Failed Radiation therapy surgery option?

Thanks dgin, JNF and halbert (thanks for letting me know about your cat-I am an animal lover and cat's are my favorite)

JNF I like your view and would very much consider it however, I do not do well with low testosterone. I know how serious an issue this is and that it opens a can of worms and I do not want to get into a debate as it will not help.
I have been on TRT for many years due to opioid induced hypogonadal syndrome. My RO asked me to stop replacement to get a base reading and after 54 days off my testosterone dropped to 25 and would have continued to castration levels as my body no longer makes natural testosterone. I explained to Dr Deutsch that I cannot and will not stop TRT and he said he'd treat me anyway. I did reduce but am going to continue. Why? Why would I put myself at risk?
One would have to walk in my shoes to know the answer and I do not want to rehash the horror of my low testosterone.
I found out maybe 20 years ago that my T levels were very low and my family doctor put me on Androgel. It worked fine but after losing my regular insurance, my medicare plan did not cover it so to me, "no big deal" That was until it became a big deal. In a nutshell in 2005 I began to fall apart emotionally and could not put my finger on why. I ended up addicted to Xanax and even Ambein because of severe anxiety, depression, inability to make simple decisions, timidity (I'm a very big strong person) to the point of being afraid of "jaywalking" because I might end up in jail and I'm claustrophobic. (sounds silly but these weird fears I had)
I kept thinking and even telling my wife "something is wrong inside of me" Finally after a blood test I was told of my very low testosterone and started injections. Well it was hellish getting off the benzo's and Ambien but when I healed from that, I felt like my old self again.
When my biopsy showed cancer, my testosterone was stopped and slowly the old horrors began. An incident at a mall where I screamed like a mad man at my wife over a silly thing, I said screw this and found a clinic and began TRT again. Yes I lied and did not tell them about the cancer but I have told my other doctors that I continue against their advice.
As said, I will not debate this. My life and my choice and of course I agonize over it.

I do feel I have some time on my side and want to get some things in order so if possible I'd rather have the surgery in the early Spring. I weighed 340 at one time then got to a steady 290 to 295 then I dropped down to 260 thanks to a new medication called Victoza (my diabetes) I have a bike machine up here at my "cave" and a gym membership in our Manhattan building. I want to lose 10 or 20 pounds and have been doing Kegel
I'm drinking green tea and eating mostly healthy foods (my only vice is candy and that I overdue)
I will need a new car because the cat converter needs replacement and it will not pass inspection when due at the end of March and is way too costly to replace (2005 Altima 240k miles)
My wife does not know about cars and one needs one up here so that has to be taken care of. We do not have a lot of money so I want to get a deal soon.

Sorry the last items are not important I'm just overwhelmed and if I'm having surgery I want to be a the best shape I can be

Glen

Glen, you're right: getting in shape before surgery is a really important factor. The better shape you're in--especially in your core groups/pelvic muscles, the better your recovery for continence will be.

It's not a bad plan to do it in the spring, when it's easier to get out and walk outside. As I noted in my recovery journal, 2 days post surgery (I think) it dropped to -11F where I was, so outside simply wasn't a happening deal.

It sounds like you're settling on a plan now, and it's time to focus on getting ready.

Called and left message with Dr Decastro's office staff. I was shaking like crazy and had to hold the phone with both hands. I do not know why but suppose the doctor will be upset that number one I choose to have my prostate removed and number two that I told them I do not want the surgery right away because I want to lose weight and work on building abdominal muscles,do Kegel, get over my current UTI and heal any possible radiation damage. The covid vaccine may be making it's way to people of my age (I'll be 68 in two days) and lastly, I hate the cold and gloom of the dark Winter here in NY

I feel like a child afraid of the doctor maybe pressuring me to get it done quickly.
One more time I'll say this-If TURP was a 90 to 100% sure way of keeping my urine flow, I'd have it done and follow the radiation route. Imagine I get half way through and retention begins again then what?
I just cannot risk going through this.
BTW I am peeing okay not great but better then before I started on the antibiotics and can live with this another month or two or three-BPH and weak flow has been part of my life for many years.
My last DRE a couple of months ago showed a smooth surface and as far as I know my grade is 7 G6 cores and one upgraded upon second opinion core of G7 So I do not see this as a dire situation that cannot wait a couple to 3 months

Wish me luck

Glen

Thanks Mumbo
Things were very bad back when NYC was full blown pandemic ridden. Eventually they called about the radiation treatment. I think thing's have eased up now but a delay will not be a problem. They did not call back today

Glen

Yep Halbert I'll get back if I don't hear from them.
I'm healing from the UTI I actually found myself singing aloud which is a good sign..
One day I'll get back to my church's choir. I really love to sing.
My wife who is a trained semi professional singer thinks it's too much like work.
Anyway getting off topic

Glen

The only Kegel item I remember prior to surgery is to stop your urination mid-stream and remember that muscle, that is the one you are trying to train. Just tried to remember to do them when I was in the car as that was easy to remember. Do 10 of them with 5 sec hold on the way to Home Depot and back. It is pretty tiring at first but the number and duration starts low and you work up. No bonus points for overdoing it, just slowly build up.

