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Retzuis Sparing v RALP

User
Posted 05 Nov 2018 at 21:25

Hi Everyone


Thank you to those who have replied to my question, which I asked on Carl M's thread.


Upon advice I have started my own thread.


To re-iterate, I am 49 years young, diagnosed with a Gleason 6 in July 2018. I had the MRI before the biopsy.  8 of the 15 cores taken in the biopsy were cancerous, spread across both halves of the prostate = T2a I believe.


I have met the Brachy surgeons and the RALP surgeon, but Retzuis sparing is not available at my local hospital (but is at one not too far away). I have no medical insurance.


I have been offered Active Surveillance, but because of the high volume of infected cells both sets of surgeons suggested I would have to have to under go some form of treatment within 2 years. As I am relatively fit, and not known for my patience, I would like to get on with some form of treatment now.


Initially I was leaning towards Brachy ( a friend had it 15 years ago and is very happy with the outcome). However I am concerned about a return of cancer to my prostate in future years ( I hope to have 20+ more years) and if I have Brachy now future options are more limited.


So now I am looking at the surgery, but do not like some of the side effects.  


Retzuis sparing seems a good alternative, but one surgeon I spoke to was concerned that working in such a small space was difficult, and he had some concerns about removing all the neck of the prostate when using this method.


Incontinence is the biggest worry, if I am honest.


So the 2 questions I have are:


please could persons share their experience's/knowledge of Retzuis sparing prostate removal, in as much detail as is allowed on this forum (but I will happily private message anyone at a later date). 


If I opt for the traditional RALP, with a good surgeon, will I experience some form of incontinence, and if so for how long ?


Thanks to all for your time, and I hope you all return to a clean bill of health soon.


Mark

User
Posted 05 Nov 2018 at 22:43

Copied from other thread:


I think there are only 3 members here that have had Retzius sparing so you are not going to get a huge amount of reliable or balanced data On this forum. It is a very new technique in the UK and not done in the same method as overseas (which is where you will get a lot of data from) so the main challenge in deciding whether or not to opt for Retzius sparing will be geographic - it can be quite problematic to have your op hundreds of miles from home unless you have clarified beforehand who is going to be responsible for your after-care. If you live local to the surgeon that does RS then obviously you don't have that additional worry to contend with.


Men in their 30s and 40s tend to have a more aggressive and persistent prostate cancer than those who are older, and 50% of cores affected is rather high so I doubt you would be suitable for AS as anything other than a holding position while you make decisions and any arrangements necessary (sperm banking if you haven't finished having a family, for example).


If you are considering AS, you can ask your doctors what % of the 8 cores was affected and whether the affected cells were deep in the gland or nearer the outer edge.


 


As to the question of whether you will experience incontinence with Da Vinci or routine keyhole RP, it is impossible to predict. Some ar3 fortunate and find that they have urinary control as soon as the catheter is removed. Over 80% of men are using one pad or less by 12 months post-op. Open surgery has a slightly lower risk of incontinence but requires a longer recovery time and hospital stay. Two men having the same op with the same surgeon can have very different outcomes, one being dry very quickly and the other left incontinent on a temporary or permanent basis - it is partly down to surgeon skill but also affected by your personal internal layout, how the sphincter recovers, whether the lower urinary valve has to be removed / resited and whether there is any accidental damage done to the urethra during the op. We hear too often on here about surgeons who minimised the risk of incontinence, leaving men shocked and distressed when it happen. Also important to ask surgeon to use clear language; the NHS  defines ‘incontinent’ as needing more than one pad per day so if a surgeon says that 98% of his or her patients are ‘continent’ 12 months post-op, I would ask them what % don’t actually wear any pads at all. 

Edited by member 05 Nov 2018 at 22:57  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 06 Nov 2018 at 02:57
Hi again Mark,

I am in contact with three or four other blokes here who have also had their Retzius-sparing surgery carried out by Professor Whocannotbenamed, the same as me.

They all report their continence is fine, and were overwhelmed by the skill of our surgeon. It does seem a bit of a cheat that surgeons claim continence statistics when incontinence pads are still involved occasionally a year later. I bought a pack of fourteen Tena lights after my op and there are three or four still left in the box, never to be used (I hope).

Retzius-sparing is supposed to preserve erectile function (which in my case it hasn’t, yet). A friend from South Africa came to London and paid around twenty grand to a top Harley Street surgeon for his non Retzius prostatectomy, his operation went well and he has no incontinence problems now, five months post-op, like me. However his erectile function has not returned either.

I am almost in tears sometimes when I read about someone here who has had constant abdominal pain for three and a half years since his operation or the bloke who has been in nappies for five years. Obviously we here do not know the extent of their cancer their surgeon had to contend with, and thus how much to excise.

So as I think I said before, if you elect for surgery, do your research as to who is going to be doing it, and their volumes and ‘success’ rates. I suppose ‘success’ is removing the cancer, but you don’t want hideous side-effects for years after if possible.

There are many ‘What ifs?” with PCa, but I will never ask myself ‘What if I had had a different surgeon?’

Cheers, John.
User
Posted 08 Nov 2018 at 15:37
Another Retzius sparing patient here, done mid-June, by the same surgeon as cannot be named above.

While I didn't have a trouble-free run due to a post op bleed (which could have occurred whichever way the surgery was done) I'm happy with my choice. I should also say that my surgery was complicated by having a very large prostate.

I've had no real continence issues since catheter removal and still have pads left from the original box. Questionable whether they were actually needed at all after the first couple of days.

ED wise, there were signs of life from early on and now (nearly 5 months on) I have some, if rather unreliable function unaided and full function with sildanafil 25mg (though not liking the side-effects). Tadalafil 10mg is a bit less effective but very much less side effects.

As I understand it, the key with RARP, Retzius sparing or not, is a having a highly experienced high-volume surgeon. The benefit of Retzius sparing is that the direction of approach means that fewer key structures have to be cut allowing quicker recovery of full continence and erectile function. At one year post-op, figures are similar.

This is a serious procedure to deal with a serious disease. It's a question of minimum damage. No technique, including the radio-therapy routes are zero damage. RT can also cause continence issues and ED and in younger patients carriers the risk (albeit quite small) of late side effects.

Hope this helps a little with this very difficult decision.

