Prostate Cancer (Merged)
Loose rivets
I have only just seen this thread - sorry
I am happy to put you in touch with a surgeon who does robotic radical prostatectomies in the UK - please email me as I dont want him inundated. He has been doing them for some time with the Da Vinci system,
My understanding from him is that the robotics does NOT effect the success of the operation in terms of getting you into remission. It does allow more intricate dissection of the tumour from the surrounding nerves and thus reduces the incidence of nerve damage which includes impotence.
Best of luck
I have only just seen this thread - sorry
I am happy to put you in touch with a surgeon who does robotic radical prostatectomies in the UK - please email me as I dont want him inundated. He has been doing them for some time with the Da Vinci system,
My understanding from him is that the robotics does NOT effect the success of the operation in terms of getting you into remission. It does allow more intricate dissection of the tumour from the surrounding nerves and thus reduces the incidence of nerve damage which includes impotence.
Best of luck
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Hi StickRudder
Please accept my sympathy and best wishes and allow me to outline my experience with prostate cancer for whatever use, comfort and encouragement it may be to you.
I was diagnosed at age 58 three years ago. My PSA was 66 and Gleason (if I understand correctly) 7.5. The cancer was outside my prostate but had not spread, bone scan, MRI etc etc were all clear. It was made clear that delayed treatment was not an option for me.
I did what I usually do when faced with a challenge outside my sphere of expertise and that was to find an expert I could trust and to put my trust in him. His advice was to take the path of hormone therapy and radiation treatment. Three years later I have a normal life expectancy and no side effects that are more than a mere annoyance.
During treatment which started with 6 months of hormone therapy, basically supression of testosterone, my PSA fell to 9 which is not great but better than 66. I had 33(?) sessions on the linear accelerator and another year of hormone therapy. My PSA was 1.4 earlier this year and is now 1.2.
I did have some side effects, the radiation treatment caused such tiredness that I avoided driving after treatment though I did drive to work each morning. I had hot flashes which are not funny but no big deal as many women put up with these as a matter of course. I lost 30% of my strength according to weights at the gym. I laid down both male and female pattern fat deposits! My balding was reversed and for a while I had a full head of hair again! I did not suffer total impotence and anyway, as they say, (sort of) you can always learn a new tune to play on an old fiddle.
I avoided going into 'invalid mode' and carried on my life as normal as possible during treatment. I did up my gym programme a little and did not spend even one day at home 'sick'.
My advice is the same for everyone I meet who is in the early stages of the prostate cancer experience and that is to take the advice of an expert. I dont believe all prostate cancers are the same and neither do I believe the right choice for someone is the best for another.
I have met a few men in the last couple of years for whom diagnosis came too late or have serious and permanent side effects but they are among the minority.
Regarding diagnosis, monitoring PSA is still, as far as I know, the best way of early detection of prostate cancer. PSA is a natural substance and plays a part in the reproductive process so every man should have some and the normal level in one is not the normal in all others. It does however raise alarm flags when the level changes. Biopsies are a much better indicator but are not without risk as they require needles being stuck deep into the abdomen and the most practical path raises serious risk of infections.
Once again, please accept my best wishes for you and the people around you during the time ahead.
Please feel free to PM me if you wish.
John
Please accept my sympathy and best wishes and allow me to outline my experience with prostate cancer for whatever use, comfort and encouragement it may be to you.
I was diagnosed at age 58 three years ago. My PSA was 66 and Gleason (if I understand correctly) 7.5. The cancer was outside my prostate but had not spread, bone scan, MRI etc etc were all clear. It was made clear that delayed treatment was not an option for me.
I did what I usually do when faced with a challenge outside my sphere of expertise and that was to find an expert I could trust and to put my trust in him. His advice was to take the path of hormone therapy and radiation treatment. Three years later I have a normal life expectancy and no side effects that are more than a mere annoyance.
During treatment which started with 6 months of hormone therapy, basically supression of testosterone, my PSA fell to 9 which is not great but better than 66. I had 33(?) sessions on the linear accelerator and another year of hormone therapy. My PSA was 1.4 earlier this year and is now 1.2.
