time to decide and I'm stuck....

@retireditguy
"Following radical prostatectomy, a significant number of patients notice a progressive shortening of the penis, a fact confirmed in recent studies. To better understand why, Italian researchers measured the length of the flaccid and stretched penis in 126 patients at five time points: just before surgery, when the catheter was removed 7 to 10 days later, and at 3, 6, and 12 months postoperatively."

What? Get off me with that measuring tape, ya perv.

"The researchers theorize that the death of nerve cells and reduced blood flow (and thus a loss of oxygen) to the penis during surgery and recovery may contribute to shortening."

Who cares? At least we're on the right side of the dirt, as someone here said a couple of days ago.

@peterj116

BUT, that is why penile rehabilitation is important ! ; )

Studies show that patients that use a pump for rehabilitation do not have changes or have minimal ones.

And yes, when they talk about progressive shortening and actually tell the change (like Australian study) we are talking of about 10 mm change . Give me a break 😂. One definitely can not feel or see that 1 cm change IF it ever happens - I mean who could notice that ???

I still think that with good surgeon it is really a non issue to begin with and non issue in general XP.

AND, BTW, more drastic and really visible changes happen with ADT which is usually a part of RT. It effects both parts of the "apparatus" and also causes ED. 😔 Luckily all things slowly recover after ADT is discontinued.

For me personally the only thing that matters is that my hubby is well and by my side - could care less about anything else. 🥰

@surftohealth88 Ahem…10mm’s is about 2 INCHES if we’re talking from a man’s point of view! Ask any man if he would like 10mm more and the answer will always be YES PLEASE!😊

My second biopsy showed two cores of cancer, one 3+4. I decided on surgery, I just wanted the cancer gone. I was also told that if I decided on radiation, surgery may not be possible down the road. Surgery went fine; I am one of the fortunate 10% that had ZERO incontinence issues. (Lots of Kegels). No other big issues except some constipation which was alleviated with Senna. My pathology report came back as having that core at 4+5. I was even more relieved that I had it removed. I just passed the two year mark since my surgery and have had six PSA tests, all at < 0.01. Make sure you have all your questions answered and are sure of your “condition”. I hope this helps you. BTW, I am now 73 and in excellent physical condition. Best wishes

I had a similar decision:
> 65y
> PSA 7.976
> Gleason: 3+4=7
> localized

With success rates comparing surgery with radiation being statistically equivalent, the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.

> “eliminating the cancer” by getting the prostrate removed is not a certainty, as you see from many of the comments on this forum.

> “Radiation is appealing but I do fear the long-term effects.” Whatever those “long-term” effects are can be minimized (or avoided). What specific long-term effects concern you most?

For me, I’m very process-driven with every major decision that I make; this was a major decision. So, I first had to do some serious introspection and truly understand myself and what I wanted to come out of treatment.

I wanted to balance survival (of course!) with quality-of-life, along with the possibility of treatment in the future if needed (as medical treatments progress). I wanted the least chance of ED, GU, GI, bowel or other similar complications - quality-of-life following treatment was a priority.

For me it was always about utilizing modern treatment techniques to get the best outcome while still surviving and maintaining my quality-of-life. (Every medical-related decision I ever made I made the same way; why not this?)

So, I put together a spreadsheet and listed all treatment options from the referrals and literature that I had read. Then I listed all possible & possibilities (%) of side-effects from all types of treatment, and gave each one a score. The one with the lowest total “score” ranked highest. I then took that list, and narrowed it down based on the prevention techniques available for each side-effect.

I then “scored” the quality of life priorities that came out of my introspection, and compared that final score result with the treatment options score result.

The score that was closest matching was my 1st choice (proton), 2nd was IMRT, 3rd was SBRT; surgery ranked last. So at 65y, I had 28 fractions of proton radiation + SpaceOAR.

That was how I decided on treatment. So far - 4-1/2 years later - everything has turned out great!

Good luck with your decision.

@heavyphil

10 mm = 1 cm which is about 1/3 of an inch lol (0.39 inch to be precise )

How did you come up with 2" 😆 ??? Well, that would be really completely different story from any point of view XP

@kjacko
Thanks for posting an update of your case 🌺. It is comforting to see it since my husband has very similar case to yours (initially found 4+3 that turned out to be 4+5 in actuality , high decipher and possible tiny EPE with the first PSA 0.014).
Wishing you undetectable PSA for at least next 30 years 😉 !

I will add that the treatment side effects are also very dependent upon the expertise and equipment. For RP, some surgeons have superior techniques and expertise with continence and ED statistical results supporting . For RT, some RO’s are using smaller margin precision equipment and protection techniques that result in less damage to heathy tissue.

@surftohealth88 …been dreaming of ‘just 2 more inches’ my whole life!!!😂
Phil

The optimal radiotherapy dose is provided by 'LDR' (low dose radiotherapy, i.e., permanent seeds) a form of brachytherapy. Low dose is a misnomer. External beam radiotherapy [EBRT] whether SBRT or IMRT is suboptimal. Any higher irradiation would be injurious to healthy tissues through which the converging beams must pass. Nonetheless if you are greater than 75 and wish to avoid a procedure (outpatient 'seeds') EBRT particularly SBRT might do the trick. The risk of DELAYED urinary tract symptoms may be reduced with a low score on the UCLA derived ProsTOX test (Meredx [sp/]) {LOW 5% Higher RISK 15%}. ACUTE symptoms post SBRT or IMRT are about the same which disappear at about the same time. (Summary of information found on various PCRI.org videos which I highly recommend on You-Tube. As Prostate issues are moving targets with improving horizons check the newer relevant videos)