Prostate Cancer

From what my Urologist described to me (early stage cancer, PSA 4.7, age 60, 2 of 12 biopsy samples positive w/Gleason's of 7), surgery was my best option. Radiation was best for patients with advanced cancer that had spread beyond the prostate. My surgery was in late August. I had the DaVinci Laparoscopic system surgery. I had very little scaring, no blood loss, catheter in 6 days, w/6wk no-lifting recovery. Incontinence has now returned to near normal and impotence is getting better. The surgery is a "nerve sparing" surgery. PSA's since surgery have never exceeded less than 0.1. Best of all, my Prosate cancer is gone, hopefully forever. I have absolutely no medical or physical restrictions at present.

First, you MUST research each procedure.
Second, the decison MUST be yours
Third, there are NO GUARANTEES with any of the different procedures.
Fourthly, there are SIDE EFFECTS of varying degree with each. YOU MUST know what these potentially are and ask pointed questions of each doctor as to their success rate - how many have they performed and how long have they been doing it!!! Its your body, not theirs.

The main objective is to remove or cure. How you get there and the risks (side effects) with each procedure go with it. Much like taking a vacation, you may have some limited car trouble on the way and you have to address them as they occur.

1. Surgery - removes the prostate (supposedly the entire cance is removed). The nerves that control erection and much of your sexual arousal run along the sides of the prostate. Many doctors do what they call "nerve sparing" surgery but, you have to understand the potential ranging from no effects, limited erection to none. There are drugs and other treatments available to help if they occur. Ask your surgeon.

2. External beam radiation -- radiates the prostate killing the cancerous cells. Usually I believe done over an 8 week period, 15 minutes a day. As treatment continues, radiation absorbtion grows, you can become fatigued AND it to can cause damage to the nerves as well other organs to varying degrees causing some other side effects that will take a little time to cure.
Supposely, external beam as greatly improved such that it follows a computerized picture and supposedly only hits the confines of the prostate?

3. seed implant -- puts the radiation directly into the prostate without having to go through other parts of the body and is done in a one day procedure. Back to work 2-3 days normally. Side effects are same as the radiation -- can affect erection etc.... Fatigue is all at once (all the radiation is in place all at once.)

4. Cryognic -- super freezes the prostate killing it and the cancer cells. Don't know much about this but you need to be aware of it.

5. Hormone therapy -- this is sometimes done separately OR with the any of the above treatments depending on YOUR medical situtation.

a. the hormone supposedly deprives the cancer of its food - male hormone
b. it shrinks the size of the prostate so as to minimize the area to be radiated (thus the amount of radiation) as with external beam procedure or the quanity (number) of seeds (amount or dose of radiation needed) since the physical size is smaller a lesser dose is required.
c. the hormone therapy supposedly causes the cancer cells to be more suceptiple to the effects of radiation.
Don't know if it would make a difference with surgery since they will remove it regardless of size?

So, as you can see, you need to research further and as long as your cancer is not aggressive (ask your doctors how long you have to make a decision without causing any harm while you research?

I had seed implant, hormone therapy before and after for the reasons stated above but even hormone therapy HAS its side effects. Found myself want to go shopping more HA! HA!.

So, if you want more details let me know but generally the toughest part is making a decision and being comfortable with it. Sounds as if you have a very treatable situtation. Once I found out all of the treatment options, talked to others my fear of the unknown went away and I took it as another task to deal with in life. Family has been very supportive.

Supposedly, any radiation will rule out surgery later (it scars the prostate causing its removal to be very difficult later according to my doctor).
Having Surgery supposedly does not rule out radiation / hormone therapy and etc... later if required. Major concern is to prevent / limit the cancer getting out of the prostate so don't delay any longer than your doctors recommend.

I have tried to be honest yet not cause any fear. The REAL JOB is making an INFORMED decision and going with it. REMEMBER, IT IS YOUR DECISION - even though you may confer with family members for their guidance and support.

Best Regards,
Joe Nutter

Hello hrl201,
I was diagonosed with prostate cancer on December 12, 2002 and had nerve sparing RP on February 10 and things are going very well post op. I concur with everything said here. Joe Nutter and Roger Moore are very objective, helpful, and have been here on a regular basis since I've been coming here in February. Personally, after considerable research and discussion with my urologist and two friends who went through the surgery three years ago, I chose the RP because it seemed the best chance for a complete cure. I had a psa of 5.6 pre-op with Gleason 6 and estimated 15% of the tissue involved. The post-op pathology report showed psa 5.7, Gleason 7, 25% tissue involvement, and, worst of all, positive margins top and bottom. That meant a 50/50 chance of containment. Fortunately, my 6 week post-op psa was <0.1, which is essentially as low as they can measure. With my doctor's support, I've decided against immediate follow-up radiation pending possible rising psa. We'll check again in July. I believe the cancer was contained in the prostate and it's all gone now - that's my story and I'm sticking to it! Even if the psa does rise, follow-up radiation should be very effective and that could be followed by hormone therapy if necessary.
Chosing which one of the treatment options to go with can be a nerve-wracking process. You didn't mention your age (I'm 56 and in excellent health) or general health. If you're young (60 or less), you'll probably want to get the SOB out of there. That's what most guys have done that I've talked to. At 12 weeks post-op I have excellent bladder control, improving sexual response (orgasm with partial erection) and have returned to a vigorous exercise and mountain biking routine. Whatever you decide to do, keep the faith that you will be back to good health. And return to this site from time to time to ask questions and share your experience with others. We can make a big positive difference for each other!
Jeff