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Posted 9/28/2017 4:06 AM (GMT -5)
Based on numerous factors it is highly probable I will seek treatment for my PC in the spring of next year. Probably surgery but still need to do a lot of investigating and discussions with docs.

Given that I will treat, what can I do to best prepare for it? I am healthy, at a healthy BMI, very active, don't smoke or drink, and I am a vegetarian. I am a runner, bike rider, and golfer. I get hours of exercise each day.

I know that I want to strengthen urinary sphincter via kegel exercises. What else for those that have been through treatment? Thanks, Denis
Posted 9/28/2017 5:29 AM (GMT -5)
Denis,

Congrats on working on staying healthy. I'd suggest keeping up with what you're doing. Particularly if you go with surgery, a key is getting your core strong. Some Uro's have connections with physical therapists who have expertise in teaching men how to do kegals, you might ask.
Posted 9/28/2017 5:53 AM (GMT -5)
I am fortunate my wife is a PT! thanks Den
is
Posted 9/28/2017 6:00 AM (GMT -5)
Denis we can chat this weekend at GFMPH. I had RALP and can tell you what to expect if you go that route.
Posted 9/28/2017 7:39 AM (GMT -5)
Thanks gardner
Posted 9/28/2017 8:43 AM (GMT -5)
Get a comfortable recliner to sleep in the first few nights as getting in and out of bed will be difficult. And get a big bucket with a handle to put the cath's collection bag in at night and to carry it around during the day.

Little things really help. Good luck!
Posted 9/28/2017 8:56 AM (GMT -5)
sounds like you're already doing what you need. Good health, investigate options. That's the path.

Andrew
Posted 9/28/2017 9:00 AM (GMT -5)
Since you already have the health aspects covered, I suggest that you have lots and lots of sex during this period.
Posted 9/28/2017 10:01 AM (GMT -5)
I do like the suggestion of having lots of sex... However as a runner my pelvic muscular status was of such conditioning I never did, nor have I ever done, a Kegel.. I can say that post operative I have never been able to enjoy the running like I did prior to surgery, I still get after it, but it is a mystery as to why if feels different, Now it is perhaps that I'm 8 years older. Runners with great BMI in my opinion (very anecdotal) have no difficulty with incontinence, assuming that you have a reasonably competent surgeon.
Post surgery I spent hours on my bike and then put it away after nearly getting smashed by a car, however I'm back at it only I'm very selective where I ride when on the road.
I was in the best shape of my adult life when I had surgery which helped in so many different ways.
Good Luck!
Hero
Posted 9/28/2017 12:47 PM (GMT -5)
Thanks hero. Once we are in Florida, in a few days, there are great safe trails to ride. Be well. Denis
Posted 9/28/2017 3:05 PM (GMT -5)
Planks. They were recommended to me and I did many to strengthen my core over the six months leading to surgery. I believe they helped in my recovery.
Posted 9/28/2017 3:10 PM (GMT -5)
I second the folks saying strengthen the core. I'm 5 weeks post op, and believe that losing some weight, lots of walking (4 miles / day or so) kegels and planks / sit ups helped speed my recovery. about all I have now is some itching at the incisions.

Best of luck

Rob
Posted 9/28/2017 3:49 PM (GMT -5)
This question gets asked here all the time. (Of course it does. It's a great question.)

I've read many older threads, and the phrase that used to be very commonly used was: Drain your prostate as frequently as possible before treatment.

Of course, the reason for this is that if you have surgery, it'll be a while—maybe weeks, maybe months, maybe years, maybe never—before you'll have another chance to experience the (almost) complete sensation. Oh, the experienced men around here will tell you that there's "workarounds" (yes, one can climax without an erection), but for those who are sexually active with partners, the impact on the sexual experience can be...well, let's just say significant and multi-dimensional. (soooooo many threads attest to this)

One of the facts that continues to amaze me about the aggressive prostate cancer treatments is the high degree and utter randomness which guys pull the short straws in this area. A small number recover sexual functionality relatively quickly. Another similar smaller number don't recover, and some of those end up going the route of adding a urological mechanical device to achieve erection-on-demand...and there was absolutely no clue whatsoever going into their RP surgery that they would ever not recover functionality. Largely random.