Nick
User
Posted 09 Nov 2018 at 05:04

Originally Posted by: Online Community Member

If I may ask, how long is it after surgery (either form) before people return to work and drive ?
Best Wishes
Mark


Hi Mark,


I trotted across the road with my trolley bag to the hospital social club upon my discharge for a pint - I was parched - must have been the after-effects of the general anaesthetic. Maybe😉. Where they refused to serve me as I still had my hospital wristband on!


Anyway, I got a drink after involving a pair of scissors and Her Loveliness finally arrived but couldn’t park the car, so I had to. So in fact I ‘drove’ within an hour of leaving hospital. The hospital discharge leaflets say that you should not drive until you are able to jam your brakes on and do an emergency stop. Our wonderful Matron here points out that some car insurers may stipulate a certain time-span before recommencing driving, so check with yours.


I was not in any pain and could certainly stop, so I drove again properly the day after discharge. As for work, I do most of mine on this here ipad, so I even did some from my hospital bed whilst connected up to a plumber’s nightmare of pipework! They say you should have around six weeks off if you have laparoscopic surgery, and probably longer with open surgery. If you do any kind of manual work, the time off would be longer. You wouldn’t want to upset all that internal stitching and plumbing.


I know nothing about radiotherapy except - in my case - to avoid it!


Cheers, John.

User
Posted 26 Nov 2018 at 08:01
My surgery was done at Private Care at Guys, London Bridge so that on the spot pathology could be done. This means that surgical margins could be checked (they were clear) before I was put back together.

As regards recovery time, I’d say there is an element of luck involved. John seems to have got the best case, which was pretty close to what I’d originally been told, whereas the complications I had meant I was out for nearly 12weeks. On the plus side I have no missing inches..... so swings and roundabouts!

Nick
User
Posted 28 Apr 2019 at 11:07
20mg is the max for a single "session". Some guys say the side effects get better with time, I found they didn't 😟.

So 4 years down the line I am happy with my Durex ring and occasional Viagra (same effects but you don't get side effects all weekend!).
User
Posted 12 Oct 2019 at 19:10

I’m 60 years old and had a Retzius nerve sparing robotic prostatectomy on May 14th 2018, four blood tests later my PSA remains at <0.03. I’ve been continent (zero pad use) since the supra pubic catheter was removed 11 days post op. I recovered pre-op (full) sexual function without Cialis seven months later.

On the 9th March, three days after my PSA test I had an MP MRI scan. On March 12th the urology consultant confirmed PC. The radiologist classified it as T2b organ confined. Good news, as the cancer appeared to be contained within the Prostate capsule. Treatment options were reviewed but my immediate and unerring decision was to have the Prostate removed. A biopsy would confirm the diagnosis but I could see the cancer on the MRI scan for myself.

I met DC, my Surgeon in London on the 21st March. Incontinence, ED, the possibility of radiotherapy post surgery were all reviewed but there was never any doubt in my mind, removing the prostate would be the only way forward. A transperineal biopsy on the 3rd April confirmed the prognosis and a Gleason score of 3+4.


On the May 14th, 6 weeks post biopsy, I had a 3 hour Retzius nerve sparing robotic radical prostatectomy with 'on table’ pathology. The Retzius surgery technique is claimed to be less invasive and offers better nerve and continence outcomes. After my prostate was removed and whilst I was still anaesthetised,  it was examined by a pathologist to determine if enough tissue had been removed to provide clear or ‘negative' margins. The surgeon subsequently removed additional tissue post pathology which thankfully proved negative.

I went home on the 16th May, returned on the 25th May to have my catheter removed and had my first erection on the 29th May and on the 31st May I had an erection sufficient for full penetrative sex using 5mg of Cialis - phew!

Since my operation I’ve had four PSA tests all <0.03. To date, I have not required further treatment.

As for bladder control, I have been dry since day 1 - no pads. I do still wake up in the middle of the night to use the toilet and during the day I’m urinating every 3-4 hours, sometimes less depending on how much coffee I’ve drunk. 

By August I was riding my mountain bike and walking the hills again. By November 2018 I regained my pre-surgery sexual function without Cialis, might have been sooner from a physical perspective, but it’s all about confidence.

I’ve had a great outcome and it's definitely down to the skill of the surgeon I used. I’m happy to chat to anyone who wants to know more. 




Edited by member 13 Oct 2019 at 17:14  | Reason: Not specified

User
Posted 09 Nov 2018 at 23:37
Some insurers say simply that you can drive when you are able to execute an emergency stop, others stipulate 6 weeks. In our case, John had a company car and the employer’s insurer refused to cover him until 12 weeks post op plus they wanted a letter from the surgeon confirming that he was fit to drive (which the surgeon refused to provide because, as he pointed out, he had no idea what John’s standard of driving was before). Best to check with your own insurer though.

General advice is that you will be off work for 6-8 weeks after keyhole RP and 10-12 weeks after open RP, but this would be longer if the work involves lifting.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 21 Nov 2018 at 06:50
In some hospitals and I think at one private London hospital where your man works, they do real-time pathology on bits removed to see if they are cancerous. Didn’t happen in my case.

Very few surgeons here use the Retzuis-sparing technique because of its technical complexity, and because they have not been trained to do it by the likes of Professor Rha in Seoul and the doyen of the method, Professor Bocciardi in Milan.

You will have a supra-pubic catheter for ten days, much more comfortable than a urethral one.

Post-operative care consists of catheter removal on day ten, it takes a few seconds. The urologist here has been very accommodating. I thought he would be pissed off that I had gone elsewhere for surgery, but that was not the case, and I am now back ‘under his wing’ and in touch with both urology and oncology at my local hospital. Make sure similar arrangements are in place for you. The urology nurse there is very good, and she liaised with her counterpart here to arrange the catheter removal.

I hope it all goes as well for you as it did for me. It’s been an ‘interesting’ year! I found I had cancer last November, and now I do not. What’s not to like? Oh, did I mention the missing 2”.............?😉

Best of luck.

Cheers, John.
User
Posted 23 Dec 2018 at 20:26
Enjoy your Christmas and New Year festivities. All the best for a successful operation and a good recovery.
Good food, drink, company and laughter are great tonics.
Ian

Ido4

User
Posted 23 Dec 2018 at 21:51

Well, good luck Mark.


If it ever came to it you wouldn’t have had to pay for a template biopsy as you could have had one on the NHS as so many have had to have, subsequent to a TRUS. Anyway that’s a moot point as you have now been diagnosed.


