Complications for RALP surgeon

There was a lot of scar tissue built up around my prostate which made nerve-sparing surgery a challenge. There was also some attachment to the rectum due to the scar tissue. Although it is a delicate procedure, an experienced surgeon can make it happen.

Music, I suggest you speak with your doc (or maybe even a second opinion doc) about two possiblities:

Re #1, the chance of positive margins because of this issue.

Re #2, the chance of incontinence because of this issue.

Did you ever check with RO's re radiation options, particularly in light of those two issues?

Jim

My surgeon expressed no doubts that he would have problems doing it. He did say that if it became to difficult to do it robotically he would switch to open surgery, but wouldn't expect that he would need to.

Given those complications, have you considered radiation as an alternative? Did you speak with a radiation oncologist, and if so, what did they say about your case? Radiation has its won set of complications, but they may be less complicated in your case.

Music, as long as some of the doctors were radiation oncologists and not just GP's or urologists it sounds like you have done your homework. You might also read Dr. Scholz, "Invasion of the Prostate Snatchers" and "Key to Prostate Cancer".

Good luck,

Jim

musicmanone said...
After much research on my own (reading Dr. Patrick Walsh's book "Guide to Surviving Prostate Cancer - 550 pgs, reading all I can from Mayo, Cleveland Clinic, Harvard, John's Hopkins on the internet, among other sites including some from England and Australia), talking with 4 different doctors (who all agree that surgery is the best option for me) and 6 friends who have had treatment for prostate cancer (3 RALP, 1 open surgery, 2 radiation) I believe that RALP is the way I'm going.

surgeons believe surgery is the right choice

I never try to talk a man out of his decision.

Here...they get avalanched.

Music man...you do what’s best for you. Not one person here knows what’s best for another human being. They are not you.

Be cool man and please keep us posted.

Good luck. 👍

Thank you Island Time and Mumbo. I am past changing my mind. It's been nearly 9 months since my diagnosis; much time to research, talk, think, pray about my decision. I was given three options - Active Surveillance, Radiation or Surgery. Active Surveillance is NOT something I could mentally or emotionally handle. So, I weighed the differences between radiation and surgery. I have decided that I MUST get this cancer out of me!! Then, I know what my base PSA should be - undetectable. If it rises, then I know I must do more. Whereas, with radiation, there is no definite "base PSA". Also, I weighed the possible/probable side effects of the treatments, and have decided that I would much rather deal with the side effects of surgery than those of radiation. There is also the fact that my PSA levels never rose above 2.1; my mpMRI didn't show any cancer; nor was there any indication of cancer with DRE. The only times there was indication of cancer was with the tissue removed during my TURP and my biopsy. Therefore, I would have no confidence in testing if I chose radiation.

People tell me that I'm the most severe perfectionist they know. When something is wrong, I MUST get it fixed. Even one of the doctors I consulted picked up on this trait within the first few minutes of our discussion. I can laugh at myself about this, but it's something I can't really change, even though my sister tells me that I have "mellowed" some as I've gotten older.

I hope this helps some of you understand where I am. I've always hoped that I would live to be at least 100 years old, and this is the first time I realize that may not be possible. I'm not afraid to die, but I have MUCH more I want to do and much more living I want to do.

Also, this is really the first time I've been "sick" in my life. I didn't miss even one day of school K-college graduation. In the last 10 years, I've only missed 1/2 day of work.

This has hit me quite hard mentally and emotionally. There have been many nights in the last 9 months that I've slept less than 4 hours.

OK, I've gone on too long. Thanks for reading and, hopefully, understanding.

I'm glad you've thought this through carefully. All of us here wish you only the best. I can't help at all with the specific complications you mention in the first post, but I do have some advice as a surgery patient. First, do your kegels! Second, have lots of sex!

Mumbo said...
I'm with island time. There is a time and place for everything and musicman is past that point and needs support, not argumentative BS.

Frankly, I debated with myself as to whether or not to even bother to post again on this thread but here I am. Obviously I disagree with the above statement. One of the beauties of our site is that we are about far more than support; we are also about sharing information and advice. Sometimes it's a fine line between advising and nagging but most of us are simply trying to help. Regardless of JNF's admitted bias, does anyone really believe that his advice is wrong? Almost every one of us suggests that new members get educated and get opinions from both uro-surgeons and radiation oncologists. By omitting RO's in his search, Musicman has not done his homework -- pure and simple. At least that's my take at this time since he has not told us that RO's were among the doctors he consulted despite questions about this.

Of course it is his right and his decision to make choices when he feels it is appropriate. I'm sure all of us wish him well with whatever choice he makes. We just hope it's a choice made after extensively exploring ALL of the options. Even the most rabid radiation fan among us probably went thru the "get it out" syndrome before doing more investigation that led to a different (but not necessarily better) choice.

Finally, to the point that Ed (F8) made, this is not only about Musicman since these are not PM's. Other newbies may be reading this and it's important to recognize that as well.

Jim

i think its apparent that MM has made his decision, and i dont think it was based on "get it out" syndrome. He clearly understands the differences in PSA metrics after surgery vs after radiation, and has decided he wants to deal in absolutes. Whether any of us think thats a valid reason for deciding on surgery, its a valid reason to MM, which in his case, is all that matters.

I understand where MM is coming from, i too am "right brained" and like to deal in absolutes. So again, what is a right decision for one guy, may be a wrong decision for the next guy even if the circumstances are the same. The psychology of this issue is often ignored and it shouldnt be
JMHO

Go back to the OP: he only asked if anyone had experience with similar issues (large prostate, possible adhesion to the bowel wall), not for help in deciding which treatment to choose.

It's important to give advice only when requested, and about the question asked.