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  • I've decided on surgery

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    Old 05-26-2021, 06:12 AM   #1
    MrJohnny
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    I've decided on surgery

    I’ve decided on surgery to treat my prostate cancer.

    My urologist recommended I speak to a radiation oncologist to hear both options before making my decision. I met with the radiation oncology team yesterday and it was eye opening.

    I am paraphrasing, but the oncologist’s opening remarks were something like “We’ve done a thorough review of your charts. Today I want to explain the types of radiation treatment, what we would recommend it you choose radiation, the side effects, and answer all your questions. When we’re done, I’ll explain why we recommend you choose surgery.”

    The radiation oncology team took into account my age (54), high PSA (27.1) and lifestyle (still working, active, healthy) as reasons for their decision to recommend surgery over radiation as my first treatment. They felt surgery could be better followed by radiation IF there is more cancer in the future rather than radiation now and then again later.

    The oncologist also felt that the addition of hormone therapy combined with radiation would not be ideal for my personal situation.

    Bottom line, they felt my best treatment option is to begin with surgery.

    Another piece of the puzzle is filled in. I’ll schedule the surgery today and the urologist is looking mid-June after I’ve fully healed from the biopsy.
    __________________
    My Journey so far:
    54 at diagnosis.
    02/21 - PSA 27.1
    4/13/21 - CT scan shows 11mm tumor at left lateral apex at the 3 - 4 o'clock position relative to the urethra. PI-RADS 4. No neurovascular bundle or seminal vesicle involvement by malignancy.
    04/23/212021 - Biopsy results, 7 of 14 cores positive including left base, left apex, right base and target, all positive cores scored Gleason 3+4=7 with between 5-30% graded 4.
    05/11/21 - CT pelvis scan and Technetium bone scan both negative.
    5/25/21 - Decided on RP, to be scheduled.

     
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    Old 05-26-2021, 08:27 AM   #2
    Prostatefree
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    Re: I've decided on surgery

    Well done.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    1-15-21 PSA less than 0.02; zero club 4.5 yrs

     
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    Old 05-26-2021, 09:07 AM   #3
    Terry G
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    Re: I've decided on surgery

    Wading through the treatment options can be a little taxing; but, once done most of us feel relieved. The best choice is an informed one. You’ve done your homework now it’s time to get it done. Best wishes and keep us posted on your progress.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
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    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8

     
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    Old 05-26-2021, 09:46 AM   #4
    DjinTonic
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    Re: I've decided on surgery

    Excellent! Take this time healing from your biopsy to get in shape. You can research pelvic floor (kegel) exercises and begin them. Have a look here and around the forums for advice on what to have on hand for your first day home and what to do and not do based on lots of guys who have gone before you

    Djin
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    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 05-26-2021, 03:11 PM   #5
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    Re: I've decided on surgery

    An informed choice is a confident decision.

    Best wishes for your surgery.

     
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    Old 05-27-2021, 08:28 AM   #6
    gser
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    Re: I've decided on surgery

    Hi
    I wish all the best with the surgery

     
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    Old 05-27-2021, 12:15 PM   #7
    Frankh1967
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    Re: I've decided on surgery

    I’m not an expert, but will parrot my surgeon’s remarks….”if you choose radiation, later surgery will be quite problematic. If surgery fails to get all the cancerous tissue, you can still have radiation.”
    I think you made the best decision to follow the oncologist’s excellent advice!
    Best wishes for a quick recovery!!!

     
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    Old 05-27-2021, 03:00 PM   #8
    ASAdvocate
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    Re: I've decided on surgery

    Quote:
    Originally Posted by Frankh1967 View Post
    I’m not an expert, but will parrot my surgeon’s remarks….”if you choose radiation, later surgery will be quite problematic. If surgery fails to get all the cancerous tissue, you can still have radiation.”
    I think you made the best decision to follow the oncologist’s excellent advice!
    Best wishes for a quick recovery!!!
    Well, while I wish you well with the surgery, I will respond to the misleading half-truth about “surgery after radiation”

    Was it explained to you that radiation is a whole gland treatment, and that any remaining cancer had already escaped the prostate? In that case, surgery would not be appropriate, anyway. Targeted radiation, especially SBRT or protons, or cryotherapy, or HIFU would used as curative salvage treatments.

    Far too many men state that they believed there were no other options after primary radiation, because of being told that surgery talking point.

     
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    Old 05-28-2021, 11:50 AM   #9
    Gary I
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    Re: I've decided on surgery

    Quote:
    Originally Posted by ASAdvocate View Post
    ....Far too many men state that they believed there were no other options after primary radiation, because of being told that surgery talking point.
    Probably not as many as have bought into the RT talking point about little or nothing to worry about with a little supplementing hormone treatment...six months to three years, but not to worry, the side effects are minimal.

    Yeah right.....
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
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    SRT, 2ADT, IMGT 70.2 Gy, complete 5/18
    PSA 0.066 1/20, .059 6/20, .077 9/20, .099 11/20,.075 1/21 .079 4/21

     
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    Old 06-01-2021, 09:56 AM   #10
    MrJohnny
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    Re: I've decided on surgery

    Quote:
    Originally Posted by ASAdvocate View Post
    Well, while I wish you well with the surgery, I will respond to the misleading half-truth about “surgery after radiation”

    Was it explained to you that radiation is a whole gland treatment, and that any remaining cancer had already escaped the prostate? In that case, surgery would not be appropriate, anyway. Targeted radiation, especially SBRT or protons, or cryotherapy, or HIFU would used as curative salvage treatments.

