Husband newly diagnosed

Again, thanks for all the knowledge and your experiences. I have 2 questions:
1. Is it true that if you do radiation and then have a recurrence, you can't have the RALP? Therefore, it may be better to do RALP and have radiation therapy in your back pocket for a recurrence?
2. Is it normal to still have mostly all bloody semen a week + after the biopsy?

BWeaver,

OK, I'll take a run at your q1:

That statement is one that many surgeons make, to convince people that primary radiation is a bad idea, because if it fails, you're finished and can't do anything else. It's sort of true. Performing surgery on radiated tissue and scar tissue from radiation is complicated, and frequently has poor outcomes. There are many highly skilled urologic surgeons who won't even go there.

That being said, the implication is simply not true. First, it assumes that the primary radiation treatment has a high probability of failure (no cancer control). Simply not true. Planning for failure is really not a good plan, is it? Second, it delves into an area of specialty that the surgeon does not have. Yes, there are limits to how much radiation an individual can have in their life--but there is no requirement that the primary radiation treatment will use all of that limit in one hit. Also, if you're dealing with primary treatment failure...the surgery can fail as well. There are many other secondary options. Hormones, immunotherapy, chemo, etc.

So, my thought is this; (and I'm a 'surgery guy'). With the G8 diagnosis, he is high risk. The key question for treatment selection is this: What treatment, or combo of treatments, is most likely to give long term cancer control with minimal, or at least manageable side effects? Most likely, the answer is the combo method: ADT plus radiation plus (maybe) some chemo process. Surgery may not get it all--especially if they suspect the cancer has left the gland and is in the pelvic bed. Surgery may also have the worst side effect profile if the surgeon has to "go wide" and get it all. That could mean immediate and permanent ED and incontinence. ADT of course is immediate ED as well--but after the ADT is over, the ED usually goes away too.

You've got a lot to think about....but the key questions are about finding treatment with curative intent, and don't worry about what could be or could happen a year or two or 5 down the road. The surgeon to gave you that speech is injecting more worry to get himself more business.

For #2 yes it lasted at least a month for me.

For #1, surgery is difficult after radiation because of adhesions/scarring etc...

While prostate cancer is front and center now, given your husbands young age, there is always a chance he may need radiation for other kinds of cancer that may occur in the future. Generally speaking an area can only take so much radiation. You hear the term “overlapping fields”in these kinds of discussions. So if the scans lead your team to believe the prostate cancer looks to be within the capsule, keep this in mind.

When I was deciding (diagnosed age 52) this was a consideration. Unfortunately after they pulled my renegade prostate out, my psa never reached non detect so i needed radiation and adt anyway.

But I took a shot, and mentally it felt good knowing i could take a couple of good swings.

Whatever you do.....dont look back and play “what if” head games. Take your best swings, take no prisoners, and think positive thoughts on what you are doing to eliminate, with extreme prejudice, the critters.

BWeaver, the gang has given you guys some great advice I'm glad you found this forum there's some very knowledgeable guys here. I just want to strongly encourage that you and your husband and family become your own advocates and it sounds like you are doing this, and then get a great and I mean a great medical team in place and then decide on a treatment. Each treatment has plus and minus, and some times you might need two or three different forms of treatment. You have a little time so don't be rushed into making a decision overnite. JMHO.

Larry

When interviewing surgeons for a RP, in addition to the number of RALP performed, I would ask their personal stats for (a) oncology outcomes, (b) continence outcomes, and (c) potency outcomes for patients with the same status as your husbands, i.e. G8 (or whatever the 2nd opinion is) and similar imaging workup and PSA history. (In other words, it doesn't help to know their outcomes for G6 men.)

500 Procedures may be on the small side; more than 1000 would be better. Your choice of an experienced surgeon is probably the most important factor when opting for surgery as your primary treatment. Also, statistically speaking, larger institutions have better results than smaller ones.

I wish you all the best. Please keep us posted.

