Recently Diagnosed - rushing to surgery?

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Dan_in_Fla
New Member


Date Joined Aug 2009
Total Posts : 6
   Posted 8/19/2009 1:22 AM (GMT -6)   
Back in April my urologist strongly recommended that I look for a robotic lap. surgeon
and get it done ASAP!

I am glad I took the time to look into alternatives (Proton, Radiation, RP, Active Waiting, ...)
and in the end decided to go the RRP route.

As things stand now, my RRP is scheduled for Sep 2009 in NY.

Part of me is looking forward to the RRP/ "getting rid of the cancer" ... the other part
of me is wondering if I should wait...but waiting makes me nervous.
Age 58 - Working/Living in FL
PSA 1.6 - TUNA 6/2007
PSA 1.8 4/2008
PSA 1.9 4/2009
DX PC 5/2009 Gleason Score 3+3 on 2 of 12 cores

Proscar/Arimidex since 5/2009
PSA 1.1 6/09 ;
PSA 0.7 8/09

Uncomfortable with active waiting or radiation.

Scheduled for RRP at NYP -Cornell 9/2009 following radiation and surgery
consults.


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 8/19/2009 5:52 AM (GMT -6)   
Dan,
Making this decision is the hardest part of the whole process, I think. You obviously did your homework, so rest easy in your decision and don't look back. Good job with NYP-Cornell. Who is the surgeon? They advertise a newish technique that helps with continence numbers, don't they? If you have any questions or need any help with the NYC aspect of things, let me know. I live just outside the city. Need a visitor??
Paul
46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
One year PSA - undectable!

ED Website: www.FrankTalk.org - frank discussions of Erectile Dysfunction - check it out.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 8/19/2009 6:29 AM (GMT -6)   
Greetings, Dan.  It looks like you have done your homework and come to a conclusion that is right for you.  Different guys choose different options and any of the choices can be right for a particular patient.  As I often say, once you make a decision begin to focus on getting it done and don't look back.  You will do great.  Please keep us posted on how things are going.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/19/2009 7:35 AM (GMT -6)   
Dan, I think you already know in your mind and heart what you need to do. You have already been waiting for 4 month at least while you study the various primary treatments available to you. While your stats show you with a potenially low grade of PC when dx., the facts are, it is cancer, it's not going to go away on its own, and even if it is only microscopically, its still growing everyday.

When you are ready, you just committ to your choice, and as others have said, you go for it and don't look back. You don't have to have anyone's aprroval, its your choice alone and its your body.

Whatever you decide, take comfort knowing that we are all here for you, and will back you all the way, from start to finish.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,
meeting with Rad. Oncl on 8/14 about lastest PSA
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/19/2009 7:48 AM (GMT -6)   
Welcome Dan...getting the decision to do something is always better than no decision in my book. Good luck on your journey and keep us posted with your outcome. It always helps others new to this forum to learn what others have done in similar situations.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 8/19/2009 9:04 AM (GMT -6)   
Welcome to the club that hates to get new members.
As others have said, our strongest advice is always to learn about and consider your options and you have done that. If you are in otherwise good health, then selecting watchful waiting could be the start of a very long process and you have judged yourself as unsuited to this.

Let me suggest that it is time to change your focus to active preparation -- it is better than feeling helpless. Start a regimen of healthy diet and exercise. Learn what to expect during surgical recovery and make preparations -- for example, do you have baggy sweat pants to wear with the catheter? Keep two things in mind. You are not helpless and you are not alone.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 8/19/2009 9:26 AM (GMT -6)   
Welcome to the Forum, and I wish you a routine and uneventful procedure, with a normal recovery. smilewinkgrin
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
22 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix 30/1/20-.05ml 2X week continues
PSA's: .04 each test since surgery


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 8/19/2009 3:31 PM (GMT -6)   

Dear Dan:

You can consider this the minority report.  Most of the guys on this forum have had surgery and, predictably, will tell you what a good decision you have made for choosing that route.  I usually shut up during those discussions, feeling that once someone has made a decision...even one I disagree with...there is no point in bringing up other alternatives.