You are lucky to be able to ‘enjoy’ the live biopsy to see what bits of you can be left alone, something Professor Whocannotbenamed can only offer at a certain London hospital as part of his twenty grand package.


I do no exercise, no Kegel, no pelvic floor, no Pilates, and am right as rain. Apart from a truncated and limp dick.....😉


I hope you are as well or better in six month’s time.


Best of luck with the surgery and enjoy your Christmas.


Consumption of plenty of fluids is recommended post-prostatectomy.....if not before...🍾🍷🍾🍷🍻


Cheers, John

Edited by member 24 Dec 2018 at 05:44  | Reason: Not specified

User
Posted 23 Feb 2019 at 13:04
Dear All,
Where I would be without you all sharing your experiences I do not want to know.
I had the prostate removed 07th Feb 2019, and my experiences have matched parts of all your conversations. The following points seem the best ones to repeat:
1) Do as much preparation pre-op as possible, including pelvic floor exercises and learning more about the experience the surgeon has (if you have the luxury of time to do this).
2) Really impressed with people who go home the day after, I stayed two nights and the 90 minute car journey home was ok.
3) I was advised not to take a laxative, but had to on day 4 post op, and wish I had taken it sooner.
4) View the catheter as a short term friend,track suit bottoms with zips the full length of the leg made emptying it easy, and its removal was more embarrassing than painful.
5) Be pro-active regarding making all follow up appointments.

For me I had all the nerves removed on the left, with some saved on the right.I will hear the official results from the pathology department when I meet the consultant near the end of March. I have been dry since the removal of the catheter,but no sign of action on the erection front (but I am not surprised after what the poor chap has been through over the last couple of weeks).I am walking a couple of miles a day, and plan to start working part time from home on Monday (18 days post op).

I would like to thank you all again for your help.

Cheers, Mark

User
Posted 23 Feb 2019 at 13:16
Glad to hear that all went well, Mark. Best of luck with your recovery.

Chris
User
Posted 24 Feb 2019 at 09:31

Always good to get feedback. Especially when its positive.


Whoever advised against laxatives though. Sadist! Needs re-education!


Good luck at your post-op meeting


cheers


Nick

User
Posted 27 Apr 2019 at 16:40
Well its been a while since I posted - partly to give me a "break" from the cancer subject, and partly being selfish and trying to sort myself out a bit.
So what has happened ?
Good bits -
Met the consultant about 4 weeks ago - first PSA result was "less than 0.04" - I do not think it gets much better than that. I was hoping for "clear margins", but the consultant said that he could not say this, as he had to remove all the nerves on one side (as opposed to only some of the nerves on that side). However he was confident the op was a success, and the first blood test backs him up. Next PSA test 3 months later.

Not so good bits -
Having boldly stated I was dry, this has not continued to be the case. OK through the night and for the start of the day, but as I get tired I leak a bit. Most days one level 2 pad will do, and hoping for improvement.
I was also prescribed Cialis. I took one tablet (20 mg) on a Tuesday. Mild signs of action, but from the Thursday to the Sunday my back hurt so much I could not lie down in bed - spent three nights trying to sleep in a chair. Needless to say I have not taken anymore, but when I feel brave enough I may cut the pill in half and try again.

Thanks again to all on the site who helped me, and if anyone reads my post and wants to know more, just make a comment and it should alert me.

Here's to a healthy future for all of us.

Cheer

Mark
User
Posted 28 Apr 2019 at 09:30

20mg Tadalafil seems like a fairly big dose....... I thought 10 was the usual. That’s what I have and I cut them in half.....


Have to say though that I do wonder at the apparent popularity of tadalafil and sildanafil as both of them, especially the latter make me feel fairly unwell for 6 - 8 hours afterwards with symptoms somewhere between a migraine and a head cold, though never back ache.


They both work reasonably well, though in direct proportion to side effects. Thankfully I can mostly manage without these days.


Otherwise it sounds like you are doing pretty well. I’m sure the continence will continue to improve.  Not sure the PSA anxiety ever goes away though......


Hope the recovery continues apace...... and tiredness making you leak is natures way of telling you to back off! 


Nick

User
Posted 03 Jul 2019 at 19:23

Hello old friends (and not so old friends).


I have now had my second PSA blood test, being 6 months after my prostatectomy, and I am relieved to say the result is "less than 0.04 ug/L" - so that is good news.


It would be a lie to say everything is back to normal down below, but steady improvements over time is hoped for.


I hope everyone is in a good state of mind and hopefully has a reasonably healthy body to go with it.


Best Wishes


Mark

User
Posted 05 Jul 2019 at 19:06
That’s good news Mark.

The improvements do continue in my experience. The ED especially takes a while. Certainly I’m still seeing steady improvement one year on.

Nick
User
Posted 29 Sep 2019 at 21:05
Hope my on line friends are all still in good health and making the most of life.
I have just had the latest PSA test results, being about 7 months since the op, and I am pleased to say the readings were "less than 0.04".
Best Wishes
Mark
User
Posted 30 Sep 2019 at 22:23

Hi Nick


I read one of your post on this blog, regarding how you have recovered from surgery with interest.


I'm 57, diagnosed in August with Gleason 3+4=7. MRI would suggest it's confined to the single organ. 


I have decided to go for surgery, however I recently met with someone who, having gone down the radiotherapy/Hormone treatment route, was very scornful of surgery. He had done a lot of research, but I don't know from where he found his data. He suggested that success rates weren't as good as the stats claim and that 70-80% of patients suffered long term issues with ED and urinal control.


I suspect he might just be a little angry about the whole thing, so I wanted to contact some guys who have had surgery.


I am new to this site, so can't contact privately yet. Would you be happy to chat?


Regards


Mark

User
Posted 01 Oct 2019 at 11:35
"He had done a lot of research, but I don't know from where he found his data. He suggested that success rates weren't as good as the stats claim and that 70-80% of patients suffered long term issues with ED and urinal control."