Of course, the majority of outcomes are not at the extremes and most do have some basic functional recovery (almost always having to use some chemical or mechanical aids) somewhere in the months-to-years timeframe...but again the variations here are totally random. "Stuffable" is a term that gets used around here a lot. The extent of recovery seems to have very little to do with the skill of the doctor, their case characteristics (even if nerves spared), or anything else identifiable. High degree of variation/randomness.

Want to be prepared? Be prepared for a random (or at least a highly variable, minimally-controllable...pretty much the definition of random) sexual functional recovery outcome. Of course, this is one of the big reasons for making darned sure treatment is really necessary. The other big reason is the very similarly random outcomes of serious incontinence. Those men here with urological implants to stop their incessant post-treatment dripping never planned for that either...and there's not really any pre-surgery prep that helps improve ones odds; it's really random. This weekend, ask Worried Guy (Jeff, in NY) about why he got one of the short straws on incontinence. Random.

In the mean time, the old school recommendation is to drain the prostate often up until treatment time.

Post Edited (NKinney) : 9/28/2017 3:36:28 PM (GMT-6)

Posted 9/28/2017 4:18 PM (GMT -5)
Don't agree. SEs are not totally random. It's also because there are big differences between the individual surgeons. For example the risk of incontinence between different surgeons from the same hospital ranged from <5 percent to >30 percent. Denis- If you can, prepare by choosing the most competent surgeon you can find.
Posted 9/28/2017 4:34 PM (GMT -5)
Largely random; not totally random.

The significance (statistical term) of the surgeon selection is a small factor, although it is a factor. There is wide variation in results amongst ALL surgeons, although it's true that you can raise the average odds by a small amount going with a highly experience surgeon...but that's not a highly significant factor.

The top surgeons totally randomly have patients (right here at HW!) who have poor sexual function recovery. On the flip-side there's the other cases of minimally-experienced community doctors with only 50 cases under their belts having some patients with "good" (as good as it gets) outcomes. When you envision the population distributions, the widely varying ranges greatly overlap with slightly offset means.

Yes, choose an experienced surgeon to slightly boost your odds, but the randomness of outcomes amongst all doctors nearly completely overshadows this.

Post Edited (NKinney) : 9/28/2017 3:39:15 PM (GMT-6)

Posted 9/28/2017 4:47 PM (GMT -5)
www.europeanurology.com/article/S0302-2838(10)01057-2/fulltext#sec0035

Conclusions
A patient’s likelihood of recovering erectile and urinary function may differ depending on which of two surgeons performs his RP. Functional preservation does not appear to come at the expense of cancer control; rather, both are related to surgical quality.

To our knowledge, this is the first study to show that erectile and urinary function after RP vary between surgeons and therefore that a patient’s risk of functional impairment can depend on which of two surgeons does his RP.
Posted 9/28/2017 5:05 PM (GMT -5)
Key word from the Conclusion above: "may"

The highly overlapping confidence intervals (distributions) from different surgeon experience levels which I discussed are shown in the study, Figures 1 and 2: www.europeanurology.com/article/S0302-2838(10)01057-2/fulltext#sec0035

Here’s an eyeball statistical observation that anyone can do with the charts. Basically, if the confidence intervals of different surgeons overlap, you cannot say that there is a difference (statistically significant); in other words, whatever differences exist when the CIs do overlap are only random. The results from the highest performing surgeon on the chart overlap with most (not all) of the other surgeons. By the same token, the results from the lowest performing surgeon on the chart also overlaps with most (not all) of the others. Analysis: there is a wide ranging variation with strong overlap of similar results.

Bottom line (repeating): Choose a highly experienced surgeon to somewhat boost your odds. Highly experienced surgeons also, however, have widely varying results. Check with their patients...they are right here at HW/PC.

