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Posted 11/18/2017 4:10 PM (GMT -5)
I’m newly diagnosed and have a few questions. Yes, I’ve read all the introductory information but still have some unanswered questions.

Background: I’m 64, very active, trim, non-smoker, very light drinker. No related cancer in family. Two years ago my internist found a trace of blood in my urine and sent me to a urologist. Blood issue has subsequently gone away and at that time digital exam was normal with a slowly rising PSA over time (3.86 in 2016). I decided to see a different urologist a few weeks ago for my 2017 check-up and he found some irregularities in a digital exam and performed a biopsy. My PSA is now 4.0. Biopsy found: Adenocarcinoma, Gleason of 7 (4+3), 6 of 12 cores positive
My URO mentioned some new cryo technique but said that since it was not approved by insurance, it would cost $15K+.

I’m now working with Memorial Sloan Kettering (MSK) and have a urology oncologist / surgeon (https://www.mskcc.org/cancer-care/doctors/alvin-goh). Both the last urology group and MSK reviewed the slides with similar results, so I don’t see any value in sending to Epstein, etc. PET scan showed nothing. On 12/7/17, after the trauma of the prostate biopsy wears off, I will have a prostate MRI. I think the likely recommendation to be surgery (DiVinci robotic).

A few questions:

1) Since I have some lead time, I was wondering… It is my understanding that post surgery I will have some strengthening exercises to perform. Is there anything that I might want to do leading up to the surgery that could shorten my recovery period? My weight is good and my diet is excellent.

2) An oncology nurse with my health insurance company alerted me to a concern related to post treatment medications. He said that Viagra is covered in full and Cialis (since it is considered a “weekend drug” is only covered for 8 pills / month). Is there a difference? Can I just tell my MD to prescribe one over the other?

3) Any other recommendations?

Thanks in advance.

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LeonardR
Age: 64, 64 at DX
PSA: 2.1 12/12, 3.1 12/13, 3.4 7/14, 3.2 11/14, 3.7 11/15, 3.86 10/16, 4.0 9/17
G 4+3
Stage T1c
6 out of 12 positive
No treatment yet
Posted 11/18/2017 4:48 PM (GMT -5)
Welcome Leonard, sorry you had to show up here and deal with this, but since you've done the reading, you know this will all work out in the end.

To your specific questions...
Some would recommend you start doing Kegel exercises now, to strengthen your pelvic floor. Its the exercise you will be doing after surgery, so get into it now. I did so starting about 6 weeks before surgery, and i believe, but have no proof, that it helped me get continent quicker.

Also, my doctor recommended i walk 4 miles a day, every day, in the weeks leading up to surgery. I also worked on my core, doing planks most days, and crunches a few times a week.
I think all of this helped with my recovery. Everyone has a different experience.

Re the ED drugs - My insurance also approves only 6 or 8 pills a month on Cialis, but my doctor called the insurance company and pushed the envelope, and i got approved for daily Cialis (the copay is not small, as there is no generic version. I dont see why you couldnt try Viagra first see if it works, as long as your Dr has no objection.

I'm a surgery guy, but i made sure i did my due dilligence on radiation options as well before making a final decision. Others will be along to drive that point home, so i'll leave it to them.

And i agree, if you got concurring opinions on the pathology from 2 pathologists and one of them was MSKCC, i dont think you need to have Epstein look at them.

Question, just curious, the uro who talked about Cryotherapy...was it by any chance Aaron Katz, at Winthrop?

Good luck, stick around for more responses, and keep us posted. Welcome to the Reluctant Brotherhood
Posted 11/18/2017 4:54 PM (GMT -5)
Thanks Pratoman.

In answer to your question, it was Luis Galdieri http://www.njurology.com/our-providers/louis-c-galdieri-md/
with New Jersey Urology

I will begin the exercise regimen immediately!!!
Posted 11/18/2017 5:02 PM (GMT -5)
Welcome to HW.

I would also explore your radiation options as well before committing to a treatment path. Both surgery and RT will work for you.

and I wouldn't worry too much about post treatment meds. You don't know where you'll be. Some guys recover without meds and some never recover even with meds.

Andrew
Posted 11/18/2017 5:28 PM (GMT -5)
Hi there. Sorry you are joining our band of brothers with your diagnosis. One of the Docs at MD Anderson wanted me on an ED drug two times a week but the VA denied that even after an appeal. Not a big deal now, I'm pretty much 100% "out of service" with Mr. Happy.

Like the guys said, radiation or surgery would be a good option for you. Good luck with your journey.
Posted 11/18/2017 5:38 PM (GMT -5)
As for exercises, I had several recommendations to start Kegels before surgery. It's too early for me to have an opinion on if they helped, but they can't hurt.
Mike
Posted 11/18/2017 9:18 PM (GMT -5)
John_Tx Don't want to hijack this thread but..............your comment about VA and "get it up meds" I get 4 "vardenafil" a month and that has nothing to do with PCa. Just "old mans ED"
Posted 11/20/2017 9:23 AM (GMT -5)
LeonardR - As the others have said, welcome to the club that nobody in their right mind wants to join. Glad to meet you, but sorry it has to be here.

I can't add very much to the advice you've already received, except to underscore the advice that you explore all of your treatment options before committing to any of them. With your biopsy results you are rated as "intermediate risk" - which means that either surgery or radiation will have a good chance of curing your cancer. With surgery there are a few methods in use - open surgery, laparoscopic (manual) surgery, or laparoscopic robotic surgery. With radiation, there are quite a few more options - traditional IMRT (25-40 treatments), SBRT (5 treatments), low-dose brachytherapy (permanent seeds, one treatment), high-dose brachytherapy (temporary seed implant, one or two treatments), as well as some others.

My two cautions are:

1. Learn about ALL of these before you choose yours. In your particular case, they will all have similar disease control/cure results, but they will all have different side/after effects. Think carefully about which side effects profile will be the easiest for you to live with. You will most likely have a long time to deal with these side effects, so choose carefully.

2. Be sure that seek experts in the particular treatments you want to learn about. You cannot expect a surgeon (like your urologist) to be able to tell you all the details about radiation. You also cannot expect a radiologist who offers brachytherapy to tell you all about SBRT or any other external radiation, unless he/she also delivers that. In other words, assume that any doctor is ONLY an expert in what they normally do, regardless of what they say. Most of them mean well, but they cannot know details about treatments with which they have no experience.

I hope I haven't increased your anxiety level with my advice. I had to deal with all this just a year ago, so the thoughts are still fresh in mind.
Posted 11/20/2017 9:50 AM (GMT -5)
You will need to do Kegels and be concerned with incontinence only if you do surgery. Incontinence is usually not a problem if you choose radiation.
Posted 11/20/2017 9:52 AM (GMT -5)
I'm sorry to hear about your diagnosis and that you're part of our club. But I would say that based on your first post you sound like you're taking this in stride. That, plus your healthy habits should help you get through this in flying colors.

Since I wasn't a surgery guy, I don't really know the answers to your questions. I would probably recommend that you talk to at least one RO since you do seem to be concerned about potential ED. Also, if the MRI shows an increased possibility of spread beyond the capsule, radiation could actually be preferable. That said, surgery is definitely a valid option for you and many guys here are more comfortable going that route.

Good luck to you and I hope we can help you get through your journey!
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