two with your Uro, you are only getting a wavetop touch on their knowledge. Same with a RadOnc. But with the internet, it’s all there for the taking. Got to be smart about it.

I have never been to a doctors meeting since I started educating myself that I didn’t already know most of what they were going to say. At first that kind of bummed me out, as in why am I paying for this consultation? Now, I realize it lets me evaluate if they are up on the latest, following best practices, and can I trust them with life decisions. I think they appreciate me showing up educated and understanding there are trade offs too. Can skip the basic stuff and move into the real decision making. Nothing slam-dunk about this, every choice has tradeoffs. Be smart, gather your knowledge, then commit.

Best of luck, shipmate.