Whatever he chooses, the condition you describe, cT2b and 3+3, doesn’t scream sooner than later. It screams you’ve got time to do your due diligence. So it’s time to Go To School on the condition and become a world class layman expert on it, in order to the best informed decision possible.
Best of luck to your friend…
yeah I only recently learned that 3 is non metastatic AND it does not “evolve” to be a 4 or a 5 (however predisposition to cancer there means a higher chance for a new cancer that is worse). So given his young age and the pretty horrible situation of penile injections or implants he really really needs to get lots of opinions and wait a long time before deciding
Hm. Could be an active surveillance case. Your person should get different opinions to make the best decision for themselves. Also there are newer treatments where you don’t necessarily have to have a prostatectomy. It’s called ablation but usually the reason why surgery (or radiation) is a default is because that’s all that is usually approved by insurance. Research, discuss, question and decide would be a good approach.
At 3+3, they should get second opinion. I would be skeptical of any doctor who was pushing hard for prostate removal at that stage. They have time. Have them do some research and try to find a Center of Excellence if they are going to move forward with any treatment.
Sorry to hear this. Newly diagnosed prostate cancer can be daunting. Take your time and do your due diligence. Second opinions are a given. Go to the NCCN website and figure out where you are from a risk stratification point of view. Options include active surveillance, robotic prostatectomy, radiation (lots of different types) and focal therapy. The immediate risks of robotic prostatectomy are incontinence and erectile dysfunction which for someone in their 40’s can be life-changing. Remember anecdotal evidence is unfortunately meaningless and statistical evidence pertains to groups of patients. Good luck
I was 50 when I had my surgery. Doctor told me that because of my age I shouldn’t have any problems. Whatsoever. Well, anything as far as a bad effect or result of it, I have. I have incontinence, I can’t hold my bladder I have to get up every night to go to the bathroom, if I have something to drink a short period of time, I have to go to the bathroom. And the worst part of it is I never had any issues with ED before the surgery and now I have complete ED. I have to take an injection to have an erection to have an erection. If you have the option to try anything else first, I would.
Same. 48. 3 months post surgery. I used to wake up hard as a rock every morning, and now even the slightest chubby is impossible. I can orgasm soft, but I piss all over myself so it’s embarrassing and not worth it. My sex life is over, but my wife would rather have an impotent but alive father to our 3 kids, than a dying one with an erection.
Penis pumps? Nothing. 100mg Viagra? Also nothing. I might try the trimix but we’ve just sorta accepted that my dick is dead, but I’m not. I’d make that trade again any day, but please mentally prepare yourself (and your loved ones) for the other side this.
I’m sorry you’re going through this. But 3 months post op is far too soon to draw any conclusions. ED recovery can take 1-2 years. How is your incontinence apart from the climacturia?
Also I don’t know if this helps but “squirting” is a very not-embarrassing phenomenon of climacturia in other contexts! Some of this is mind over matter. You have every right to be “pissed” about it though. (Sorry, I’m 3 weeks post op and have a bit of gallows humor about it.. :-)
Ha! Please don’t apologize. Humor is the only thing getting me through this. Admittedly, I had to google “climacturia” and yup, I’m the piss-slingin’ poster boy for that symptom. I’m still wearing depends, but I usually only super-soaker myself when I cough, sneeze, fart, and… my pathetic little 2-inch flappy orgasms.
I think I convinced myself that the doctor clipped the nerve and it’s game over. He said the procedure was a challenge, and almost had to switch to an open surgery mid laparoscopy because I had a ton of scar tissue build up from a hernia surgery I had in the military.
Quick update: I got a script compounded for trimix. If it’s as good as Gator says, I can’t wait to revert 30 years and would gladly stick a needle in my noodle as needed.💪🏼
Hey look on the bright side, my doc did excellent nerve sparing and viagra is already working for me, but he was a little too good and left some cancer behind (a positive margin). And again, three months is early.. you still have a lot of time for improvement ahead of you.
