It's too aggressive to just ignore so I get to choose. The good news is the doctor is one of the best at the surgery, but side effect is goodbye erections and hello dribbling. Radiation has it's own can of worms. I can't just ignore it because I haven't been paying tithing so I'd be in one of the lower kingdoms. I'd make a real shitty servant.

Is the entire prostate cancerous? If not, partial removal can do wonders.

He says it's too far gone for partial. All or nothing.

Not a great choice to have to make.

I have zero advice, except to look for advice from professionals.

My husband doesn't have prostate cancer, but we've discussed what we would do in that situation. We both agreed surgery is the way we would go. I want him around - erection or not.

I would ask the doctor what he would advise if you were his father.

I have a colleague in Dallas, TX, that had 2 or 3 cancerous nodes. Even then, they recommended removal. The good news in this case, the doctor uses the latest computer-guided surgery technique that yields very high rates of erections and continence.

Personally, I would go with removal and avoid radiation if at all possible.

My husband went through the surgery one year ago. Biopsies showed the entire prostate was involved. No option but to go thru with the surgery using the Da Vinci knife. He was able to use a Doctor who came highly recommended. He was in and out of the hospital in less than 24 hours and he said the pain was manageable. The catheter came out after a week. He was given exercises to do to help in the healing process and retraining of the bladder. After a year it is basically under control. As far as the sex life goes it took about 6 months for things to heal enough to attempt with the ED drugs. After a year things are basically back to normal and he continues with a daily dose of the ED drug. We have been told he is ahead of the curve and are so thankful for that. Hope this helps in some small way. My thoughts are with you as you go through this difficult time.

Thanks. It does help because the doc says I need to decide. It sounds like surgery is the better route. One thing he said was if the radiation fails, then you can't go back and do surgery, so the options get norrower. This doc has written articles and given talks on this kind of stuff. So he knows his stuff.

One year ago I was diagnosed with a prostate nodule during a digital rectal exam by my primary care physician. My PSA level was 3.5 (abnormally high, probable prostate cancer). He referred me to a urologist who is a Johns-Hopkins trained physician. The urologist scheduled a biopsy during which he took 16 samples from the prostate. Cancer was present in 9 of the 16 locations. He had me get an MRI scan and it showed there was no cancer in my bones.

For treatment the urologist recommended hormone therapy (blocking production of testosterone), 25 sessions of external beam radiation therapy, and brachytherapy (insertion of radioactive seeds into the prostate. I asked about surgery and he recommended against it. He said that if he did prostate removal surgery I would still need the same radiation therapy, so there was really no benefit to having my prostate removed. The doctor guaranteed me that the recommended hormone and radiation treatment would cure my cancer. He said "I guarantee you that you will die from something other than prostate cancer."

I started the hormone therapy (an injection) on May 28, 2013. The type of cancer I have will cease to grow if there is no testosterone present in my body. I will need to be on the hormone therapy for two years. I had gold marker insertion on June 28, 2013. The three gold markers in the prostate are used at the start of each external beam session to aim the machine at the prostate. That minimizes any collateral damage to healthy tissue in the area.

The external beam radiation therapy started on July 23, 2013 and continued through August 28, 2013. I had the brachytherapy on October 3, 2013. The doctor said that the radiation could be detected (with an external geiger counter) for about 60 days. If I needed to pass through airport TSA screening for a flight I would need a letter from the doctor telling them why I was positive for radioactivity. I didn't do any flying during that period. That was the end of my treatment for prostate cancer.

In February 2014 I had blood drawn at the urologist's office. They tested for my PSA level, which was zero. They also tested my testosterone level which was low. So my prostate cancer has been cured. I have been totally satisfied with the medical care I have received.

Interesting info...very good to know.

My friends who've faced that choice have had a complete removal. Much less invasive than a decade ago I'm told...and now they are cancer free....so far, my PSA's and digital exams are good...my Dad had prostate cancer in his 80's and lived to be 90...hope I'm so lucky...I'm 65 now. Best wishes to you and to your surgeon.

Ron Burr



Edited 1 time(s). Last edit at 03/21/2014 06:12PM by Lethbridge Reprobate.

A family member had prostate cancer and elected to have surgery at Johns Hopkins. He's cancer free and in excellent health several years later. From what I've read, surgery is the recommended option for "younger" guys (he was early 60's at the time.) I can't even begin to tell you what a relief it is to talk to the surgeon afterward and to have him tell you he "got it all."

