Which way to go ,

Was diagnosed at 52 (2022), had RP the same year. I recovered quick, back at work after 4 weeks, and hiking good distances after 8 weeks. I was very fit pre-op. Despite full nerve sparring I suffered ED for a year and it's taken nearly 3 years to get to close where I was before.  However everyone's experience of all the above is different. Why did I choose RP over RT. For one I did not like the idea of taking hormones for potentially a long time. With RP the treatment is quicker and I could get on with life. Second although you are given a choice and left to make up your own mind, my oncology team strongly pushed me towards RP. This is because of my age, potentially I have a long life ahead of me, if the cancer returns then RT can be used as a secondary treatment. The concern being HT used too much can cause damage. That said HT has improved considerably. You should be offered the opportunity to talk to both the Surgery and Oncology teams before make a final decision. 

That is a very good video Adrian has posted. You may also find it helpful to read the 'Tool Kit' provided by this charity as here https://shop.prostatecanceruk.org//our-publications/all-publications/tool-kit?limit=100

PCa is a very individual disease and the response and reaction to treatment of anybody who replies here may be quite different to what you experience. If going for surgery which is more often the preferred option for younger men, I would seek an opinion from your surgeon on whether s/he considers all your cancer can be removed, as if not, you may, like a number of other men, require salvage radiation and thereby have the potential side effect of both types of treatment. Also ask your surgeon if s/he thinks nerve bundles on one or both sides of the Prostate can be preserved, so your chances of Erectile Dysfunction are minimised.

Edited by member 23 Aug 2025 at 13:03  | Reason: to highlight link

Hi steven

Sorry to hear about your diagnosis

I’m about 5 1/2 years post retzius sparing RARP with NeuroSAFE. No regrets and pleased I acted when I did.

No real problems with urinary incontinence.  I tend to keep it empty when I’m doing heavy weight training at the gym because there’s only one valve in your pelvic effectively, whereas before there two. So you do have to adapt to the new anatomy but it works will be the odd slight drip or squirt but those are fairly predictable and avoidable I find.

The retzius sparing approach enters the prosthetic area from a technically different angle thus leading to less disturbance of the nerves situated underneath the bladder which are associated with quicker urinary control recovery post-op.

The key I found is to find a highly experienced high volume surgeon to do the work.

In terms of ED I think I’m pretty fortunate on that front as things are about 80% what they were beforehand. If I’m not tired, it doesn’t affect me at all but if I’m mildly tired then I would need something like a small dose of Viagra to make up the last 20%.

hope that’s useful and please shout if you need any more information as I was ~52 when this all kicked off.

cheers

simon

Edited by member 23 Aug 2025 at 17:34  | Reason: Not specified

Being incontinent was my biggest worry. The surgeon was pretty confident that the position of the tumour would be mean I would be OK. So its one of those questions that should be on your list. 

Following surgery I did have some leaks in the daytime, but only spots. Was always dry at night. Fortunately it was not for long, I had done plenty of pelvic floor exercises pre and post op once the catheter was removed. I was advised six times per day.

Hi Chaz

thanks for the kind words. Have PM’d

best

simon

That’s great!

If you get the option it’s worth seeing him at London Bridge in person as you can get a feel for the vibe better in my view than via a zoom call. It’s only a short meeting, but all points generally conveyed a lot easier.

Also worth registering via their patient portal and putting in some background history maybe as I did. I also printed out and took with me a complete medical dossier and CDs with scan data. The main advantages of registering on their portal is you will instantly get copies of any correspondence, test results and as such as they happen. Very refreshing as most clinicians don’t really seem to embrace technology as well as perhaps they should. For instance, I got my post-op pathology results day six as it landed in my inbox simultaneously as it did with the professor.  I preferred this rather than waiting four weeks for our meeting. in fact after my surgery I saw his correspondence to my GP detailing how surgery had gone within two hours of coming out of theatre. I like to see the raw data and information rather than having it filtered plus the associated delays that can occur.

Hope everything goes well & you are in good hands.

best regards

Simon

Edited by member 25 Aug 2025 at 11:08  | Reason: Not specified