It is true that the stats can be misleading if you don't know the exact meanings of the phrases used. For example, it is widely known that 90% of men are continent 12 months post surgery ... the full fact is that 'continent' is defined as using one pad or less per day. Men who cannot wear light trousers just in case or who have a constant slight dribble can feel angry that 'continent' didn't mean quite what they imagined. Likewise, nearly 90% or men who had full nerve sparing RP can get an erection 12 months post op; what isn't always understood is that some of those men can get an erection alone but most will need either tablets, injections or a vacuum pump to do so and "getting an erection" is not the same as "getting an erection firm enough for penetrative sex"

The % likelihood for side effects of the two main treatments are broadly similar; the difference is that with RP they are mostly immediate but if you are lucky will improve over time. With RT they may be okay to begin with and then get worse over time (often emerging 5 or more years later). Add into the mix that HT side effects will be mostly immediate but many will improve once HT is stopped and you have much of a muchness between them all.

The best advice I have seen is: choose the treatment that gives you the best chance of full remission and then decide whether you are happy to risk the side effects. If not, then choose the treatment whose side effects you are willing to risk, accepting that you may not get remission. And remember that one side effect of treatment is getting rid of the cancer.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Oct 2019 at 19:39

Hi Mark


Thank you for the private message.  I apparently need to do a few more posts on the public forum before I can reply to your message. 


I will be in touch asap. I have decided to stop the procrastination, make a decision and proceed with the treatment in November.


Cheers


Grant60

User
Posted 03 Oct 2019 at 12:40

Hi Grant 60 


I’ve not posted enough to be able to DM anyone yet but looking at your posts my husband’s diagnosis is very similar ( he’s Gleason 4+4)  I’ve read lots and lots of posts over the last month and he’s decided to go down the surgery route to hopefully get rid of IT. Also I’m aware that with only 12 biopsies done there could be more undiscovered cancer cells. My husband is 56 years and travels a lot with his job ( he runs two businesses) and likes to keep fit by cycling and skiing so is keen to get back to these things without the worry of the cancer spreading. 


 

User
Posted 18 Feb 2020 at 19:52

Hi Mark


Sorry to hear this and hopefully it’s just a random fluctuation. There are better informed folks on here than can give suggestions. From what I have gathered and have in the back of my mind if ever needed. Is firstly take professional ie urologist consultant advice. Usual appears to be involvement of an oncologist if repeated PSA tests comes back with a similar result. Next areas for me would be PSMA PET scan with a view to RT but I believe the PSAs need to be a little higher to be effectively defected. 


Hopefully others can give better guidance and perspective.


Best


TG

Edited by member 18 Feb 2020 at 21:46  | Reason: Not specified

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User
Posted 05 Nov 2018 at 22:43

Copied from other thread:


I think there are only 3 members here that have had Retzius sparing so you are not going to get a huge amount of reliable or balanced data On this forum. It is a very new technique in the UK and not done in the same method as overseas (which is where you will get a lot of data from) so the main challenge in deciding whether or not to opt for Retzius sparing will be geographic - it can be quite problematic to have your op hundreds of miles from home unless you have clarified beforehand who is going to be responsible for your after-care. If you live local to the surgeon that does RS then obviously you don't have that additional worry to contend with.


Men in their 30s and 40s tend to have a more aggressive and persistent prostate cancer than those who are older, and 50% of cores affected is rather high so I doubt you would be suitable for AS as anything other than a holding position while you make decisions and any arrangements necessary (sperm banking if you haven't finished having a family, for example).


If you are considering AS, you can ask your doctors what % of the 8 cores was affected and whether the affected cells were deep in the gland or nearer the outer edge.


 


As to the question of whether you will experience incontinence with Da Vinci or routine keyhole RP, it is impossible to predict. Some ar3 fortunate and find that they have urinary control as soon as the catheter is removed. Over 80% of men are using one pad or less by 12 months post-op. Open surgery has a slightly lower risk of incontinence but requires a longer recovery time and hospital stay. Two men having the same op with the same surgeon can have very different outcomes, one being dry very quickly and the other left incontinent on a temporary or permanent basis - it is partly down to surgeon skill but also affected by your personal internal layout, how the sphincter recovers, whether the lower urinary valve has to be removed / resited and whether there is any accidental damage done to the urethra during the op. We hear too often on here about surgeons who minimised the risk of incontinence, leaving men shocked and distressed when it happen. Also important to ask surgeon to use clear language; the NHS  defines ‘incontinent’ as needing more than one pad per day so if a surgeon says that 98% of his or her patients are ‘continent’ 12 months post-op, I would ask them what % don’t actually wear any pads at all. 

Edited by member 05 Nov 2018 at 22:57  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 06 Nov 2018 at 02:57
Hi again Mark,

I am in contact with three or four other blokes here who have also had their Retzius-sparing surgery carried out by Professor Whocannotbenamed, the same as me.

They all report their continence is fine, and were overwhelmed by the skill of our surgeon. It does seem a bit of a cheat that surgeons claim continence statistics when incontinence pads are still involved occasionally a year later. I bought a pack of fourteen Tena lights after my op and there are three or four still left in the box, never to be used (I hope).

Retzius-sparing is supposed to preserve erectile function (which in my case it hasn’t, yet). A friend from South Africa came to London and paid around twenty grand to a top Harley Street surgeon for his non Retzius prostatectomy, his operation went well and he has no incontinence problems now, five months post-op, like me. However his erectile function has not returned either.

I am almost in tears sometimes when I read about someone here who has had constant abdominal pain for three and a half years since his operation or the bloke who has been in nappies for five years. Obviously we here do not know the extent of their cancer their surgeon had to contend with, and thus how much to excise.

So as I think I said before, if you elect for surgery, do your research as to who is going to be doing it, and their volumes and ‘success’ rates. I suppose ‘success’ is removing the cancer, but you don’t want hideous side-effects for years after if possible.

There are many ‘What ifs?” with PCa, but I will never ask myself ‘What if I had had a different surgeon?’

Cheers, John.
User
Posted 08 Nov 2018 at 15:37
Another Retzius sparing patient here, done mid-June, by the same surgeon as cannot be named above.

While I didn't have a trouble-free run due to a post op bleed (which could have occurred whichever way the surgery was done) I'm happy with my choice. I should also say that my surgery was complicated by having a very large prostate.

I've had no real continence issues since catheter removal and still have pads left from the original box. Questionable whether they were actually needed at all after the first couple of days.

ED wise, there were signs of life from early on and now (nearly 5 months on) I have some, if rather unreliable function unaided and full function with sildanafil 25mg (though not liking the side-effects). Tadalafil 10mg is a bit less effective but very much less side effects.