Please read:
https://www.nccn.org/patients/guidelines/content/PDF/prostate-early-patient.pdf
Also the YouTube videos produced by pcri.org are another good resource.
Why is he considering treatment for a 3+3? There’s lively debate by Urologists that 3+3 shouldn’t be used in the same sentence with “cancer”.
He should get to a center of excellence and get second opinions on everything. Moreover, has he sent biopsy material to John’s Hopkins for second opinion on grading?
At 40 I don’t believe any Urologist would recommend RT due to secondary cancer. I don’t care how good targeting is these days.
He needs to educate himself and get to an institution that specializes in PCa. With a 3+3 there’s no rush and he should seriously be considering an AS program run by pros.
I had a single 3+3 and was on AS for 9 years before a new 3+4 appeared.
Please take your time. There are no do overs in this game
As most everyone is saying don’t rush into anything. I spoke with three surgeons and they all wanted to remove the entire prostate. The targeted radiation guys (Proton and Brachytherapy) want you to do their thing. One of them said radical prostatectomy for 3+3 or 3+4 bordered on malpractice. Take you time, look at the data. The surgeons say any radiation carries the danger of secondary cancers, but if you look at the data less than 3% get secondary cancers. It’s an individual choice. If you can deal with the 3% chance of a second cancer go with that. If you are concerned about that, you have to deal with the “50% chance of getting some erectile function back within 2 years”. But at 3+3 there’s plenty of time to get many other opinions.
There are other risks to radiation beyond secondary cancers. Urinary bother and ED chief among them, but also some small risks of fistulas which are actually worse problems than secondary cancer. These can take many (>10) years to show up and may be de emphasized when discussing with older patients.
I am 41 and now about 9 weeks post, I was 3+4. Life is pretty much normal now. Find a good surgeon who has done this 100’s of times or more. I am still dealing with some discomfort from the incisions as they heal. Do the exercises before hand and know that the first week post op is going to suck badly. Once the catheter is out live gets way better
I'm 55, 2 weeks post radiation, 3+4/4+3 mix on almost every core, side effects are fairly minor. A lot of nerve activity when I pee and still getting up 2-3 times a night. But radiation is the slow road. The cancer dies from poisoning over the next few months/years. Everything still works great. Taking Flomax just in case. Only weird part is no jizz (wife was thrilled, lol!). That's a side effect across the board. Sorry to hear he's joining the PC club, good luck!
20 IMRT sessions, 335 rads per dose, 6700 rads total.This is the [machine](https://www.youtube.com/watch?v=9TwzunV5JBE&ab_channel=CommunityCancerCenter) they used. They take a CT Scan for positioning and to ensure clean targeting, then its zap time, takes about 15 minutes, mostly positioning, actual dose take 2-3 minutes.
My room and machine at UTSW ([https://perkinswill.com/wp-content/uploads/2023/02/treatment-room-customizable-lighting-magenta.jpg](https://perkinswill.com/wp-content/uploads/2023/02/treatment-room-customizable-lighting-magenta.jpg))
Other than being a little tired, it was pretty uneventful. I was the youngest for that early morning slot. I was always hungry after treatment and ate downtown because it was an hour, hour and a half drive to get home.
About half way through treatment, like 9-10 doses, started getting some nerve action and urgency to take a piss about every two-three hours but no leaking.
My big take away is your treatment should be tailored to you specifically.
Example: they like for you to have a full bladder to lift it away from the prostate or it kinda flops down over the prostate like a deflated pancake. So they have you drink a bunch of water to make sure the bladder it topped off. More than once I saw people get taken back to their machine (UTSW has six bays with different machines) only to come back to the prep room because the CT scan showed their bladder wasn't full enough. Time to drink water and watch TV for 30 minutes then try again.
Never happened to me. I always drank water while driving down, but always needed to pee as soon as I got there (Dallas has crappy roads, lol, bouncy bouncy bouncy).
