67 years old Gleason score (3+4) next

You don’t get any better than Memorial Sloan Kettering! Which ever treatment you choose they will have the most up to date Surgeons on surgical techniques and latest robotic’s and Radiation Oncologist’s with the same. Their expertise and guidance will help you in your decision. For me, it was surgery.

There is a new surgical technique that almost eliminates incontinence especially for a small prostate. My surgeon used the new single port DaVinci Robotic model. The surgical technique which not all Surgeon’s are trained in, he is able to spare what’s called the puboprostatic ligament during the 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 that you will see any reduction in your penile size that many people 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 typically the surgeon operates from below in between the persons raised legs. He said in this procedure he operates from behind the persons head with the patient still basically lying flat. Using the single port Davinci system he makes one small incision above the belly button and you have faster healing with less blood loss during surgery. The multi port I believe leaves three or four incisions to heal adjacent to or just below the belly button. Many surgeons are not familiar in the use of this new approach and this is how he is able to spare the ligament which he said is a significant advancement in prostate surgery. 

I was immediately continent upon removal of the catheter and no loss in penile size and doing pretty darn good on the erection side with a dose of viagra beforehand.

I was very scared of surgery and side effects  including just the thought of a catheter for 10 days. To me I knew both surgery and radiation had side effects, some overlap such as incontinence and ED and others like rectal are tied to radiation. ED after surgery is right away, while it will come later during Radiation treatment or after treatment.  Today versus years ago, with the leaps in technology I knew they 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 was being used to minimize rectal side effects and focal Radiation procedures have become common.

I made my decision in Surgery not Radiation knowing that I would still have Radiation as a backup and I was approaching 71. The age window for the surgery option was getting closer which is generally 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.

Another reason I chose surgery was that while I was in surgery after the prostate was removed and the tissue was removed the tissue was going to be sent immediately to the hospital pathology for immediate 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. Anyways my thoughts on my direction I chose.

Hi,

I had robotic surgery 10 yrs ago and don’t regret it. My PSA has been undectable for the same amount of time. I too was 3+4 with PNI, no other spred outside of the Prostate. With great facilities and great doctors your outcome should be very good. I still drip a drop now and then so I wear a pad every day. Ed has improved from dead as a door nail to a useable member, my healing plateaued at about 1.5 yrs. That one port surgery that Wheel talked about sounds very promising. Radiation can also have side effects that effect the bowel and bladder a few years down the road, there are no guarantees with surgery or radiation. Do your homework, talk with your doctor team and family members and you should come to the right decision.

Dave 3+4

Hi,

I was 62

Though treatment protocols rarely vary, no two PCa cases are the same but similar.

Surgery and radiation are the common choice when we look for cure. Other options exist but these become usually palliative and short lived. They prolonge the time we live with the bandit, postponing a radical treatment and letting us live, that period, somehow with a better quality of life.

The presence of PIN makes your case risky for future recurrence. It will be difficult to know how far away the spread of prostatic cells have gone in affected nerves bundle. Surely, a nerve spare surgery wouldn't be the best choice.

However, even the radicals RP or RT aren't 100% perfect assuring cure forever. This is the reason that leads to look into the risks and the side effects of each therapy making them accountable in our choices.

In the end we will have to learn to accept and live with the consequences.

Which ones are more acceptable to you.

Wishing you luck in your journey.

VG