Djin

BWeaver, good news on the bone scan.
As Djin said, the choice of surgeon is so important. Even more than whether the surery performed will be Robotic or open. And i think, for me at least, 1000 surgeries in whatever method a doctor practices, should be a bare minimum.
I'd be curious to know, if you care to share, on what basis the 3 doctors, or more specifically, the 2 radiation oncologists, recommended surgery. Note: i'm not disagreeing, in fact I'm a surgery guy, and if i had to do it all over again, i would still do surgery, even though i needed radiation afterwards. I;m just genuinely curious)

Based on the locations of the biopsy lesions and your husband's imaging, your surgeon should be able to estimate the likelihood of sparing each of the two neurovascular bundles. My surgeon was fairly sure he could spare the left side, but would know about the right only after the RP began. It turned out he was able to spare both. He asked again immediately before my surgery (as he did in an office visit) to confirm that I wanted him to put cancer control first and nerve sparing second (of course I said yes again).

Surgery offers high-grade, prostate-confined PCa cases a chance to avoid both radiation and ADT.

Djin

DjinTonic said...
Based on the locations of the biopsy lesions and your husband's imaging, your surgeon should be able to estimate the likelihood of sparing each of the two neurovascular bundles. My surgeon was fairly sure he could spare the left side, but would know about the right only after the RP began. It turned out he was able to spare both. He asked again immediately before my surgery (as he did in an office visit) to confirm that I wanted him to put cancer control first and nerve sparing second (of course I said yes again).

Surgery offers high-grade, prostate-confined PCa cases a chance to avoid both radiation and ADT.

Djin

His surgeon told him the same thing. Cancer is confined to right side. Left side all benign. So Dr felt pretty certain he could spare left side bundle, but would have to see about the right side when he was in there. Dr. Walsh's book "Surviving Prostate Cancer" stated that sexual function should not be depleted if only one neurovascular bundle was saved. I think I'm remembering that right. Something about men came with a spare bundle.

BWeaver - your husband and I are at similar ages and stats. I'm one year removed from surgery. I would be willing to talk or email with your husband, if he would like to speak. I went back and forth on the decision between radiation and surgery, and ended up choosing surgery due to my age and the fact that radiation is a solid option in event of a reoccurrence. I too had mostly cancer on the right side of the prostate with the left side being fairly benign with 2 cores at 3+3.

Anyway, everyone is different. I can can tell you, as you've seen, you'll get honest, personal and factual advice from the folks on this site. My email is visible in my profile if your husband would like to connect. The offer will always be out there.

Dave

Hello BWeaver,
You have ace received great information and advice. You mentioned you read Newly Diagnosed on our page one. Great technical info there. Here's what I feel is just as important, a thread started from our own premier poster, Cyclone-ISU titled:

"Letters to the Newly Diagnosed"
https://www.healingwell.com/community/default.aspx?f=35&m=3675218

As always Keep the Faith!
wings aka Dan in So Cal

BWeaver, thanks for the response.

Pay close attention to Halberts advice above. It will help recovery immensely. My surgeon asked me to walk 4 miles a day in the month leading up to surgery, and 3 miles a day as soon as possible after surgery.

When you say "threw out" I reckon you mean threw out as information to/for...and not threw out the med centers for treatment considerations....on another topic...you have made...based on you last post...it's surgery for treatment...good on ya for resistance of pressure...hence forth I would hope all other posts to you would consist of help to that end...

BWeaver, I would have to put in a plug for Mayo in Rochester as that is where I doctor. What I liked is that there is a whole team there so that makes things easier if further treatment is required. I'm sure all the other great facilities are the same way. And yes I believe prostate surgery changes things for a guy just like a hysterectomy changes things for a gal, I have been married to two gals who went through this so just speaking from experience. What the surgery doesn't take care of, radiation and ADT finish it off so yes things are going to change for you guys. For me getting rid of Gleason 9 stage 3 cancer was no. 1 priority and when you get to a testosterone level of 7 the other thing isn't as important as spending time with my family!!!! The one thing that does occur from surgery is shrinkage which makes it difficult sometimes to urinate this is something you don't hear to much about but when I talked to guys at the hope lodge it was quite common. But you find ways to work around it. As I mentioned earlier PCa changes your life like diabetes does but it doesn't have to be worse in fact as you read through some of the posts here some of us are almost thankful for our cancer if that is a good way to say it? Because it has made us appreciate our familys and friends more! I would still be working but because of cancer have been able to spend tons of time with my grandson helping out with the craziness of distance learning and the craziness of the world. I can honestly say I wouldn't trade it if I had the chance. And yes the guys have mentioned walking so important if your husband has surgery walking after words will in my opinion be as important as kegals in helping with the incontinence issue.

Larry