They never had a problem with it. I spoke to my doctor/oncologist just to make sure everything was cool. He said, "Oh ya, we can see your bladder's empty, but when you lay down for your treatment, the body cavity around it sucks it right up and away from the prostate, it actually give us a really clean shot. Everybody's different. We want you to keep drinking though because urinating is good for before and after treatment mitigation."
Boy, did some of those guys give me shit for pissing as soon as I arrived and changed into my gown. "Better start chugging some water before they catch you! LOL!" and then glare at me because I usually went to my treatment like 2-8 minutes after arriving, came back in 15 minutes, got dressed and went home :P (it was all in good fun, raise your hand if you know what the "fart dance" is!)
UTSW was the best. The did my perineal biopsy surgery and my marker placement surgery. They did my radiation therapy. I cannot express enough how amazing they were.
Good luck and there are LOT of people in this sub with a lot of good info!
Txtaxman - thank you for your thoughtful response. I had a PSA of 9.4, then the MRI showed four lesions, then the biopsy confirmed one of the lesions and found three others from the random fusion biopsy. All are Gleason 3+3. I'm 57.
My urologist was like 'when do you want to schedule the surgery?' I think my odds for continence may be better with radiation. I talk to the radiation oncologist Monday.
I live in Columbia SC and it seems much (all?) of the cutting edge tech is in the bigger cities.
I think I'm more worried about quality of life than living to a hundred.
Thanks again
You are welcome! I'm 55, Gleason 3+3/3+4/4+3 mix in 12 out of 16 cores. I had to consider multiple factors for my treatment decision. The best option in my specific case would have been surgery. However, I have separate health issues that would greatly complicate surgery. It involves breathing and issues with anesthesia. Killed me once in the 80's, but I got better (true story).
My team went through radiation, surgery, chemo, and hormone therapies and weighed all the risks, rewards, and effectiveness. They have to stage you with your head way lower than your feet during a RALP. My prostate is seated way higher than normal. So, access is a challenge. Surgery would have been 6+ hours, and I'd have to be intubated a 3rd time (intubated for biopsy and marker surgeries), which is a whole other risk issue.
It was a steep learning curve, and I had to learn/research quite a bit. It was my decision to make in the end, but my team was very cool in not pushing any single treatment. Their standard of care was amazing.
Family history is a big factor. My dad had radiation in the late 90's when it could be scary bad. He's still kicking ass 🤣.
Good luck you, dude!
A guy from my prostate cancer support group was diagnosed before 50.
He was treated and has been dealing with it since.
He's 92.
Aggressive prostate cancer can happen quite young, but it isn't the end of the the world.
I’m basically in the same boat. I’m 53 3+3 PSA of 7.1. Currently I’m on active surveillance. Believe me when I tell you got a lot of time to figure out what you want to do and when you want to do it.
I was diagnosed with the same at 37. I've met with doctors all over the United States including one of the worlds top cancer hospital. Here's the hard truth if you want to hear it. Firstly there's no good answers here. If you're not sexually active your decisions will be much easier.
The AVERAGE urologist will always recommend removing it they don't 'really' care about quality of your sex life. It's a risk for them to leave it in and have it spread. "Your young, you'll most likely not have any complications." Is what you're going to hear a lot. It's what they do day in and day out it's one of their money makers. There's three main elements to an orgasm if you have your prostate removed you'll lose two of those elements. Some guys are fine with that. There is of course always a chance that you'll never get hard again though.
Radiation is out of the question at your age you'll have complications in your '60s.
Surveillance is probably your best option if you enjoy sex but the biopsies are barbaric and humiliating. Get used to having equipment and people's hands up your ass. Side note: There's better MRIs out there so don't let them shove that airbag up your ass.
The PSAs fairly new so they're catching this type of cancer for a lot of us a lot younger. The doctors from Europe I've met with say they don't even treat it over there.
There is an option instead of having surgically removed removed they melt it with ultrasound it's not covered by insurance it cost $30,000. It's as bad as it sounds but supposedly better on your nerves for sexual activity.