As I understand it, the key with RARP, Retzius sparing or not, is a having a highly experienced high-volume surgeon. The benefit of Retzius sparing is that the direction of approach means that fewer key structures have to be cut allowing quicker recovery of full continence and erectile function. At one year post-op, figures are similar.

This is a serious procedure to deal with a serious disease. It's a question of minimum damage. No technique, including the radio-therapy routes are zero damage. RT can also cause continence issues and ED and in younger patients carriers the risk (albeit quite small) of late side effects.

Hope this helps a little with this very difficult decision.

Nick
User
Posted 08 Nov 2018 at 21:36
Hi Nick
Thank you very much for taking the time to post such a comprehensive reply.
I did not realise the 1 year post op statistics were the same for either form of surgery.
I will look into the ED treatment when/if needed.
If I may ask, how long is it after surgery (either form) before people return to work and drive ?
Best Wishes
Mark
User
Posted 08 Nov 2018 at 21:46

Hi John


I think my original reply to your comments may have gone straight to your inbox, rather than appear as a post - apologies.


Thank you for your comments, and for being so open and honest.


I have to say I felt quite isolated with my decision dilemma a week ago, reading various expert opinions on the internet, and inevitably just going round in circles.


Finding this forum has been a light bulb moment.


Thank you to not only those that have answered my question directly, but all the others with their own threads that I have been looking at.


Now to find the name of this Professor Whocannotbenamed.......... 


Best Wishes,


Mark

User
Posted 09 Nov 2018 at 05:04

Originally Posted by: Online Community Member

If I may ask, how long is it after surgery (either form) before people return to work and drive ?
Best Wishes
Mark


Hi Mark,


I trotted across the road with my trolley bag to the hospital social club upon my discharge for a pint - I was parched - must have been the after-effects of the general anaesthetic. Maybe😉. Where they refused to serve me as I still had my hospital wristband on!


Anyway, I got a drink after involving a pair of scissors and Her Loveliness finally arrived but couldn’t park the car, so I had to. So in fact I ‘drove’ within an hour of leaving hospital. The hospital discharge leaflets say that you should not drive until you are able to jam your brakes on and do an emergency stop. Our wonderful Matron here points out that some car insurers may stipulate a certain time-span before recommencing driving, so check with yours.


I was not in any pain and could certainly stop, so I drove again properly the day after discharge. As for work, I do most of mine on this here ipad, so I even did some from my hospital bed whilst connected up to a plumber’s nightmare of pipework! They say you should have around six weeks off if you have laparoscopic surgery, and probably longer with open surgery. If you do any kind of manual work, the time off would be longer. You wouldn’t want to upset all that internal stitching and plumbing.


I know nothing about radiotherapy except - in my case - to avoid it!


Cheers, John.

User
Posted 09 Nov 2018 at 21:06
Hi John
Thank you again.
I am a Primary Food Producer (used to call myself a Farmer, but started feeling a bit left behind in the job title department !) so manual work and driving are a daily activity for me. Having said that, no one is indispensable, so I am sure they will manage fine without me for a while.
Used to always be up for a pint or 3, but too much time spent peeing means I have moved onto shorts now !
Thanks also for the private message. Unfortunately the system will still not allow me to respond privately, in case I am spam.
Attempting to get an appointment with Professor .
Cheers
Mark
User
Posted 09 Nov 2018 at 23:37
Some insurers say simply that you can drive when you are able to execute an emergency stop, others stipulate 6 weeks. In our case, John had a company car and the employer’s insurer refused to cover him until 12 weeks post op plus they wanted a letter from the surgeon confirming that he was fit to drive (which the surgeon refused to provide because, as he pointed out, he had no idea what John’s standard of driving was before). Best to check with your own insurer though.

General advice is that you will be off work for 6-8 weeks after keyhole RP and 10-12 weeks after open RP, but this would be longer if the work involves lifting.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 11 Nov 2018 at 15:49

Hi John


According to Prostate Cancer UK I am still a spammer, so I will post publicly my thanks to you for the last message you sent me.


It seems like I am lucky enough to be speaking to the right people, and agree with the sentiments included in your message.


I feel I know the direction I am going in now, and will update the site once final decisions are made.


Thanks to you and other users on this forum for sharing their invaluable experiences/thought process/opinions.


Best Wishes to all


Mark

User
Posted 20 Nov 2018 at 21:17
Hi John, LynEyre, Nick (names in alphabetical order (!), as you have all been very helpful) and anyone else who makes the time to read this reply/question.
I have a meeting with Retzius sparing Professor at the end of the week, and am looking for guidance on the right questions to ask.
So far I have got:
1) I have read somewhere (German hospital I think) that some surgeons have the margins of the prostate tested whilst the patient is on the operating table, and if they come back positive they remove a bit more. Is this something anyone else has heard of ?
2) In your post LynEyre you mentioned they use a different Retzius technique in the UK to abroad. Do you have anymore info, but I will ask the question.
3) Catheter (I really do not want one) - Does the surgeon use a supra catheter.
4) Post operative care - can this/should this be done at a more local hospital.

Any other questions I should ask ?

I have looked at the number of operations this individual has performed and am happy he is about as good as it gets.

Now saving up to buy that pint you suggested John, and to enjoy the view!

Thanks to all
Mark
User
Posted 21 Nov 2018 at 06:50
In some hospitals and I think at one private London hospital where your man works, they do real-time pathology on bits removed to see if they are cancerous. Didn’t happen in my case.

Very few surgeons here use the Retzuis-sparing technique because of its technical complexity, and because they have not been trained to do it by the likes of Professor Rha in Seoul and the doyen of the method, Professor Bocciardi in Milan.

You will have a supra-pubic catheter for ten days, much more comfortable than a urethral one.

Post-operative care consists of catheter removal on day ten, it takes a few seconds. The urologist here has been very accommodating. I thought he would be pissed off that I had gone elsewhere for surgery, but that was not the case, and I am now back ‘under his wing’ and in touch with both urology and oncology at my local hospital. Make sure similar arrangements are in place for you. The urology nurse there is very good, and she liaised with her counterpart here to arrange the catheter removal.

I hope it all goes as well for you as it did for me. It’s been an ‘interesting’ year! I found I had cancer last November, and now I do not. What’s not to like? Oh, did I mention the missing 2”.............?😉

Best of luck.