However, despite the body of your post, the title would indicate that you still have doubts, so I will presume you do and give you some other things to chew on.

Without seeing the rest of your stats, it's hard to know whether or not you are a good candidate for active surveillance.  Here is some info from Johns Hopkins that can give you some perspective on what they view as a good candidate:

1.  Age 60+.

2.  T1C, i.e. nothing felt on DRE.

3.  PSA density of .1 or less (this is PSA divided by size of prostate, e.g. PSA of 3 divided by prostate size of 35cc equals PSA density of .086 which is less than the .1 threshhold.

4.  Gleason 6 or less.

5.  2 or fewer cores of cancer.

6.  No core with more than 50% cancer involvment.

So, before you dismiss this perfectly reasonable option, I would urge you to take some time to read through a number of threads on this forum about post surgery incontinence, ED, catheters, injections, pumps, shorter penises, ejaculating urine, etc. and consider quality of life as part of your equation.

Also, if you will permit a little more length in my reply, I am pasting in a recent response I gave to a patient who was considering treatment options. 

General

First of all, with early stage cancer you have time to research the heck out of your alternatives so you can feel comfortable that you are making an informed decision.  If you haven’t bought it yet, I advise you read “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”.  It’s not perfect, by any means, but is an excellent primer.  Secondly, both of the options you are considering will most likely cure you.  There are multiple long term studies for surgery and brachytherapy that indicate they provide basically the same cure rate for early stage cancer patients.  Of course, each man is different and I suggest you plug your stats into some of the predictors available to see where you fall.

You should also make sure you consult at least three EXPERIENCED doctors to gather your options.  They are your uro-doc surgeon, a radiation oncologist and a prostate oncologist.  Many of the major cancer centers, e.g. Johns Hopkins, Duke, MSK, M.D. Anderson, etc., can provide those three in a multi-disciplinary team setting.  Otherwise, you can and should still do it on your own.  I highlighted “experienced” because there are definitive studies that demonstrate better outcomes if your practitioner has done 250+ procedures…let them learn on someone else. 

You also might consider getting a color doppler biopsy to assist with your baseline.  I didn’t even know such a thing existed but would have gotten one if I had known about them.  The bottom line is to make sure you are totally comfortable with the decision.  This is huge and they are messing with pretty important real estate!

Surgery

As I said, you will likely get lots of advice here from the experienced surgery guys.  The two choices I looked at were robotic and open.  Robotic is newer but there are plenty of experienced guys now who can do it.  I would have chosen robotic if I had chosen surgery.  With surgery you get the aforementioned likelihood of cure, the immediate post-procedure knowledge of the pathology of your cancer and the psychological advantage of “having it out”, that is very important to some men (it was not to me). 

But surgery is invasive, even the robotic kind.  You have the inherent risks of major surgery, a catheter for some period of time (a week to months) and some time needed to recover from the operation.  You also almost certainly will experience incontinence – typically improving over a period of months.  You will most likely experience ED.  That improves over time for most men, especially with the help of Viagra, Levitra or Cialis.  There is some clear evidence that ED is psychological as well as physical.  In other words, once you lose the ability to have erections, it’s tough to get them back because you are trying so hard to make it happen.

The things that some surgery docs don’t tell you are that you lose your ejaculate, your penis make get shorter and many men ejaculate urine.

One advantage of surgery that many surgery patients cite is the fact that, if the cancer recurs, you have salvage radiation as an option for further treatment.  I personally find this a rather specious argument, since the cure rate from this "broad beam" radiation treatment is quite low and further treatment is likely to be required anyway.

Brachytherapy

This was my choice and, 8 months out, I’m glad I made it.  I’ll let you know in 20 years if I’m still glad!  You can read my “story” if you click the link at the bottom of my signature.