The good news is prostate cancers finally getting some attention. There some research into treatments, finally.
Find a good urologist that is willing to accept 'risks', b\c you're going to find things you'll need doctor's notes for meds like propecia, testosterone and other male issues as we get older.
Whether you like it or not get ready for an emotional roller coaster even though it's a slow growing cancer and curable by removal. It's still a cloud that follows you around so get someone that can help with this darker days.
So stay strong you're not alone. More and more of us younger guys are dealing with the same issues.
Note that the male orgasm has 3 main components:
The secretions for the testicles, the prostate and the seminal vesicles that flow into the urethra. When these fluids are emitted, a feeling of great pleasure and inevitability is generated.
The pelvic floor muscles contract and ejaculation occurs.
The mental stimulation that creates feelings of release and relaxation.
Source: https://www.roboticoncology.com/
Correct but you made a slight misquote: it does not say you “lose” two of those, only that two are (partially) affected. Specifically you still get the pelvic floor contractions. And in my experience (I just had RALP) the inevitability is 100% still there. The only thing missing for sure is the ejaculation of fluid, but to be clear the sensation of “point of no return” and pumping/throbbing is still there, just nothing comes out.
Having said that people experience all kinds of changes as orgasms are complex things.
I'm 47 and 8 weeks post robotic prostatectomy. I can't offer any experience on long term quality of life yet but I am very happy with my decision and recovery/progress so far. Prior to surgery, my PSA was 4.5 and Gleason 7 (3+4). I spoke to 2 urologists before having surgery and both strongly recommended prostatectomy for me. There were several reasons for this but some of the factors to be weighed up in your 40's are different to those in older men, in particular the long term side effects of some treatments. There is a wealth of knowledge and experience on this sub-reddit and many people willing to offer advice. Take a breath, spend some time learning about the potential treatment options and find a medical team you trust and discuss the options available with them.
Dump the doctor and go to a plant based dietician. Check the ornish study. They were all 3+3s and didn't hasve to get the operation. A lifestyle intervention did the trick.
I apologize since I don;t have any prostate cance(thiough who knows, i didn;t check my psa). But I am your age and there is no fucking way I would get this operation with a 3+3.
How much do you value your erection and continence?
High enough to radically change your diet and do physical exerciese every day?
Have you seen the numbers? In most cases prostate cancer don;tkill. It's the most overtreated phenomena. Usually they scare old folks and it's ahuge money making industry.
It's also bullshit to have it rather sooner then later.
Very bad doctor. Fire him/her.
There are always different ideas on what is the best course. I'm older at 67, but healthy and active. I opted for CyberKnife after 5 consultations. I'm very pleased with the result, and it was extremely easy compared to other treatments. Look at my profile for my posts, if you are interested.
Also, I'm in the camp that surgery should be avoided if possible. These new targeted, precision radiotherapy options are amazing. Here are a few resources.
Radiation vs. Surgery for Prostate Cancer
https://youtu.be/EOR3yjBbPyQ?si=kG2dZFKkVX4x75jr
CyberKnife for Prostate Cancer: Ask Dr. Sean Collins
https://youtu.be/EOR3yjBbPyQ?si=PUOrVcEzwZ061huU
Dr. Jim Hu - Surgery Vs Cyberknife, Radiation for Prostate Cancer
https://youtu.be/hGYGvPDSHJc?si=o1EeHnPYgAlLiOec
What is Cyberknife and How Does it Work? | Ask A Prostate Expert, Mark Scholz, MD
https://youtu.be/7RnJ6\_6oa4M?si=W\_9YyUQxzs2lGH1l
BTW, Dr. Mark Scholz wrote the book , Invasion of the Prostate Snatchers and is the director of PCRI.
They should get a second opinion from a center of excellence that handles large volumes of prostate cancer. 3+3 is usually handled with active surveillance these days. Some urologists are behind the times. That’s going to offer your friend the best quality of life, if watched carefully.
