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.