Hi. I’m new here.

Hey all. I live in Chapel Hill. So my doctors are at Duke Oncology. A pretty reputable center.

Prostate surgery after primary prostate radiation is absolutely possible…but highly, highly undesirable. It’s really a “Hail Mary” because of the nasty side effects of treatment which are for the most part assured. It is NEVER something someone should build into their plan.

On the other hand, the patient’s age should always play a role in wise, fact-based treatment decision making. What you’ll generally find is that over large populations of men, those most satisfied over the long-haul with their primary treatment choice have elected for radiation if they are older, and surgery if they are younger. Radiation is great in the short-term, but it’s the late-term side effects down the road that (can) get gross.

Casey, that was the case with older radiation methods before DART, 3DCRT, IMRT, IGRT etc., were developed. Since the 1990’s IMRT/IGRT CyberKnife and SBRT have revolutionized external beam radiation improving focus and greatly reducing toxicity to benign tissue and these long term effects are simply not showing up as they did with older techniques that have not been used for more than two decades. And these problems you site have never been apparent with interstitial treatment (brachytherapy) which has been used for more than 100 years having been introduced in 1901.

Just look at the number of men on this board, who used radiation as the initial treatment, with long term results like mine where we simply don't suffer from any of what you refer being bowel problems that are long term and can be debilitating. Some in the short run develop temporary bouts of proctitis, but that applies equally to men the use surgery and the have to radiate to salvage a failed surgery. This surgery failure rate has long been reported to be about 35% and mainly affects higher risk men.

It remains, study after study, that radiation as an initial treatment is as good or better than surgery for cancer control and presents fewer and less significant negative treatment side effects. It also remains that the combination of surgery followed by radiation presents the greatest probability and frequency of negative treatment side effects. Simply follow the studies and the numbers; and the anecdotal evidence from men on this board. Irrefutable. Today’s radiation methods are actually superior to surgery in treatment conformity of the cancer and suspected areas. Modern radiation can safely treat well outside the margin the surgeon can cut and kill cancer that the surgeon must leave in place. As an example, with high risk men, radiation can effectively treat all the pelvic lymph nodes whereas a surgeon can not even find all of them to remove.

So, a man is told by the surgeon, “you need surgery instead of radiation” and asks “what if surgery doesn’t work”? “Well, then we will use radiation to cure you”. Man says, “why don’t I just start with radiation and avoid the cutting and inherent surgical damage”? Duh……

Touchdown, welcome.
I am late to the game on this thread. You have been given a lot of information and it may all sound confusing. That is because all of us here collectively have been treated for our PC, with either surgery, radiation, chemotherapy, hormone treatments or a mixture of them. We all have our opinions of what is the best path to follow. You are just starting your journey. This is the time to do your own research to see what is the best choice for you. Your scan will give you more information to help you make that decision. This is not our decision and it is not your doctors, It will ultimately be yours. As stated here, there are quite a few options to choose from. We are all here to support you no matter what you choose to go with.
I do recommend as stated here before that you also get input from a radiation oncologist to give you more than one choice. This cancer is not a death sentence unless you do nothing.
Take some deep breaths and stay active in both your physical and mental health, but most of all stay positive.
My best wishes to you and your family.
Jack

Terry's Cellar said...
If RO’s were the physicians diagnosing PCa…I wonder what % of men would choose surgery for treatment?

very few

Good plan, visit any time. I really hope your PSMA Pet scan provides good results and you can get on with a well defined treatment plan and back to your family life. Later…..

Touchdown,
Will you be kicking an extra point or going for two?? In any case I predict you have many many more years to score!
All of the replies above have given you great advice, Mine is to read my bio and keep the Faith Brother!!!

Please go the the start of our forum and read the sticky thread "Nnewly diagnosed with PC" by Casey59. Also the thread actually started many years ago, I brought back up to the top, "Letters for the newly diagnosed" started by our friend Cyclone ISU.( I seem to have forgot how to do the clickable link!) You will find many posts with encouraging words there !

Wings aka Dan in So Cal

TD,

Welcome back, I hope you're getting there.

It's good to hear your PSA is gone. That's a hooray! It's also great to hear that it was organ confined! You should have received a post-surgery pathology report with a detailed look at the gland. What did it say? Specifically, what was your final Gleason score, was there SVI (Seminal vesicle invasion), EPE (Extra Prostatic Extension--the tumor is pushing out of the gland)? Did they take any lymph nodes and what did they show? These are important questions for your future.

You didn't say if you had any treatment besides the surgery. Did you have ADT (Lupron)?

I'm sorry to hear you're having ED and incontinence issues. What is your urologist saying? Has he put you on an ED medication? Many of us have found that low dose daily cialis helps both. It increases the blood flow to the pelvis, which promotes healing of everything in the area.

Sorry for all the questions. Another important one is--what does the pathology report--or the doctor's surgical notes--say about the nerves? Did the nerves (either one, there are 2) get nicked or removed? Are there any indications that the bladder sphincter got damaged?

You're about 3 months out from surgery. It's still early. Keep doing your kegals. For the ED, is anything happening at all?

TD – Your pathology report should have some basic summary information in the beginning followed by all sorts of details of prostate examination. Most pathologists use a report template so they tend to look more similar than different. It can be confusing as the form may list horrible sounding items but then say “negative”, “not identified, and so on. In some cases, they are just left blank.

You should first be looking for classification, pT2a, pT3b… maybe followed by pNx for lymph node involvement if any. Then look for all the other stuff. Things like nerve sparing will not be in the pathology report and you will have to discuss with doctor as it would be in the surgery report.

As far as continence and ED go, this is measured in months, not days or weeks. You will not know where you end up for up to a year. If all goes well, you will know much sooner but you have to give your system time to recover and re-adjust to your “new normal”.

I was 99% continent after catheter removal and wearing underwear to my follow up doctor visit a week or so later. This is not normal as he noted but reflects one extreme, the other extreme are those who never regain control. The success percentage is pretty high, like 90+% at 1 year so hang in there.

ED does not have as high of a success rate given all the factors that affect sexual function as well as the surgery but has improved a lot since nerve sparing surgery was discovered. The key is starting early with rehabilitation and staying with it.

I never had much luck after partial nerve sparing on one side and radiation follow up but it was not for lack of trying. I was older (66) and my wife reminded me that I was not quite the stallion I was when younger so probably a little ED creeping in before surgery as well. There was some activity after surgery but never became enough to do the job.

My doctor started me on low dose Viagra followed by a vacuum pump to exercise Mr. Winky. I am pretty sure the pump helped with stretching and reducing shrinkage as well as bringing blood into the penis. I switched to Cialis due to bloody nose issues. The 5 mg dose was the maintenance dose and the 20 mg dose was the event dose as I recall. I also have had some issues with orgasm leakage which I can control much better now assuming the bladder is not full. It even has a name, climacturia, if you want to read about it.

It is hard to imagine what this experience is like at 46. If anyone has a chance at a good recovery, it would be you. My wife is a cancer survivor so her sex drive was tempered long ago and she has been ok with everything. Hard to undo a life of being on top of the sex game but I got used to it. There are a whole lot of things I cannot do as well as I get older and there are muscles that I never knew could hurt until now.

Hoping things are going well for you, in your recovery.

I hope each day brings continued healing, Touchdown.

Sending positive thoughts your way, in the NEW YEAR!

All my best,
CYCLONE # Iowa State University