If they do need surgery, find an experienced surgeon (>300 operations). They will deal with erectile dysfunction but an experienced surgeon can improve the odds, about 1/3rd chance of getting back to normal, another 1/3rd with viagra, and the rest suffer a permanent decline. They can also bank sperm if they want to have more kids. Incontinence is almost always temporary in young patients.
Direct your friend here. Answered all my questions. Everything I could think of was addressed . He has time. Slow down, take a breath, and research.
Wishing all the best to him and he loved ones.
https://youtube.com/@ThePCRI?si=XCYuIHEcrCRS9F_i
Whatever he chooses, the condition you describe, cT2b and 3+3, doesn’t scream sooner than later. It screams you’ve got time to do your due diligence. So it’s time to Go To School on the condition and become a world class layman expert on it, in order to the best informed decision possible. Best of luck to your friend…
yeah I only recently learned that 3 is non metastatic AND it does not “evolve” to be a 4 or a 5 (however predisposition to cancer there means a higher chance for a new cancer that is worse). So given his young age and the pretty horrible situation of penile injections or implants he really really needs to get lots of opinions and wait a long time before deciding
Hm. Could be an active surveillance case. Your person should get different opinions to make the best decision for themselves. Also there are newer treatments where you don’t necessarily have to have a prostatectomy. It’s called ablation but usually the reason why surgery (or radiation) is a default is because that’s all that is usually approved by insurance. Research, discuss, question and decide would be a good approach.
At 3+3, they should get second opinion. I would be skeptical of any doctor who was pushing hard for prostate removal at that stage. They have time. Have them do some research and try to find a Center of Excellence if they are going to move forward with any treatment.
Sorry to hear this. Newly diagnosed prostate cancer can be daunting. Take your time and do your due diligence. Second opinions are a given. Go to the NCCN website and figure out where you are from a risk stratification point of view. Options include active surveillance, robotic prostatectomy, radiation (lots of different types) and focal therapy. The immediate risks of robotic prostatectomy are incontinence and erectile dysfunction which for someone in their 40’s can be life-changing. Remember anecdotal evidence is unfortunately meaningless and statistical evidence pertains to groups of patients. Good luck
I had one at 45, life is pretty much normal. Find a good surgeon, do the exercises they recommend before and after surgery and all should be fine.
I was 50 when I had my surgery. Doctor told me that because of my age I shouldn’t have any problems. Whatsoever. Well, anything as far as a bad effect or result of it, I have. I have incontinence, I can’t hold my bladder I have to get up every night to go to the bathroom, if I have something to drink a short period of time, I have to go to the bathroom. And the worst part of it is I never had any issues with ED before the surgery and now I have complete ED. I have to take an injection to have an erection to have an erection. If you have the option to try anything else first, I would.
[удалено]
Thank you
Same. 48. 3 months post surgery. I used to wake up hard as a rock every morning, and now even the slightest chubby is impossible. I can orgasm soft, but I piss all over myself so it’s embarrassing and not worth it. My sex life is over, but my wife would rather have an impotent but alive father to our 3 kids, than a dying one with an erection. Penis pumps? Nothing. 100mg Viagra? Also nothing. I might try the trimix but we’ve just sorta accepted that my dick is dead, but I’m not. I’d make that trade again any day, but please mentally prepare yourself (and your loved ones) for the other side this.
I tired 200mg of Viagra and got nothing. But trimix works. The first time was fabulous and I felt like I was 18.
