Hello Friend, thank you very much for your response… it is very helpful.Looking at your data and age, it is a very similar case to mine.
I understand your reasoning perfectly, they are very logical.
I am from Spain and I do not know any surgeon who operates
with the Retzius and Neurosafe technique therefore it is a limitation.
I have consulted several specialists (some in favor of AS and others in favor of RARP
and read countless articles and videos on the internet about Gleason 6.
of which it seems that its metastatic capacity is very low or non-existent.
Unfortunately, both the MRI and the biopsy are a true reflection of reality but not necessarily reality.
Unfortunately we can only know this 100% when we remove the prostate (with the side effects that entails)
and it is analyzed in its entirety by the pathologist.
Delaying the timing of treatment is a game of craps in exchange for gaining maximum quality of life
time, but it is also a risk of undergoing theoretically unnecessary surgery.
at Gleason 6 (according to the recommendations of the European and American Clinical Guidelines),
which would be overtreatment.
From what I see in your case, the biopsy was a G6 and post-surgery it confirmed G7
and multiple foci, therefore a posteriori your decision was correct, and your surgery fortunately
went well without side effects, therefore the objective of being cured without aftermath.
B.R.
Originally Posted by: Online Community Member
Prior to surgery: Gleason 6 T2 pirads4 PSA:5.6
post surgery: Gleason 7 (3+4) T2c PSA <0.006
It’s quite a journey. I don’t have a single regret over having a retzius sparing RARP with neurosafe. Choosing a high volume surgeon and top rated hospital I found helped mitigate a lot of concerns.
if I did it again I would have done it earlier as best to remove cancer as soon as possible in my view. Cancer can spread at any time…that’s the simple pathology of the disease although less likely in early stages. I whip it out when low grade rather than roll the dice waiting for potential prostate capsule breaches. Biopsy can also setup an environment for mets and hopefully in a few years tests and scans will reduce their need.
i looked at focal therapies extensively but wasn’t suitable as my disease was in all four quadrants of the prostate. PCa tends to be a multifocal and in my case this was reinforced by histology which picked up smaller medium grade cells which were missed on biopsy (fairly common). I was also mindful that focal therapies tend to just kick the can down the road in any case and would likely end up needing RARP as some point which would be more complex.
What have a learnt from this journey? Maybe us guys should be offered a baselining PSA test when around 40. Get a second opinion and find a verified high volume surgeon who is regarded as outstanding in their sphere and pioneers the field.