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Prostate Cancer

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

My story:67 year old male; PSA 4.72 increasing over the last 3 years; Digital Rectal Exam, prostate is not swollen; father had prostate cancer elected removal (the cancer did not cause his passing); I requested a 3T MRI prior to biopsy; MRI indicated 2 lesions one a PIRAD 5 and one a PIRAD 4; biopsy confirmed prostate cancer in the PIRAD 5 lesion; PIRAD 4 no cancer. Urologists recommends: Prostate removal with pelvic lymph node dissection.  I am looking at an experienced urologists who only does robotic guided prostate removal now (over 1,000 procedures).  He did offer hormone and radiation but did not think that was the best route due to tumor and it being only in the left apex of the prostate.  I feel very comfortable with this surgeon.  My wife and I decided on the removal of the prostate and lymph node dissection procedure.  On the lighter side, during our interview the surgeon did ask us did we have sex.  My wife did not say anything, I told him everytime I can catch her, but she is very fast.  Anyway go to preop March 5 and surgery on March 20.  Gleason 4+3=7.

Clevelandguy
Posts: 441
Joined: Jun 2015

Hi, 

Sorry to say but welcome to the club.  I had my Robotic surgery about 3.5 years ago with no detectable PSA so far.  Most doctors will tell you surgery give you symptoms up front(ED + bladder leakage) that usually gets better over time and radiation is just the opposite.  The best day will be when they pull the catheter out about 10 days after surgery,  Hope all goes well with no complications.  Keep us informed on your progress.

Dave 3+4

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Thanks for the reply.  Always interesting to hear from other people who share the same boat.  Glad to hear the positive in your reply.  I personally think attitude is everything.  Wish you well.  I will keep folks informed on my progress.  Again, thanks. 

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Well, met with a physical therapists the other day to help me through this journey.  She pretty much evaluated me (mostly stretching).  Then, I had to turn on my side to test my kegle muscles response.  She connected a machine with 3 probes to my rectal region, then told me to squeeze.  My wife was with me, literally cheering me on.  She came back and told us I was rated a 4 out of 5.  She provided some info and rouitines for me to perform to strengthen those muscles. Right now I lift some weghts; walk 2 miles at a 7 degree incline; and do core training.  I do this 3 to 4 times a week.  I am 5'11" and 172 lbs in the raw.  

Old Salt
Posts: 720
Joined: Aug 2014

It looks like you are in caring hands and that you are properly preparing yourself for the surgery.

Wishing you a great outcome!

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Thanks.  I appreciate all the comments.  

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

LWood68,

Welcome to the board. I read your story in another thread. I wonder if you had any symptom that could be associated to cancer. With only one core positive and a negative DRE and no other positive data in the MRI exam your case can be thought as contained. The pattern 4 seems to be the baddy in your story. High grade Gleason types usually produce lesser amounts of PSA serum but the PSA of 4.72 ng/ml seems to fit the diagnosis for just one core (solid tumour). Did the doctor provide you a clinical stage?

I believe you have researched on the common risks attached to surgery and now you are at peace with the matter.

Best wishes for a smooth operation on March 20. Hope you update us with the good news on remission.

VG

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Thanks for the kind words of encouragement.  The only probelm I was having was nocturia.  He did stage it at T1c.  "Stage T1c Gleason 4+3=7 adenocarcinoma of the prostate (anterior transition zone tumor, left TZ and apex). High volume anterior transition zone Gleason 4+3=7 adenocarcinoma of the prostate (unfavorable intermediate risk).Excellent surgical candidate. I believe that surgery is his best option given the fact that he has such a large volume of anterior tumor. Were he to have radiation, he would have to have combinedandrogen-deprivation therapy and I frankly believe surgery has less side effect long-term than a year or 2 of ADT plus external beam. I believe he can have bilaterally nerve-sparing because his tumor is anterior."  I will update .  Again, thanks. 

MK1965
Posts: 174
Joined: Jun 2016

Surgical side effects are far more serious and longer lasting then you think.