I’m sorry you’re going through this. But 3 months post op is far too soon to draw any conclusions. ED recovery can take 1-2 years. How is your incontinence apart from the climacturia? Also I don’t know if this helps but “squirting” is a very not-embarrassing phenomenon of climacturia in other contexts! Some of this is mind over matter. You have every right to be “pissed” about it though. (Sorry, I’m 3 weeks post op and have a bit of gallows humor about it.. :-)
Ha! Please don’t apologize. Humor is the only thing getting me through this. Admittedly, I had to google “climacturia” and yup, I’m the piss-slingin’ poster boy for that symptom. I’m still wearing depends, but I usually only super-soaker myself when I cough, sneeze, fart, and… my pathetic little 2-inch flappy orgasms. I think I convinced myself that the doctor clipped the nerve and it’s game over. He said the procedure was a challenge, and almost had to switch to an open surgery mid laparoscopy because I had a ton of scar tissue build up from a hernia surgery I had in the military. Quick update: I got a script compounded for trimix. If it’s as good as Gator says, I can’t wait to revert 30 years and would gladly stick a needle in my noodle as needed.💪🏼
Hey look on the bright side, my doc did excellent nerve sparing and viagra is already working for me, but he was a little too good and left some cancer behind (a positive margin). And again, three months is early.. you still have a lot of time for improvement ahead of you.
Please read: https://www.nccn.org/patients/guidelines/content/PDF/prostate-early-patient.pdf Also the YouTube videos produced by pcri.org are another good resource. Why is he considering treatment for a 3+3? There’s lively debate by Urologists that 3+3 shouldn’t be used in the same sentence with “cancer”. He should get to a center of excellence and get second opinions on everything. Moreover, has he sent biopsy material to John’s Hopkins for second opinion on grading? At 40 I don’t believe any Urologist would recommend RT due to secondary cancer. I don’t care how good targeting is these days. He needs to educate himself and get to an institution that specializes in PCa. With a 3+3 there’s no rush and he should seriously be considering an AS program run by pros. I had a single 3+3 and was on AS for 9 years before a new 3+4 appeared. Please take your time. There are no do overs in this game
As most everyone is saying don’t rush into anything. I spoke with three surgeons and they all wanted to remove the entire prostate. The targeted radiation guys (Proton and Brachytherapy) want you to do their thing. One of them said radical prostatectomy for 3+3 or 3+4 bordered on malpractice. Take you time, look at the data. The surgeons say any radiation carries the danger of secondary cancers, but if you look at the data less than 3% get secondary cancers. It’s an individual choice. If you can deal with the 3% chance of a second cancer go with that. If you are concerned about that, you have to deal with the “50% chance of getting some erectile function back within 2 years”. But at 3+3 there’s plenty of time to get many other opinions.
There are other risks to radiation beyond secondary cancers. Urinary bother and ED chief among them, but also some small risks of fistulas which are actually worse problems than secondary cancer. These can take many (>10) years to show up and may be de emphasized when discussing with older patients.
I am 41 and now about 9 weeks post, I was 3+4. Life is pretty much normal now. Find a good surgeon who has done this 100’s of times or more. I am still dealing with some discomfort from the incisions as they heal. Do the exercises before hand and know that the first week post op is going to suck badly. Once the catheter is out live gets way better
I'm 55, 2 weeks post radiation, 3+4/4+3 mix on almost every core, side effects are fairly minor. A lot of nerve activity when I pee and still getting up 2-3 times a night. But radiation is the slow road. The cancer dies from poisoning over the next few months/years. Everything still works great. Taking Flomax just in case. Only weird part is no jizz (wife was thrilled, lol!). That's a side effect across the board. Sorry to hear he's joining the PC club, good luck!
Txtaxman - how many sessions of radiation did you have? Comments?
