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New Diagnosis
GJBKLYN posted:
I am 59 years old and just found out I had Prostate Cancer last Thursday. My Gleason score is 3+3 and there were 4 out of 12 samples that showed cancer. My surgeon is recommending Robotic DeVenci surgery and assures me that I will be able to have an orgasm, but it will be a dry one. I have had some ED disfunction and he thinks that may imorove as well over time with the removal of the Prostate. I know my other option is radiation, but I am concerned about the long term complications. Can anyone share with me their results of either procedure? Thank you,
BillH99 responded:
I had the robotic surgery on Jan 7, and Jan 24 I was mostly dry and starting to have erections. So it is possible.

BUT I know that my experience is not typical.

My next door neighbor had it done about 3 years ago. I think that he was dry within a month or two. But he has had some ED problems. Don't know if he had them before or not.

" I have had some ED disfunction and he thinks that may imorove as well over time with the removal of the Prostate."

To me that does not sound right that exiting ED can get better after the surgery.

And, in general, a significant number of people have ED side effects after the surgery.

I would ask him to explain that in more detail and maybe check with some other surgeons.

But also remember that there are treatments for ED.

When I was researching my options I found one research paper that had found two years after treatment both those that chose surgery and those that chose radiation reported the same qualify of life on the average.

But remember each person had the own biases about how much they could accept different side affects.

In my case I have had bowel problems so that put radiation way down on my list.
Fairwind replied to BillH99's response:
ED seldom if ever improves after a radical prostatectomy..Men who had problems before the surgery usually have worse problems afterward..This also applies even though the "nerve sparing" technique was used..ED is a major side-effect of surgery and it tends to become a problem with radiation too..

Studies have shown that 3 years post treatment, the side-effects for surgery and radiation are about the same.

Many men with PC wind up on hormone therapy sooner or later and the side-effects from this can be worse than those associated with surgery or radiation...

Do your homework carefully...
bogie11 responded:
Your doctor recommends surgery because that's his stock in trade. And before you decide on treatment, check all the options. Remember that all radiation treatments are not the same. I opted for proton radiation 2 yrs ago and have had no side effects at all. I've heard from many other men who have had the same treatment, and all of them have had zero to minimal side effects and are very happy that they chose proton. I started having ED 2 yrs before my treatment, and I started Viagra which worked well. After treatment I continued with the same results, and my sex life is great. I'm now 86.
GJBKLYN replied to bogie11's response:
Hi Boogie 11

Thank you for responding. I just read about the proton radiation and I do have an appointment with a radiologist in the next few weeks. Is this technique a better option than surgery or seed implants in your opinion.

Thank you, gjbklyn
Fairwind replied to GJBKLYN's response:
There are no good studies that show proton treatment having any benefit over photon treatment..For many years, Loma-Linda was the only center that offered it, but their record keeping was such that it is useless for making comparative studies..You still may have to travel to find a treatment center with a proton machine..The treatments are very expensive, especially if you are living away from home..Check with your insurance company as many do not cover this type of treatment...
GJBKLYN replied to Fairwind's response:
Hi Fairwind

Based on your knowledge do you feel surgery is a better way to go than radiation given my 3 3 score and age of 59?

Thank you,
Fairwind replied to GJBKLYN's response:
Yes...(That's just my opinion)..But choose your surgeon well..

Overall success with surgery depends largely on the skill of the surgeon..(and the extent of your cancer)..

But at least now, should surgery fail, you get a second chance with radiation..

These are the factors that guided my decision to have surgery which failed. I'm a gleason 9, a COMPLETELY different ball game than Gleason 6...
GJBKLYN replied to Fairwind's response:
Thanks Fairwind. I am limited with my choices of surgeons because I belong to Kaiser. The surgeon has performed over 120 of these operations with great success, or so he says.

BillH99 replied to GJBKLYN's response:
There is no clear cut way to differentiate between the different options.

There is no good head to head comparison between the different ones. A few of years ago they tried a study, but gave up after a couple of years because they could not get enough people that would allow them to be randomlly assigned to the different options.

And data of side affects is 5 to 15 years old. And during that time there have been many changes in treatments.

In surgery more in terms of refinements. But lots of changes in radiation.

Here is one way to look at it. First look the side effects of the different treatments and decide on which ones you would be OK with and which would cause you more problems. And look at the reported percentage of that side effects.

After you at them and decide on a preliminary option start talking to the provider of that option.

Start taking to him and ask about what has been his experience with those side effects. And ask him about how he defines the side effects. For example clinically continence is often defined has not needed more than one pad a day.

Some patients that would not be a problem at all. Others would not find that acceptable.

If you don't feel comfortable with that provider. Then think back see if you want to reconsider the method or try another doctor.

And if you won't have a strong feel that one is better than the other, for YOU, then the idea that you can get radiation after surgery, if needed, might help trip the balance.

For me I had a strong negative for the radiation, because of possible bowel problems. And the 8 weeks of treatment (most common, but not all versions) and fatigue was also a negative.

So that pushed me towards the surgery and I as confident in the surgeon. I was not I knew of several other surgeons that are on my plan. If I was not comfortable with them then I was going to check with the different local radiation centers to see if they had any of the newer radiation systems that where more focused and had less side effects.
Fairwind replied to BillH99's response:
If you choose surgery, I would try VERY hard to find a surgeon who has done 300 or more prostatectomys..This is one of the most difficult and challenging operations there is..Your surgeon, at 120 procedures, might be very good indeed or he might be still in the learning phase. Who knows? Good surgeons keep accurate records..They survey their former patients to see how they are doing. The best surgeons achieve a low percentage of positive margins on the post-surgery pathology report. They also manage to achieve a low percentage of incontinence and impotence..Only the best excel at all three...Have I mentioned reading Dr. Patrick Walsh's book, "Guide to surviving prostate cancer"?? It's the Bible of prostate cancer information..

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For more information, visit the Duke Health Prostate Cancer Center