A typical poster-boy candidate for brachytherapy will have Gleason 6 or less, a prostate size of 50cc or smaller, Stage T1-T2, and PSA less than 10.  With G-7, brachytherapy alone may also be used if all of the other criteria are met plus cancer found in only a few cores and with a small %.  Otherwise, the doc will typically use HT to lower the prostate size and/or supplement the brachytherapy with a 4-5 week course of other radiation therapy.

Brachytherapy as a procedure is pretty non-invasive and is typically done on an outpatient basis.  There is very little pain involved and the patient pretty much returns to normal activities within 48 hours.  Besides the aforementioned curative power of seeds, the urinary effects are much different than surgery.  There is rarely any incontinence, but a patient may experience some frequency and/or urgency during the first couple of months.  Most docs put men on Flomax for 3 months to assure normal urinary activity.  Pre-procedure, most patients take a written test about their urinary activities.  If things are pretty normal pre-procedure, they are more likely to be normal post. 

The same can be said for ED in brachytherapy patients.  A patient performing well before seeding is more likely to perform well afterward.  In any case, most of the “performing” patients return to sexual activity within a couple of weeks of the procedure.  However, if and when ED occurs in brachytherapy patients, it is likely to be a couple of years down the road.  If that happens, the same little blue pills that help surgery guys will likely do the trick for seed guys.  In general, brachytherapy patients show somewhat less ED than do surgery patients when normalized for age, diagnosis, etc.

While “radiation after surgery” is generally available (but not highly successful) if the cancer returns for surgery patients, “surgery after radiation” is not usually an option for brachy patients.  There are only a few docs who will do salvage surgery after radiation and personally, I would not recommend it.  So, if cancer returns to a brachytherapy patient, the options are likely to be hormone therapy, cryosurgery, re-seeding or maybe even HIFU.

Sorry for the length of this reponse, but I just couldn't let your thread go by without sharing these additional thoughts.

Tudpock

 


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 8/19/2009 4:11 PM (GMT -6)   
Dan,
I echo what Tud said. The Prostate Cancer Research Institute web site has a section on treatment options that may give you some more information on which to base your decision.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Dan_in_Fla
New Member


Date Joined Aug 2009
Total Posts : 6
   Posted 8/19/2009 4:19 PM (GMT -6)   
Dear Tudpock18:
Thank you for your reply.

I was told brachytherapy was not an option post TUNA - though I'm sure with some
digging I would find someone to do it. (It is still radiation...I am leaning to stay away from it.)

Bottom line is there is no way to ascertain what we're dealing with (aggressiveness wise) ...hence
every alternative looks is as good (or bad) as the rest.

A top rad oncologist summarized it this way: chances are whatever you do will work (surg / rad)
your choice is to pick which side-effects you want/can deal with (i.e. stress incontinence vs urgency
incontinence)...

Dan
PS - You are right! Surgeons don't bring up the touchy subjects (loss of ejaculate or urine ejaculation)
and I learned about those from forums such as these...to their credit though, it's hard to
predict who will experience these side effects (and I am hoping they are not that prevalent!)
Age 58 - Working/Living in FL
PSA 1.6 - TUNA 6/2007
PSA 1.8 4/2008
PSA 1.9 4/2009
DX PC 5/2009 Gleason Score 3+3 on 2 of 12 cores
Negative CT Scan; Suspicious bone scan ruled negative following MRI/X-Rays.
Proscar/Arimidex since 5/2009
PSA 1.1 6/09 ;
PSA 0.7 8/09

Uncomfortable with active waiting or radiation.

Scheduled for RRP at NYP -Cornell 9/2009 following radiation and surgery
consults.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 8/19/2009 6:08 PM (GMT -6)   
Dan:
 
I would agree with the top rad oncologist that you quoted (is he your doc?) that multiple treatments will work, so then compare the SE's.  I would qualify that I am talking about early stage PCa.
 
So, if that is the case I suggest you research the SE's completely.  You mention "incontinence" for radiation and surgery like you believe they may be equivalent, e.g. "urgency" vs. "stress".  They are not equivalent as surgery most often brings with it diapers, pads and months of leaking and dribbling.  That is incontinence.  Radiation most often brings urgency and frequency (both controlled by meds) but no need for the Huggies you need with surgery.
 