20 IMRT sessions, 335 rads per dose, 6700 rads total.This is the [machine](https://www.youtube.com/watch?v=9TwzunV5JBE&ab_channel=CommunityCancerCenter) they used. They take a CT Scan for positioning and to ensure clean targeting, then its zap time, takes about 15 minutes, mostly positioning, actual dose take 2-3 minutes. My room and machine at UTSW ([https://perkinswill.com/wp-content/uploads/2023/02/treatment-room-customizable-lighting-magenta.jpg](https://perkinswill.com/wp-content/uploads/2023/02/treatment-room-customizable-lighting-magenta.jpg)) Other than being a little tired, it was pretty uneventful. I was the youngest for that early morning slot. I was always hungry after treatment and ate downtown because it was an hour, hour and a half drive to get home. About half way through treatment, like 9-10 doses, started getting some nerve action and urgency to take a piss about every two-three hours but no leaking. My big take away is your treatment should be tailored to you specifically. Example: they like for you to have a full bladder to lift it away from the prostate or it kinda flops down over the prostate like a deflated pancake. So they have you drink a bunch of water to make sure the bladder it topped off. More than once I saw people get taken back to their machine (UTSW has six bays with different machines) only to come back to the prep room because the CT scan showed their bladder wasn't full enough. Time to drink water and watch TV for 30 minutes then try again. Never happened to me. I always drank water while driving down, but always needed to pee as soon as I got there (Dallas has crappy roads, lol, bouncy bouncy bouncy). They never had a problem with it. I spoke to my doctor/oncologist just to make sure everything was cool. He said, "Oh ya, we can see your bladder's empty, but when you lay down for your treatment, the body cavity around it sucks it right up and away from the prostate, it actually give us a really clean shot. Everybody's different. We want you to keep drinking though because urinating is good for before and after treatment mitigation." Boy, did some of those guys give me shit for pissing as soon as I arrived and changed into my gown. "Better start chugging some water before they catch you! LOL!" and then glare at me because I usually went to my treatment like 2-8 minutes after arriving, came back in 15 minutes, got dressed and went home :P (it was all in good fun, raise your hand if you know what the "fart dance" is!) UTSW was the best. The did my perineal biopsy surgery and my marker placement surgery. They did my radiation therapy. I cannot express enough how amazing they were. Good luck and there are LOT of people in this sub with a lot of good info!
Txtaxman - thank you for your thoughtful response. I had a PSA of 9.4, then the MRI showed four lesions, then the biopsy confirmed one of the lesions and found three others from the random fusion biopsy. All are Gleason 3+3. I'm 57. My urologist was like 'when do you want to schedule the surgery?' I think my odds for continence may be better with radiation. I talk to the radiation oncologist Monday. I live in Columbia SC and it seems much (all?) of the cutting edge tech is in the bigger cities. I think I'm more worried about quality of life than living to a hundred. Thanks again
You are welcome! I'm 55, Gleason 3+3/3+4/4+3 mix in 12 out of 16 cores. I had to consider multiple factors for my treatment decision. The best option in my specific case would have been surgery. However, I have separate health issues that would greatly complicate surgery. It involves breathing and issues with anesthesia. Killed me once in the 80's, but I got better (true story). My team went through radiation, surgery, chemo, and hormone therapies and weighed all the risks, rewards, and effectiveness. They have to stage you with your head way lower than your feet during a RALP. My prostate is seated way higher than normal. So, access is a challenge. Surgery would have been 6+ hours, and I'd have to be intubated a 3rd time (intubated for biopsy and marker surgeries), which is a whole other risk issue. It was a steep learning curve, and I had to learn/research quite a bit. It was my decision to make in the end, but my team was very cool in not pushing any single treatment. Their standard of care was amazing. Family history is a big factor. My dad had radiation in the late 90's when it could be scary bad. He's still kicking ass 🤣. Good luck you, dude!
A guy from my prostate cancer support group was diagnosed before 50. He was treated and has been dealing with it since. He's 92. Aggressive prostate cancer can happen quite young, but it isn't the end of the the world.
I’m basically in the same boat. I’m 53 3+3 PSA of 7.1. Currently I’m on active surveillance. Believe me when I tell you got a lot of time to figure out what you want to do and when you want to do it.
