Final countdown to RP on 3/26th and I’m anxious

You'll do great! I was diagnosed with G8 at age 68, no spread in late 2022. Had RALP done at end of January 2023 (was downgraded to G7) and recovery wasn't anywhere near as bad as my imagination had led me to believe. Very little pain (easily managed by Tylenol) but it did take almost a year to regain full continence. I never had VERY bad incontinence but I did leak and needed 2 pads a day (one overnight).

ED is no issue either at this point.

We obviously don't know all the specifics of your diagnosis but in general I think your choice of surgery for Gleason 9 with no evidence of spread is relatively common. Some doctors recommend surgery in cases like yours to hold radiation back as a second treatment in the event that there is any return or progression of the disease; having radiation as the first treatment is usually considered to rule out surgery later leaving fewer options for treatment.

I was also diagnosed as Gleason 9 based on a saturation biopsy (MRI had indicated no lesions but an ExoDx urine based screening test had indicated a 36% probability of treatable cancer so my doctor recommended going ahead with the biopsy and I am very glad he did.) Two of the 24 biopsy samples showed a very low percentage of Gleason 9 cancer in each sample. I had a RALP and the pathology report on the full prostate following surgery downgraded my case to Gleason 7 (4+3 with tertiary 5). This illustrates another benefit of surgery: the entire prostate can be analyzed after removal and a more complete report on the full extent and grade of whatever disease is present can be determined. I am 18 months post surgery and have PSA checks every 3 months and all have been undetectable.

Based on what you have told us about your diagnosis I feel you are on the right course with your current plan of treatment and wish you all the best.

Have you considered if you might be a candidate for Tulsa pro less invasive ablation technique?

@billfarm No. I was offered two choices radiation or radical surgery. I don’t think I was a candidate for much else. Thanks

@tmestanas91
We all have gone through the agony of trying to decide what to do.

When in doubt you will see many posters mention second opinions. I did that because my PCP asked me too. He wanted me to have two different opinons on diagnosis and applicable treatments. I did and then with consultation with PCP I chose proton radiation versus photon. That was the only difference in my treatments offered by both facilities.

I did not have RP. It was not a recommendation for me based on my specific diagnosis and my heart failure and age. I don't have personal experience with RP. Did they discuss hormone treatments in addition with RP? I was first recommended to have both radiation and hormone treatments. Mayo recommended a Dechipher test which came back low risk verus the intermediate risk I got from Gleason. So my treatment recommendation changed to radiation only and no hormone treatments.

Bottom line it is a personal decision you need to make for yourself. My suggestions is as it was what I did was second opinions and every test that can help with diagnosis (PSMA, Decipher, bone scans were all ones I took in addition to biopsies).

My doctors chose RT plus ADT for two years- Gleason 8-9 on 13 biopsies. Today 26 months later PSA < .01 . May stop all ADT soon. Doctors chose RT due to my age of 74 at the time 2 years ago. FYI only.

That pre-op anxiety is real! I had it too. I wasn't worried about surgery, it's not my first rodeo - in fact, I got the same surgeon, same Da Vinci system and even the same incisions as my last surgery for kidney cancer - so I already knew without any doubt what that part of surgery would be like.

What scared me was what I would be like post-op. It's easy to scare yourself senseless when you read horror story after horror story on forums like this, but you have to try to temper that with the knowledge that very few people that come out the other end of treatment without serious side effects are likely to keep coming here to post because there are no more questions to be asked or knowledge to be gained. Some of us stick around, and it's why I'm still here every day, so I can be the voice of success.

So what is your anxiety based on? The quality of life after? Fear of ED? Fear of incontinence? Worry about recovery and pain? Concerned about this being step one of 1,000? All things I worried about too. Other than an incision that didn't close, which has been pretty awful and like having a marsupial pouch on my stomach that I have to pack every day until it heals, the worst part was the first few days of recovery and the catheter removal - neither of which were really all that bad.

@survivor5280 Thank you I’m actually ok with the surgery and the recovery. I know it won’t be fun but I’m in decent shape. More worried about outcomes, incontinence , getting negative margins, if it spreads. I guess that falls in the step 1 of 1000 category. Thank you for your encouragement. Hoping for a downgrade of Gleason 9 and no detectable PSA! 🤞🙏👍

Best of luck for you TM91! Anxiety is real and normal. As I was told pre-surgery 18 months ago, you’ve made an informed decision. Lean into it and do the best you can moving forward. Both radiation and surgery have similar successful outcomes. You are much more likely to do well - especially with a positive attitude imo - than to have significant problems.

I’m looking forward to hearing your success story on the other side!

Best wishes for a successful outcome.
At 72 I had RP for G 9. Postop path was clear except for EPE.
.19 PSA 90 days postop led me to Salvage Treatment.
PSA < .02 undetectable since treatment completed, now 18 mos.
For me, surgery was the choice. Recovery not consequential. Continence excellent; ED work in progress.
You will do well !!!