Advice
I'm a 65 year old recently diagnosed. My PSA was 5.34 in April and my urologist recommended an MRI. MRI in June showed showed prostate volume 38cc. T2 hypointense lesion involving the the left posteromedial mid gland peripheral zone measures 0.3cm and demonstrates focal restricted diffusion and low ADC with early focal enhancement. T2 PI-RADS score 4, DWI PI-RADS score 4, DCE PI-RADS score Positive. A TP biopsy in June shows Adenocarcinoma, Gleason score 4+3=7(Pattern score 90%) grade group 3, involving 15% of the tissue (7mm). PET & CT scan in September shows cancer limited to the prostate. Consultation with my Urologic Oncologist surgeon, he laid out several different treatment options such as surgery, cyberknife radiation, cryotyherapy and sound wave ablation. I have a consult with the radiologist next week to hear what he says. At first I definitely ruled out surgery, but now I am considering it more and more as surgery would also alleviate the symptoms that go along with an enlarged prostate. Would appreciate any input from those who have been there.
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Khaffey, I was 67, 4+3 with BPH issues, and had to make the same decisions. I went into the process thinking for sure radiation would be my choice. After consultations, I chose surgery because I wanted the cancer out of my body. There are side effects with both radiation (especially if you have to do hormone therapy too) and surgery, and at that age we are right on the borderline of which is recommended. I am glad I went with surgery, not only because the BPH issues were immediately gone, but because the post-surgery pathology showed my cancer was more aggressive than they could tell from the biopsy. It's still major surgery and recovery for me was longer and more difficult than I was prepared for. But as you may know, if cancer returns after surgery, they can still do radiation treatment, but it's a lot more difficult to do surgery after radiation.
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Khaffey, my DaVinci laparoscopic surgery ( 4 incisions) was at the end of June 2024. So 4 months. Side effects - sure, I have no prostate. That means no fluid for sex. My penis is shorter than it was (apparently not everyone has this, but it's worth noting). Still have some odd sensations and discomfort in bladder area. I still leak a bit, and wear pads or shields, but continence improvement continues. On the other hand, urine stream is strong and complete. I believe I'll have to have quarterly PSA tests for the rest of my life.
Like I said, some of these side effects can occur with radiation too. I consider whatever sacrifice I've had to make and whatever discomfort I have, it's all about having a longer life, with less risk of dying of cancer. The reason age is a factor is that PC is slow growing, and most men die of something else before it kills them.
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Khaffey,
I had a DaVinci Robotic Single port (one incision) surgery. In a certain technique which not all Surgeon’s are trained in, the Surgeon is able to spare what’s called the puboprostatic ligament during robotic prostatectomy. In essence my Surgeon said this technique keeps the continence mechanism intact and it also helps maintain urethral length. A longer urethra allows for more control in the release of urine reducing the likelihood of incontinence and also the Puboprostatic ligament provides support to the urethra in keeping it in its position. He further does Retzius sparing of the tissue between the bladder and the prostate which further helps with continence. Another benefit of sparing the Puboprostatic ligament is the less likelihood the patient will see any reduction in their penile size that many patients report by either perception of it or a slight amount as its drawn in.
He explained that during Surgery I am certainly not upside down but he will operate through the Davinci robotic system as if I were upside down during the surgery. He said many surgeons are not familiar in the use of this approach and this is how he is able to spare the ligament. He said it was developed by a European Surgeon.
I had no incontinence and can see more girth size of an erection in morning but not totally hard and feelings in my jewel as the nerves regenerate. Hopefully soon. Just be sure your Surgeon is an expert in having done hundreds,
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Hi,
First of all the choice is up to you and your doctors based on your specific conditions to get the best results. I had robotic surgery back in 2014 and I am still undectable(less than .1) today. I do drip the occasional drop if I strain too hard or make an awkward move but a light daily pad takes care of that. Still have a touch of ED but can get the job done. It took me about 1.5 yrs. to plateau out with my recovery. Marion is correct that if your cancer does return you still have the option of radiation, Proton radiation,cryo, or ablation if you choose surgery. The best thing you can do is to get a experienced surgeon along with the best facilities to get the best results. Second opinions from different doctors/ hospital network is not a bad thing. No one can predict your results with surgery or some form of radiation, just too many variables. Surgery or radiation can have almost none to severe side effects as many survivors have posted on this forum.
Dave 3+4
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Dont mess around with radiation ..did you have it checked to make sure that it’s not cribiform I was in the same boat at 57 six years ago I wish to God I had it removed. I did the radiation and I went through hell and messed up my bowels. I had bloody hemorrhoids. It was very stressful and on top of everything it didn’t work it didn’t kill all the cancer so I ended up having salvage surgery thank God it was still in the prostate. Look it up the gold standard for prostate cancer is surgery …to me. There’s three steps to prostrate cancer one if it contained to the prostrate plan a is surgery then Plan B if it happens to come back, you’ll always have radiation and then plan C the dreaded hormone treatment. Good luck you’ll be fine.
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I am 65 and had a similar diagnosis about a year ago. I was given the option of surgery and cyberknife. I picked the radiation treatment, which took place in late December last year. The actual treatment was really very simple, 15 minutes a day for 5 days. No pain or discomfort during treatment, no issues with bladder control, though I did experience relatively proctitis soon after treatment, this did recur about 6 months after treatment but has cleared up since. My PSA was over 6 pre treatment and the latest test 8 months after treatment was 0.8. My urologist said that the target was to be under 1.0, so mission accomplished.
It’s a complicated decision to make, but I’m glad I made the choice that I did. The urologist had told me that the outcomes based on surgery or cyberknife were equivalent. So, based on that information I went with the less invasive option.
Good luck!
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Saw the radiologist yesterday. Cyberknife radiation is an option but with a 4+3=7 Gleason score, 6 months of hormone therapy is necessary. 2-3 months before treatment and 2-3 months after. Leaning more towards surgery. If the radiation is a 6 month process, at 6 months after surgery, I should be well on my way to recovery.
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Six months of 'hormone' therapy isn't very long and your testosterone is likely to recover at your age. BTW, Orgovyx allows a faster recovery.
Yes, surgery appears to be a good option for you, but do read all these recent posts about incontinence, diapers, etc.
As has been pointed out repeatedly on this forum, a highly experienced specialist is of utmost importance, whether it's for surgery or radiation.
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Either treatment will be done at NYU Langone Perlmutter Cancer center NYC. They are very experienced in either treatment. It's a tough call to make. I'm off on a two week vacation so I'll have plenty of time to consider each option. I spoke to two guys I know who had the surgery, one used the same surgeon, and both are very satisfied with the outcome. I know every case is different, but it is encouraging. Thanks everyone for your support.
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