Also, don't give too much credit to the docs who do not mention the SE's because they are difficult to predict.  Do your own research.  With surgery the ejaculate is gone, period.  That's a done deal and not subject to anyone's prediction.  That may or may not bother you, but that's the fact.  Also, re penis size, a reduction in size with surgery is very common.  One oft quoted study says that 2/3 of men show some decrease in size and 1/5 of men lose 15% or more.  That may not bother "Joe the Horse", but for most men who care about size, it is of some significance.  My point is to do your own in-depth research on SE's...that way you will be educated whatever path you choose.
 
Tudpock
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

cvc
Regular Member


Date Joined Jun 2008
Total Posts : 440
   Posted 8/19/2009 7:50 PM (GMT -6)   

Dan, arn't your PSA numbers well w/i "normal" range ?? What made them ask for a biopsy, I really thought 58 yrs old with a 1.6  psa was well w/i range ?

 

Just curious..

 

Good luck !


will be 50 years old this year ( 2009 )
 
Uro said enlarged prostate 
 
DRE Negitive
 
Psa  2003- .55
 
     2007 - .99
 
     2008 -  1.01
 
watchfull worrier , lol


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/19/2009 10:46 PM (GMT -6)   
Bro. Tud,

The rad. oncologist I talked to Friday actually explained the penis size issue you brought up above in your post better to me than my dr/surgeon. It still has to do with the connection between the urethra and the bladder neck, and make up the difference where the prostate use to be. In the flacid state, he said the penis is shorter in most all cases because it is being retracted inward. But when it is errect, it is usually the same size as before surgery. As both an open surgery guy and someone that is still getting natural errections, I can testify in my case that is exactly what is going on. When completely limp I am embarassed, because its just a wee one, much smaller than pre surgery, but when full and errect, easily as big as before.

You bring up some good points and I think a fairer comparison between radiation and surgery. While I have fully adjusted to a sex life without any ejaculate, and that took months to re-train my brain, I would still prefer to be able to ejaculate. But, I am happy to still have a natural sex life, so not really complaining.

Squire David
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 8/19/2009 11:00 PM (GMT -6)   
Hey, Mr. Dan,

We're sorry for the reason you had to join us, but welcome to a great support site!

As far as timing for treatment goes, only you can make that decision. In my humble opinion, it is good to get that cancer treated while it is present in lower volume and less aggressive.

I wish you the best in your decision and wish you comfort that you've made one. Now it is time to look forward to getting to the other side of treatment.

Please ask all the questions you wish. There are folks here with many, many different experiences who are available to help.

Best regards,

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


Dan_in_Fla
New Member


Date Joined Aug 2009
Total Posts : 6
   Posted 8/20/2009 9:09 AM (GMT -6)   
cvc said...
Dan, arn't your PSA numbers well w/i "normal" range ?? What made them ask for a biopsy, I really thought 58 yrs old with a 1.6 psa was well w/i range ?



Just curious..



Good luck !


I went for a follow up (two years post the TUNA in 2007) and mentioned that urgency feelings
and slightly more frequent urination were coming back ... he did a full work up and the ultrasound
showed a MINIMAL (hardly noticeable) difference in shading between the left and right side of the
prostate...hence the DRE ... hence the biopsy...
Age 58 - Working/Living in FL
PSA 1.6 - TUNA 6/2007
PSA 1.8 4/2008
PSA 1.9 4/2009
Positive DRE
DX PC 5/2009
Gleason Score 6 (3+3 ) on 2 of 12 cores (#4, #6 - LEFT SIDE)
Negative CT Scan; Suspicious bone scan ruled negative following MRI/X-Rays.
Proscar/Arimidex since 5/2009
PSA 1.1 6/09 ;
PSA 0.7 8/09

Uncomfortable with active waiting or radiation.