Cheers, John.
User
Posted 21 Nov 2018 at 07:28
Thanks John - I will let you know how we got on.
I will have a look about for your missing 2 inches, but cannot promise you anything.......
Cheers
Mark
User
Posted 26 Nov 2018 at 08:01
My surgery was done at Private Care at Guys, London Bridge so that on the spot pathology could be done. This means that surgical margins could be checked (they were clear) before I was put back together.

As regards recovery time, I’d say there is an element of luck involved. John seems to have got the best case, which was pretty close to what I’d originally been told, whereas the complications I had meant I was out for nearly 12weeks. On the plus side I have no missing inches..... so swings and roundabouts!

Nick
User
Posted 23 Dec 2018 at 19:43
Hi Everyone
It's been a while since I posted, but we have not been idle.
Decision made - I will be having a conventional RALP operation on the 7th Feb 2019, at Stevenage.
I visited the private surgeon in London, who was very helpful. Unfortunately he could not offer me Retzuis sparing at his local hospital on the NHS, and I have no medical insurance. However, as pointed out by others on this site, after one year the recovery statistics are the same which ever route you choose.
I have been fortunate enough to be offered surgery by a high volume surgeon on the NHS, who has funding for a trial which allows for the margins to be checked whilst I am on the operating table (Neuro Safe).
As also mentioned by others, the choice of which route you go down, if offered a choice, is very personal.
For me, I am not enjoying the 3 monthly PSA checks (bit like hoping you have not won the lottery every 12 weeks), I am not keen to repeat the biopsy procedure (if I did have to I would find the money and have the more thorough Prostate Mapping - something new readers may choose to investigate), I am "only"49 so wonder vaguely the long term effect of exposing my prostate to such high intense radiotherapy (I hasten to add I have not found any evidence that shows any long term effects) and finally if the problem reappears in the bed of my prostate it leaves me open to the option for them to zap it in the future.
In preparation for the op I am running three times a week, trying to remember to do the pelvic floor exercises, and also invested in an hours private lesson from a local Pilates teacher, who has also given me some more exercises to do !
I thank each and everyone who has offered advice to date, or whose stories I have read, and will investigate what I need to get ready for the op, and for my recovery, in the New Year.
Meantime I intend to drink too much and have a Christmas full of laughter with my family.
Merry Christmas to all, and a healthy New Year.
Mark
User
Posted 23 Dec 2018 at 20:26
Enjoy your Christmas and New Year festivities. All the best for a successful operation and a good recovery.
Good food, drink, company and laughter are great tonics.
Ian

Ido4

User
Posted 23 Dec 2018 at 21:51

Well, good luck Mark.


If it ever came to it you wouldn’t have had to pay for a template biopsy as you could have had one on the NHS as so many have had to have, subsequent to a TRUS. Anyway that’s a moot point as you have now been diagnosed.


You are lucky to be able to ‘enjoy’ the live biopsy to see what bits of you can be left alone, something Professor Whocannotbenamed can only offer at a certain London hospital as part of his twenty grand package.


I do no exercise, no Kegel, no pelvic floor, no Pilates, and am right as rain. Apart from a truncated and limp dick.....😉


I hope you are as well or better in six month’s time.


Best of luck with the surgery and enjoy your Christmas.


Consumption of plenty of fluids is recommended post-prostatectomy.....if not before...🍾🍷🍾🍷🍻


Cheers, John

Edited by member 24 Dec 2018 at 05:44  | Reason: Not specified

User
Posted 23 Feb 2019 at 13:04
Dear All,
Where I would be without you all sharing your experiences I do not want to know.
I had the prostate removed 07th Feb 2019, and my experiences have matched parts of all your conversations. The following points seem the best ones to repeat:
1) Do as much preparation pre-op as possible, including pelvic floor exercises and learning more about the experience the surgeon has (if you have the luxury of time to do this).
2) Really impressed with people who go home the day after, I stayed two nights and the 90 minute car journey home was ok.
3) I was advised not to take a laxative, but had to on day 4 post op, and wish I had taken it sooner.
4) View the catheter as a short term friend,track suit bottoms with zips the full length of the leg made emptying it easy, and its removal was more embarrassing than painful.
5) Be pro-active regarding making all follow up appointments.

For me I had all the nerves removed on the left, with some saved on the right.I will hear the official results from the pathology department when I meet the consultant near the end of March. I have been dry since the removal of the catheter,but no sign of action on the erection front (but I am not surprised after what the poor chap has been through over the last couple of weeks).I am walking a couple of miles a day, and plan to start working part time from home on Monday (18 days post op).

I would like to thank you all again for your help.

Cheers, Mark

User
Posted 23 Feb 2019 at 13:16
Glad to hear that all went well, Mark. Best of luck with your recovery.

Chris
User
Posted 24 Feb 2019 at 09:31

Always good to get feedback. Especially when its positive.


Whoever advised against laxatives though. Sadist! Needs re-education!


Good luck at your post-op meeting


cheers


Nick

User
Posted 27 Apr 2019 at 16:40
Well its been a while since I posted - partly to give me a "break" from the cancer subject, and partly being selfish and trying to sort myself out a bit.
So what has happened ?
Good bits -
Met the consultant about 4 weeks ago - first PSA result was "less than 0.04" - I do not think it gets much better than that. I was hoping for "clear margins", but the consultant said that he could not say this, as he had to remove all the nerves on one side (as opposed to only some of the nerves on that side). However he was confident the op was a success, and the first blood test backs him up. Next PSA test 3 months later.

Not so good bits -
Having boldly stated I was dry, this has not continued to be the case. OK through the night and for the start of the day, but as I get tired I leak a bit. Most days one level 2 pad will do, and hoping for improvement.
I was also prescribed Cialis. I took one tablet (20 mg) on a Tuesday. Mild signs of action, but from the Thursday to the Sunday my back hurt so much I could not lie down in bed - spent three nights trying to sleep in a chair. Needless to say I have not taken anymore, but when I feel brave enough I may cut the pill in half and try again.

Thanks again to all on the site who helped me, and if anyone reads my post and wants to know more, just make a comment and it should alert me.

Here's to a healthy future for all of us.

Cheer

Mark
User
Posted 28 Apr 2019 at 09:30

20mg Tadalafil seems like a fairly big dose....... I thought 10 was the usual. That’s what I have and I cut them in half.....


Have to say though that I do wonder at the apparent popularity of tadalafil and sildanafil as both of them, especially the latter make me feel fairly unwell for 6 - 8 hours afterwards with symptoms somewhere between a migraine and a head cold, though never back ache.


