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Age and radical prostatectomy 2

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User
Posted 11 Nov 2014 at 14:53

Hi,


I began a thread under the above title early in 2014. At that time, I was told by a team consultant that I should take a further 6 months active surveillance as my cancer was low risk and not likely to endanger me in the short term. I was not happy with that recommendation, having been referred to his hospital for da Vinci surgery by my local urologist and so far had nothing to show for it. I sought and was granted a further consultation with a different consultant. This time he took on board the fact that I could not have an MRI scan due to my pacemaker and had no certainty that my initial diagnosis was accurate. In 2013 it had been Gleason 6 (3+3) T2b PSA 7. I was referred for a template biopsy under general anaesthetic. This was conducted, without complication in June 2014 and the outcome was that my cancer  was now considered Medium risk as the tumour was more widespread within the prostate than had been demonstrated at my original biopsy a year earlier. I was now Gleason 7 (3+4) T2b PSA 9. This reclassification set the wheels in motion for a radical solution; either surgery, radiotherapy or focussed ultrasound. They all had their plusses and minuses but in the event I stuck with my original choice of surgery. which was carried out in September, without complication. I have thus answered my own original query, which was whether at 70 and with a heart condition, I might be leaving it too late to have surgery. Others in this situation can take heart!    


Daves

User
Posted 11 Nov 2014 at 14:53

Hi,


I began a thread under the above title early in 2014. At that time, I was told by a team consultant that I should take a further 6 months active surveillance as my cancer was low risk and not likely to endanger me in the short term. I was not happy with that recommendation, having been referred to his hospital for da Vinci surgery by my local urologist and so far had nothing to show for it. I sought and was granted a further consultation with a different consultant. This time he took on board the fact that I could not have an MRI scan due to my pacemaker and had no certainty that my initial diagnosis was accurate. In 2013 it had been Gleason 6 (3+3) T2b PSA 7. I was referred for a template biopsy under general anaesthetic. This was conducted, without complication in June 2014 and the outcome was that my cancer  was now considered Medium risk as the tumour was more widespread within the prostate than had been demonstrated at my original biopsy a year earlier. I was now Gleason 7 (3+4) T2b PSA 9. This reclassification set the wheels in motion for a radical solution; either surgery, radiotherapy or focussed ultrasound. They all had their plusses and minuses but in the event I stuck with my original choice of surgery. which was carried out in September, without complication. I have thus answered my own original query, which was whether at 70 and with a heart condition, I might be leaving it too late to have surgery. Others in this situation can take heart!    


Daves

User
Posted 11 Nov 2014 at 23:58

Well done on your op and persistence. Definite encouragement for others!

Stay Calm And Carry On.
User
Posted 13 Nov 2014 at 02:20

Devon lad, it could be to do with the fact that your samples showed 20% affected; you also have high grade PIN. Also, a 40g gland isn't usually described as normal size - it is not the largest in the world but certainly bigger than the average for your age!

Watchful waiting and active surveillance are not quite the same thing. It might be that Michael's medical history means recovery from radical treatment may be more problematic than usual - some surgeons don't encourage a patient to have the op if there is a chance it will appear on their stats as a poor outcome for some reason.

Michael, do you already have any urinary problems / incontinence? Just because your surgeon is well known doesn't guarantee that you will be free of side effects - there are members here who have been treated by the most highly regarded of all but have been left with debilitating side effects and in one case, the most appalling after-care. You should still do your research, prepare yourself for how life might be afterwards and ask the surgeon to give you detailed data on his recent outcomes with similar men to you. If your prostate is very large, have they said whether your op will be open surgery or keyhole?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 Nov 2014 at 22:58
Brian

Where do you get no sex after RARP ? I had da Vinci op in April no nerves spared have ED and still have a good sex life ,it takes a different format but still good for both of us,frustrating and depressing at times but you need to make the most of what you have.

Continence, almost dry 4 days post catheter removal and despite 2 bladder neck stretches still good.Some on here did better and a lot seem to be back to normal at four months.

We are all different and there are no guarantees, but all options have there risks.

Thanks Chris


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User
Posted 11 Nov 2014 at 23:58

Well done on your op and persistence. Definite encouragement for others!

