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Posted 3/9/2022 3:06 AM (GMT 0)
Hi everyone. After many years of BPH, I had a TURP procedure last October -- the bits and pieces were sent to pathology and came back showing some PCa (Gleason 3+4=7). This is despite always having a PSA of under 4.0 (mostly varying between 2 and 3). After some healing time, this was followed up with a MRI, which confirmed something was going on. The MRI was followed up with a biopsy, which showed 3+4=7 in 5 out of 12 areas, 3+3=6 in 2 areas, and 5 areas benign. If I hadn't had the TURP procedure, none of this would have been known. My urologist has said that ultimately I have the choice of radiation or robotic RP, and I'm leaning towards the RP to just end this mess. Meeting with the surgeon, who is apparently the best in our state, this week. I've done some reading here and find this forum overall helpful and encouraging -- I realize that almost certainly my PCa isn't going to kill me. It is, of course, disturbing. I'm 63 and not out of shape or otherwise compromised health-wise -- however, I do have very low testosterone which has been treated over the past 7 or 8 years with shots to keep me in a normal range. Obviously, I'm off of T-shots for now am not looking forward to the consequences, such as depression, night sweats, etc. Appreciate any comments or suggestions, and will try to reciprocate as I learn and experience more.

Post Edited (azroadrunner) : 3/8/2022 8:11:11 PM (GMT-7)

Posted 3/9/2022 5:46 AM (GMT 0)
Az, welcome, you will get great advice from the veterans here. Making a choice of treatments is solely your decision. Take time to research all options including radiation. What I learned is that a good Urologist will give you the option to choose. Mine did and I ended up with radiation. However having had a TURP, some radiation treatments are limited. Ask lots of questions both here and to your doctors. My best to you,
Jack
Posted 3/9/2022 2:37 PM (GMT 0)
azroadrunner, my only piece of advise is that once you make your treatment decision, don’t look back and don’t play the “what if” game.

BTW, if by your handle you are a runner, that will be your friend. I’m a distance runner and being in good shape helped getting through the whole process easier. I also swim and was back in the pool once the incisions healed and got back to running after a few months of just walking. And, as you might know, that type of exercise, like pretty much all exercise, is great for mental health as it is for physical fitness.
Posted 3/9/2022 4:08 PM (GMT 0)
AZ, Both glad you found this forum and sorry you’re here. I believe you’re fortunate to have identified the cancer early and that provides you a little time to investigate all the treatment options. Selecting “RP to just end this mess” may not be your best choice. Your previous TURP may change your radiation options; however, radiation options should be investigated. Todays modern radiation treatments are effective, safe, and come with fewer long term side effects than does RP. This forum is a good place to start the learning process.

You can also get information from the video site that a lot a lot of people go to (can’t use the name here). Search for videos by Dr. Scholz surgery vs. radiation for prostate cancer. Dr. Scholz is a Medical Oncologist who specializes in treatment of men with prostate cancer. He sees the failures of both radiation and surgery.

No matter what treatment choice you decide on I hope you make an informed decision and choose wisely. No matter the treatment, I also urge guys to seek out the best practitioner and team they can find. I’m convinced that the very best can make a big difference. Keep us posted. Terry
Posted 3/9/2022 4:13 PM (GMT 0)
azroadrunner,

I also discovered incidentally that I had PCA after a TURP. The urologist who performed the TURP was hesitant to do the surgery because he found, from personal experience, that the TURP compromises the topology of the prostate, making the surgery more difficult with more potential side effects. Consequently, he recommended radiation. I then consulted with another surgeon who assured me that doing the surgery was no big deal. However, when he conducted a digital rectal exam he found one side of the prostate to be hard and sent me to get an MRI to look for extraprostatic extension. The MRI turned out to be negative. I decided finally to avoid both surgery and radiation, choosing AS instead. This all occurred ten years ago.

My advice is to speak to a RO as well as a urologist in order to find out what the ramifications of the previous TURP might be on any radiation therapy.
Posted 3/9/2022 4:17 PM (GMT 0)
Hello AZ and welcome. We get your initial inclination to "get it out", "end this mess", etc. but RP may lead to another set of undesirable challenges as well. So you should get yourself educated about the various options including visiting RO's who specialize in HDR Brachy and SBRT, both of which are probably good choices to cure you.

Re the videos that Terry referenced, here are a few that may interest you:

https://www.youtube.com/watch?v=pya8n78br7s

https://www.youtube.com/watch?v=agevawx2ons

https://www.youtube.com/watch?v=xorlw-cnwbk

Good luck.

Jim
Posted 3/9/2022 5:05 PM (GMT 0)
My uro/surgeon did both my (successful) TURP and, several years later, my (successful) RP. The TURP reduced my prostate size from 90 to 30 cc. By the time of my RP it had grown back up to 63 cc. Be sure to discuss with any radiologists you consult with the post-RT statistics for men with a history of BPH--perhaps you'll be lucky and get more than the dearth of information I've seen in the literature.

