Hello - My father-in-law was recently diagnosed with stage 2 prostate cancer (it is confined to the prostate but considered a moderate growing cancer). His doctor has discussed two forms of treatment: radical surgery or radiation. He is now left with the decision and his two daughters and I are trying to give him all the info we can - so far with one suggesting radiation and the other suggesting surgery. First, he is 75 and in very good health. He is also quite active. I have done hours of research and have a couple of questions and if any of you would be willing to answer I would be sincerely grateful. 1) Is surgery considered a cure or a treatment? 2) After radical surgery is there any hope of an active sex life? 3)I have read that sometimes you have the surgery only to find you have to have the radiation too. Is that because a different type of surgery was done or is there another reason? 4) How risky is the radiation? I ask because his wife had breast cancer nearly 5 years ago with surgery, chemo & radiation therapies. I was beside her for the majority of all of it and the radiation was much harder on her than either the chemo or the surgery. And she has pretty severe scarring from it. It seems to me that radiation in the prostate area would be very risky. The breast cancer was a little easier because they just told us how to treat it (we still, of course, researched it too.) How on earth can we know what is the right way to go with the treatment? My sisters-in-law and myself by no means are trying to make this decision for him and my MIL - they have asked for our help and input. The fear of permanent incontinance (sp) seems to be scaring him more than anything else. His free PSA is 14, Gleason score is 3+3=6, and his normal PSA is 6.5. I would sincerely appreciate any help, stories, info or anything. Do any of you know where I could post a message directly to a doctor? Thanks so much for your time.

Hi roseb3
over the last 15 months or so I have had reason to do a lot of searching & reading of material on prostate cancer & the radical P.C.surgery problems.
I was advised some years ago that I appeared to have an early cancer & the urologist I was referred to then suggested I have surgery right away. I already had a considerable knowledge of the results as I had several close friends who had already had treatment of one sort or another.In the light of what I knew about their sexual & incontinence problems I decided to forget it for as long as possible before the next check up.
Although I had never experienced any symptoms before,I noticed about 18 months ago that erections were not quite as spontaneous as previously & that urination at night was somewhat more frequent.The check up brought on a biopsy & numerous scans,which in turn indicated that the cancer had certainly gone as far as it could go without escape from the prostate.
I had already done a lot of research on the various possibilities & I also had by then a urologist who is highly recomended nationally,so after considerable discussion,I had a radical prostate op.at the end of Feb.2000. The situation appeared to be one of little choice.Radio therapy was not recommended as a reliable treatment at that stage & the published likely side effects are certainly not desirable.On the other hand,if complete removal could be carried out before any spread occured there was a likelihood of complete cure,but a certainty of some unpleasant side effects with sexual function and incontinence.
The operation did not show any cancer cells in the lymph nodes,& I was able to get out of bed to go to the toilet within 12 hours & was able to leave hospital after 6 days.Physical strength returned very quickly & that aspect is still as good as before.
To put things in perspective I should mention that I was 71 a couple of weeks before the op.& am in very good physical condition.I ski well & fairly hard & fully used a season ticket the winter before the op. I still swim & use a surf ski & while retired for some time,can carry out long periods of heavy work & lift objects like oxy welding cylinders without effort. In the circumstances I expected to be able to overcome resulting problems as well as anyone could expect. Unfortunately,at this point 12 mouths later I still have to use a pad for incontinence throughout the day,but not in bed& have still not achieved a fully firm erection without assistance.
The story is not all as bad as it seems.The incontinence is very difficult & involves the constant need to be careful & aware,but is slowly improving.KEGEL EXERCISES help. The commercial pads at about 61 cents each were quite inadequate & were smartly changed for a female type super size sanitary pad folded inside a plastic sandwich bag & taped to the underpants with masking tape.This arrangement costs about 16 cents overall & holds over twice the volume of absorbed liquid when compared with the best commercial variety available. While I was using about 12 to14 pads a day at first I am now safely down to about 4 to 5,so that aspect has definitely improved.
The problem of sexual function has also taken a lot of patience (for which I am not noted) & a lot of experimentation;though I must add that the experimentation does have a lot to recommend it in its own right.
Full spontaneous erections have not happened & of course as there is no prostate left,there is no fluid produced.This takes some time to accept as the feeling is somewhat different,though still very desirable.
Fortunately, we led a very active sexual life up to the time of the operation and our experience undoubtedly helped.Within a few weeks we found that, by using a finger to guide the partial erection, we were able to regain frequent quite spectacular orgasms for my wife and very high levels of satisfaction for myself.
We tried various methods to assist in gaining a full erection but avoided the injections, which, I understand, are very effective. We felt that it would be better to try to gain results with more natural methods, if it were possible. The urologist recommended a vacuum device which is placed over the penis and pumped by hand and after a time we obtained one of these. The reslt is very satisfactory as a full return to original erect size was achieved after a few days trying. It is necessary to use a rubber band placed over the base of the penis to maintain the erection for long, but this seems to be becoming less needed as time goes on. It is worth noting that while the device was available through the Medical profession, at around $600, I found that a very effective,almost identical device was available at the better "adult toys" type sex shops for $59.
Viagra has some effect but is not that good unless the operation was done using the "nerve sparing" techniques which are employed by the better surgeons where possible. ASK ABOUT THIS particularly in the case of older men. Remember however, that this method is not always adviseable if the cancer is too advanced in size before surgery is carried out.
The whole thing can be a bit depressing at times but with both partners making use of fairly advanced levels of foreplay, we are finding a return to a very active sexual partnership is quite possible.
Your father-in-law's PSA is much lower than mine was indicating that the cancer is not as advanced. It seems to me that he would be advised to have the operation soon in the hope of a complete cure. Putting up with after effects is not good but it is claimed that things get better over the first two years at least. As I have only taken 12 months to get to this point, I guess it was well worth taking the chance.
There is a lot of work being done in the field of genetically engineered vaccines but this may take a lot more time. The are also a lot of so called "natural" products being offered as hopeful possibilities. Some, particularly those containing high levels of estrogen like chemicals seem to offer some help, but apparently not for long, and in some cases, with rather nasty side effects.
The thing we have to remember is that,if the cancer spreads beyond the prostate, due to failed radiotherapy, or an operation left too late, it means real trouble. There is as yet no cure for that stage and the only real treatment being offered is either chemical or surgical castration. Neither of these is a pleasant prospect as the results are identical but the drugs have serious side effects. There are a lot of good sites mentioned in the earlier discussions on prostate cancer on this discussion board. I will add a few more of the ones I have used in the next few days.
NEVILLE.

