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Uke50 posted:
I was just diagnosed within the last few weeks and have met with my urologist to talk about treatment options. I'm 51, T1c with PSA of 3.3. I had 4/12 samples with the highest being 3+4. He's recommending robotic radical prostatectomy.

I'm a little scared about the side effects (especially the sexual ones). Not sure whether I should go for a second opinion though everything I've read so far seems to square with what he's recommending. I'd love to hear from anyone who's been through the procedure what their experiences were. Thanks.
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marinemustangpa responded:

Can only provide my history w/PC.

Back in 1997 I had a PSA 4.2. I didn't get a biopsy then and my PSA went up a tenth or two and down a tenth or two until 10/2000 when it went to 5.2 and I got a biopsy, which came back positive in only one area (Left Apex - very small foci of cancer, less than 3%). It was graded a 3 4 = 7 Gleason (negative digital exam). With consultation of my Urologist I decided to wait and the PSA went down to 3.8 in 02/2001. In 03/2001, I got another PSA which went back up to 4.4 and got a second biopsy which came back negative in all areas. Over the next year my PSA went up a bit and I got a third biopsy 03/2002 which again came back negative in all areas. The PSA testing continued every 3-4 months and finally in 12/2004 it went up to 9.0 and I got the fourth biopsy which came back positive again in one area, left Apex (small foci) with Gleason 3 4=7 So I decided to treat the cancer with 40 doses of external radiation ending in 05/2005. My PSA dropped over several months to a nadir of 1.7 (never did get to under desired 1.0) .

Since then the PSA has remained steady or climbing slowly. Until it hit around 12.0 in 02/2012. I had an X-Ray, Bone Scan, and CT-Scan (which I had before getting the radiation treatment). All came back with no indication of metastatic cancer. I have advanced local cancer but it hasn't gone to the bones. The point I'm making is that it is now 15 years since I had the 4.1 PSA and 7 years since I had the radiation and I'm still enjoying a good quality of life (of course the radiation as does an operation affects sex life but not as much as getting hormones). I know that within a year or so I will have to start hormones if/when the cancer goes up but I'm still preserving quality of life which is very important to me.

Each of us make our own decision. Most of the time prostate cancer is very slow growing. There are arguments for getting the operation right away and others to wait. Same as selecting an operation or radiation. I would certainly get a second opinion in your case. I would also read and learn as much as I could about the disease. Dr Walsh's book on "Surviving Prostate Cancer" is a good place to start.

Good luck! We each make decisions we can live with. There is no one path.

Chuck
 
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bogie11 responded:
I recommend that you research the alternatives, and especially proton radiation, which has minimal to zero side effects. I chose it 3 years ago, and i'm delighted with the results: no side effects wand no change in my sex life. I will be 88 next month.
 
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Fairwind responded:
It all boils down to percentages..Side-effects are part of the game.."At the 3 year post surgery mark, 50% of the patients suffered some degree of impotence...." Right. But the same is true for radiation..And that includes proton.....So how can you tell which 50% group YOU will be in?? You can't. It's as simple as that. But THIS is a fact. The BEST doctors and surgeons do considerably better than the bottom half of that group...This holds true for any of the recognized treatments..

There are many things to consider before you make your choice..
 
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bogie11 replied to Fairwind's response:
I'd like to know how you found that 50% of proton patients became impotent as a result. None of the men i've talked to have had this happen.
 
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Fairwind replied to bogie11's response:
Proton patients report slightly lower problems with ED but significantly more problems with bowel / rectal issues...

Those considering proton treatment for prostate cancer should check their insurance coverage first as many companies will reject it...

http://www.huffingtonpost.com/2012/02/01/proton-therapy-prostate-cancer-side-effects_n_1246873.html
 
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Uke50 replied to Fairwind's response:
c
 
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Uke50 replied to Uke50's response:
Gotta get used to the keyboard shortcuts for Mac vs. PC. Here's what I was trying to say before I accidentally copied nothing (and posted nothing useful as well):


I'm not sure what to think now. Had an appointment with a urologist at Hopkins and he recommended open RP over robotic. I asked if I could get an opinion from a radiation oncologist too just to make sure I had heard from all the experts before making a decision. He said I would be just as good a candidate for radiation (preferring brachtherapy). Then I got good news/bad news on the second opinion on the biopsy slides.

Their pathologist downgraded the Gleason score from 7 to 6. The bad news was they said perineural invasion was present. Walsh says not to worry about it but I've seen a couple of studies that indicate it may be a predictor for recurrence. I was leaning towards the surgery and not sure if this has any implications for which treatment option to pursue first or urgency. I guess I'll have to go back and ask.

Greg


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