They both work reasonably well, though in direct proportion to side effects. Thankfully I can mostly manage without these days.


Otherwise it sounds like you are doing pretty well. I’m sure the continence will continue to improve.  Not sure the PSA anxiety ever goes away though......


Hope the recovery continues apace...... and tiredness making you leak is natures way of telling you to back off! 


Nick

User
Posted 28 Apr 2019 at 11:07
20mg is the max for a single "session". Some guys say the side effects get better with time, I found they didn't 😟.

So 4 years down the line I am happy with my Durex ring and occasional Viagra (same effects but you don't get side effects all weekend!).
User
Posted 03 Jul 2019 at 19:23

Hello old friends (and not so old friends).


I have now had my second PSA blood test, being 6 months after my prostatectomy, and I am relieved to say the result is "less than 0.04 ug/L" - so that is good news.


It would be a lie to say everything is back to normal down below, but steady improvements over time is hoped for.


I hope everyone is in a good state of mind and hopefully has a reasonably healthy body to go with it.


Best Wishes


Mark

User
Posted 05 Jul 2019 at 19:06
That’s good news Mark.

The improvements do continue in my experience. The ED especially takes a while. Certainly I’m still seeing steady improvement one year on.

Nick
User
Posted 07 Jul 2019 at 20:58
Thanks Nick
User
Posted 29 Sep 2019 at 21:05
Hope my on line friends are all still in good health and making the most of life.
I have just had the latest PSA test results, being about 7 months since the op, and I am pleased to say the readings were "less than 0.04".
Best Wishes
Mark
User
Posted 30 Sep 2019 at 22:23

Hi Nick


I read one of your post on this blog, regarding how you have recovered from surgery with interest.


I'm 57, diagnosed in August with Gleason 3+4=7. MRI would suggest it's confined to the single organ. 


I have decided to go for surgery, however I recently met with someone who, having gone down the radiotherapy/Hormone treatment route, was very scornful of surgery. He had done a lot of research, but I don't know from where he found his data. He suggested that success rates weren't as good as the stats claim and that 70-80% of patients suffered long term issues with ED and urinal control.


I suspect he might just be a little angry about the whole thing, so I wanted to contact some guys who have had surgery.


I am new to this site, so can't contact privately yet. Would you be happy to chat?


Regards


Mark

User
Posted 01 Oct 2019 at 07:03

Hi Mark


Your posts have been helpful and informative.


I am in decision making stage as to prostatectomy or Brachytherapy.


I have posted on the on line community but would value a one to one conversation and you closely mirror my situation and concerns.


Would you be happy to do so? Not sure how this is arranged.


Regards

User
Posted 01 Oct 2019 at 11:35
"He had done a lot of research, but I don't know from where he found his data. He suggested that success rates weren't as good as the stats claim and that 70-80% of patients suffered long term issues with ED and urinal control."

It is true that the stats can be misleading if you don't know the exact meanings of the phrases used. For example, it is widely known that 90% of men are continent 12 months post surgery ... the full fact is that 'continent' is defined as using one pad or less per day. Men who cannot wear light trousers just in case or who have a constant slight dribble can feel angry that 'continent' didn't mean quite what they imagined. Likewise, nearly 90% or men who had full nerve sparing RP can get an erection 12 months post op; what isn't always understood is that some of those men can get an erection alone but most will need either tablets, injections or a vacuum pump to do so and "getting an erection" is not the same as "getting an erection firm enough for penetrative sex"

The % likelihood for side effects of the two main treatments are broadly similar; the difference is that with RP they are mostly immediate but if you are lucky will improve over time. With RT they may be okay to begin with and then get worse over time (often emerging 5 or more years later). Add into the mix that HT side effects will be mostly immediate but many will improve once HT is stopped and you have much of a muchness between them all.

The best advice I have seen is: choose the treatment that gives you the best chance of full remission and then decide whether you are happy to risk the side effects. If not, then choose the treatment whose side effects you are willing to risk, accepting that you may not get remission. And remember that one side effect of treatment is getting rid of the cancer.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 01 Oct 2019 at 22:25

Hi Grant60


I have sent you a private message.


Cheers


Mark Ja

User
Posted 02 Oct 2019 at 19:39

Hi Mark


Thank you for the private message.  I apparently need to do a few more posts on the public forum before I can reply to your message. 


I will be in touch asap. I have decided to stop the procrastination, make a decision and proceed with the treatment in November.


Cheers


Grant60

User
Posted 03 Oct 2019 at 12:40

Hi Grant 60 


I’ve not posted enough to be able to DM anyone yet but looking at your posts my husband’s diagnosis is very similar ( he’s Gleason 4+4)  I’ve read lots and lots of posts over the last month and he’s decided to go down the surgery route to hopefully get rid of IT. Also I’m aware that with only 12 biopsies done there could be more undiscovered cancer cells. My husband is 56 years and travels a lot with his job ( he runs two businesses) and likes to keep fit by cycling and skiing so is keen to get back to these things without the worry of the cancer spreading. 


 

User
Posted 03 Oct 2019 at 18:53

from Lyn Above


"It is true that the stats can be misleading if you don't know the exact meanings of the phrases used. For example, it is widely known that 90% of men are continent 12 months post surgery ... the full fact is that 'continent' is defined as using one pad or less per day. Men who cannot wear light trousers just in case or who have a constant slight dribble can feel angry that 'continent' didn't mean quite what they imagined. Likewise, nearly 90% or men who had full nerve sparing RP can get an erection 12 months post op; what isn't always understood is that some of those men can get an erection alone but most will need either tablets, injections or a vacuum pump to do so and "getting an erection" is not the same as "getting an erection firm enough for penetrative sex""


3 months post RAPL. I find your post the most telling I have seen. I am slowly beginning to understand the language - I wish I took more interest before. I shall start a thread - "Erection or Improvement"

User
Posted 05 Oct 2019 at 10:41

Hi Gooders,


not quite sure which post caught your eye? There are pros and cons to surgery and the various RT methods. It’s also fair to say that each method has its enthusiasts and naysayers. Urologists tend to favour the surgical approach and oncologists RT.


All approaches have side effects in most men. For obvious reasons, the surgical approach causes immediate and marked side effects, which then improve over time. RT side effects tend to build with treatment time and can continue to worsen even long after actual treatment has ended. They may also affect other systems (bowel function for example), which surgery rarely does.