I did have some side effects, the radiation treatment caused such tiredness that I avoided driving after treatment though I did drive to work each morning. I had hot flashes which are not funny but no big deal as many women put up with these as a matter of course. I lost 30% of my strength according to weights at the gym. I laid down both male and female pattern fat deposits! My balding was reversed and for a while I had a full head of hair again! I did not suffer total impotence and anyway, as they say, (sort of) you can always learn a new tune to play on an old fiddle.
I avoided going into 'invalid mode' and carried on my life as normal as possible during treatment. I did up my gym programme a little and did not spend even one day at home 'sick'.
My advice is the same for everyone I meet who is in the early stages of the prostate cancer experience and that is to take the advice of an expert. I dont believe all prostate cancers are the same and neither do I believe the right choice for someone is the best for another.
I have met a few men in the last couple of years for whom diagnosis came too late or have serious and permanent side effects but they are among the minority.
Regarding diagnosis, monitoring PSA is still, as far as I know, the best way of early detection of prostate cancer. PSA is a natural substance and plays a part in the reproductive process so every man should have some and the normal level in one is not the normal in all others. It does however raise alarm flags when the level changes. Biopsies are a much better indicator but are not without risk as they require needles being stuck deep into the abdomen and the most practical path raises serious risk of infections.
Once again, please accept my best wishes for you and the people around you during the time ahead.
Please feel free to PM me if you wish.
John
Psychophysiological entity
One was offered the Da Vinci machine in Tx. before Christmas, but there were so many other symptoms that I imagined that there might a secondary in my spine. Years of back pain were blurring with the symptoms and a displaced rib (caused by the Rivetess' rather vigarous back adjustments
) was causing me to yelp when rising from bed. She managed to put it back from whence it came, and the anti-inflamatories I take now have subdued the back pain....so, it was just the cancer to considder. Not quite in that order, but you know what I mean.
I'm now carrying 80-100 radio iodine seeds, and these have been irradiating me for some weeks.
I now can not have surgury. I guess because all the once clear boundaries of different organs are glued together in a, I hope, dying mass.
When I was diagnosed, all I wanted to do was to come home. Just be here, dunno why. It wasn't the money, cos I've spent far more than the $23,000 than the total hospital package would have cost. Now I don't know. There has been one cock-up after another. Mostly paperwork. A total disregard for my personal burdens like work, despite making an impassioned plea for the first check-up to possibley be done whereever my work took me. I stressed that I was not on holiday or retired, but had a real need to work. No. GET HERE.
I got there and filled in a five point form on how well I pee. I still don't know what I'm going to do about this, I walked out miffed but determined to bite my tong. Many days later I'm still as angry as hell. We'll see.
Other things I asked to be check as a logical procedure are now, after 7 months, being attended to with a vengeance. I was filled with Barium and air and had about 20 pics taken of my large intestine. Plus being on the fourth blood test in as many weeks.
Why wouldn't they listen? Is it some secret procedure that anything a patient thinks might be a good idea is taken off the list of possible treatment?
If I've got cancer of the gut, all the prostate work will be wasted. Total confused madness.
Haven't they heard of CRM? We're now supposed to listen to passengers reports of sparks coming out of engines etc., are doctors above listening?
It wasn't just that. My surgeon had shown (3 times) what my (highly quallified ) kids think is a very poor show in patient psychology. Strange little hissy fits about unrelated issues, with threats of cannceling my treatment at the last moment. All his retiue round the bed looking embarresed. They'd seen it all before it seems, and I was told not to worry. My life is in this man's hands.
) was causing me to yelp when rising from bed. She managed to put it back from whence it came, and the anti-inflamatories I take now have subdued the back pain....so, it was just the cancer to considder. Not quite in that order, but you know what I mean.I'm now carrying 80-100 radio iodine seeds, and these have been irradiating me for some weeks.
I now can not have surgury. I guess because all the once clear boundaries of different organs are glued together in a, I hope, dying mass.
When I was diagnosed, all I wanted to do was to come home. Just be here, dunno why. It wasn't the money, cos I've spent far more than the $23,000 than the total hospital package would have cost. Now I don't know. There has been one cock-up after another. Mostly paperwork. A total disregard for my personal burdens like work, despite making an impassioned plea for the first check-up to possibley be done whereever my work took me. I stressed that I was not on holiday or retired, but had a real need to work. No. GET HERE.
I got there and filled in a five point form on how well I pee. I still don't know what I'm going to do about this, I walked out miffed but determined to bite my tong. Many days later I'm still as angry as hell. We'll see.
