The Battle Begins

Thank you so much !

Everyone's journey will be different, but I felt better after I made my peace with cancer as part of who I am, instead of seeing it as an outside invader.

In your case, you have a very strong reason to hope for a cure, but still, your life after treatment will involve more-active monitoring, biting your nails waiting for the result of each test, wondering if each unexplained pain is cancer they've missed, dealing any permanent side-effects, and so on. It will be a new "normal," not the old one you left behind. But I promise you can get used to it and get just as much joy out of life (if not even more).

Best of luck!

Wow. That’s is sage advice. Thank you I will try my best to stay positive. I’m ready ( I think ) for the new life. I appreciate your insights sincerely..

Forgot to link you. A million thx @northoftheborder

Thanks for the kind words. It's ok not to be positive all the time, too. Leave some room for grief and fear and other tough emotions, but don't let them take over and define you.

When you do have a bad day, let us know. This is a great forum, and we're all here to support each-other.

Great words and spot on NOTB! I'd add to this wisdom that at 34 months post RP(PSAs at zero) these words continue to ring true and while not as much of a daily front of mind, they are always close in the rearview mirror.

As for what I'd do pre-op, I'd live my life as normally as possible including your normal sexual activity if for no other reason than mental health and connectivity. I'd had seven joint surgeries including a hip labral repair and this surgery left me the most tired of all previous surgeries so plan on a well-deserved step back from the daily grind. Yes, there were a few post op hurdles along the way...BUT remaining on this side of the dirt as long as possible is the goal that matters and all else is the bonus!

GOOD LUCK!

Well, others have provided their experiences.

With the clinical data you present, the decision not to treat is not an option.

So, treat, with what?

Surgery is an option though waiting for the PSMA scan may make that decision mute if the scan shows PCa outside the prostate. In fact, much in making your treatment decision may be a function of the PSMA PET scan, is it "localized" or "advanced...!? Keep in mind there are no absolutes with micro-metastatic PCa.

Hormone therapy is an option, question, which one, for how long, do you add an ARI, again, which one?

Radiation, again, an option, again, which one and do you treat the prostate only, extend to the pelvic lymph nodes.

Then there are combination therapies - look up doublet therapy for De Novo PCa say an ADT + ARI, ADT + radiation....how long on ADT, 6 months, 12, 18, 24, 36...? Here's one link, https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc, you can find others.

Consider not only your urologist but radiologist and oncologist, when deciding on treatment.

Familiarize yourself with the NCCN Guidelines - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459, they can serve as a starting point in your discussions with your medical team about treatment choices, keep in mind while based on science, they are population based and lag somewhat behind clinical trials impacting clinical practice. The art of medicine is the application of science to your specific clinical data,

Attached is my clinical history. I elected surgery in 2014, keep in mind the state of the imaging and treatment choices then - there were no PSMA PET CTs and treatment was binary, surgery or brachytherapy. today, you have a plethora of choices. In 2023 when my PCa came back yet again, no surprise, my medical team and I had great discussions about which treatment, for how long....

I can't say I did anything special before my surgery, my wife picked up some Depends. When my nurse pulled out the catheter, zero incontinence, didn't need them. Keep in mind statistics, Bell Curve, standard deviations, averages, mean, mode...in my 11 year journey I often fall outside any of those statistics though I am high risk - GS 8, GG4, PSADT and PSAV, 18 months to BCR...Despite my "successful" surgery, I had a 30% of recurrence, yes, it did. After surgery, well, the first weekend I travelled from Kansas City to Saint Louis to watch the Jayhawks in the opening round of the NCAAs, by week two I was playing basketball and lifting weights again, albeit moderately, no incontinence. Yes, I had a good surgeon but I also had and continue to have an active lifestyle so that helps.

So, read up, talk with your medical team, come back and talk with us after you've had your PSMA scan and consults and we'll provide our thoughts.

Kevin

@kujkujhawk1978 thank you. Yes I’m anxiously waiting on that PET scan and hoping no spread. I’ll come back and post you on the findings. I feel lucky to have the insight of people like you so thank you again. I too am active and I’ll continue to be so. Keeping the faith!