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Scheduled for a Radical Prostatectomy and having Second Thoughts

Posted by hmish @hmishkind, 3 days ago

Am I doing the right thing? I am 69 years old, in good overall health and was recently, to my utter surprise,diagnosed with prostate cancer. My PSA in 9/21 was 1.46; 11/22 was 1.64;12/23 was 1.33 and increased to 2.46 in 8/23. This led to an MR of the prostate in 10/24 that revealed a PI-RAD 5. with no evidence of extracapsular extension and no evidence of enlarged pelvic lymph nodes. 11/24 my Prostate Biopsy showed a Gleason score of 4+3=7 Grade Group 3 of the left lateral apex; a Gleason score of 4+4=8 Grade Group 4 of the right medial apex; a Gleason score of 3+4=7 Grade Group 2 of the left medial apex. My PSMA Pet Scan showed no evidence of metastatic disease.
I have met with surgery and radiation oncology and have reviewed the advantages and disadvantages of both and have elected to have a radical prostatectomy the end of this month.
I am scared and wondering whether I am making the right decision for surgery vs. radiation vs. doing nothing. After all my PSA was still within normal limits even though it was increasing.
I would love any and all thoughts on my scenario. I am worried about my quality of life after surgery. I appreciate any and all thoughts from this group on my concerns.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

heavyphil | @heavyphil | 1 day ago
In reply to @peterj116 "Thankyou Phil. I really appreciate that. Apparently my new guy is "a reconstructive urologist, with expertise..." + (show)
@peterj116

Thankyou Phil. I really appreciate that.

Apparently my new guy is "a reconstructive urologist, with expertise in management of urethral stricture disease as well as penile deformities and incontinence."

Urethral stricture disease and urethroplasty
Revision hypospadias surgery
Inflammatory disease (BXO) of the urethra and penis
Lower urinary tract reconstruction
Kidney and ureteric stones - Endoscopic removal and shock wave lithotripsy
Kidney bladder and prostate cancer
Vasectomy and vasectomy reversal
Prostate biopsy
Scrotal surgery

So he must know his way around that bit.

From what I've read, the standard approach it to remove the internal urethral sphincter along with the prostate. I've never understood why.

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I believe it is only removed if the cancer has invaded it - don’t think it is standard but have heard many echo this same line.
Why remove a body part whose function is so complex just to make life easy?
If you know for sure based on surgical pathology that your cancer had been invasive in this area then the surgeon had no choice. If not, well, you know….

REPLY
westernflyer | @westernflyer | 16 hours ago

NO DOUBT OTHERS HAVE COMMENTED ON PROTON RADIATION THERAPY AS AN OPTION. DID ANY OF YOUR DOCTORS RECOMMEND THIS OPTION? IF NOT, WHY!

2010, I had proton radiation therapy at Loma Linda Hospital in Loma Linda, California, one of the pioneers in proton radiation therapy for then children's brain cancer. Because of localized radiation with proton in lieu of the x-ray type, there was little or no damage except to the cell structure of the cancer. It is not for everyone and depends on many issues. Gleason was 3 plus 3, PSA then was 6.47. I played racquetball most days. have never had any issues..none. The point: review all the options..go to the best there is...like Mayo. Good luck RH/Florida

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anosmic1 | @anosmic1 | 14 hours ago

It sounds like our cases re similar. I had a PSA of 6.6 last spring, 7 by summer. Gleason was 4+3 after the MRI and PET scan. I chose surgery. Most of the other guys I've met through other groups has surgery and were happy with the results. I also was told that if more treatment is needed after surgery you can turn to radiation, but if you start with radiation surgery isn't usually a second option. I had surgery Nov. 11, 9 weeks ago, and it went well. They discovered that the cancer was more advanced than they realized and told me I was Gleason 9. I've been fine after surgery. The incontinence has been more of a challenge than I expected but I wasn't committed enough to do the kegels before surgery. No regrets about choosing surgery. I have a follow-up PSA scheduled for late February and then I see Dr. Borhan again. Good luck.

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bens1 | @bens1 | 12 hours ago

@hmishkind if you are considering radiation, you might want to look at the Mridian or Elekta radiation machines as they have built in Mri so the images are in real time and what they see, they can treat.

I had 5 Hypo-fractional treatments with the Mridian in 2023. Most radiation treatments for the prostate involve treating the entire prostate plus a margin around. The built in MRI allowed my oncologist to use a 2 mm margin so less healthy tissue was exposed with fewer side effects vs non-mri radiation machines which use 3-5 mm.

The Mirage randomized trial showed the difference in toxicity between built in mri vs non-built in radiation machines.
Here is a link to an article from Uro Today describing the results: https://www.urotoday.com/conference-highlights/astro-2024/astro-2024-prostate-cancer/155368-astro-2024-mri-guided-versus-ct-guided-sbrt-for-prostate-cancer-2-year-outcomes-from-the-mirage-randomized-clinical-trial.html

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