Other things I asked to be check as a logical procedure are now, after 7 months, being attended to with a vengeance. I was filled with Barium and air and had about 20 pics taken of my large intestine. Plus being on the fourth blood test in as many weeks.
Why wouldn't they listen? Is it some secret procedure that anything a patient thinks might be a good idea is taken off the list of possible treatment?
If I've got cancer of the gut, all the prostate work will be wasted. Total confused madness.
Haven't they heard of CRM? We're now supposed to listen to passengers reports of sparks coming out of engines etc., are doctors above listening?
It wasn't just that. My surgeon had shown (3 times) what my (highly quallified ) kids think is a very poor show in patient psychology. Strange little hissy fits about unrelated issues, with threats of cannceling my treatment at the last moment. All his retiue round the bed looking embarresed. They'd seen it all before it seems, and I was told not to worry. My life is in this man's hands.
Last edited by Loose rivets; 25th Aug 2008 at 23:51.
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LR, hang in there mate! Getting grumpy is part of the process and I believe I still have a couple of grumpy cards up my sleeve.
Lets hope it has not spread, have you got any indication that it has apart from the back pains which you have an explanation for anyway?
Take heart in that your Prima Donna doc only keeps his job because of his skills, not his personality!
Lets hope it has not spread, have you got any indication that it has apart from the back pains which you have an explanation for anyway?
Take heart in that your Prima Donna doc only keeps his job because of his skills, not his personality!
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Some years ago, Rivets, I was on a hospital credential committee considering a new neurosurgeon. He brought a track record of obnoxious behavior from several prior places. Yelling, throwing stuff, cussing at nurses, that sort of thing. I was opposed to him. It always gets worse with time, and we had enought of those bozos.
A surgeon colleague looked at me, and simply said "but who do you want looking after your 17 year-old who's been in a car wreck - the demanding one, or the touchy-feely one?"
He was right. The guy was a bozo. A very skilled bozo.
Continued best wishes, LR. You've had good treatment.
A surgeon colleague looked at me, and simply said "but who do you want looking after your 17 year-old who's been in a car wreck - the demanding one, or the touchy-feely one?"
He was right. The guy was a bozo. A very skilled bozo.
Continued best wishes, LR. You've had good treatment.
Psychophysiological entity
Thanks for that. One will maintain a dignified silence for the moment.
His main hissy came from me saying that I react to pethidine. Such a sensible piece of information to give I would have thought. But there, 'The whole world's daft...' etc.
His main hissy came from me saying that I react to pethidine. Such a sensible piece of information to give I would have thought. But there, 'The whole world's daft...' etc.
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I bring this subject up again.
Last week I talked with a specialist urologist (prostates) in Johannesburg. He stops doing radical extraction operations now and uses brachytherapy. He told me the following story...
A man was referred to him absolutely convinced that he had prostate cancer. He has no symptoms at all. His test PSA comes in at 1.0. Yes - one.
So the surgeon tells him not to worry. The patient makes insistence that a biopsy be made and it is. Yes certainly the analysis is that he does have prostate cancer.
So what made him go to the specialist surgeon in the first place?
The answer is that a friend of his wife has a dream in which an angel appeared and told her to go to her friend and speak with her because her husband has prostate cancer.
Now, you may laugh or not, but this is a true story and the surgeon I saw is not a man to make a joke of this thing. He told me that it makes the hairs on the back of his neck stand up. It makes mine to curl a little too.
Last week I talked with a specialist urologist (prostates) in Johannesburg. He stops doing radical extraction operations now and uses brachytherapy. He told me the following story...
A man was referred to him absolutely convinced that he had prostate cancer. He has no symptoms at all. His test PSA comes in at 1.0. Yes - one.
So the surgeon tells him not to worry. The patient makes insistence that a biopsy be made and it is. Yes certainly the analysis is that he does have prostate cancer.
So what made him go to the specialist surgeon in the first place?
The answer is that a friend of his wife has a dream in which an angel appeared and told her to go to her friend and speak with her because her husband has prostate cancer.
Now, you may laugh or not, but this is a true story and the surgeon I saw is not a man to make a joke of this thing. He told me that it makes the hairs on the back of his neck stand up. It makes mine to curl a little too.
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Mmmmm. For every case where the angels/psychics/tea leaves correctly reveals some nugget of information, there are thousands that get it wrong.