There aren’t many, if any, studies that provide a balanced comparison between surgery and RT. Not least because data collection between the two schools doesn’t seem to use the same parameters. 


For me, the decision came down to the following factors.


The only RT option I was prepared to consider was brachytherapy and my very large prostate meant that it was only maybe possible after 3 months hormone treatment to shrink it.


I wanted the cancer gone (the only good tumour is the one in the bucket....)


My research indicated that at my age and stage and general health, my chances of making a near full recovery were very good - provided the surgeon was good - and I was lucky enough to be able to influence that.


Should surgery not be fully effective for cancer control the RT remains as a backstop.


15 months on it still seems like the right decision. Though my initial recovery was slowed by post-op complications, it has been pretty complete.  Continence was never really an issue even early on (my definition of continence doesn’t involve pads or dark trousers) and progress on ED has been steady to the point that a small dose of tadalafil has been an optional performance enhancer only for at least the last 6 months.


PSA anxiety? No known cure, other than the temporary effect of a good test result!


hope this helps.....


Nick


 


 


Originally Posted by: Online Community Member


Hi Nick


I read one of your post on this blog, regarding how you have recovered from surgery with interest.


I'm 57, diagnosed in August with Gleason 3+4=7. MRI would suggest it's confined to the single organ. 


I have decided to go for surgery, however I recently met with someone who, having gone down the radiotherapy/Hormone treatment route, was very scornful of surgery. He had done a lot of research, but I don't know from where he found his data. He suggested that success rates weren't as good as the stats claim and that 70-80% of patients suffered long term issues with ED and urinal control.


I suspect he might just be a little angry about the whole thing, so I wanted to contact some guys who have had surgery.


I am new to this site, so can't contact privately yet. Would you be happy to chat?


Regards


Mark


User
Posted 06 Oct 2019 at 10:47

Hi Nikko


A good summary, and similar to my thought process.


Cheers


Mark 


 

User
Posted 12 Oct 2019 at 19:10

I’m 60 years old and had a Retzius nerve sparing robotic prostatectomy on May 14th 2018, four blood tests later my PSA remains at <0.03. I’ve been continent (zero pad use) since the supra pubic catheter was removed 11 days post op. I recovered pre-op (full) sexual function without Cialis seven months later.

On the 9th March, three days after my PSA test I had an MP MRI scan. On March 12th the urology consultant confirmed PC. The radiologist classified it as T2b organ confined. Good news, as the cancer appeared to be contained within the Prostate capsule. Treatment options were reviewed but my immediate and unerring decision was to have the Prostate removed. A biopsy would confirm the diagnosis but I could see the cancer on the MRI scan for myself.

I met DC, my Surgeon in London on the 21st March. Incontinence, ED, the possibility of radiotherapy post surgery were all reviewed but there was never any doubt in my mind, removing the prostate would be the only way forward. A transperineal biopsy on the 3rd April confirmed the prognosis and a Gleason score of 3+4.


On the May 14th, 6 weeks post biopsy, I had a 3 hour Retzius nerve sparing robotic radical prostatectomy with 'on table’ pathology. The Retzius surgery technique is claimed to be less invasive and offers better nerve and continence outcomes. After my prostate was removed and whilst I was still anaesthetised,  it was examined by a pathologist to determine if enough tissue had been removed to provide clear or ‘negative' margins. The surgeon subsequently removed additional tissue post pathology which thankfully proved negative.

I went home on the 16th May, returned on the 25th May to have my catheter removed and had my first erection on the 29th May and on the 31st May I had an erection sufficient for full penetrative sex using 5mg of Cialis - phew!

Since my operation I’ve had four PSA tests all <0.03. To date, I have not required further treatment.

As for bladder control, I have been dry since day 1 - no pads. I do still wake up in the middle of the night to use the toilet and during the day I’m urinating every 3-4 hours, sometimes less depending on how much coffee I’ve drunk. 

By August I was riding my mountain bike and walking the hills again. By November 2018 I regained my pre-surgery sexual function without Cialis, might have been sooner from a physical perspective, but it’s all about confidence.

I’ve had a great outcome and it's definitely down to the skill of the surgeon I used. I’m happy to chat to anyone who wants to know more. 




Edited by member 13 Oct 2019 at 17:14  | Reason: Not specified

User
Posted 18 Feb 2020 at 19:34
Hmmmm
I have been dipping in and out of the site but have not made many contributions as I do not think I could add anymore to the quality of the replies posted already.
But now I find my PSA result has "gone up to" 0.1 even though in theory it should be less, as I have no prostate to create any PSA .
Making me think a bit, hopefully unnecessarily, but any comments on what to do should the cancer return would be appreciated.
Cheers
Mark
User
Posted 18 Feb 2020 at 19:52

Hi Mark


Sorry to hear this and hopefully it’s just a random fluctuation. There are better informed folks on here than can give suggestions. From what I have gathered and have in the back of my mind if ever needed. Is firstly take professional ie urologist consultant advice. Usual appears to be involvement of an oncologist if repeated PSA tests comes back with a similar result. Next areas for me would be PSMA PET scan with a view to RT but I believe the PSAs need to be a little higher to be effectively defected. 


Hopefully others can give better guidance and perspective.


Best


TG

Edited by member 18 Feb 2020 at 21:46  | Reason: Not specified

User
Posted 18 Feb 2020 at 20:21

Firstly, ask for an actual print out of the result to confirm that they haven't just missed the < sign - some medical staff don't seem to know what it is or why it is significant. It is possible that your hospital lab has stopped doing ultra-sensitive PSA tests, as many have over the last couple of years.


If the next test in 3 months is also 0.1, ask your urologist or clinical nurse specialist for a referral to oncology for salvage RT (probably with HT). With a post-op PSA that went down to <0.04 and then rose over a period of time and positive margins, you are showing classic pattern for a recurrence in the prostate bed so RT can usually go ahead without waiting for the PSA to get high enough for a scan (which means allowing the cancer cells enough time to develop further).

Edited by member 18 Feb 2020 at 20:23  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 18 Feb 2020 at 20:49
Thank you Lyn and TechGuy.
Had second PSA test today and have an appointment with Oncology department next week in case one is needed (they said happy to cancel it if not needed).
Thank you for the pointers, I will do some research over the weekend.
 
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