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Choosing a simple RALP vs. a radical RALP vs. a compromise RALP?
Prostate Cancer | Last Active: Jan 28 12:22pm | Replies (10)Comment receiving replies
That’s a doctor-question, with each option you mentioned having to be very well-defined within its own context as to its ability to treat the disease while still maintaining the quality-of-life desired. Then score each option against each other and see which ranks best.
However (none of this being medical advice):
(1) If it were me, I would first try the less-invasive option of Finasteride, in hopes of shrinking the prostate and resolving/reducing the BPH issues.
That would also be beneficial for radiation treatment because there would be a smaller prostate to treat.
Depending on where the lesions are in your prostate, (based on the FLAME protocol) a boosted radiation dose can be administered where it’s needed, and less where it might not be needed (perhaps near the nerve bundles to further minimize risk of ED?). (My oldest brother recently had 28 IMRT sessions using the FLAME protocol, where at each session, three different Grays of radiation were administered, more Grays to areas of concern and less to other areas, thereby minimizing risks near areas of less concern.)
Also, if using radiation, caution should be taken to avoid radiation to the penile bulb, in order to avoid late ED issues.
(2) If it were me, I would be cautious about thinking that RALP “permanently solves” anything. If that’s what I was thinking, then I would do a bit more research on the possible side/after-effects of the procedure.
For a RALP:
> if sexual function is the priority, then a nerve-sparing procedure is preferred (with as much of both nerve bundles preserved as possible, and with minimal movement of them).
> if incontinence Is the priority, then a retzius-sparing procedure is preferred.
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@brianjarvis Your advice sounds solid for most patients, but perhaps not for me, because, unlike most patients, my SOLE goal is avoidance of pain... I should have explained that earlier. It's like two people walking into a casino with two completely different goals...one wants to enjoy a little minor gambling and maybe win something or maybe not, the other needs $1 million to pay off the mafia loan sharks that are going to kill him, and so it makes sense for him to gamble away every penny he has, if necessary (and if he loses, then there is always suicide as an option).
Since my sole goal is avoidance of pain at all costs, I'm willing to gamble away everything that I have in an attempt to keep my pain to a minimum (and if I lose, then there is always suicide as an option).
You don't have to read the following unless you want to (obviously), but it explains how/why my thinking is going to be different from most patients:
Radical RALP + suprapubic catheter is not a panacea, but...since my SOLE goal is minimal PAIN...that means:
1.) Minimal # of biopsies w/o general anesthesia,
and
2.) Minimal # of urethral insertions w/o general anesthesia,
and
3.) Minimal chance of urinary retention.
...and it seems to me as if a radical RALP + suprapubic catheter would minimize all of the above, while simultaneously also solving my current severely enlarged prostate problem AND any well-contained current or future prostate cancer problem.
And even if I currently have prostate cancer that is NOT well contained, why wouldn't I STILL want the radical RALP + suprapubic catheter?
And even if I currently have NO prostate cancer, why wouldn't I STILL want at LEAST a SIMPLE RALP + suprapubic catheter?...although I would argue that, given my sole priority of minimal pain, a RADICAL RALP + suprapubic catheter still would make the most sense, because a biopsy can miss existing cancer, my prostate is prone to developing cancer in the future because my father had prostate cancer, and because of those two factors not removing my entire prostate now means that I likely will need repeated biopsies over the years and also likely need a 2nd RALP (radical, at that point) surgery in the future (doubling my chances of surgical complications over a single radical RALP now).
Neither loss of sexual function nor incontinence cause PAIN, and so I am 100% fine living with those problems, in exchange for the pain reduction above.