Other than Cancer

Oddly enough, a DRE (digital rectal examination) is still the most reliable, initial indicator of prostate cancer. During a DRE (digital rectal examination), it appears very distinctively as a hard, sharp mass like a piece of walnut shell. In other words, there is no other prostate abnominally having that indication. Although I'm going way past your original question, let me go a little further:

After a positive DRE, the big question is then whether or not minute amounts of cancerous tissue have migrated outside the prostate capsule into surrounding soft-tissues. Following up a positive DRE with a biopsy can confirm DRE results and provide additional information as to whether it has spread to both the left and right side of the prostate capsule. A biopsy can also provide a measure of the level of aggressivenes based on microscopic examination of cell structure...a major factor.

Although, he'd definitely want to follow up with a biopsy, when pathologists are point-blank drilled on biopsy accuracy, they'll reluctantly admit that needle biopsies can be similar to throwing darts at a dart board. When the hollow-needle device is positioned as best as possible with ultrasound to extract small cores of tissue, it may or may not hit the targeted cancerous growth each and every time. It could slightly miss and extract healthy prostate tissue. The Gleason scored derived from a biopsy is a major consideration, in that it can indicate the level of aggressiveness, scored as 1-9 (9 is the most aggressive).

Although labled as a "slow-growth" cancer due to historically slow rates of cell replication, the opposite can also be true for some.

To date, the only chance of a cure for prostate cancer is to take action before it has migrated outside the prostate capsule. This means complete removal of the cancerous tissue via radical prostatectomy or killing all cancerous cells via cryoablation (cryogenic surgery), brachytherapy (implantation of low-level radioactive seeds), or radiation. A radical prostatectomy is still the so-called "gold standard" in that it removes the entire prostate, lessening the chance of leaving a few cells behind that can replicate. After DREs and biopsies, undetectable cancerous cells may have nevertheless already migrated outside the prostate capsule. This is even though biopsy results may show (expressed as a x or y percent possibility) the cancer is likely confined to the prostate capsule. That was my case...too late.

Bottom line, once outside the prostate capsule and migrated to lymph nodes, other soft tissues, or the bones (a common metastatic route), prostate cancer is incurable.

When you step back and take a broader look, this wretched disease is subject to a lot of pure luck, even considering all the advanced diagnostics and treatment options. The luck factor is no doubt more heavily influenced by the earliest possible detection whereby removal of the entire prostate gland provides the best chance of complete removal of all cancerous tissue.

Another piece of luck might include one's age when early-stage prostate cancer is first detected. If it is one of the least aggressive forms of prostate cancer, an older person could merely be placed on watchful waiting and die with it rather than from it.

If your guy is lucky enough to have benefited from early-stage detection, I'd say go for a radical prostatectomy immediately, presuming he's a candidate from the standpoint of general health, age, and other factors.

Here again, depending on age and other factors, I'd suggest a nerve-sparing or nerve-transplant radical prostatectomy. Although nerve-sparing and nerve transplantation success rates in preserving or renewing function of the nerve bundle are at acceptable levels, in the event of permanent ED, I'd suggest one of the newer, 3-piece, saline-inflatable penile implants. See the "American Medical Systems" web page.

Best of Luck,

"Perry"