Connect
← Return to Choosing a simple RALP vs. a radical RALP vs. a compromise RALP?
Discussion
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
@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.
Replies to "@brianjarvis Your advice sounds solid for most patients, but perhaps not for me, because, unlike most..."
@jercalif
If you want, no pain, then the regular catheter is the solution. I had to have one for two weeks. There was no pain involved at all.. Taking out is nothing.
You’d rather have a hole cut in your stomach to put in a tube, You don’t think there’ll be any pain and some recovery time from that, compared to just having a regular catheter.
Radiation causes the least pain no real recovery time other than maybe some irritation while peeing, I had 8 weeks of IMRT and never had that problem. Actually had absolutely no side effects at all.
You could also do SBRT radiation, Around five sessions really do the job on your prostate.
No catheter involved if you do radiation.
Connect
@jercalif I can appreciate pain avoidance. Personally, I hate needles. But, in every instance I weigh the benefits of appropriate diagnosis and management against any potential risk/pain.
But, if my SOLE (and absolute) goal was avoidance of pain... yes, that would certainly limit medical care.
As I heard one doctor explain it, the only pain-free choice is watchful waiting. It’s absolutely pain-free.
If I were absolutely against the pain of a tissue biopsy, then I would request one of these liquid biopsies (some of which involve somewhat painful blood draws):
> FoundationOne®Liquid CDx; Guardant360; Caris Assure.
And there are other liquid biomarker tests:
> (blood): 4KScore; EpiSwitch PSE; Phi Prostate Health Index;
> (urine): SelectMDx; PCa3 (PC Antigen 3); MyProstateScore (MPS), ExoDx.
As for treatment, if your sole goal is to avoid/minimize pain, then the only option is radiation;
> proton
> photon
No needles; no catheter; no anesthesia; no surgery; minimal chance of urinary retention. Depending on how well is it’s done, minimal chance of serious side-effects.
My proton radiation treatments were relatively uneventful. My wife later told me that if she hadn’t known I was undergoing radiation treatments, she wouldn’t have realized it from any change in me.
If you look at the data, RALP does not solve “any well-contained current or future prostate cancer problem.” Recurrence rates of RALP for localized prostate cancer are between 30%-40% (just like with radiation).
If you currently have prostate cancer that is NOT well contained, and you still went with radical RALP + suprapubic catheter, you’d then have to go through radiation + hormone therapy anyway, so why go through both RALP and radiation? Why not just only do radiation and avoid the pain/discomfort of the RALP/catheter procedure?
Since your father had prostate cancer, have you had a genetic (germline) test to see if you’ve inherited any gene mutations related to prostate cancer? If you have not inherited any gene mutations related to prostate cancer, then your father having the disease has no impact on your prostate being prone to developing cancer in the future.
Yes, a biopsy can miss existing cancer, but there are other tests to monitor whether there is something more insidious lurking unseen.
Again, with your sole goal to minimize pain, RALP+catheter should be out of the picture.
As for needing repeated biopsies over the years, I had proton radiation treatment in 2021, and haven’t seen my urologist since. There’s no need for another biopsy. If my PSA ever gives indication of recurrence, then a PSMA PET scan is the next step (& then a treatment decision made from there), never a repeat biopsy.
If there is a confirmed recurrence following initial radiation, choice of treatment would depend on the nature of the recurrence; there are other options (either painless or painful): focal therapy (e.g., cryo), SBRT, brachytherapy, and yes even re-radiation in some cases. I personally know two guys who had their prostate recurrence re-treated with SBRT, because the recurrence was a single spot.
> surgery as salvage treatment is old-school that doesn’t consider modern treatment techniques.
I had 28 sessions of proton radiation + hormone therapy; the treatments caused no loss of sexual function, and no incontinence. The only pain I experienced were from the Eligard injections; these days there are Orgovyx pills to take instead.
If pain-free is the sole goal, radiation is the way to go.