The difference is that the only ones that get noticed is when, by some statistical abberation they guess correctly, as in this case.
I do trust that the urologist relied on some other more medically scientific reason to carry out the procedure other than the belief of the patient's wife's friend (Who he had never even met!). Had he proceeded with any invasive investigation on such ridiculous evidence alone he would not have had the patients best interests at heart.
I wouldn't trust this man with my bits if the story is correctly reported!
The difference is that the only ones that get noticed is when, by some statistical abberation they guess correctly, as in this case.
I do trust that the urologist relied on some other more medically scientific reason to carry out the procedure other than the belief of the patient's wife's friend (Who he had never even met!). Had he proceeded with any invasive investigation on such ridiculous evidence alone he would not have had the patients best interests at heart.
I wouldn't trust this man with my bits if the story is correctly reported!
Psychophysiological entity
Well, several months after being implanted with Radio Iodine 125 seeds, I'm down to a PSA 4.5 I gather that this is about on schedule. My Free PSA is still low (not good-should be >20) but I can't get any data on how this particular test is skewed by the procedure.
According to a graph on the net, the radiation should be down to .165 of the original power. During these months I have been almost without any post operative symptoms whatsoever. By this, I mean pain, sexual function and the like. There was however, some soreness of the urethra for a while, and I seem to be reliant on 'Flow' pills as much as I was before. But, all in all, the Brachytherapy seems to be the least disruptive of all treatments. So much so, that One wonders if anything is happening sometimes. However...My fellow traveler through this did have to be rushed back to be catheterized. Must give him a ring. A pal in Texas had to be rushed in three times for a catheter after external beam. So, not much to choose from that point of view.
The pre-procedure, called 'Volume Studies', was/were done under general anesthetic and is supposed to be very much more accurate than the early days. Hope so. They then order the seeds for that patient only. If the op is missed, they throw the seeds away! You go in the day before, or even on the day, and the seeds are put in via holes made between testicles and rectum. Not many holes for the 80 - 100 seeds, but the targeting is supposed to be very accurate.
(It's funny, but weeks later, I had a look at my glowing seeds on an active low level x-ray machine, and there didn't seem to be that many. They were certainly radiating in the x-band as well as gamma, thought the x is much less.)
Anyway, the whole thing took three days for me, well, one and two half-days really. So you can see just how great the advantages are - if it works! Worst figures I've seen are the surgeons...at 67% success bottom line. Better on some other statistical assessments. There is supposed to be no difference between this and the external beam success wise - according to numerous sources.
Now I've got two issues. 1/ Will it save my bacon? and 2/ Will the peeing get better?
Again, the issue of folk not getting checked is showing up. Two friends are steadfastly not getting their PSA checked. They can not explain why. It seems to be a bloke thing, but I'm hacking away at them, they'll do it soon if I have my way.
According to a graph on the net, the radiation should be down to .165 of the original power. During these months I have been almost without any post operative symptoms whatsoever. By this, I mean pain, sexual function and the like. There was however, some soreness of the urethra for a while, and I seem to be reliant on 'Flow' pills as much as I was before. But, all in all, the Brachytherapy seems to be the least disruptive of all treatments. So much so, that One wonders if anything is happening sometimes. However...My fellow traveler through this did have to be rushed back to be catheterized. Must give him a ring. A pal in Texas had to be rushed in three times for a catheter after external beam. So, not much to choose from that point of view.
The pre-procedure, called 'Volume Studies', was/were done under general anesthetic and is supposed to be very much more accurate than the early days. Hope so. They then order the seeds for that patient only. If the op is missed, they throw the seeds away! You go in the day before, or even on the day, and the seeds are put in via holes made between testicles and rectum. Not many holes for the 80 - 100 seeds, but the targeting is supposed to be very accurate.
(It's funny, but weeks later, I had a look at my glowing seeds on an active low level x-ray machine, and there didn't seem to be that many. They were certainly radiating in the x-band as well as gamma, thought the x is much less.)
Anyway, the whole thing took three days for me, well, one and two half-days really. So you can see just how great the advantages are - if it works! Worst figures I've seen are the surgeons...at 67% success bottom line. Better on some other statistical assessments. There is supposed to be no difference between this and the external beam success wise - according to numerous sources.
