I want to learn more about side effects of robotic prostatectomy

I am 69 & have 3/4-7 & 3/3-6 intracapsulsr prostate lesions. I had 2 pirad 4 & 1 pirad 3 on MRI with no PCE, SVI or LN involvement noted on MRI. I was offered SBRT radiation or RARP. It is a tough decision & I read Robert Marckini book, ‘You Can Beat Prostate Cancer’ on proton therapy. Radiation & surgery have similar long term BCR free results, but I would rather have the cancerous gland removed.,

There is higher risk of ED after RARP. Incontinence is worse for RARP initially but with time similar to radiation. Radiation may have additional bowel or urinary issues.

Take your time, pray & research. I chose surgery to remove cancer & have still have salvage radiation as back up plan if recurrence.

You are probably a candidate for active surveillance or if you want to be more pro-active, focal therapy.
This treatment only targets the lesions with cancer using ultrasound /heat. TulsaPro is very popular and proven; side effects are minimal and usually of no impact to sexual/urinary function.
But PLEASE have this procedure done only by a doctor who is certified, qualified and does this procedure repeatedly and frequently. Do NOT use a urologist who ‘can’ do it or dabbles in it.
If you Google TulsaPro you will find where it is done. Best,
Phil

I had rarp Jan 25. Incontinence and ED persist
Incontinence is better (at 12 months,)
I know that many men on this list did not have Incontinence and that really is good

However, the research reports that the majority of men have Incontinence, and the majority get better close to a year. I am one of these.

I would do it all over again as I want as many years as I can get.

This list is a great resource

I had 2 cores of cancer, one @3+4. After talking with a number of people, I decided on surgery. My post op pathology report showed that my cancer was actually 4+5, so I was glad it was removed. Second, after my RP I had ZERO incontinence issues. My surgeon told me I was one of the lucky 10%. Some food for thought. Best wishes!

My diagnosis was similar to yours, just ten years younger. I was 3 + 4 and was going to be on active surveillance until they did the Decipher test that showed it to be aggressive and then had the surgery.

As you'll see me post repeatedly for the benefit of all those who, like me, only read about the doom and gloom of this procedure: I never had a single moment of ED or incontinence after RARP. Remember that most guys that stick around on the forums are still dealing with issues or are new. That represents a very small group of men as the vast majority are back to normal within 12-18 months (as in over 90%).

I would request a Decipher and if you aren't low risk then keep getting your tests. If you are in good health and decent shape you have a good chance of no negative side effects, if not then you should start getting into shape now so that if and/or when you have to go down this path that you give yourself that absolute best outcome possible.

@survivor5280
I sure wish that the number of people that were back to normal was as large as you say, but unfortunately, it is not.

If someone has a Prostatectomy, The studies show a 16% to 46% 15-year cumulative incidence of BCR. The percentage risk is based on the risk factor of the surgery results. If someone has aggressive issues found in the prostate biopsy that can really raise the percentage chance of their having BCR.

Then there is radiation. Approximately 15–40% of men who undergo radiation therapy (RT) for prostate cancer develop biochemical recurrence (BCR) within 10–15 years. While some studies estimate the risk up to 50%, the rate heavily depends on pre-treatment risk factors, with studies showing 18% for low-risk, 24% for intermediate-risk, and 36% for high-risk patients over 15 years.

@jeffmarc odds look slightly better with radiation. Why do you think so many opt for surgery?

@edinmaryland I had Zero incontinence after RP, and my surgeon said I was one of the lucky 10%.

@lyricw
Radiation’s side effects do occur a year or two after treatment while surgery side effects occur right after with incontinence and ED issues. And in some cases, neither of these treatments cause either of these problems. It’s a real crap shoot.

I think people get Surgery because they want to get it out and figure that’s the best way to eliminate the problem completely. Unfortunately, there are side effects and it doesn’t always get it out completely. In my case, my father had radiation and died from prostate cancer so I had surgery. He died when Lupron was the last drug. I have had many other drugs available, So I will live many more years than my father did with prostate cancer.

Researchers have found that radiation or surgery causes the exact same result in the long run. There are cases where aggressive cancer issues make one option or the other preferable.

@jeffmarc
This is a good discussion with a lot of good information; I thought I would add one more data point on why I chose surgery.
As stated, the odds of long-term survival and recurrence are roughly similar with either surgery or radiation/ADT. So it comes down to how do you want to live your life and which side effects you want to live with. Of course, it's a crap shoot and you never know for sure what will happen.
Based on my specific situation, I think there is a very good chance I will have BCR within the next few years, at which point I will probably have to start radiation/ADT.
Starting about 6 weeks after surgery, I felt relatively "normal" and began biking, going to the gym and traveling domestically and internationally. I had incontinence, but it wasn't a big deal and it didn't really slow me down (and it has dramatically improved now that I am 6 months out from surgery). I still have ED, but I am hopeful that will improve with time, too. Had I not chosen surgery, I was looking at a year or likely more of ADT after radiation, and I thought it unlikely I would feel "normal" and have the energy to live my life the way I wanted during that time. So hopefully surgery has bought me a few years to live normally before I have to deal with the side effects of radiation, while choosing radiation/ADT would have forced me to face those side effects immediately.