Decision Time - Why do younger men choose surgery?

You can do surgery after radiation but it is just highly unlikely that you can successfully spare the nerves - at least this is what my surgeon told me who also is head of the urology dept.

I think the statistics are frustrating for all of us - it seems that there are so many contradictory studies and many of them just don't seem to jive with what you see from men who have been through the procedures. Most studies that take either a surgery or radiology bias seem grossly over-optimistic.

For the OP, I would suggest talking to a doctor who specializes in radiation and also one who does surgery. You may not get an unbiased opinion but in my case both told me that surgery was probably the best option.

For some men brachy may be the best solution and for others it is surgery -Something I would say which may sound strange is to "trust your gut". I realize that this is hard to do when so many emotions come into play.

Hobster,

I had a large Prostate which would have required the doctors to try and reduce its size with hormones. I chose surgery instead.


Joey,

Based on a G6 and T1C I would guess you may be a good candidate for active surveillance. You may not need treatment.

Post Edited (RCS) : 3/11/2015 7:20:10 AM (GMT-6)

halbert said...
The "50/50" statistic is for ALL patients, regardless of age or physical condition prior to surgery. It' a lot harder to find reliable numbers broken down by age and medical history pre-surgery.

I showed the best stats available broken down by age category in the following article:
Half of long-term erectile function (EF) loss after brachytherapy (BT) is due to aging

Medical history is more difficult to sort out. Diabetes and CV dysfunction are the two leading causes of ED. Usually researchers look at erectile function across men who were potent at baseline in order to sort out that bias. That approach will work unless those risk factors cropped up during the study period and were differentially greater in one subset than another. Hopefully, it evens out across the groups. As we get full registry data, we'll see if there are differential effects. I would expect the bias to be in favor of surgery because those risk factors are more likely to preclude surgery vs. radiation.

Yes, it does. That's why I think the choice would be so hard. I would be looking at every option available to completely avoid the standard treatments. If I ever have a recurrence and I'm told I need ADT, I'm not sure I'm willing to go down that path. The reality of such a situation might change my mind, but I simply don't want that treatment.

Going to get a 2nd opinon at John Hopkins hopefully next week. I really don't know what to do. I have a meeting with a team at George Washgington there going to give me all my options but i think another opinon i good for me.

All- thank you for the input. My wife and I spent part of the day at the Mayo Clinic in Rochester talking with the doctors. After going through the pros and cons of each we decided surgery would be the treatment. As everyone commented it really ends up being a personal decision. The biggest deciding factors for my decision were wanting the prostate removed and having that piece of mind and finding out the pathology report. I was a little concerned with seconary cancers but they both said that would not be a big risk but still a risk with radiation. It was my decision but it was great to have a supportive wife as this will effect us both. My surgery will be March 27 by a skilled surgeon who has a proven track record. Another must for those considering surgery. Any suggestions on items I will need after surgery? I saw a post about snap up sweats being good. How about the catherbag? Thanks

Best of luck, Hobster. I found baggy shorts worked well. I could simply slide the shorts over the bag, if needed, and they did not get caught up with the catheter. Actually, the baggy shorts idea was my brother's. I found a foam donut quite useful for the first couple weeks. Some people preferred sleeping in a recliner, but I had no trouble with my bed, and preferred it. If I wanted to sleep on my side, I'd just tuck a pillow between my legs. Good luck, and keep us posted. We'll be thinking about you on the 27th.

You also get 5 seconds of feeling good before lights out.

Thanks for this discussion, guys. I am currently on active surveillance whilst I lose weight for surgery. PSA has gone up recently from 7.71 in November to 11.07 last month, but oncologist reckons this might be lingering effect of biopsy in mid-December. I too am looking to surgery here in UK rather than radiotherapy, as the options seem to be more open and there is less risk of side effects for a 53 year old such as myself. I'd be interested if there is anything I could do in terms of preparation for surgery, though - maybe will raise question with my consultant on 9 April when I see them next.

My husband can not tolerate the thought of surgery. Funny, he has had his knee rebuilt a couple of times. Brachy was not recommended in his case, but we had already rejected it because our two year old grandson lives in the apartment upstairs. We knew that the little one would want to sit on his grandfather's lap drawing pictures of fire trucks on the computer and generally destroying his desk.

My husband also wanted to be able to see patients without them knowing he was sick. Surgery wouldn't work, but maybe radiation will. There is some worry that he'll nod off during a session, but there are medications, scheduling, and naps to help that issue.

Our almost a doctor son came with us for the committee consultation meeting. He asked an interesting question: "Which therapy will make my father feel less like a patient?"

dmlvt said...
I was 51 at diagnosis, 52 at surgery, and 53 now. My pathology and PSA were nearly identical to yours. I don't know what I'd choose if I had a do-over, but I absolutely hate the side effects from the surgery. Yes, the cancer appears to be gone and I was able to resume testosterone therapy, which was important to me. But, I feel like I've been permanently maimed. My ED is mostly resolved, but not completely. I never know for sure when a real erection will show up. My orgasms are a shadow of what they were, although others report better results there.

I know it's probably not cool to lament the quality of my sex life when others here have it much worse. But, I feel like a huge part of my life has been permanently stolen from me. I still have a sex life, but it's nothing like it was before and I feel robbed.

