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    Infooverload posted:
    Recently diagnosed with PC (T1 Gleason 3+4) bone scan and CT are clean. I am told the cancer is localized to the prostrate. For the past two months I have read everything on line and in books about the subject. I have the luxury of choosing between radiation or surgery. My real concerns are the aftereffects of surgery, form a physcological prospective I do not think I can tolerate the incontinence for any long periods.
    I have seen a urologist, a urologist/oncologist and a radiation oncologist. Two have recommended radiation, the surgeon however has made a strong case for surgery being the only sure cure.
    Recently spoke to a friend who had robotic PC surgery 4 months ago, he is happy with the cure but not the side effects.
    I would appreciate hearing from anyone with their experiences, whcih would help me become comfortable with my ultimate decision.

    P.S. I am very comfortable with the surgeon and the radiology doctors so they are not as much of a factor.
    BillH99 responded:
    I know that my experience was not typical. But I want to give you the good side of the coin.

    I had surgery on Jan 7. By the 17th I stopped using a pad. Had a couple of minor incidents for the next week or so as I learned what worked and didn't.

    And the 19th I started having erections.

    Based on both some studies that I have seen along with my personal experience it helps to be withing normal weight, be fit & active, and practice the kegel exercises before the operation.
    Gottano responded:
    Hi info. You might want to follow Raynman's discussion under "How relevant is age...". He's wrestling with the same decision. Did your surgeon explain the basis for his confidence for "the only sure cure"? You might ask him if there are any randomized, controlled studies which support his recommendation. If you've read extensively on line and in books about PC, then you know that surgery and radiation are not the only options. There's a wealth of experience in radiation therapy (in various techniques/applications) on this forum. Don't rush into treatment. Take the time to hear from some others' experience and don't hesitate to get another professional opinion. I chose surgery about two years ago and could probably be considered a success story, but If I had to decide today, I'm not sure I'd do the same thing.
    rjorgeron responded:
    I was diagnosed in February with PCa gleason 3 4 T2C, only prostate involved. After much research I opted for a procedure called a Nano Knife. The medical term for it is Irreversible Electroporation of the Prostate. It involves the insertion of electrodes into the prostate through the perinium and building up an electrical field of 3000 volts. This causes pores in the cell membranes causing the cells to die. It is a fairly new procedure that has only been around for 2years. Dr. Jaime Wong at the Malizia clinic in Atlanta, GA performed my procedure. He has done more than any other doctor in the world. This is an outpatient procedure so there is no hospital time. I had a catheter for a week and then have had to cath myself for another week post in dwelling catheter removal. I am very happy with my choice and the treatment of Dr. Wong and his staff. I will have a base line PSA drawn at 3 months post procedure. The good thing about this procedure is that if the cancer returns in later years I have every option open to me as if I had never had PCa. I can even have the Nano Knife procedure done again. I would probably opt for surgery. If you have radiation then surgery is no longer an option because of the physical changes to the prostate. Good luck with your choice of procedure. Also with the nano knife you should have no lasting side effects. Of course there is always the chance of ED and incontinence but that is with every procedure for this disease.
    BillH99 replied to Gottano's response:
    You might ask him if there are any randomized, controlled studies which support his recommendation.

    There aren't any. One was tried a number of years ago, but after a couple of years it was discontinued because way too few PT's where willing to be randomly assigned to surgery or radiation.
    Gottano replied to BillH99's response:
    Hi BillH, I didn't think there were any either, but I was wrong. The PIVOT trial (which you may be referring to) was not discontinued. Although a large number of screened patients did not want to be randomized (either not wanting surgery or thinking surgery was their only chance), 731 mend were selected and randomized for the study. See:

    An earlier Scandinavian trial (RP vs watchful waiting) was also reported in the New England Journal of Medicine in 2005.
    BillH99 replied to Gottano's response:
    I was not familar with that one, but my comment was about surgery vs radiation.

    The OP did not mention his age. I see that the average age in the PIVOT study was 67.

    About a year ago there was a study, IIRC by Sloan Kettering, based on data from Europe (Scandinavia?)

    It was done on frozen blood samples that had been taken in the 80's for a heart study. This was before PSA test.

    Then they checked the records of the people in the study.

    IF they got PC and their PSA at age 60 >2.0 they had a high likelihood of metastasizing or death from PC (IIRC about 60-70%). And if less than 1.0 very low probability and that they did not need future testing.

    I would like to see something like PIVOT further refined by what their PSA was at 60.
    Infooverload responded:
    Thank to all for the help and suggestions, your eexperiences really do help. I have decided to take the radiation route and will begin late July. Once again thanks to all.
    bogie11 replied to Infooverload's response:
    I hope that you have chosen proton radiation because it iis more precise ,and the side effects are minimal to zero. I had zero and am fine after two years plus.

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