If you have any doubts or questions about your options, get a second opinion. Go to a teaching hospital (a hospital affiliated with a medical school) and get an opinion from one of the professors. That professor will be completely up to date on all the best treatments.



Edited 1 time(s). Last edit at 03/21/2014 06:27PM by summer.

My experience, FWIW:

I opted for the surgery. The surgeon said that he could remove the prostate and leave the nerves intact that are necessary for an erection. He did. No real problem with erection or orgasm. Of course there is no semen expelled. No dribbling problem. This was 12 years ago, when I was 68.

Dr. David Esrig, Eugene/Springfield Oregon, is THE best. He'll do a suprapubic prostatectomy. Scrapes out the entire contents of the prostate, but leaves the empty shell, sewing back up all the abdominal layers. Sounds awful, but you get to sleep through it. The only after-effect is the retrograde ejaculation. Not really an issue for old guys like us.

He opted for cryosurgery. Then radiation. Then chemo. Then more radiation. Then more chemo. Then pinpoint radiation. We had him 8 years longer than we thought we would, but in the end, he regretted not having complete removal.

His was the genetic kind, and it did not respond to treatment.

The best to you.

Both my Dad and my brother have it. My Dad was told that his is not operable, so he's been on a hormone similar to estrogen. He gets a shot in the leg every 3 months, or something like that. It halted the thing in its tracks and all of his levels have been better-than-normal for about 3 or 4 years now. The doctor told him he could go off the hormones now, but my Dad decided that if it's working, he doesn't want to mess with that success.

My brother is having his removed in a few weeks.

Probably each case is unique.

I hope everything goes well for you, whatever you decide.

This is all just personally stuff I know due to my own prostate issues.

SURGERY: If you have the prostate removed, your cancer is gone unless it has spread. With abdominal surgery, they take the lymph nodes and find out if it spread by removing it abdominally. With the other surgeries, they have to go back in surgically if they need to look at the nodes. Anything less than having the abdominal surgery is taking a bigger chance.

This is one of those things where different doctors tell you different things. Johns Hopkins pioneered all this back in the early 90's or so it essentially no one has improved on it. They've tried it with perineal removal and with the DaVinci machine. (Don't even have a mole removed with a DaVinci machine!!) One of the Salt Lake doctors will only do perineal surgery. But with abdominal surgery they can get in there and remove the prostate and separate it from the nerves that control continence and sexual function, so long as the nerves are not involved in the cancer. After a time, you can normal get functions back, and if not, they now have ways of fixing you up. One of the biggest reasons to consider the abdominal surgery is because they can take the nearby lymph nodes and see if

RADIATION: As for radiation, prostate cancer cells are tough and require a lot of radiation. If they irradiate it, it kills much of the adjacent tissue, including parts of the intestine. A fellow I know essentially lost his lower intestine and now had an ileostomy. He has been unable to travel for years.

In addition to killing valuable tissue, radiation also leaves you permanently incontinent and impotent, with no hope of getting anything back.

SEEDS: Some surgeons promise that seeds are the best. Other doctors say to never, ever do seeds. Seeds, successful or no, also leave you incontinent and impotent because they destroy the nearby nerves. Don't know much beyond that. My doctor scared me away with the seed talk.

NOT DOING ANYTHING, SO-CALLED WATCH AND WAIT: That's fine as long as you're in your late 70's or in your 80's. You probably will die from something other than prostate cancer. If you're in your 40's, 50's, or 60's, you don't want to leave it, because you're more likely to die of the cancer. But some doctors pooh-pooh that and tell you that it's okay to wait. Fine. But if you start getting pains in your lower back because the lymph nodes are involved there, your prostate cancer is now terminal.

So if there's a conclusion to be had, it would be to get the opinion at least three urologists, consider your age, and not let anyone talk you into radiation or DaVinci surgery, no matter what. No sense in talking about one's own problems and solutions, because it's highly, highly selective and personal, and it's all a wild crap shoot. But with surgery, you can walk in with cancer, and walk out with no cancer. With abdominal surgery there is a few more days of recovery, but with any of them you are up and about in no time, and with all of them, you are still attached to a catheter for a couple of weeks because they have to cut your urethra in half, and it has to heal. It is having a catheter up your business that makes you lose bladder control for a while, but it most often comes back if your nerves are spared and if you do your exercises.

No DaVinci, no radiation. Be wary of seeds. Good luck.

Thanks for the info. That's a lot to think about. I'm mid 60's and it's a pretty aggressive cancer so wait and see won't work.