It seems to me that there are many solutions that can cure the cancer. The question is, does the cancer need to be cured? And if so, are you willing to live with the side effects of the cure?

I think that if I was starting over on the decision path now, my choice would be so much more difficult.

You are singing my song, DMLVT. My feeling since the surgery- exacerbated greatly when I did not get the hoped for containment and cure- is that I made a terrible error and am stuck with the consequences of that for life. And, yes, maimed is the feeling. However, unlike you I have no sex life. The results of the injections have just never been adequate- though I sure get the aches and close but no cigar result. But even with the inadequate response, I have managed to pull it off(just barely) with penetration a couple of times in the last 13 months, and some manual help a couple of times. But when I have, it just does not feel worth a dang, with no good sense of release. But maybe I do get to shoot out a little urine for fun, and of course standing up is required. All of that for me gives little incentive to stick a needle in it, so mostly I don't.

So as another important year is lost with zero sexual pleasure, I have been telling myself that maybe I'll subject myself to yet another surgery and all their possible complications and get that penile implant that so many folks seem so happy with, maybe a sling or AUS along with it so I won't have to worry about peeing on my partner, which can really put a dent in the mood. But even if get an implant and it manages to work including a firm glans(seems to be some question about that), - will it ever feel right even then? Does that improve at 2 years or 3 years? Lord I hope so, but tempus fugit. Maybe the sensation will improve, but I'm starting to kind of doubt it. Seems to me like I heard a lot from the surgeons about how the sensation was not effected by cutting the erection nerves or RP in general. Sounds like total BS to me now, even though I know others have a MUCH different experience. But I can only go by the lack of pleasure from MY dead as a doornail, way more pain than pleasure from my injection induced so called erection that I have. I am extremely lucky though, no Peyronie's yet!

It does seem to me that- considering my G9, SV+. margin+ results, I am spectacularly lucky with my PSAs so far. So that surgical result has been good so far, and I am so grateful for that. But if I could have felt how these SEs (still a bit wet and totally limp and poor sensation) would feel before hand, and certainly if I could have seen my path report before hand(and maybe even if not), I just feel like I would never let that surgeon near my privates with his knife and robot. When we got the path report, he told me I had no better than a 50% chance of not needing further treatment. Now that of course is NOT the same as a 50% chance of dying from PC. I have no idea of what that % is. But lets just say I have, after surgery, a 20% chance of dieing from PC in the next 10 or 15 years if a stroke or MI or other cancer does not kill me first. And lets say it can be shown those odds rise(if they actually do rise and I sort of doubt it) to 30 or 35% with RT primary. I say bring it own, I'd take that chance. (and considering I was not confined, my odds might even- also debatable- be improved with RT primary!) I'd rather have a few more years now with dry pants and my last few years of sex life and hoping for a break through in treatment, than a few more years tacked on to the end when so much of that stuff is fading naturally anyway, and spending those years with these SEs. That's how much I'd love to get rid of these SEs, that I'd trade them for a somewhat increased chance of dying some years in the future from PC before an MI can get me.

Apologies in advance for this long rant. Because I know that there are guys who do so much better, even trifecta guys. But if you are choosing the surgery for your G6, how can you possibly know you are going to be in that lucky group? And don't tell me it's just a matter of getting the right surgeon. We have at least one guy here who chose the most experienced guy in the nation maybe the world(7000 RRPs), who has published articles about his trifecta results. And this man still had to have an AUS installed at 2 years out, and I'm not sure his nerve spared results were what one would hope for either. There are NO guarantees when you start cutting in those tight confines of the PC bed. Still, some(most?) of you will be lucky.

Gather info, and choose your poison. (although AS won't be a poison IF you don't spread) If you are low(or whatever) risk, get your doctor to spell out your risk of PC specific death if you go AS vs RT vs surgery. Maybe research it on your own or here. Then think a while and choose. Good luck and God bless!

Bill in MS

Post Edited (BillyBob@388) : 3/21/2015 7:49:17 PM (GMT-6)

Real quick, I am four weeks out post op, Radiation was discussed as was robotic surgery. I am 56 and without a doubt I had the surgery and happy that I did. It is however a decision that one has to make. All the answers about having the radiation and then later wanting to have the surgery, well that usually is not an option any longer. Surgery and then radiation, that is an option. Already had two strong erections, and the worse part for me with the surgery? The constant leaking, until today! Only one pad all day worn with the skivvies pulled up tight. I am a building inspector, went back to work after two weeks (wrong!!) and definitely should have given it at least another. Anyway, up until this morning, I have had to use a depends and a pad. This has been a great day for me guys and I want to thank you for your continence, sorry, confidence in coaching me along and saying not to be depressed. I think from now on I will get better by the day and quit worrying about it so much. We have a price to pay for having the robotic surgery but we all have to take the chance that we will get a little better, definitely nothing like we once were but in my case I'm here and alive. Cancer was so bad when the surgeon went in that she told me if I had waited six more months, we would have been talking about making arrangements and not about a surgery. All of my numbers were somewhat low which didn't alarm them to much and was put on AS for a year. Still, numbers were low but surgery was discussed, and I said, lets do it. I'm in Chapel Hill and in good hands. 56 years old, been married 34 years, kids are all grown so if he doesn't spring back up as he did before, no worries, as long as I can piss normal. Thanks guys.