Stay Calm And Carry On.
User
Posted 12 Nov 2014 at 00:13

Congratulations and well done Daves,

On your persistence and determination.

I have never understood that when having being diagnosed with having Cancer, anyone would opt for the option of "let's do nothing except for watching it closely, CLOSELY mind, and actively, ACTIVELY mind, and see how it, the Cancer, develops in my body shall we.

Dave

User
Posted 12 Nov 2014 at 13:35

Thanks for your messages Daves.

I was given my cancer diagnosis just yesterday (Gleason 3+4, T2) and it was suggested that I opt for Active Surveillance, but I also feel that, since it will eventually require some sort of treatment (I had 7 positive cores out of 85 in my template biopsy and i have a rather large gland), I'd rather just have it out. The decision is made easier by the fact that the op would be performed by a well-known and very experienced surgeon.

I'm 65 and in good health, about to retire so this all comes as a bit of a kick in the teeth, good to hear about the experiences and thoughts of other sufferers.

Thanks again all,
Michael

User
Posted 12 Nov 2014 at 23:26

Hi Redbunthorne


Thank you for your post.


I am interested in the advice you were given re. watchful waiting as I'm not that much younger than you and a Gleason of 3+4 and a normal sized prostate but I have strongly been encouraged to have surgery. Just wondered what your PSA was and in which part of the country you live?


dl

User
Posted 13 Nov 2014 at 02:20

Devon lad, it could be to do with the fact that your samples showed 20% affected; you also have high grade PIN. Also, a 40g gland isn't usually described as normal size - it is not the largest in the world but certainly bigger than the average for your age!

Watchful waiting and active surveillance are not quite the same thing. It might be that Michael's medical history means recovery from radical treatment may be more problematic than usual - some surgeons don't encourage a patient to have the op if there is a chance it will appear on their stats as a poor outcome for some reason.

Michael, do you already have any urinary problems / incontinence? Just because your surgeon is well known doesn't guarantee that you will be free of side effects - there are members here who have been treated by the most highly regarded of all but have been left with debilitating side effects and in one case, the most appalling after-care. You should still do your research, prepare yourself for how life might be afterwards and ask the surgeon to give you detailed data on his recent outcomes with similar men to you. If your prostate is very large, have they said whether your op will be open surgery or keyhole?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 16 Nov 2014 at 16:50

Just been diagnosed with prostate cancer, Gleeson 4+3 =7, 7/12 biopsies effected plus some high grade PINS. so its not the mildest form or there again not the most aggresive form. Devastating news especially when one thinks about treatment and the possible collateral damage, Have discussed Radical propstectomy, or Radiotherapy with hormone treatment, with a surgeon, have to have a bone scan next week, and another discussion, The MRI showed one possible seminal vesical involvement, at the moment its T2 but could be T3b. At the moment ive been thinking that RT+HT is the best treatment, but what is HT like; It would be for 5 years apparently, How do people cope with that?, How would I view my wife when Im on it, or any other woman for that matter?. There are clearly side effects with RT, but Im attracted to the high-tec nature of it, There again with surgery, its all presumably over more quickly, and if one can recover ones bladder and rectal control, life could be bearable. I gather the nerves are dissected along with everything else, so presumably sex is out of the question.  Sorry about spelling, Im still shaking with nervous exhaustion as I write this. Yours Brian

Edited by member 16 Nov 2014 at 16:53  | Reason: Not specified

User
Posted 17 Nov 2014 at 10:23

Originally Posted by: Online Community Member


Just been diagnosed with prostate cancer, Gleeson 4+3 =7, 7/12 biopsies effected plus some high grade PINS. so its not the mildest form or there again not the most aggresive form. Devastating news especially when one thinks about treatment and the possible collateral damage, Have discussed Radical propstectomy, or Radiotherapy with hormone treatment, with a surgeon, have to have a bone scan next week, and another discussion, The MRI showed one possible seminal vesical involvement, at the moment its T2 but could be T3b. At the moment ive been thinking that RT+HT is the best treatment, but what is HT like; It would be for 5 years apparently, How do people cope with that?, How would I view my wife when Im on it, or any other woman for that matter?. There are clearly side effects with RT, but Im attracted to the high-tec nature of it, There again with surgery, its all presumably over more quickly, and if one can recover ones bladder and rectal control, life could be bearable. I gather the nerves are dissected along with everything else, so presumably sex is out of the question.  Sorry about spelling, Im still shaking with nervous exhaustion as I write this. Yours Brian



