First post here.
I'm 70 years old. I had surgery, robot-assisted, at the end of August. My PSA had been climbing alarmingly and had reached 16.2 in December of 2018. (It had risen from 2.7 in 2004 to 11 in 12/2017.) DREs were always negative. After switching doctors because I wasn't comfortable with the first one I'd found, I had an MRI that found a suspicious area. The biopsy in May took 3 samples from that area plus the usual 12. A number of the samples had cancer: some, including those from the MRI-identified area, were Gleason 7, but two were Gleason 8. The biopsy was reviewed by the head of the pathology dept. at a large teaching hospital, and I was satisfied with that and didn't get a second opinion. I then had CAT and full-body scans, which found no metastases. I scheduled surgery, but I also scheduled a consultation with the urologic radiation doc. After that consult, I chose to go ahead with surgery.
I chose surgery for a number of reasons. I'd had a grossly enlarged prostate for decades, and I wanted it out. Surgery can be supplemented later by radiation if necessary, but not, I understand, vice versa. The radiation treatments would have been daily for several months: I couldn't have seeds because of the size of my prostate. (It was too big to shrink sufficiently before the treatment, they told me. After surgery, it weighed in -- or out, thank goodness! -- at 97 grams.) Also, I didn't want the ADT, which they told me I'd be on for two years. My surgeon had done over 2,000 robot-assisted prostatectomies, so I felt confident in him.
Surgery was done at the end of August. Post-op recovery was not bad; almost no pain, and just a day or two with bladder spasms while the catheter was in, but the docs stopped that with medication. Cancer had abutted the prostate capsule on one side, so the nerves on that side are gone, but the other side is mostly intact: at least some erectile function may return. Urinary control has been progressing reasonably well: at 3 months out, I'm leaking between .75 and 1.25 oz per day. (That's quite a novelty after decades of having difficulty urinating. I don't like the leaking, of course, but when I intentionally urinate, the strong flow is wonderful.) Although the incontinence had been troublesome, it is now leakage instead of flooding, and I've been experiencing greater control as time passes. I'll need to continue with kegel exercises, I'm told, for the rest of my life, but I don't mind that. I don't regret choosing the surgery, even if full continence remains elusive.
PSA six weeks post-surgery was undetectable; it will be checked every 6 months for the next three years and then annually. If the PSA comes back and things look risky, I should still have the option of radiation before moving on to other treatments if necessary.
No recommendations here: just a report of my unique case. If there's something useful in it, all the better. Best wishes!
Post Edited (daruma) : 12/7/2019 5:09:58 PM (GMT-7)