If you would cut off and throw away one important part of your car, do you think car will work. For cars, you can buy new part and put it in and car will be functional again. 

That is not case with guys. Surgery is damaging guys important function to control micturation and hold urine where is supposed to be and erectile function which means continuation of QoL. Of curse, Cancer control is number one priority in the first place.

Why sacrifice QoL when other excellent means of controlling cancer are available.

once damage is done, it is irreparabl e and we have to lieve with our choices.

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Quality of life and Quantity of Life were considerations in making a decision to have surgery that my wife and myself have made.  My surgeon told me about other choices, if you are talking about hormone; radiation, beam, chemo.  He told me that due to the size of my tumor, I would have to have the "Full Monty" of that kind of therapy.  The doctor that told me that is a graduate of Duke University; was over the Oncology (Urology) at Levine Cancer Institute; he has over a 1000 robotic guided prostate removals.  I have talked to a few people with prostate cancer.  One elected to go with the hormone/radiation treatment at age 60.  He is 62 now.  He is what is called Stage 4 and on chemo today.  Another one had his removed and appears to be doing fine. I am 67 years old.  I was in the military for 26 years went to 2 wars.  I moved my family 15 times in 26 years. I have been retired for 4 years. My QoL revolves around my wife, children, grandchildren, and camping. You make a good point with what you say and your analogy.  My friend who is in chemo now with Stage 4 prostate cancer told me if he had it to do over again he would have had it taken out.  So my friend, we have to roll the dice.  I realise the removal comes with permament side effects, on the sexual one, my wife is awfully hard to catch.  On the incontinence one, I am already having issues with that and nocturia.  You have a great day and thanks for posting.  

MK1965
Posts: 174
Joined: Jun 2016

LW,

I was also 4+3 after biopsy, had RARP on 11/2/16 with pelvic lymph nodes dissection and bilateral nerve sparing according to my surgeon.

Fortunately, I was downgraded to 3+4 after surgery with Ca organ contained. Since surgery, my PSA is undetectable.

I recovered continence 99% by the end of 3 months post op. I still have stress incontinece with any physical activity but I learned to live with it. I am very active person who works 50 hrs / week, excercise 3-4 times a week, walk my dog every day 2 miles distance and officiate sport games every weekend. Still use pad in my compression shorts whenever running or officiate games.

I did not have luck in recovering of my sexual function. My sexual life is non existent after surgery and when loss of penile length of 2+ inches is added to my unfortunate recovery, I totaly regret having prostate taken out.

I am very confident, RT in my case would give me way better QoL after treatment. SE 10 years down the street would not impact me same way as it is now. Wanted to be in AS but urologist did not want to accept me because of 4+3. Don’t get me wrong; I am blessed to be cancer free and hope to stay forever free but on the other side, I think I could do way better with different treatment modality. And everything happened at age of 51.

God bless you and good luck with your surgery and even better recovery.

MK

 

 

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

God's Peace to you.  We are never alone in this journey.  I am at peace with myself right now. 

MK1965
Posts: 174
Joined: Jun 2016

LW,

I was also 4+3 after biopsy, had RARP on 11/2/16 with pelvic lymph nodes dissection and bilateral nerve sparing according to my surgeon.

Fortunately, I was downgraded to 3+4 after surgery with Ca organ contained. Since surgery, my PSA is undetectable.

I recovered continence 99% by the end of 3 months post op. I still have stress incontinece with any physical activity but I learned to live with it. I am very active person who works 50 hrs / week, excercise 3-4 times a week, walk my dog every day 2 miles distance and officiate sport games every weekend. Still use pad in my compression shorts whenever running or officiate games.

I did not have luck in recovering of my sexual function. My sexual life is non existent after surgery and when loss of penile length of 2+ inches is added to my unfortunate recovery, I totaly regret having prostate taken out.

I am very confident, RT in my case would give me way better QoL after treatment. SE 10 years down the street would not impact me same way as it is now. Wanted to be in AS but urologist did not want to accept me because of 4+3. Don’t get me wrong; I am blessed to be cancer free and hope to stay forever free but on the other side, I think I could do way better with different treatment modality. And everything happened at age of 51.

