Previous Cancer survivior (cholangiocarcinoma) and now prostate cancer

This is something that I am having done as well. My cancer burden/ PSA score and Gleason scores are somewhat contradictory (low PSA score relative to burden/biopsy testing). I'm new to the lingo so hopefully I do not further complicate my case. Urologist said he wanted to send it out for DNA testing. My Gleason scores were 5 cores @7 with 4 of those cores as 3+4 and one at 4+3, and 4 cores at 3+3. PSA was 6.9. Regular MRI with contrast showed no cancer in the surrounding areas of the prostate including lymph nodes. Fusion biopsy confirmed this essentially. So, we re talking about clinically local cancer with my choice to have the prostate surgically removed. The only downfall for me (aged 56) is that he does not think nerve sparing surgery can be fully realized as one side of the prostate has the cancer cores lining the area where the nerves are while the other side of the prostate looks to be ok for the nerve sparing attempt.

I'm inclined to speak with the surgeon and see if he/she agrees with the urologist and if so getting a second opinion.

Very helpful. Certainly the same path I took with my cholangicarcinoma as it is relatively rare to begin with. You need to do everything you can to find out info and advocate on your behalf with such a diagnosis--at least I felt I did.

I am getting a second surgical opinion on the nerve sparing pursuit. My urologist, who does do surgery, just not Davinci, said based on the location of my malignant cores (these are on the outer most interior location) that one side could likely be salvaged while the other may not. For the same reason you stated (quality of life), and while it may be true, it behooves me to verify this with a second surgeon at a center for excellence (research hospital Indiana University) .

Why did I go straight to surgery? You didn't ask but I'll tell you. Because when you are diagnosed with such a rare cancer and you are told up front it is stage 4 and incurable, and then you beat it, you learn to recognize miracles and not play the odds. I would much rather have the cancer out of me while localized to prostate than having it metastasize. Could radiation do that--certainly possible. But then there goes my shot at surgery if it comes back. Additionally, he was almost certain I would have zero incontinence issues. As such, when you weigh the pros and cons of all the procedures, consider your own perspectives and history, life goals, and combine with science it becomes easier.

Your comment on tackling any ED issues down the road is well understood on my end as well. Of the possible rehabilitation processes and treatments, I am perfectly happy to entertain all and 'deploy' as necessary.

Very helpful. Certainly the same path I took with my cholangicarcinoma as it is relatively rare to begin with. You need to do everything you can to find out info and advocate on your behalf with such a diagnosis--at least I felt I did.

I am getting a second surgical opinion on the nerve sparing pursuit. My urologist, who does do surgery, just not Davinci, said based on the location of my malignant cores (these are on the outer most interior location) that one side could likely be salvaged while the other may not. For the same reason you stated (quality of life), and while it may be true, it behooves me to verify this with a second surgeon at a center for excellence (research hospital Indiana University) .

Why did I go straight to surgery? You didn't ask but I'll tell you. Because when you are diagnosed with such a rare cancer and you are told up front it is stage 4 and incurable, and then you beat it, you learn to recognize miracles and not play the odds. I would much rather have the cancer out of me while localized to prostate than having it metastasize. Could radiation do that--certainly possible. But then there goes my shot at surgery if it comes back. Additionally, he was almost certain I would have zero incontinence issues. As such, when you weigh the pros and cons of all the procedures, consider your own perspectives and history, life goals, and combine with science it becomes easier.

Your comment on tackling any ED issues down the road is well understood on my end as well. Of the possible rehabilitation processes and treatments, I am perfectly happy to entertain all and 'deploy' as necessary.