Now I've got two issues. 1/ Will it save my bacon? and 2/ Will the peeing get better?
Again, the issue of folk not getting checked is showing up. Two friends are steadfastly not getting their PSA checked. They can not explain why. It seems to be a bloke thing, but I'm hacking away at them, they'll do it soon if I have my way.
Psychophysiological entity
Had I known that back pain and other symptoms were not related to the cancer, I would have gone for the quick removal in Texas, but they based their reason for not doing further tests on my initial Gleason figures. I had a 4+3 and several 3+3s, so you can see that I was getting to the risky stage.
The trouble was that I have a very active imagination, and I could visualize offshoot cell growth making its way to the edge virtually at cellular size. Just a thin line, that's all it would take. I wanted more than an assessment of chance.
As it happens, the time at home cost me a deal that was to be my income for some years...so not always the best option to shy away from spending a bit.
The trouble was that I have a very active imagination, and I could visualize offshoot cell growth making its way to the edge virtually at cellular size. Just a thin line, that's all it would take. I wanted more than an assessment of chance.
As it happens, the time at home cost me a deal that was to be my income for some years...so not always the best option to shy away from spending a bit.
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Hello again Loose Rivets.
Your irritative urinary symtpoms are very common post brachy for the first 3 - 4 months. likewise the need for Flomaxtra - type pills. The need for such pills should reduce soon.
If your disease was Gleason 6 - 7 , you have moderate risk disease that hopefully should be dealt with by the seeds . In the longer term, as a urologist, I would like to see your PSA to down to below 1, after brachytherapy. (You can get a PSA "bounce" up to 2 - 3, about a year to a year and half post treatment).
You should make a point of finding out whether your post treatment dosimetry was adequate (i.e did you get the best possible dosage from the seeds) . This would have been checked by means of a CT or MRI scan done after your seed implant : this is important in knowing that the whole gland has adequate treatment.
Continued good luck to you LR.
Aussie
PS Our surgical results are almost as good as brachy, and much better than the 67 % mentioned. Horses for courses though !
Your irritative urinary symtpoms are very common post brachy for the first 3 - 4 months. likewise the need for Flomaxtra - type pills. The need for such pills should reduce soon.
If your disease was Gleason 6 - 7 , you have moderate risk disease that hopefully should be dealt with by the seeds . In the longer term, as a urologist, I would like to see your PSA to down to below 1, after brachytherapy. (You can get a PSA "bounce" up to 2 - 3, about a year to a year and half post treatment).
You should make a point of finding out whether your post treatment dosimetry was adequate (i.e did you get the best possible dosage from the seeds) . This would have been checked by means of a CT or MRI scan done after your seed implant : this is important in knowing that the whole gland has adequate treatment.
Continued good luck to you LR.
Aussie
PS Our surgical results are almost as good as brachy, and much better than the 67 % mentioned. Horses for courses though !
Last edited by aussiepax; 10th Dec 2008 at 10:12. Reason: poor spelling
Just been told that I have P.C. (gleeson 3+4 whatever that really means).
My question is, how do you identify that the person giving me advise is as good as possible. There is no 'score system' that 1 can judge a specialists/surgeons skill advise against. Initial advise has been surgery.
Early days for me so all just a little scary and at 57 have only finished 50% of what I want before I leave this mortal perch. I fully intend to achieve all my goals, so just want to base my next steps on the best advise possible.
My question is, how do you identify that the person giving me advise is as good as possible. There is no 'score system' that 1 can judge a specialists/surgeons skill advise against. Initial advise has been surgery.
Early days for me so all just a little scary and at 57 have only finished 50% of what I want before I leave this mortal perch. I fully intend to achieve all my goals, so just want to base my next steps on the best advise possible.
Psychophysiological entity
Thanks for that, Aussieand all.
I'm trying to work my way through all sorts of problems at this juncture of life. The cancer has seemed like minor, if rather tedious, interruption into what has become a chronic nightmare. Having said this, I accept life's challenges for what they are, and am just hanging on...flying through a storm, as I put it the other day. The endless banter on JB in my case, is an indicator of the extent One can go to to avoid reality.
maxter. I read obgraham's post several times. Getting skilled advise that you can trust is always problematical. Humans are strange creatures, and sometimes interaction that is good in one instance, is bizarrely inadequate in another. But all in all, I think you can trust this finding as a starting point at least.