God bless you and good luck with your surgery and even better recovery.

MK

 

 

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

 This also showed up on the MRI.  Probably will not be able to confirm or rule out until he gets in there.  My MRI was with a 3 Tesla machine.  Signs of extracapsular disease: Slight bulging the left anterior fibromuscular stroma and loss of hypointense prostatic capsule along the anterior right base (image 18, series 6). Seminal vesicle involvement: None. Membraneous urethra involvement: None.  Urinary bladder neck involvement: Suspicion for invasion along the base of the bladder wall with loss of hypointense prostatic capsule (image 15, series 9).PI-RADS score: 5

contento
Posts: 76
Joined: Jul 2017

Lighterwood, with the suspicion of extracapsular extension should you get a second opinion from a radiation oncologist ? Might be more fitting than doing surgery.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Sugggest that you speak with specialists for various treatment options to do your due diligence.

The side effects from surgery can be greater than other treatment options.

Many men at this site are treated with SBRT, that is accomplished in 5 days or less,  that have comparable outcome to surgery with less side effects. In the case of a more aggressive cancer 4+3, the perimeter of the treatment can be enlarged to treat area immediately outside the prostate.

https://prostatecancerinfolink.net/2016/01/06/nine-year-outcomes-after-treatment-with-sbrt/

Strongly recommend that you have additional image study which may show extracapsular extension, that is if the cancer has escaped the prostate; specifically a T3 MRI (uses the best magnet in clinical use). This information is imperative to your treatment decision.

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Thanks for the info.  My MRI was with a 3 Tesla machine.  Signs of extracapsular disease: Slight bulging the left anterior fibromuscular stroma and loss of hypointense prostatic capsule along the anterior right base (image 18, series 6). Seminal vesicle involvement: None. Membraneous urethra involvement: None.  Urinary bladder neck involvement: Suspicion for invasion along the base of the bladder wall with loss of hypointense prostatic capsule (image 15, series 9).PI-RADS score: 5.  Again, thanks for posting. 

Clevelandguy
Posts: 441
Joined: Jun 2015

Hi Lighter,

Sounds like you have done your homework and made your choice.  Just remember that both surgery & radiation of various forms all have side effects.  If there was one treatment that had no side effects we all would have chosen that one, but there is not.  Good point on the person you know on chemo.  The reason I chose surgery is because as long as the cancer was contained I felt my chance of re-occurance was better. by removing the gland.  Most radiation side effects come later on after treament where surgery has most side effects up front that get better over time plus, I did not want unintended parts of my body(bladder,colon) exposed to excess radiation.  Radiation can make cells mutate which does not sound good to me.  Your nocturia hopefully won't get any worse after surgery.  I would get up at night maybe 2-3 times per month to pee before surgery and now almost 4 years after surgery I still get up maybe 2-3 times per month.

Hope you have a good quick recovery so you can get back to "normal".  Sounds like you have any active life and good attitude which will aid in your recovery.

Dave 3+4

hopeful and opt...
Posts: 2224
Joined: Apr 2009

surgery is a localized treatment. With extracapsular extension, cancer outside the prostate surgery will not cure. Additional treatment radiation and or hormone will be necessary. The side effects of each treatment type is cummulative.

Did you have a bone scan?

 Recommend that you strongly consider radiation plus hormone, or hormone only. Surgery will be redundant( and in your case the nerve bundles will most likely be cut to cause ED).

Contact  a medical oncologist, the very best that you can find to lead your medical team. This person will not be biased, and will be the best person to administer any hormone treatment.