Scheduled for RRP at NYP -Cornell 9/2009 following radiation and surgery
consults.


Bob S
New Member


Date Joined Aug 2009
Total Posts : 1
   Posted 8/20/2009 4:00 PM (GMT -6)   

HI Dan,

 I had surgery in Aug of 07 Dr. Ash Tewari at NY Prysbyterian probably the same doc or someone in his group, my surgery was Monday at 11am, I was out of the hospital the next day. He has you walking the next day and 3 miles a day after that. I was back in my office a few days after surgery, although with a cathedar for a week,. but all is fine, you can contact the local US-TOO group, for more followup. Let me know if you would like more info, BoB S


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/20/2009 4:11 PM (GMT -6)   
Dan - you are blessed to have a great doc. Follow his advice.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


55 and healthy in NJ
Regular Member


Date Joined Apr 2009
Total Posts : 58
   Posted 8/21/2009 11:50 PM (GMT -6)   
Dan,
 
If the biopsy definitely showed the presence of PC, then if you are considering surgery, some would recommend having it done sooner rather than later, if only because the more it spreads throughout the prostate gland, the more careful the surgeon needs to be in order to spare the nerve bundles.  My more experienced brothers on the forum will correct me if I get this wrong, but I believe the length of time to recover potency is directly related to the amount of trauma the nerve bundles go through during the surgery.  In other words, the smaller the gland and the less cancer cells present, the easier the surgery and therefore the faster the recovery.  I'm three months post-surgery and I have only stress incontinence now, which continues to improve every week.  I expect the potency to take longer to get back, as my surgeon told me the cancer was more prevalent on one side, and as such it required him to be more careful so that the nerve bundle wasn't damaged.  But he still had to move it out of the way, and that caused the trauma.  I would agree your case appears to be in a very early stage, but the 3+3 Gleason is medium risk.  Good luck with whatever decision you make, and rest assured that if you have done all your homework and are comfortable with your decision, then you won't second-guess yourself.
 
Greg

Age 55
PSA history: 2.9 (Oct 04), 3.7 (Dec 05), 2.79 (Nov 07), 4.54 (Jan 09), 4.9 (Feb 09)
05/18/2009 - Robot-assisted (daVinci) laparoscopic radical prostatectomy by Michael Esposito, M.D. and Vincent Lanteri, M.D. http://www.roboticurology.com/ both nerve bundles spared
Surgical Pathology: Prostate gland 51.8 grams; Gleason score 3+3=6; Pathologic stage T2c, N0, Mx; Left/Right Pelvic lymph nodes clear (no tumor present); No presence of extra-capsular invasion;  No margin involvement
05/26/2009 - Catheter and incision staples removed
05/30/2009 - Started Viagra 25mg 3x/week
07/06/2009 - 1st post-surgery PSA <0.1


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 8/22/2009 9:52 AM (GMT -6)   
Welcome Dan,
You have done the right things researching your options, now just start preparing yourself what for the surgery and the recovery period. Everyone is different in how soon the recover for incontinence and ED. Exercising and doing Kegels before surgery will help with recovery from incontinence. As far as ED, it depends on how ggod your surgeon is in preserving your nerve bundles. Good luck.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1


richienofear
New Member


Date Joined Feb 2009
Total Posts : 18
   Posted 8/24/2009 12:15 PM (GMT -6)   
turn  Welcome,but sorry you have to be here
I took 4 months to make my decision
2 of 12 were cancer
both on the left and right edges of prostate
studied all the methods
decided on Da Vinci method
May 24th 2009
cathter out in 10 days
incontinence is one pad/day
slight leakage under exertions
ed ,I take 5o ml viagra every other day
no errections but doc says its for blood flow
I feel real good mentally about my progress
68years old and active softball player 4 days a week
play tennis once a week and golf once/wk
wife is biggest supporter
never sorry about my decision
hopefully sex can come back sometime in the next year or so
Good luck on your journey
and keep a good mental attitude
Life is good

working at it,on my journey

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