Prostatectomy Question? Side effects outweigh benefits?

After a year of being on ADT, and doing research for about an hour a day most days. I chose RALRP. Had it done 10 days ago. With me it came down to choosing a doctor and a place that I would have confidence in. Also, having the surgery leaves the option of radiation on the table. Most places will not do surgery after radiation. My research indicates, after 3 months and after 5 years, results are about the same. Bad side effects with both, It seemed to me that managing the side effects with the surgery would be more successful. HOPE I'M RIGHT.

Hi.

I am one of the lucks one’s . I chose surgery over radiation + hormone therapy. The decision to have the surgery was quite difficult as you may all agree. The point that got me off the fence (surgery vs. radiation) was learning the side effects of hormone therapy. I have clinical depression which is under control. The thought of suffering a setback in my mental health which is a common side effect of hormone therapy pushed me into the surgery zone.

I was lucky. Great surgeon (trained at Mass. General and MD Anderson) and good hospital (Cleveland Clinic- Weston Florida.

Surgery was done on March 7 th of this year. The surgery took 6.5 hours and recovery was a “bear”. Today, about 4 months out my incontinence is limited to coughing and more frequent urination.

As far as ED, I would say I’m at 50% and moving in the right direction.

My labs from surgery were great as far as margins and no trace of cancer in thec51 lymph nodes removed. My PSA results 90 days post surgery was undetectable. My conservative surgeon told me that is would be highly unlikely for the cancer to return ( prior to these results the thinking was that there would be a 40% chance of recurrence.

Hope this helps!

RS

My husband’s surgeon said that if you talk to a surgeon they will always tell you surgery is the best option. If you talk to a radiologist they will tell you radiation is the only way to go. His surgeon did offer him a visit with a radiologist if we wanted a different opinion. I also think it depends on overall health, age and aggressiveness of the cancer.

Diagnosed 3/28/22. Cancer confined to the prostate from PSMA test, Gleason scores 3+4’s and 4+3’s. PSA was 19.8. Had one 3-month Lupron shot, which gave me wild hot flashes. Got prescription for Venlafaxine, which eliminated those. HOORAY!

Bought Dr Walsh’s book on surviving prostate cancer, available @ Amazon - read highlights at beginning of each chapter, then decide whether you want to read entire chapter.

I began online research at reputable sites line Mayo Clinic, Cleveland Clinic and more. Learned that radiation after surgery ( in case of recurrence) is doable; surgery after radiation may not be possible.

I chose RALP & set 8/23/22 as surgery date, which allowed 3-4 weeks of Pelvic Floor PT to lessen chances of incontinence after RALP. No pain after surgery, some discomfort though. Catheter came out 10 days later.

Several days later I resumed PT sessions for a few more weeks at a Baylor Scott & White Clinic in Austin Texas where my “therapist” was educated/specialized in Prostate Surgery recovery. She had some clients who did PT only after surgery and were having continence issues 4-6 months after surgery.

I was FULLY CONTINENT after surgery! No leaks or dribbles at all!

Additionally, all cancer was removed. The pathology report indicated a previously undetected cancer that would have survived radiation. Today my PSA measures less than 0.008, undetectable. I feel blessed.

I wish you the best of luck! Come back when you have more questions.

Surgery and radiation are about equally effective, however, surgery preserves the option of radiation when the cancer returns I choose surgery and I am pleased with that decision

I am so happy for you bud. I am going in tomorrow for my little bast=rd removal and since Gleason 8 and PSA 6.9 and biopsy was full of cancer and on the margin but CT and Bone Scan said no spread. I am on Lupron and will be for some time as there is no way some cancer does not escape once on the margin. I will do radiation also and poison this nasty chit. Very upsetting as mine is aggressive and my last physical a year ago was totally normal. It is in God's hands now.

Too many factors go into that decision to say "right or wrong..." in my opinion.

I had my surgery in 2014 when I was 57. At that time, based on the available imaging, CT and Bone scan and Biopsy, TRUS, my life expectancy and PSA, surgery was my choice. The surgeon was experienced and it went "well." When he reviewed the pathology report, T2CNoMx and his surgical notes, he opined "Kevin, you shouldn't have any problems with recurrence in the future...!" The surgery was nerve sparing and I did regain sexual function with the help of a daily cialis. I had zero incontinence, zero!

Two of my good friends also had surgery by my surgeon, theirs never came back though both have ED.

Sill, I knew that statistically I had a 30% chance of recurrence based on my GS 4+4...sure enough, 15 months later. So, I believe my decision was the "right" one, just didn't have the outcome I was looking to achieve, the gold ring (think riding merry go rounds when we were kids and the gold ring was the prie, a free ride!). Why did my surgery not "cure" me..? I expect that there was already disease in the pelvic lymph nodes, just couldn't be seen with the state of the art imaging at that time.

Today, with the PSMA imaging, I may have more clinical data with which to make that decision and certainly more treatment options than in 2014 which were pretty limited - surgery, radiation...Even so, there is some data which supports taking out the mother ship, the source, so one who is diagnosed today and with imaging shows prostate cancer outside the prostate, may still be faced with a decision, take it out or....?

Today, a person also has many non-surgical options, doublet, triplet therapies, ADT, ARIs... Throw in genomic testing...

Generally, treatments have side effects, some immediate and get better, some show later.

My medical team admits that if you put one hundred urologists, oncologists and radiologists in a room, presented a clinical case, you could not get agreement on a treatment plan.

So, back to my original thought, I do not believe there is a right or wrong answer about surgery, it is a choice based on clinical data, personal preferences and the trust in your medical team's skills and input - shared decision making.

Kevin

I agree with the previous comments, the decision is a personal one and each person is in a different place (age, health, life expectations, etc.). For myself, I can't imagine relying on imperfect imaging devices and potentially leaving known cancer in my body. However, I am 57 now and 56 when I had my RP (GS 7 --> 4/3). Also, healthy (outside of PC), active, and look forward to another 30 years of retirement with PC free life (fingers crossed). Surgery does not guarantee the prostate cancer will never come back, but for me, getting the known cancer out and leaving the most follow-up procedures available made sense.

Good luck with your decision and and a 'cancer-free' life!!

Jim

Very insightful info. Thank you for sharing your details

I won't say I was lucky, but I had three consultations and all agreed that my case warranted a prostatectomy. My General Practitioner and the radiation specialist agreed that my urologist was right in favoring the Robot Assisted Laparoscopic Prostatectomy. Imaging and the fusion biopsy implied the cancer was in one area only, but aggressive enough (4+3=7 Gleason) to suggest removal, especially at my age of 70. And the subsequent lab reports showed that was true. I wish you well.