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Post Prostatectomy Two Week Progress
PART 1
First of all, I'd like to convey my sincere and heartfelt thanks to all of you on this forum for helping me come to my treatment decision. Your knowledge, advice, and experience that you’ve shared with me either directly, or just by my reading through all your posts have been a great resource to me. And thanks to the Mayo clinic and moderator of this forum for making its existence possible. And also a special thanks to my wife for all her help, without which this recovery would be much more difficult.
After years of steadily rising PSA, a couple of biopsies that found nothing, and then leveling out at a PSA around 12, my urologist said it was time for a new MRI. The MRI done in July 2025 found a larger PI-RADS 5 tumor, and a smaller PI-RADS 3 tumor, followed by a biopsy in August, which found that the larger tumor was a 3 + 4 = 7 with perineural invasion, and the smaller one was a 3 + 3 = 6.
I started researching prostate cancer, and its treatments in July, using reputable sources such as Mayo Clinic, John Hopkins, Harvard, NCI, the health services of Canada, the UK, Australia, and the Prostate Cancer Researchers Institute which has lots of excellent videos. I came to the conclusion that SBRT would be the treatment for me. I also took the advice of a lot of these sites and got second opinions. I got a second opinion on my biopsy pathology from a center of excellence, University of Wisconsin Madison Carbone Cancer Center, and also talked to one of their docs for a second opinion. They pretty much jived with what I was getting in my own local area. I got the decipher test on which I scored high. I also had a PSMA PET scan performed on me, and it showed no spread outside the prostate capsule. Then I heard about the Prostox test that can predict future serious genitourinary complications from radiation treatment. There's one for SBRT and one for CFRT. Unfortunately, I scored high risk on both, so I had to rethink my treatment, and I decided I'd go with prostatectomy. A 3 + 4 = 7 tumor contained within the prostate would normally mean I could even qualify for active surveillance. But because of my high decipher score and the fact that I had perineural invasion, I decided I better just get it out before it did spread. Just to note, the tests like Decipher, PSMA PET, and Prostox, I had to ask for. Maybe my doctors would have mentioned them to me, but I guess because of my research, I was on top of it, and got to it before they did. So, as many other people have said in this forum, you got to be your own advocate.
I scheduled my prostatectomy, and I had it two weeks ago today. It was a RALP, using a da Vinci machine. The surgeon said it went well with no complications except one which showed up on the post prostatectomy biopsy. The biopsy report said there was one positive margin. So that worried me at first, but my surgeon said that when he was pulling the prostate out, the region where the margin is stuck to the prostate capsule tore, so hopefully that is just, you know, a little hiccup in the process and not a true cancer margin. But we'll see on my future PSA tests if the PSA declines to undetectable. He was able to save most of my nerves, so ED hopefully won't be a long-term problem, and he said he was able to do something with the urinary sphincter that should make continence come back faster.
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@swen77
I'm 67 and I also preferred radiation but after learning about the Prostox test from a PCRI video, and getting the test, I found out that radiation of both SBRT and CFRT were high risk for me so I decided on RALP. Now three and a half weeks out, my incontinence has continued to improve. I only leak a little each day. My surgeon was able to spare all the nerves on one side and most on the other. Since I had no ED prior to surgery, I'm hoping to get fully functioning again. The doctor said to wait for the six week mark to begin penile rehab. Every guy is different, so if radiation worked for your friends, it may not for you. I encourage you to check out the Prostox test.
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1 Reaction@quaddick thanks for the tip about Prostox test. Will try to get my doctor to order it.
Heads up. I had a small bit of struggle ordering it. It helps if you
contact Mirakind (Prostox) directly by phone. They asked me my zip code and
said it would be no charge for my location.
@swen77 A buddy chose radiation due to so many he knows having to have salvage radiation later. I went BCR in two years post surgery. 25 sessions of salvage radiation has me either home bound or taking Imodium if I want to go out for any length. Hopefully cauterization will help. My thought is cancer removal over "nerve sparing" with wide margins. Wood is nice, cancer free is better. I think never sparing is part of the surgeons sales pitch.
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1 Reaction@chippydoo
I'm sorry to hear that. I won't be too surprised if I do experience BCR. Only time will tell.
You grow old and things happen. You don't know when or what- only that they will.
Best of luck to you.
Quaddick
@chippydoo Thanks. Sorry you had BCR.
@quaddick This cancer is an expectation lesson. Keep them in check.
Best wishes
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1 Reaction@swen77 Thanks. As of 6 months post tx I am undetectable which is the good news.
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1 ReactionI phoned MiraDX today, i.e. 2/24/2026. I was wondering if I will be charged for this Prostox test that was just delivered to my house.
Before he ordered this, my RO explained that the result would not be meaningful in my case if I end up being treated with his current plan which is 20 sessions of EBRT plus HDR brachytherapy boost. He said the company is currently researching how the test performs when brachytherapy is involved, so the test has not been validated for this application.
I said if the company is conducting research with the data, even if there is nothing useful to us, and if there would be no cost to me, let's do the test anyway.
MiraDX billing explained that since I am on traditional Medicare, Medicare may or may not pay, but in the case where they don't pay, MiraDX will not send a bill to me. They also explained that they also do not charge for the test if you live in certain zip codes. My zip code qualified.
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3 Reactions@climateguy ,
That was my experience also- my zip code was free. There's 2 tests in Prostox: SBRT and CFRT. I believe CFRT equates to EBRT. So it still may be relevant for your treatment plan.
Good Luck