Post Edited (NKinney) : 9/28/2017 4:29:48 PM (GMT-6)

Posted 9/28/2017 8:00 PM (GMT -5)
My surgery was more than 10 years ago. I have suffered the consequences of that decision for all that time. When asked for my opinion, I say avoid surgery if you can. There are many better treatment modes that I wish were offered to me.
Posted 9/28/2017 8:19 PM (GMT -5)
I think the best way to prepare for surgery is to see an excellent radiation oncologist. Great cancer control with far less side effects.

But you are obviously well past that consideration. I can't give you any meaningful advice regarding surgery as I haven't experienced it. But I certainly do extend my best wishes for success in every way. I hope you do very well.
Posted 9/28/2017 11:01 PM (GMT -5)

Michael_T said...
Since you already have the health aspects covered, I suggest that you have lots and lots of sex during this period.

+1 on that. Hands down the best advice I've ever seen on this forum. Not only that, now is the time for any 'special requests.'
smilewinkgrin
Posted 9/29/2017 4:50 AM (GMT -5)
Thanks to all who answered my question directly and to those who are nudging me to consider nonsurgical options. I will be meeting with radical and am looking at all the possibilities. It was only a few days ago that treatment became a reality (some are still telling me to consider AS) will sort it out, just need to stay in the muck until the path becomes clear. Denis
Posted 9/29/2017 6:52 AM (GMT -5)

Subdenis said...
(some are still telling me to consider AS)



BTW, I'm not telling you to do AS.

You have been given the gift of time. You have absolutely NO reason to exclude AS at this point. You should gather the information for all possible paths during this time. One of those data points should be a second, confirmatory biopsy in 6 or 8 months. I don't give online advice, but that's what I (an 8 year well-read, experienced veteran) would do in your shoes.
Posted 9/29/2017 7:15 AM (GMT -5)
D`....see the rad doc.....explore all...have SEX now
Posted 9/29/2017 9:29 AM (GMT -5)
I posted in this thread (and another) earlier this morning. Then I went out for my workout, and something I wrote earlier was pinging in the back of my head because it was wrong. I needed to come back and fix it before taking off for another 3-day weekend in paradise.

Earlier this morning I wrote:

NKinney said...
I don't give online advice...


That's not entirely true. What would have been more correct is that I don't give online treatment advice. I have worked 1-on-1 with guys, built a relationship and have given treatment advice, but that's not what I have going here online with the men and women of HW/PC. In fact, I cringe when I see others dishing out online treatment advice with little knowledge about the necessary details.

But there is important online advice I give to the newbies, and it pretty much the universal advice experienced men should be giving to all newbies. Educate yourself. Especially those (like Subdenis) who have been given the gift of time (although that turns out to be true for most newly diagnosed men).

Educate yourself about prostate cancer. It's not good enough to find yourself in a physician/patient relationship where you just give it all to the doctor...whatever he/she says goes. People sometimes do that (and I suppose if it's ok with them then it's ultimately ok with me), but retrospective studies have shown those are the PC patients who suffer the highest level of treatment regret after-the-fact...and I'd really like for my advice to end up helping them avoid regret.

For favorable-risk guys (like Subdenis), there's incredibly valuable articles and books out there to absorb, but they take a little time and effort. There's the infamous article I Want My Prostate Back!, and Dr Mark Scholz's book Invasion of the Prostate Snatchers. Dr. Scholz is the co-founder of PCRI, and the much trusted PC caregiver to many men here at HW/PC. He doesn't give advice in his book, either; he give provides readers with insight from the PC doctor's perspective. Sadly, there's lots of guys who simply aren't "readers"...it's no surprise that one's education level also has a negative correlation to PC treatment regret...the lower the education, the higher the likelihood of regret. You've got the time; are you willing to put in the effort?

So, I wanted to come back and correct myself. I do give online advice. Educate yourself about PC so that you don't limit yourself to a mostly emotional decision, or someone else's decision. Don't just blindly do what one specialist says to do simply because he's developed a refined ability to build rapport with patients and make them comfortable. That's a well-documented recipe for "treatment regret."

Have a great weekend in paradise...back on Monday to do it all over again!

Post Edited (NKinney) : 9/29/2017 1:51:59 PM (GMT-6)

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