Young man just diagnosed weighing brachytherapy or da Vinci surgery

I had similar stats when I was diagnosed at 50 and the decision was fairly easy for me. Both my urologist (who performed the surgery) and the oncologist recommended surgery. The oncologist joked about the fact that he was supposed to be selling me on radiation, but in all seriousness he said that if he was at my age with my test results he would go with surgery.

For the side effects the incontinence isn't a problem. It was a slow process and sometimes didn't feel like it would get better, but by 6 months I was 99% and now I don't even think about it. My urologist says that when I get old it will likely return.

ED is better than I expected. My nerves weren't spared which I knew going into surgery. It was a large tumor and he recommended removing both nerves and lymph nodes to increase my odds of success. I'd like to say it was a harder decision to make but I wanted to do whatever it took to get rid of the cancer.

I had expected a lifetime of injections but at about a year I started feeling twinges of life and now 2+ years out I can a natural erection without any drugs. One side effect that isn't talked about much is the decrease in size. The urologist had mentioned it but I didn't give it a lot of thought at the time. I'm probably 1-1/2" shorter and not as thick. On the positive side our sex life is a lot better than it was prior to the surgery. We had fallen into the post kids rut where it just wasn't happening much and like you my sex drive had dropped off.

I suffered bouts of depression for about 18 months after surgery. Part of it was related to ED but I think a lot of it was suddenly feeling a lot older.

Good luck with you decision. As you've already seen, this is by far the best place to go to discuss prostate cancer.

Aachen,

If you look at my name to the left of this comment you will see me identified as a moderator and if you look back through this thread you will also notice that several commenters got into an excessively heated argument and that I was there in the fray and was at least as bad as anyone. I apologize; it wasn't appropriate behavior, especially on a thread started by a new member looking for information while he tries to decide on a treatment. My only defense, and I acknowledge that it is thin, is that I was not yet a moderator at that time that and I wouldn't post the same comments in the same way now.

Almost everything you describe in your first post this morning applies to me as well. I was a Gleason 6 upgraded to a Gleason 7 (3+4) by a second opinion on my biopsy slides (recuts in my case -- new slides from the same samples). I am older than you are but my dad is 26 years older than me and still creaking around so I thought of myself as young. I looked at surgery, brachytherapy, external beam radiation and High-Intensity Focused Ultrasound (HIFU). I had moderate ED prior to surgery which usually (but not always) responded to PDE5i drugs (tried Cialis, Levitra & Staxin). Becasue of the size of my prostate --several years of Avodart had reduced it to a mere 90 g. -- all of the options except surgery would require several months of hormones to shrink it down to a treatable size. Since I was already struggling with my sex life that added feature made those options quite unappealing -- something of a deal-breaker, actually.

As you have noticed, if you have ED prior to treatment there is simply no information about your odds of having any erectile function afterwards. Doctors will give the general sense that the prospect is not great but there are no numbers. (It does happen, though, and can't be ruled out; it is maybe a one in five proposition.) So, no matter what you choose you are likely to be joining our injections delegation (of which I am now a member). One thing you will hear often on this forum is how important it is to make the right choice because there are no do-overs and you can't go back. That is true. But what we sometimes forget to say is that you can almost always go forward. Most of the prick prickers contingent here on this forum seem to use "trimix" (because it works and is affordable on a per-use basis) and it has an enviable success rate. And if injections don't work there are implants which have a stellar satisfaction rate. There is sex after prostate treatment. The trick is to refuse to give up.

Your libido problems are probably related to ED anxiety. I don't think the cancer has anything to do with it. Once you have ruled out low-T, performance anxiety is usually the problem with men who struggle with both ED and lack of desire. I know that was a big factor with me. I also noticed that Avodart (which I took for my enlarged prostate) reduced my libido which didn't help much.

After my surgery my pathology report re-graded my cancer as a G9 (4+5) with positive margins. Not wanting to mess around with it I followed my surgery with external radiation and, yes, two years of androgen deprivation to make the surgery and radiation more effective. The theory is that after surgery and radiation my cancer cells are wounded and trying to heal but we have introduced drugs that cut them off from the things they need to thrive. I know how they feel. But it's them or me.

Since I started the trimix about the same time as I started the hormone therapy I can't speak from first-hand experience whether trimix helps anxious guys with their libido issues. My trimix use is mostly just to keep the machinery working so that in two years, when the hormones wear off, I can find out. In theory it should be a big help.

Good luck making your decision.

Tagged

Men:

One data point seems to elude me.

Specifically, if I have surgery and cancer returns.... how effective is radiation as a secondary treatment upon return of cancer?

And how does that compare to re-radiating after brachytherapy?

Try as I might I can't get any surgeons or radiation guys to shed any light on this.

To me this is a pretty central question if the possibility of radiation as a secondary treatment is being held out as the primary reason for surgery.

I may post this in a separate thread as well....

Salvage radiation has about a 30 percent success rate. Salvage treatments after primary radiation has the same cure rate. If thr cancer is still local then salvage treatments work, if it is systemic no salvage treatment will work.

I just put my numbers into the basic tool at:

http://nomograms.mskcc.org/Prostate/PreTreatment.aspx

And it also predicts surgery as the better long term results for me. With 98% at 5 years and 97% at 10 years for surgery and 87% at 5 years with Brachy with no data for 10 years.

I wonder if putting in the optional information would change things.