Djin
Posted 3/10/2022 12:03 AM (GMT 0)
AZ, welcome. Did the MRI show that the cancer was confined to the prostate capsule? If so, then surgery could be a good option. But yes, you should educate yourself about, and meet with professionals who practice, the various forms of radiation as well.
As was stated above, once you make a decision, you want to be able to be confident, and not look back no matter what happens. The way that happens, is to get as knowledgeable as possible about your options, so you can make an informed decision.
You will encounter some strong opinions against surgery here and elsewhere. I don't agree with most of them, i feel with the right information, AND the best surgeon you can find, you have a good chance (no guarantee) of escaping the side effect of incontinence (which is no as common a side effect as it used to be, especially with an experienced surgeon) and erectile dysfunction, which is sadly somewhat more common, but not a given.

With all that said, yes, you should look into radiation treatments as well.

If you are well informed, and make your decision based on acts that you can confirm as facts, not opinions, then the only right decision FOR YOU, is the one that you choose.
Posted 3/10/2022 3:08 AM (GMT 0)
Tudpock - when do we we cross the line about advertising when listing 4 web links by the same private practice doctor might be prohibited from making the same posts?

Terry’s Cellar handled it best in my opinion. I know it can be a tough call but new members need to do their own research with some balanced guidance.
Posted 3/11/2022 1:06 PM (GMT 0)
Yesterday my wife and I met with the surgeon, who has performed over 2,000 da Vinci RPs and is recognized for his excellence and experience with prostate cancer. I was shocked to find out that my PCa is considered "unfavorable intermediate" because, although I don't have a Gleason higher than 3+4=7, more than half of the biopsy cores were positive. Surgery is really the best option for me, because my score for the possibility of a fully organ-confined disease was only about 60 percent. That's better than Vegas odds, but still a 40 percent chance I'm dealing with something that's trying to spread. Possibility of lymph node involvement or seminal vesicle invasion was only 4 percent, which was encouraging.

Everyone's situation is different, but in my case I'm satisfied with the robotic surgery option and understand the reasons why. The doctor explained that, in my case, surgery is really the only way to determine the actual extent and scope of my PCa because it allows everything to go to the lab for a detailed analysis to see if further treatments are needed (which might involve radiation).

One comment the doctor made was a reinforcement of what others have said: I'm blessed to have had the TURP procedure a few months ago. My PSA has always been low (around 2 or 3) and without that TURP, my PCa would have never been found and would have become a disaster that might very well have taken me out. He said that the PSA tests are really all they have and that it's not always reliable. He's not kidding.

So, that's my news. I feel like this will most likely turn out OK, but am a bit depressed over the whole thing. Will keep checking in here -- it's helpful to read the comments and suggestions!

Post Edited (azroadrunner) : 3/11/2022 6:10:35 AM (GMT-7)

Posted 3/11/2022 1:28 PM (GMT 0)
It sounds like you've found a capable doctor. I had the same odds, confirmed by genomic testing of my biopsy. I went ahead with RP two months ago. I'm doing great. I hope you fare great too.
Posted 3/11/2022 3:27 PM (GMT 0)
AZroadrunner,

I'm also in AZ and was diagnosed four years ago with G3+4. Visited many docs and decided RP was my best option. I had appointments with 4-5 of the top surgeons and chose one I was comfortable with and who had performed thousands of RARP's. I recovered very well and uneventfully. You should start doing your properly performed kegels now and get yourself in top physical shape. I considered strongly all of the treatment options and was pretty much at peace once I decided on surgery and which surgeon to use. I sure wish you all the best!
Posted 3/11/2022 3:34 PM (GMT 0)

maddie7 said...
AZroadrunner,

I'm also in AZ and was diagnosed four years ago with G3+4. Visited many docs and decided RP was my best option. I had appointments with 4-5 of the top surgeons and chose one I was comfortable with and who had performed thousands of RARP's. I recovered very well and uneventfully. You should start doing your properly performed kegels now and get yourself in top physical shape. I considered strongly all of the treatment options and was pretty much at peace once I decided on surgery and which surgeon to use. I sure wish you all the best!

Thanks for the feedback. My RP will be scheduled for May (Dr. Ramakumar). Glad to hear it went well for you! Was the incontinence a huge problem?
Posted 3/11/2022 6:32 PM (GMT 0)
I did a reasonable amount of kegels prior to surgery which may have helped. When I got home after my RP, I leaked a lot and had very little control. I thought I was in trouble. But within a few days it got a lot better. I did my kegels exactly as directed by my uro's PT. I was 99% dry after 6-7 weeks. I quit wearing pads at that point. I continue to do a good set of kegels almost every day. IMHO, a good way to do them and to know you're doing them right is to stop your urination for a few seconds while you're going. I still do that regularly and don't see any downside.

You can use your time before surgery to get physically strong and lean. The surgeons like their patients to have minimal abdominal fat. The weather will be really nice for you after surgery to do your walking, which is the only exercise that is allowed for the first six weeks.
Posted 3/11/2022 7:17 PM (GMT 0)
Being you're concerned about incontinence, ask you doctor for your free urethral length. Also ask if he performs a urethral suspension (CPT 51990) during your RP.
Posted 3/11/2022 7:17 PM (GMT 0)
AZ…Having a pathology on the tissue removed is very important to a lot of guys and in a lot of cases a significant advantage. That said, keep in mind that it provides no guarantee of any tissue that was left behind so stay vigilant with followup. Good luck and keep us posted on your progress. Terry
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