 


 


Hi there Brian,sometimes its best to start your own thread it can sort of get lost in amongst others,I can only give my experience regarding radical prostectamy,it may be possible to preserve some nerves to enable erections with or without the need for viagra or something similar you need to discuss this with a surgeon.Not sure what you have heard about rectal control  after surgery,of course there is a risk of damage but saying that I've not come across anyone on here who has had problems on that score.Bladder control is another thing altogether,some men recover quickly others have taken months and there are some who have complications and require other procedures.Best of luck.

User
Posted 25 Nov 2014 at 20:36

Originally Posted by: Online Community Member


Just been diagnosed with prostate cancer, Gleeson 4+3 =7, 7/12 biopsies effected plus some high grade PINS. so its not the mildest form or there again not the most aggresive form. Devastating news especially when one thinks about treatment and the possible collateral damage, Have discussed Radical propstectomy, or Radiotherapy with hormone treatment, with a surgeon, have to have a bone scan next week, and another discussion, The MRI showed one possible seminal vesical involvement, at the moment its T2 but could be T3b. At the moment ive been thinking that RT+HT is the best treatment, but what is HT like; It would be for 5 years apparently, How do people cope with that?, How would I view my wife when Im on it, or any other woman for that matter?. There are clearly side effects with RT, but Im attracted to the high-tec nature of it, There again with surgery, its all presumably over more quickly, and if one can recover ones bladder and rectal control, life could be bearable. I gather the nerves are dissected along with everything else, so presumably sex is out of the question.  Sorry about spelling, Im still shaking with nervous exhaustion as I write this. Yours Brian



Hi Brian


Yes it knocks us for 6 doesn't it when we are told. I was so led to believe that if I did have cancer is would be such that active surveillance would be the treatment I was on my own when I was told at 1/4 past 8 on a very dark evening!


If you do the research, like me, it is unlikely that it is devastating news as you now feel it is. The chances are that your cancer is curable rather than 'treatable' which is good news. Although I felt like I had been hit with a sledgehammer at first I am now quite chilled about it and have actually delayed my recommended treatment until I understand the prognosis and the options open to me better.


This site is excellent and there is plenty of other material out there that can help you - but my advice is, in general, to stick to UK material and more recent material say last 5 years or so.


Let me know if you would like me to direct you to what I have found useful but as a starter for 10 the NICE guidelines are useful: http://www.nice.org.uk/guidance/cg175 as is the Tool Kit from this organisation is a must.


dl

Edited by member 25 Nov 2014 at 20:38  | Reason: Not specified

User
Posted 26 Nov 2014 at 19:33

Had a bone scan several ways, up and down and round the back, along with a CT scan, and clear of bone cancer, whoppee. Decided for robotic surgery as the cancer is pretty well confined to the prostate, and surgery should remove it all, Other option was hormone therapy plus radiotherapy, but if there is any recurrence after surgery, there is still the backup option of HT or RT, wheras surgery cant easily be done after RT, Worried still about the loss of bladder control as the surgeons dont make any promises about nerve saving. Thanks for all your helpful comments.
Brian

User
Posted 26 Nov 2014 at 22:58
Brian

Where do you get no sex after RARP ? I had da Vinci op in April no nerves spared have ED and still have a good sex life ,it takes a different format but still good for both of us,frustrating and depressing at times but you need to make the most of what you have.

Continence, almost dry 4 days post catheter removal and despite 2 bladder neck stretches still good.Some on here did better and a lot seem to be back to normal at four months.

We are all different and there are no guarantees, but all options have there risks.

Thanks Chris


User
Posted 26 Nov 2014 at 23:06

Brian, I think you have been muddled. The nerve sparing has nothing to do with bladder control.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
 
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