    Far too many men state that they believed there were no other options after primary radiation, because of being told that surgery talking point.
    Hi ASAdvocate,

    The radiation team did go into great detail about the treatment, as well as cure rates, side effects, and future radiation. They felt my age and lifestyle were important details to consider and felt that two years or hormone therapy at 54, while certainly a good option for cure, were not the best option for my situation.

    Cheers,

    John
    __________________
    My Journey so far:
    54 at diagnosis.
    02/21 - PSA 27.1
    4/13/21 - CT scan shows 11mm tumor at left lateral apex at the 3 - 4 o'clock position relative to the urethra. PI-RADS 4. No neurovascular bundle or seminal vesicle involvement by malignancy.
    04/23/212021 - Biopsy results, 7 of 14 cores positive including left base, left apex, right base and target, all positive cores scored Gleason 3+4=7 with between 5-30% graded 4.
    05/11/21 - CT pelvis scan and Technetium bone scan both negative.
    5/25/21 - Decided on RP, to be scheduled.

     
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    Old 06-01-2021, 12:32 PM   #11
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    Re: I've decided on surgery

    Quote:
    Originally Posted by MrJohnny View Post
    Hi ASAdvocate,

    The radiation team did go into great detail about the treatment, as well as cure rates, side effects, and future radiation. They felt my age and lifestyle were important details to consider and felt that two years or hormone therapy at 54, while certainly a good option for cure, were not the best option for my situation.

    Cheers,

    John

    Hi John, Actually, I was replying to Franks’s post.

    No matter. Best wishes for for your surgery.

     
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    Old 06-01-2021, 12:44 PM   #12
    gser
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    Re: I've decided on surgery

    I would like to also wish all the best. You might find interesting the link below (I am sure it would have been posted somewhere else in the forum):
    https://prostatecancerfree.org/compare-prostate-cancer-treatments-low-risk/

     
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    Old 06-02-2021, 06:00 AM   #13
    DaveinMaryland
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    Re: I've decided on surgery

    Here's the best advice I got when I was deciding what treatment to undertake - "Chose the option you won't second guess and can live with if all does not go optimally".

    Sounds like you've done that. Forward and best wishes.

    Now, a few things to prepare for surgery.

    After returning home, sleep in a recliner the first couple of days. Makes it easier getting up and down and keeping the catheter from catching on things.

    You will have a catheter from 7 to 14 days. Make sure to follow the cleaning and lube instructions and you will have no issues. They told me twice a day. I did it once a day at first and had some discomfort. When I went to twice a day - no issues. As a matter of fact at times I forgot I had a catheter. I carried mine around in a kids sand bucket. Gave it a name - Peabody. In a weird sort of way you miss it once it's out because you never had to take a bathroom break.

    You will need pads and eventually graduate to shields. It will take several pads a day at first. You also want to have underwear that will hold the pads in place. Forget cotton underwear. You need something with spandex. 5% spandex will be enough. I had great success with 5% spandex boxer briefs.

    Measure progress for return of continence from week to week, not day to day. There will be good days and bad days. If you compare day to day it gets frustrating because you feel like you've gone backwards on some days.

    They told me 3 to 6 months to continence. For me it was 5 months. Full continence means no leaks when doing routine and everyday activities and no need for shields. There will always be some leakage when you strain or highly compress your abdominal area.

    Start doing kegal exercises now and continue after the catheter is removed.
    Get exercise now in preparation for the surgery. The better shape you are in , the faster the recovery. I had an open RP and felt great after 2 weeks. Had to remind myself to take it easy as I just had major abdominal surgery and there still was a lot of healing taking place.

    After surgery, get walking. It doesn't have to be long walks. They may very well start you in the hospital. When I got home, I started with pacing in the house while I had the catheter. I'd do 500 paces 5 times a day figuring it was a mile. I would say it definitely helped with recovery.
    __________________
    Dx at age 63 March 2017
    Prostate Cancer 3+4 Open RP May 2017
    PSA detectable May 2018, single digit .1 2 digit .06
    August 2018 2 digit .07
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    6 month Lupron Shot Dec 2018
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    Old 06-07-2021, 05:14 PM   #14
    music4ever
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    Re: I've decided on surgery

    As others have mentioned focus on Kegel exercises both before and after surgery. I liked “Michelle Kenway” u tube channel to learn how to do them properly. It’s a very subtle move at first to work the small pelvic floor muscles. You should start by doing them sitting down. If doing them properly no one will even know you are doing them when sitting. After you get the hang of controlling those muscles then you can graduate to the other thrusting and bridge type exercises that are common on the internet. But learn the proper technique to control those muscles first grasshopper. It will speed your recovery time!
    __________________
    1/2021 - 53 y/o Dx Prostate cancer Gleason 7 (3+4) over 6 cores on right side. Prolaris report "Unfavorable Intermediate" risk - PSA 3.9. 2019-PSA 3.51, 2017-PSA 2.55
    3/2021 - Radical Prostatectomy (robotic).
    3/2021 - Post-op pathology provided – pT3a pN0 MX, Stayed Gleason 7 but moved up to 4(70%) + 3. Small positive focal margin on right side. EPE. Decipher genomic test (.97) suggests "high risk" prostate cancer.
    4/2021 - 6 week follow-up PSA is 0.08
    6/2021 - 12 week follow-up PSA is 0.06

     
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