48 just found out I have cancer

Hi feisty,

Glad you found us, but sorry you need to be here.

I was diagnosed and treated last year at age 41. PSA 9. Biopsy showed Gleason 3+4. Post-surgery pathology showed Gleason 4+3.

The links in my signature below will likely be helpful to you.

-Gedman

Hello Chuck,

1) Hard question to know how to answer. I would probably make the same decision again in the same circumstances, and knowing about my cancer only what I knew then, but my reasoning would be different for sure. For historical purposes, and not particularly recommended, my reason were:

> I talked to two surgeons, a radiation oncologist and a brachytherapist. Both the radiation guys wanted several months of ADT prior to treatment to shrink my prostate to a more manageable size. One surgeon said he could deal with my enlarged prostate (the other surgeon recommended AS.) I was attracted to the solution that hoped to fix the problem without hormones. That part didn't work out...

> I was young and healthy enough to recover from the surgery. At the time I had been diagnosed as low-intermediate risk (very low-volume, single core, Gleason 7 3+4) and surgery looked like the fastest way to the exit. That part didn't work out either...

> My wife's dad died of prostate cancer and I thought decisive action would reassure her.

> I had some pre-op ED issues and had confidence problems. I noticed that the Avodart I was taking for my enlarged prostate had unfortunate sexual side-effects for me. I was aware that surgery would probably make my ED worse but I was aware that treatments were available and I had discussed penile rehab options up to and including injections with my urologist before I decided. I was really looking forward to stopping the Avodart. I still am...

> All of the doctors I talked to suggested Active Surveillance but my mental image of the AS lifestyle seemed to have too much worry for me and the wife and too many men in white coats poking spring-loaded needle guns up my butt. I had already had four biopsies and was starting to feel a bit like a straight guy stuck in a medical-themed gay p0rno film. This was (and is) not a very grown up view of AS but, as it worked out, I was "lucky" I was childish about it.

2) My post-op pathology report showed more and more advanced cancer than my doctors and I expected and I went on to have radiation of the prostate bed and two years of hormone therapy (done later this month, yay!). Between the three treatments, my side effects are incontinence (two or three pads a day) and impotence (trimix works for me but my leakage makes attempts at sex problematical and the hormones rob me of the motivation to work past the problems).

3) Question three is not a question but my biggest fear going into surgery was that it would end me sexually. As a defense against that possibility I had my plan: penile rehab, pills, vacuum erection device, injections and determined effort. I was aware that an implant was the next step after injections but hoped it wouldn't come to that. In retrospect, I should have worried more about incontinence. If a man is leaky enough it sort of doesn't matter what the limp, wet, smelly little thing might be capable of. If you want to preserve your sex life, be sure to talk to your surgeon about his continence rates and include the idea of follow-on treatments for incontinence in your "plan" along with the pills and the vacuum devices and other impotence treatments.

So, for a young guy like you, Chuck, if you decide on surgery you should understand what can go wrong and what can be done about it. You should have a contingency plan that runs several steps out. You have nine out of ten chances of being continent at one year. If you are that tenth guy who leaks after a year, then you should plan to get a sling or an artificial sphincter. It is unacceptable for a young guy like you to spent the rest of his life in diapers. Your plan should also include ED treatments.

charles54 said...
Hello, Thanks in advance for any help you can give me. I am 50 and have very similar numbers as you. PSA 3.78 and a gleason 7 (3+4). I am scheduled for RP in 3 weeks with a very well known surgeon in Birmingham, Al (around 3,000 RP surgeries). If you don’t mind if could you answer a couple of questions?
1. What made you choose your treatment over another?
2. What side effects have been major issues since?
3. I am worried about ED and the horror stories all over the web. I have already used cialis in the past and have NO problem with erections any way I can get them.

I am just trying to make sure that I am doing the right thing. I have 10/12 cores positive with 7 being 3+3 and 3 being 3+4. Two opinion believe for certain that the PC is contained and very curable. Just wondering your thoughts on everything since your treatment and if you would do anything differently if you could?

God Bless,
Chuck

Hi Chuck:

If you've already used ED pills you should not expect to be able to have sex without them after surgery. At the very best, expect to need them after surgery.

One of the variables that is critical heading into surgery is your fitness and level of potency. Many surgeons have a detailed survey they ask their prospects to take. This indicates their sexual "fitness" so they can in turn provide the prospect realistic feedback. I was 40, had never had issues with erections (other than hiding them as a teen) and scored perfectly on the survey. I was told I would fare well. However had I answered that I needed ed pills prior to surgery my score would have dropped significantly. I don't remember the name of this test/survey but perhaps someone here can help.

On the other hand, the same is true of other treatments, if you already need pills, other treatments will not improve that situation either.

F8 said...


tell me about it. there's some people even on this forum who believe testing guys your age causes more harm than good ... if you can believe that.

ed

LIKE! Catching this at such a young age may not seem like good news, but it is.