Rose,
You asked if surgery is a cure or a treatment. It is a treatment with the hoped for outcome of curing the cancer. There is no treatment that can guarantee a cure for prostate cancer.

The treatment options available at present are: surgery; radiation; seed implant; cryosurgery(freezing); hormones; Watchful Waiting.

The only time surgery is recommended is when the doctors are almost certain that the cancer is contained within the prostate. If it has escaped then the surgery is a waste of money and quality of life for the patient.

I had radiation for my cancer 4 years ago and it has improved so much in the 4 years that I feel mine was a dark ages procedure. If you are in an area that has very uptodate machines, they can pinpoint the radiation now so that almost none of the good cells are damaged.

A Gleason Score of 6 is at the top of the slow growing cancers and that is a plus for your father-in-law. He might want to discuss the Watchful Waiting method with his doctor. There is a possibility that by keeping track of the PSA, and if it rises slowly he could enjoy the rest of his life with none of the side effects that come with every form of treatment.

My cancer returned and rather than immediately getting involved in treating it, I did nothing for 22 months and felt very good. I'm now on hormones, which will control the cancer for some time to come.

Some doctors are following surgery with radiation as a precaution against it coming back or to catch any microscopic cell that might have been missed. It is like giving a woman chemo after a mastectomy.

I facilitate a Man to Man prostate cancer awareness group and we have researched the disease, new developments in treatment, diagnosis, etc.

If you need further answers please let me know.

Brad

Hi
I just found this web site and your message. I have to tell you I knew very little about prostate cancer until Nov 01. My father was diagnosed and it hit us all hard. His PSA was 7.4, His biopsy showed 5 of 10 with cancer. His had not spread. We have heard the many terrible stories regarding conventional treatments and take many herbs. The owner of our local herb shop had just returned from Germany and we assumed it was for a pleasure trip, however in speaking with her face to face only a few days after returning she told us her sister and mom had cancer. They had been to the St Georg Klinic in Munich. My father decided this was the way to go. He researched it for a week and I made the travel arrangements on the internet for under $400. His treatment for the entire 11 days was $5500. He had hyperthermia, which kills the cancer cells and leaves the good ones. Now he is on two medications, vitamin E, Zinc, Selenium, herbal pumpkin, saw palmetto and a very strict diet. There are several wonderful books on diet for prostate cancer. Dr. Bob Arnot has one that is wonderful. And also Michael Milken, the billionaire who found his own cure with diet, etc. You need to eat 30grams of soy per day, this needs to start and work up to, eliminate all pork and beef from your diet. Red meat is the worst food for prostate cancer patients. Also white sugar and white flour. This is very important. My dad has found this an adventure. Lots of fruits and vegetables, which he loves. Try to limit the fat intake to between 30-40 grams per day. Prostate cancer is the easiest cancer to treat with diet. But you must do it well. I hope this helps. WE are very encouraged by my dads choice and he as well.