 

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Well, I go to my pre-op tomorrow.  They will be doing a cystoscopy on me to check my uretha and bladder out.  My surgeon called me yesterday (on a Saturday) to expalin: Signs of extracapsular disease: Slight bulging the left anterior fibromuscular stroma and loss of hypointense prostatic capsule along the anterior right base (image 18, series 6).  Urinary bladder neck involvement: Suspicion for invasion along the base of the bladder wall with loss of hypointense prostatic capsule.  When h asked me did I have any questions?  All I said was my main concern was that when he is done with the RP that he does not have to go out to my family and tell them that the cancer had spread out from the prostate.  He said the cancer had not spread.  It is my understanding that the removed prostate and lymph node will be handed over to pathologists.  Also, I understand that the RP surgery is a surgery that is worse than the prognosis especailly if removed when the cancer has left the prostate.  With all that said , I was glad he called me (never been called by a doctor on a Saturday).  My wife and I went to lunch and had a great day.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3278
Joined: May 2012

Lighterwood,

You are correct that during surgery the removed tissues are given to a pathologist to be studied, with preliminary results, before the surgeon closes.  Pathologist's findings are then given to the surgeon, who can then adjust exactly what he must do.  For instance, capsular escape would likely cause him to remove many more lymph nodes than otherwise would be necessary. Also, his "positive margins" (area of non-diseeased tissue around the tumor) would likely be expanded.

Reports of migration to the bladder or other areas would likely cause even more radical expansion of the proceedure.

After the surgery you will get a full assessment of the pathologist's report. I recommend requesting a paper copy of such for future reference.

Good luch,

max

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Thanks for the info.  Will keep in mind.

Old Salt
Posts: 720
Joined: Aug 2014

Your surgeon seems to be an optimist...

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Right now I feed off every bit of optimism I hear.  I am a realist.  I realise this is a tough road, but I do not think it is the end of the road.  I feel I can make it through and make the best of a bad situation.

jeffman
Posts: 24
Joined: Oct 2017

I had my robotic surgery in Sept '17 (after PSA 47,biopsy,MRI, and bone scan-the works. Not a piece of cake but certainly tolerable. Agree with  earlier poster that cath removal is a great day!!

Follow up in Jan. after PSA ultra sensitive test showed PSA les than .01. Next check is April. Incontinence sucks  but is ever so slowly improving. (after 5 1/2 months.) Important to remember that improvement may be slow and measured in weels/months rather than days. Still no erections but orgasms still nearly as good as before-just dry. 

Take it slow and don't be discouraged. Patience is , indeed , a virtue with this experience.

 

 

Best of luck.

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Thanks for the advice.  I understand, that in this type of surgery, the physical side of taking the prostate out is a very serious operation with permanent repercussions.  I also understand that it can take your life and/or make it unlivable if you do not address the issue.  I am 67 years old.  I am dribbling a little anyway, probably due to the PC.  And as far as sex goes, as I have said before, I would have it every time I could, if my wife would let me catch her;  she is awfully fast.  I certainly will try to be patient.

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Well, I went in for my preop cystoscopy today.  Cystoscopy, also called a cystourethroscopy or, more simply, a bladder scope, is a test to measure the health of the urethra and bladder. The procedure involves inserting a tube into the urethra through the opening at the end of the penis.  Even though the urethra was numbed with an ansethetic gel, it did burn and felt like I was urinating.  I got to watch it all on a computer screen.  Also, I have never burned while urinating. I now know what that feels like.  They usually post their results in a couple of days so that I can view.  Also, he had me flex my kegel muscles (to see if Ihad been doing my kegel exercises I guess).  What a picture, the surgeon said that it looked good.  Anyway, definitely another first for me.  On to RP on March 20.  To me, first and foremost fix the cancer.  

lighterwood67's picture
lighterwood67
Posts: 203
Joined: Feb 2018

Well here is what came out of my visit on 03/05/2018:  "We reviewed again his MRI, which shows probable bladder neck involvement.. This is all left-sided and I told him we would do a wide margin at the bladder neck, particularly on the left side to ensure that we get negative margins. Also, I plan to extend his catheter time to 10 days since we will need to do a bladder neck reconstruction. He is potent and therefore, I have started him on preoperative sildenafil."  This will be it for a while.  This site has lifted me up. I am pretty much done until the RP surgery on 03/20/2018.  " A GIANT stands in front of me today, but he is not BIGGER than the GOD that is inside me."

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