Just found out I have stage three prostate cancer.

It would be helpful to know your Gleason scores for the cancer cores. Also it sounds like your Surgery may have been scheduled without you knowing much about your Surgeon. Surgery by the right Surgeon is important if you go that route. The numbers of robotic they have done, the technique they use, single or multiport, nerve sparing, Retzius sparing and Puboprostatic ligament sparing. I was very scared of surgery and side effects  including just the thought of a catheter for 10 days. Both surgery and radiation have side effects, some overlap such as incontinence and ED and others like rectal are tied to radiation. ED after surgery is right away, and improves over the coming months with nerve sparing, while ED will come later during Radiation treatment or after treatment.  Today versus years ago, leaps in technology have come to minimize side effects in both procedures. Surgery with Puboprostatic ligament sparing, and Retzius sparing along with procedure technique to reduce or eliminate incontinence. Nerve sparing for ED issues and Robotic Single port entry for overall quicker surgery recovery. Now with Radiation, the development of Space Oar Hydrogel is used to minimize rectal side effects and focal Radiation procedures can also.

For me choosing Surgery also had to do knowing that I would still have Radiation as a backup and approaching 71 the window to receiving surgery was getting closer to close regardless approaching 75 but sooner if my health were to deteriorate for any other reasons and preclude surgery. Salvage Radiation is much easier than a Salvage surgery as the surgery is considered much more difficult and done only by certain surgeons very experienced in that salvage surgery. Twenty years ago I had non-hodgkins lymphoma and my Oncologist recommended a lower chemotherapy regimen than CHOP saying we wanted to keep that in reserve for relapse or transformation. I liked having that as backup and I was blessed to go into remission and remain.

Another reason I chose surgery was that while I was in surgery after the prostate was removed and the tissue was removed to check on margins, the tissue was sent immediately to the hospital pathology for staining to see whether I had clear margins. This clearly delays the closing of the surgery and in my case my margins did come back positive which surprised the surgeon because based on the hundreds of tissue he visually has seen in surgery which he did not see anything unusual and the PET scan saying it was contained within the prostate really was a surprise. Many Surgeons do not bother with this and at your post surgery appointment they give you the disappointing news that you have positive margin. Well my Surgeon was then able to go back in for 2 more hours delicately continuing nerve sparing and cut for more margin and at my post surgery appointment I was told the final margin was then negative. Without that additional step of my tissue going to pathology I would have been told at my post surgery appointment that unfortunately you have positive margin as many are. His afternoon surgery appointment got delayed by two hours by the surprised breeching of the capsule by the cancer. Immediately upon my catheter coming out I was continent and have minimal ED side effects 90 days out with more improvement expected. I was up walking immediately after surgery and did not even spend that night after surgery in the hospital. Within two weeks I was back to normal activities like driving and getting out and around and traveling. Although my catheter was in for 10 days that was due to a 3 day holiday period but that allowed my surgery to continue to heal. Now on a downside I did get a blood clot in my leg from the surgery likely due to my surgery taking much longer than expected but blood clots are a side effect of any surgery not tied to prostate surgery. Anyways my thoughts on my direction I chose.

Hi,

It sounds like you have done your homework, consulting with an Oncologist is a good idea. I had surgery 10 yrs. ago and I am still undetectable today. I still drip a drop now and then, ED is present but I still have a usable member. I do not regret my decision on surgery one bit and some survivors here talk about a newer one incision robot procedure that reduces the risk of leakage & ED. With surgery I feel you have better future options if the cancer returns(ie; radiation, Proton therapy, ect). Your choice once you select your treatment based on your particular situation.

Great doctors+great facilities =great results.

Dave3+4

** Note, I am getting a message that I need to be around for a little while longer before I can post images so my biopsy and notes are not included here

DooleyJohn1 - This is my first day here and I was astounded to read your description because my diagnosis is almost identical. Below are my biospy results. After the PSMA PET scan, I had a meeting with both my oncologist and a radiologist and attached the oncologist recommendation here as well.

Without going into huge detail I went into the PET scan with optimism that it was isolated completely at the prostate, so my plan was to go through surgery and just get rid of it all. After the PET scan, while there were no signs of cancer in lymph nodes or any distant areas, there is concern that it could have reached the bladder and seminal vessical, in which case there could be a good chance that surgery would still leave cancer that would require radiation/hormone therapy. The radiologist said I could still go through the surgery followed by radiation/hormone treatment, but because they would want to start that treatment fairly soon after surgery, the side effects of BOTH at the same time may be quite difficult on me - he has a patient currently who went that route and they are really struggling.

I am getting another MRI which hopefully will give them more information as to the seminal vessical and bladder involvement, but both the radiologist and oncologist felt the best route would be to undergo High Dose Brachytherapy (involves implanting of catheters directly into the prostate and sending radiation directly inside for a short period (minutes) - this may have to be done twice. I would then be on hormone treatment to reduce testosterone followed within a few weeks by 5 day/week external radiation for 5-6 weeks.

I still have this nagging thought that I'd like the majority of the cancer just removed, then undergo the external radiation and that I can physically "handle it," but I do read that recovering from prostate removal surgery can be tough for some men and there's no way of knowing if it will be bad or not. I will have a lot of questions after this MRI , but at some point I'm going to have to make a decision soon and in the end I imagine I will put much more weight into their recommendations than what my common sense is telling me - after all, they do this for a living and have seen outcomes.

If I were in your shoes, I would FOR SURE try to find a good Oncologist both to review your biospy results and give you his/her opinions. I would also consider talking with a Radiologist and get their thoughts.

If you happen to be located close to a well respected cancer facility, that's the first place I'd start. Ask as many questions as you can and gauge not only what they say, but how they say it and everything involved. The place I am going is one of the top cancer facilities in the U.S. and they are not only incredibly well organized, they have a whole team of folks who work together and are willing to spend as much time with you as needed to come to a decision. There's value in feeling confident and comfortable with doctors and facility that puts you at ease and displays tremendous competence.

Good luck to you

indont know what kind of insurance you have or if you want to travel.. the holidays and this and that but you know you said it takes two surgeons and this and that it takes one surgeon to direct the robot and donthe surgery . It takes two assistance, one on each side of the table to guide the arms in place and another assistant to look over all the vitals and anesthesiologist it’s a lot that goes into it, but most of them have a waiting time because of the holidays and this and that you know you could always go out of state if your insurance covers it. I used a guy by the name of Dr. Robert REIT ER of UCLA Los Angeles, California look him up on YouTube. Dr. Robert Reiter look up the videos on yiu tube it may ease your worries .