I had good control after the catheter was out so something I did must have helped. Never did many after surgery as a result. Started about a month before surgery.

Nothing is too weird when it comes PCa. I should caution that you do not practice stopping the stream when peeing. It is just a test so you can focus on the feeling and pelvic muscle being activated. There are other ways also. The key is not squeezing other muscles and isolating the pelvic muscle. There are lots of instructions on the procedure and they may vary by doctor.

The recommendation was 10 reps with 5 sec holds, 4X spread over the day. Glad you are doing better.

Hello friends. I know I ought to ask the surgeon Dr Decastro and of course will talk to him about the surgery beforehand. I am sure I'll need to get the Okay from my cardiologist because I have Afib and am on a blood thinner called "Xaralto" I also know I'll have to stop the blood thinner a few days before and maybe a day or two after the surgery. I'm aware too that I'll have to speak to the anesthesiologist about what he and I plan (I have severe sleep apnea but hope by losing more weight, it will improve-at least it will not hurt) about putting me under or even if a epidural and mild sedation is possible which I doubt but will breech the subject.
So anyway, I'm looking for information about what type of prostate removal they will use. I am 257 pounds now at 5 foot 11 but hope to be 240 by the time I have the surgery-God willing. So I suppose weight is considered as to what type of incision they make (retro-pubal? or the other one?)
Dr Decastro is trained in robotic and laproscopic but was just wondering if my size will play into the choice?
I know I'm kinda flooding this posting but thoughts come up.
And yes I should have asked what method he would use but at that meeting we were talking removal or TURP followed by finishing the radiation and I have chosen removal.
I'm working on kegel's and generally eating right and usually the first ten pounds come off quickly.

Lastly, I realized how lucky I have to have an affectionate wife who will support me through all this. Last night as she often does, she did reflexology on my feet and wow that is a treat. Not sure I agree with all or most of reflexology but it sure feels great.

Glen

Radical perineal prostatectomy (RPP)
Radical retropubic prostatectomy (RRP)

Both are conventional open surgeries that access the prostate from different places. RRP is from the front like hernias, appendix, etc. RPP is from the underside.

RALP would be for robot assisted laparoscopic prostatectomy. No idea what would be best for overweight person.

Came up with this abstract
:In comparison with laparoscopic radical prostatectomy (LRP), the perineal approach to radical prostatectomy offers specific technical advantages related to obesity and its unique surgical challenges. Radical perineal prostatectomy (RPP) reduces operative time and its associated risk of complication, which may be more pronounced in obese men. It allows for low blood loss, low postoperative use of narcotics for pain, short hospital stays, and requires only 1 small perineal incision. With a proven history of success, RPP presents obese men with an advantageous surgical option.

yes Mumbo it does seem to make sense. Even if I lose 20 pounds, I'll still have a rather large belly. Dr Decastro is trained in all of the forms such as robotic so I think he will come up with the correct plan of action.
I made the mistake of watching videos of the actual operations and they all look pretty scary. I took a year of nursing school and had worked next to a gross anatomy room but when it's your own insides, well it gets too close to home. (worked morgue duty too) Do not have the stomach today for all that,

Glen

Yes thank's halbert. I have visited many websites and saw a lot of videos.

Have to admit it scares me because as per my sleep apnea, the only worse position would be to have me upside down. (may work wonders for my back lol) The problem being my tongue falls back and close's my airway. my wife often wakes me up and tells me to get on my side. I also often awaken because on my back causes great pain in my lower back and hips.
Add to that, my large abdomen will be forced by gravity upon my diaphragm limiting my breathing ability.
I'm basically putting my life into the hands of the "gas passer" (sorry but my spelling is bad so I use this term)
That is scary but if skilled, they will know what to do. I may have to bring my CPAP machine unless they can provide positive airflow.

I can only offer as much information as I can, ask questions and then trust God and the skills of these good doctors. Maybe in the end RRP may be a better choice if there is a better position I can be placed in.

Thanks for the help. I find it emotionally soothing to post and hear reply's as much as the information that is offered-the "You are not alone" part.

Glen