I assume that you've had a biopsy. The samples should be very carefully laid out for the lab work, so that the physical position of each sample is reasonably well known. I wasn't ready to accept this as the only indicator with my Gleason 7 - containing among others, one 4+3 sample...but the surgeon in Texas was. Robotic removal, without any further tests. As I've said, that wasn't enough for me.
For reasons that I don't understand, I think a 3+4 is better than a 4+3. The overall Gleason is the guideline, but the 'ferocity' of localized bits is indicated by the layout of those numbers. I'm sure you'll be fine providing you follow expert advise.
Right now, as I've said, it is the almost total lack of side affects that leave me wondering if enough has been done. aussie's post has, or will, galvanize me into planning the next stage, but if the treatment so far turns out to be adequate, it will have been a very minor burden to bear.
All in all, having been diagnosed at this stage, you're way ahead of the game statistically. Good luck.
I'm trying to work my way through all sorts of problems at this juncture of life. The cancer has seemed like minor, if rather tedious, interruption into what has become a chronic nightmare. Having said this, I accept life's challenges for what they are, and am just hanging on...flying through a storm, as I put it the other day. The endless banter on JB in my case, is an indicator of the extent One can go to to avoid reality.
maxter. I read obgraham's post several times. Getting skilled advise that you can trust is always problematical. Humans are strange creatures, and sometimes interaction that is good in one instance, is bizarrely inadequate in another. But all in all, I think you can trust this finding as a starting point at least.
I assume that you've had a biopsy. The samples should be very carefully laid out for the lab work, so that the physical position of each sample is reasonably well known. I wasn't ready to accept this as the only indicator with my Gleason 7 - containing among others, one 4+3 sample...but the surgeon in Texas was. Robotic removal, without any further tests. As I've said, that wasn't enough for me.
For reasons that I don't understand, I think a 3+4 is better than a 4+3. The overall Gleason is the guideline, but the 'ferocity' of localized bits is indicated by the layout of those numbers. I'm sure you'll be fine providing you follow expert advise.
Right now, as I've said, it is the almost total lack of side affects that leave me wondering if enough has been done. aussie's post has, or will, galvanize me into planning the next stage, but if the treatment so far turns out to be adequate, it will have been a very minor burden to bear.
All in all, having been diagnosed at this stage, you're way ahead of the game statistically. Good luck.
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Hi Maxter.
Well a Gleason 3 + 4 is better than a 4+ 3, as the first number refers to the most prominent grade (tumour activity) under the microscope. The other factors relevant are your pre biopsy PSA result and the size and texture of your prostate. Having said all that, for you at only 57 years old, the correct treatment is a radical prostatectomy operation. That is providing your staging scans show that you are free from distant disease (metastasis ) This operation has the best chance of curing the disease, from 70 - 95 % depending on the above data points, and the best method of normaising your life expectancy.
The potential downsides are erectile dysfunction and urinary incontinence, both manageable, and the former a more likely problem than the latter.
The method of surgery, whether open, laparoscopic or robotic is not so important, as all have the same incontincence and ED rates, despite what various of my colleagues and other non-urologists may pitch to you . The important thing is that you feel comfortable with your surgeon. Are you in Oz, Maxter ? feel free to private mail me if you want further local advice or to check further on what you have been told. I'm [email protected] .
Regards , (urologist) Graham
Well a Gleason 3 + 4 is better than a 4+ 3, as the first number refers to the most prominent grade (tumour activity) under the microscope. The other factors relevant are your pre biopsy PSA result and the size and texture of your prostate. Having said all that, for you at only 57 years old, the correct treatment is a radical prostatectomy operation. That is providing your staging scans show that you are free from distant disease (metastasis ) This operation has the best chance of curing the disease, from 70 - 95 % depending on the above data points, and the best method of normaising your life expectancy.
The potential downsides are erectile dysfunction and urinary incontinence, both manageable, and the former a more likely problem than the latter.
The method of surgery, whether open, laparoscopic or robotic is not so important, as all have the same incontincence and ED rates, despite what various of my colleagues and other non-urologists may pitch to you . The important thing is that you feel comfortable with your surgeon. Are you in Oz, Maxter ? feel free to private mail me if you want further local advice or to check further on what you have been told. I'm [email protected] .
Regards , (urologist) Graham
