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thoughts on what I should do.
48 years old , So How screwed am I. Dr. gave me two options radiation pellets or a Prostatectomy. Pet scan is next week. right now its panic and wait. was told if I did radiation then surgery was not an option after the fact as no dr would remove the prostate after I had received radiation first. but If I removed the Prostate and the cancer came back then I could get radiation afterword's.
SPECIMEN C: PROSTATE, LABELED AS "RIGHT APEX", CORE BIOPSY:
- ACINAR ADENOCARCINOMA, GRADE GROUP 3 (GLEASON SCORE 4+3=7)
- PERCENTAGE OF GLEASON PATTERN 4: 71-80%
- CRIBRIFORM GLANDS: NOT IDENTIFIED
- NUMBER OF POSITIVE CORES: 2 OF 2
- TOTAL CORE LENGTH INVOLVED: < 5%, 6-10%
- PIN4 MULTIPLEX IMMUNOHISTOCHEMICAL STAIN SHOWS THE ABSENCE OF BASAL
CELLS (p63 AND 34betaE12) AND IS POSITIVE FOR AMACR STAINING WITHIN
GLANDS OF INTEREST
- SEE COMMENT
Comment: The Gleason grade 4 tumor shows some nuclear stratification and
tufting suggestive of ductal features; however, the quantity of tumor
present precludes a more definitive diagnosis of ductal carcinoma.
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When I say "see", he did say that my lymph nodes were analyzed and no cancer was found, it was done in real-time as the surgery occurs, by a pathologist that attends the surgery. I can even see the detailed surgical bill where each of his tests had a line item.
My surgeon did indicate that it is his usual practice to remove all lymph nodes but the analysis indicated that was unnecessary and not done because that can lead to lymphedema.
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2 ReactionsI’m curious about how a pathologist can analyze a lymph node without it being removed first. I’d like to understand this process. Is it done by needle biopsy or similar?
Hey ctl, as in my case, he probably took out the first “bullseye” node, and finding it clear, made the call that if IT was clear, the others further down had to be.
I certainly understand the logic behind it and perhaps the custom of removing so many nodes is a throwback to an earlier protocol🤞
How did you get back to sexual function in 7 month, boy am I jealous I’m 6 months out from surgery and finish radiation tomorrow. Then one more hormone shot so that’s another 3 months or more before I should try the different options. Are pills alone working or are you using jel or injection, thanks for giving the rest of us some hope , my oncologist told me my sex days are over but my surgeon disagrees, not fond of my oncologist as you can imagine
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1 ReactionRegarding the “if I did radiation then surgery was not an option after the fact.”
According to data from the Mayo Clinic (in Dr. Kwon’s presentation), following initial radiation if there is recurrence, half the time recurrence is distant from the prostate so, surgery isn’t even a consideration. However if recurrence is in the prostate, there are other preferred treatment options besides surgery - like focal therapies (because the dose can be specifically targeted), brachytherapy, SBRT, and sometimes even re-radiation.
Treatments have advanced over the decades where the old-school thought used to be “no surgery after radiation.” These days, surgery should be considered as a final salvage treatment only when all other options have been exhausted.
(For a localized, 7(4+3), PSA of 7.9, I had 28 fractions of proton radiation (during April-May 2021) + 6 months of Eligard + SpaceOAR Vue. PSA now varies between 0.35-0.55.)
ED is not guaranteed, nor is incontinence. While I did not have radiation, I had RARP with most, not all, of my nerves spared. I had an erection within hours of surgery and have maintained frequent and strong erections since.
We have very little control over the outcome but so long as the nerves remain then you have a fighting chance. You can help improve that chance with hammering your pelvic floor.
First, a story I wrote about my journey. Not very prescriptive, but might be a bit inspirational:
http://bikrutz.org/triblog/?p=3516
Next, a link to the first program I followed, which opened several doors to the process I followed to success: https://melissahadleybarrett.com/penile-rehabilitation-program/
And, the elements (without the evidence-based justification behind them) of my rehab program. Not saying it's the only, or even the best way to proceed, only that it's what I did, and I succeeded:
1. I bought and followed the program Melissa Bradley Barrett offers in the link above.
2. I bought a vacuum erection device - https://vacurect.com - and used it ~ 5 times a week, specifically, pumping up for three minutes, releasing and milking out the engorged blood from my penis for 2 minutes, pumping again two more times. Total of 15 minutes.
3. I took the prescribed sildenafil (generic Viagra) 50-100 mg about 4-5 x a week.
4. Bought a vibrator designed for a flaccid penis and used it to induce orgasm 3-4 times a week. (https://www.hotoctopuss.com/products/male-sex-toys-award-winning-and-best-selling-pulse-solo-essential-dragon-eye-vibrating-penis-masturbator-special-edition)
[#2-4 intended to keep the nerves involved in orgasm and blood flow in the penis functional while the erection nerves recovered. There is some scientific justification for each of them.]
5. During the whole process, my wife was a patient and supportive partner. While playing around in bed after the first two months was frustrating, it kept us connected as a team trying to return to whatever level of intimacy we could create at the time. Without that, I'm sure success would not have occurred.
6. I realised I was rebuilding my sexual function from scratch, and worked on each of the elements separately before trying to put them all together: read the last half of my story above for more insight.