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Posted 10/4/2022 5:02 AM (GMT 0)
I am not sure if I had posted this or not, and a search seems to say I almost did somewhere along the way.

I have decided to do RALP with Dr. Smith at Vanderbilt. After the last biopsy earlier this year it was time for me to decide. The 2 nd opinion from Epstein of perinatal invasion was enough for me.

Dr Smith said I could continue with AS if I wanted and was a good candidate, but he knew we would eventually have to do something. We discussed side effects and he was happy to hear continence was more important the ED. My wife was way more happy about the ED part than me. 😀 He said he has had people who hear the possible report of that back out of treatment.

I am happy with decision I have made and have no lingering doubts about whether I made the best choice for my situation.

So far the hardest part has been trying to get all of my work traveling done before the surgery date since it will keep me out of the air until January.

I am scheduled for surgery on Nov. 15. I have started trying to work on my core, lose some pounds, and doing Kegel strengthening.

I will attempt to keep you posted after the procedure.

Thanks again to all who have been sounding boards for me and all the knowledge contained here. You have made this whole thing a little less frightening and easier to deal with.
Posted 10/4/2022 1:16 PM (GMT 0)
bbqdude--Dr Smith is one of the best, and I'm sure you'll do fine. You've checked all the boxes, now go and get it taken care of.
Posted 10/4/2022 3:54 PM (GMT 0)
Larry, good luck to you. You have an excellent doctor and I'm sure will have a terrific outcome.

If you don't mind me asking, did you consider less invasive alternatives like LDR Brachy or SBRT or HDR Brachy? With your stats you would certainly do well with those treatment options. I'm not criticizing your choice; rather, trying to understand why after avoiding treatment for so long you decided to go with the most invasive choice.

Best wishes,

Jim
Posted 10/5/2022 1:00 AM (GMT 0)
Jim,
Thanks for asking in a thoughtful manner. I was expecting to take some heat over the choice.

I did look at the radiation options, but our family history has not done so well with it. Most of the men in my family on both sides have had to deal with this problem and most chose radiation of some kind and ended up with issues sometime later.

My dad had brachy and external radiation in his mid 60’s. It took care of the prostate cancer. He already had continence issues from all the catheters from having several kidney stones. about age 74 he started having really bad bowel issues. He was not able to go anywhere more than a couple miles from the house. A picture showed up on my Timehop of the last time he was able to visit and that was about 5 years before he died.
He eventually died of a rare case of the radiation causing bladder cancer at 80. The docs said it was less rhan 1% chance of that happening.

Other men in the family had some Of the same issues.

Most men in my family make it a little past 80. Dad was 80 and a half.

If I was approaching 70 I would probably go the radiation route, but I don’t know that with our track record I could outlive the side effect.
My wife was also dead set against radiation, and that was part of my reason for choosing surgery. In the end it was the best choice for me at this point in my life.

Larry
Posted 10/5/2022 2:02 PM (GMT 0)
There should be no heat over any well thought out choice like you have made. That being said, surgery does have a significant recovery period and includes limited physical exertion for a while so you are doing the right thing with your travel schedule. I flew out west about 4 months post-op and all went fine. I could handle luggage to the overhead bin and longer periods of driving just making sure I stopped occasionally to relieve myself. It was a pleasure trip so did some hiking, sight seeing, drank some beer, etc. This trip would have been very difficult at the 2 month mark for me. The 3 month PSA is another good milestone to plan around given its significance.

It seems that most men have any continence issues under control by 3 months and some are lucky like me to not have any significant issues after the catheter was removed. The ED part is trickier but it seems that the younger one is and a lack of issues before surgery makes for a better results. Good surgeon helps as well.

I did kegel exercises in the car the month before surgery which is the only thing I can attribute to my lack of continence issues or just plain dumb luck. Just stop peeing in the middle of a stream and you will know what muscles you are trying to exercise and stay after it. And good luck.
Posted 10/5/2022 3:37 PM (GMT 0)
Thanks for the advice Mumbo
Posted 10/5/2022 7:48 PM (GMT 0)
Dude… Making a fully informed decision is the best any of us can do. Once that’s done there’s no benefit to looking back. Each of our situations is unique. Wishing you a speedy and complete recovery. Terry
Posted 10/5/2022 7:52 PM (GMT 0)
Thanks Terry!
Posted 10/10/2022 5:00 AM (GMT 0)
Good luck to you!

I am one year plus 3 days out after Dr. Smith performed my RALP. I was very fortunate and had very little leakage afterwards. I agree that the kegels were/are helpful so make sure to do those as often as possible.

The ED is tricky but I notice improvement all the time and am hopeful that it won’t be long before things are looking ‘up.’

Prayers for you and you will be in good hands.
Posted 10/10/2022 11:40 PM (GMT 0)
Thanks Rich,

I think my wife is actually rooting against ED recovery.😀

We will see what happens!
Posted 10/12/2022 2:29 PM (GMT 0)
"De-bulking" a tumor kicks the cancer back quite a bit - immediately. There is an emotional satisfaction from having a surgeon 'get rid of' a cancer tumor all at once versus that long wait to see the radiation results.

It was only when the surgeons had me on the table that they saw how bad my G7 was, it wasn't visible on the scans. Wife is fine with lack of sexual interest/ability, our relationship is vastly more than just sex. smile
Posted 10/12/2022 7:41 PM (GMT 0)
Trail guy,
I am aware there may be worse things lurking in the deep.

I am making the best choice for me given the information that I had placed before me.

If something else comes up we will deal with it should we have to.

Thanks,

Larry
Posted 10/13/2022 3:10 AM (GMT 0)
Best wishes to you.

I respect your choice. Get it out and move on why not?
I don't regret my choice of SBRT and I'm dealing with side effects almost a year out so you do what you want with the information you have.
You are supported throughout. This is a caring brotherhood.

Glen
Posted 10/13/2022 6:37 AM (GMT 0)
Thanks Glen! Hope all gets better for you.
Posted 10/13/2022 3:52 PM (GMT 0)
I had my date with the DaVinci 12 years ago. Three weeks later, I played 18 holes of golf. (I don't recommend that, though). As with you, continence was more important to me than the ED, although I never truly believed I would end up with permanent ED. My wife is fine with that, and there are workarounds that aren't much discussed here, but which are out there. I wore a leg bag during the daytime, and my wife and I and my brother went out for breakfast the day after I got home. The level of discomfort certainly varies from individual to individual, but for many it's not all that bad.
Like you, I worked hard on fitness prior to the surgery. I was weighing 215, and my goal was to be at 200 for the surgery, When they weighed me in at the hospital, the scale read exactly 200. I now weigh 165, but that's another story,
You seem to have a great doc, a well thought out plan, and I wish you all the best. Life goes on, even without a prostate.
Posted 10/13/2022 5:25 PM (GMT 0)
Thanks Clocknut!

I and trying to get from 272 to 260 or less. It has been hard with traveling every week for a while. I finally have a break in my travel schedule and will have about 3 weeks home and travel the week before the surgery. I have thought of changing those to virtual just to cut down on a possibility of getting covid and having to postpone. I am not covid crazy, but for this I would rather be safe than sorry.
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