Failed Radiation therapy surgery option?

Thanks Samster

That was helpful
I think with my sleep apnea this would be a safer choice. I'd insist on some sedation such as diazepam or lorazepam. I'd be too nervous otherwise. I had IV diazepam for carpal tunnel surgery and felt like I could care less about whatever!
I also had an epidural for hip replacement but was mostly asleep with profolol but did awaken once and freaked out. If they had told me I might awake, I'd not have but they did not

Glen

Glen,

Sorry to hear your situation has gotten so complicated. When I was diagnosed my prostate was 67cc and I also have some retention problems. I have been fortunate enough to still be on AS and the retention is manageable so I count my blessings. In discussions with my Urologist he put this into perspective for me by saying this, "if you get to the point of needing treatment for either condition I would go with the RP for the simple fact that it will take care of both issues. Why have a TURP which has similar potential side effects as the RP and then have radiation to treat the PCa. doing that gives you the potential for the bad side effects of both treatments." Why take two chances at ED or other things when you can minimize the risk by only doing one procedure. It makes sense to me but maybe others disagree.

Best of luck,
Perry

For what it's worth Glen, I too had a TURP, followed by RP about 15 months later, and then SRT soon thereafter. In retrospect, the TURP, which is serious surgery, didn't help. I would advise going right to RP, if that's your treatment choice.

My side effects were minimal, except that incomitance, for the first time, reared it's damp evidence, about six months after radiation. Nothing I can't live with, but annoying none the less.

PSA has never been eradicated, and for the past two and a half years has bounced around, from 0.032 to 0.099. right now it's 0,075.

Wishing you the best.
Gary

Oh BTW he did ultrasound and my bladder had empties well

G

Glen,

First off, you don't know that you will "wear depends for months". It's possible, but not guaranteed. It's also possible that you will be fairly continent after the catheter comes out. No guarantees.

Second, it's interesting that the surgeon is suggesting TURP plus radiation--does he think there is enough radiation damage already to make the surgery more difficult? If that is his opinion, then it's worth listening to way above us, who are none of us experienced surgeons.

Glen,

May I suggest you seriously try out positive thinking about your treatment, whatever you decide. The chances are very good you will soon be in a much better place both physically and mentally. Once I had decided on treatment (RP in my case), I was able to actually relax -- especially soon the morning of my surgery, as strange as that may sound. I took the attitude: I'll just let my surgical team work for me. This is what they do, and they're good at it. As you say, "This too shall pass."

Project your thinking to a time in the near future when your primary trestment is behind you and each day brings you closer to much better health.

Djin

Thanks dgin and mumbo

When I get back upstate I'll copy and paste my details. I'm not good on my cellphone

I will relax Monday when I tell them which I decided to do which is RP at this time


Glen

Mumbo I tried to find my post about my condition but could not access it so I did the best from memory and hope it comes up in the bottom of my postings

Glen

If you click on your name on a post, a summary will come up and show your last 50 posts where you maybe can find your history. You can also search for theswan and various threads will come up to sort through.

All I can say is surgery is no picnic and the recovery takes a while. The catheter is really annoying (10 days for me) but you already know that part. While there was little in the way of sharp surgery pain in my case, I was terribly uncomfortable for a about 3 days with spasms and gas pains so sleeping was intermittent at best. Lots of time spent in recliner chair for a week or two until sitting in chairs was tolerable.

Hope you get it figure out next week, just make the right decision for you.

Thanks Mumbo I searched but too many posts with too little information about the history.
JNF believe me I wanted radiation and had 6 sessions but after the 4th I had total retention had to rush to the ER to get a catheter. That was a relief then after the 5th or 6th the area below the glans penis swelled like a huge balloon and I was in misery. I was fit into an appointment with the surgeon who happens to be the one who would do the surgery. He pulled and used some vacuum device and then took out the catheter. What he said was I had "Paraphimoisis" a problem with my foreskin and that it had just started to become necrotic-in other words I almost lost the top of my penis.
Trust me once one has had that there is a great deal of fear of it coming back. Maybe the ER nurse messed up or whatever but the result was a horror show.
So here is what I know-the radiation can and did cause retention. Second, maybe but just maybe a TURP would allow radiation to start back up again. So, if I knew with 70-90% certainty that TURP would allow me to continue then yes I'd do the TURP!
I'm not trying to be a hard case I really am in a tough situation.
Surgery while not my first choice may be my only unless I go back to AS but my volume of cancer is high and one core was upgraded to a G7 (the rest are G6)
Rock and a hard place and it stinks.
Tired of having the cancer and tired of the huge prostate that has irked me for 15 years or so. What I would not give to be able to pee normal again let alone the UTI's I used to get and by the way have one right now most likely from the retention because after a month of Cipro, my common UTI's had not reared their heads in over a year after getting them almost every other month.

Surgery seems my choice but am willing to listen

Thank you both

Glen

Thank you halbert that information means a lot to me.

As far as catheters, I've had them after major back, hip and the open cut gallbladder surgeries and while not comfortable, they were not horrible. This last one was an exception and had to do with how my foreskin was positioned or not positioned. The paraphimosis as it was called split my foreskin almost in half and caused these "otherworldly" huge blisters to boil up under the head of the glans penis. I slightly recall the doctor saying something about the size of the catheter tube needing to be thinner or the like plus he said I should have been given or told to get bacitraicin cream to apply. So I think I'll do better with the next one.
Yes I will read about what you went through. I feel selfish because while I do write small postings directed to new members, I spend too much time in my own concerns. Hopefully when all is said and done that will change.
Giving or if you will "serving" others is a principle I try to practice as it saved my life. I used a 12 step program to help with my alcoholism and have not had a drink since November 4th 1987 So I look forward to sharing my information and more importantly, my hope to aid others.

Glen

OK Swan, let’s go outside the box. What I am proposing you consider will most likely draw a lot of giggles, but may also be taken seriously by some.

It is a given that your numerous comorbidities have rendered radiation therapy unavailable. These same conditions may also threaten removal by the major radical surgery as a situation to avoid. As I remember, you have been low enough risk to pursue AS until recently learning of a G4 in one of the cores. However, you have a very low involvement, low PSA and thus, what is called low intermediate risk. While this generally indicates treatment, we know that without treatment about 85-90% of men are still kicking 15 years later.

So, my proposal. Consider using a very conservative approach with ADT. You could start with the mildest being casodex to block the PCa cell receptors and Avodart to lower the more powerful DHT. These produce very little in the way of side effects for most men and cost only a few dollars a month. If you have a good initial response then consider going to intermittent therapy like 6 months on then a 6 month vacation and so on. If the response is insufficient then add a shot of Lupron/Eligard/Firmagon to drop the gonadal testosterone and again do so intermittently. Intermittent ADT is very well documented and a very popular treatment method.

This won’t cure you and will probably become a long term disease management method like statins for cholesterol, meds for high blood pressure or metformin for mild diabetes. Most adults find themselves on some or all these indefinitely and they work. But it will avoid the upfront trauma and treatment side effects of either radiation therapy or radical prostate surgery.

This approach has been the mainstay for several decades by Dr. Robert Leibowitz. He basically pioneered the triple hormone blockade approach to ADT that is the mainstay of treating high risk and advanced prostate cancer. He has published scores of peer reviewed studies and reports. His clinic is in Los Angeles and treats men all over the world. Online find them at www.compassionate oncology.org.

I think it is worth your consideration given the other issues.

I don't see the attraction of long-term disease management in Glen's case. It doesn't address his acute BPH symptoms and could lead to more serious, castration-resistant disease. A RP will definitively end his BPH and has a decent chance of curing his PCa. In addition, as time goes by, cumulative efects of the RT done could make future surgery more problematical.

Djin