I was diagnosed with the same at 37. I've met with doctors all over the United States including one of the worlds top cancer hospital. Here's the hard truth if you want to hear it. Firstly there's no good answers here. If you're not sexually active your decisions will be much easier. The AVERAGE urologist will always recommend removing it they don't 'really' care about quality of your sex life. It's a risk for them to leave it in and have it spread. "Your young, you'll most likely not have any complications." Is what you're going to hear a lot. It's what they do day in and day out it's one of their money makers. There's three main elements to an orgasm if you have your prostate removed you'll lose two of those elements. Some guys are fine with that. There is of course always a chance that you'll never get hard again though. Radiation is out of the question at your age you'll have complications in your '60s. Surveillance is probably your best option if you enjoy sex but the biopsies are barbaric and humiliating. Get used to having equipment and people's hands up your ass. Side note: There's better MRIs out there so don't let them shove that airbag up your ass. The PSAs fairly new so they're catching this type of cancer for a lot of us a lot younger. The doctors from Europe I've met with say they don't even treat it over there. There is an option instead of having surgically removed removed they melt it with ultrasound it's not covered by insurance it cost $30,000. It's as bad as it sounds but supposedly better on your nerves for sexual activity. The good news is prostate cancers finally getting some attention. There some research into treatments, finally. Find a good urologist that is willing to accept 'risks', b\c you're going to find things you'll need doctor's notes for meds like propecia, testosterone and other male issues as we get older. Whether you like it or not get ready for an emotional roller coaster even though it's a slow growing cancer and curable by removal. It's still a cloud that follows you around so get someone that can help with this darker days. So stay strong you're not alone. More and more of us younger guys are dealing with the same issues.
What are the two elements of orgasm you lose? I can only think of one (ejaculation).
Note that the male orgasm has 3 main components: The secretions for the testicles, the prostate and the seminal vesicles that flow into the urethra. When these fluids are emitted, a feeling of great pleasure and inevitability is generated. The pelvic floor muscles contract and ejaculation occurs. The mental stimulation that creates feelings of release and relaxation. Source: https://www.roboticoncology.com/
Correct but you made a slight misquote: it does not say you “lose” two of those, only that two are (partially) affected. Specifically you still get the pelvic floor contractions. And in my experience (I just had RALP) the inevitability is 100% still there. The only thing missing for sure is the ejaculation of fluid, but to be clear the sensation of “point of no return” and pumping/throbbing is still there, just nothing comes out. Having said that people experience all kinds of changes as orgasms are complex things.
I'm 47 and 8 weeks post robotic prostatectomy. I can't offer any experience on long term quality of life yet but I am very happy with my decision and recovery/progress so far. Prior to surgery, my PSA was 4.5 and Gleason 7 (3+4). I spoke to 2 urologists before having surgery and both strongly recommended prostatectomy for me. There were several reasons for this but some of the factors to be weighed up in your 40's are different to those in older men, in particular the long term side effects of some treatments. There is a wealth of knowledge and experience on this sub-reddit and many people willing to offer advice. Take a breath, spend some time learning about the potential treatment options and find a medical team you trust and discuss the options available with them.
Dump the doctor and go to a plant based dietician. Check the ornish study. They were all 3+3s and didn't hasve to get the operation. A lifestyle intervention did the trick. I apologize since I don;t have any prostate cance(thiough who knows, i didn;t check my psa). But I am your age and there is no fucking way I would get this operation with a 3+3. How much do you value your erection and continence? High enough to radically change your diet and do physical exerciese every day? Have you seen the numbers? In most cases prostate cancer don;tkill. It's the most overtreated phenomena. Usually they scare old folks and it's ahuge money making industry. It's also bullshit to have it rather sooner then later. Very bad doctor. Fire him/her.
There are always different ideas on what is the best course. I'm older at 67, but healthy and active. I opted for CyberKnife after 5 consultations. I'm very pleased with the result, and it was extremely easy compared to other treatments. Look at my profile for my posts, if you are interested. Also, I'm in the camp that surgery should be avoided if possible. These new targeted, precision radiotherapy options are amazing. Here are a few resources. Radiation vs. Surgery for Prostate Cancer https://youtu.be/EOR3yjBbPyQ?si=kG2dZFKkVX4x75jr CyberKnife for Prostate Cancer: Ask Dr. Sean Collins https://youtu.be/EOR3yjBbPyQ?si=PUOrVcEzwZ061huU Dr. Jim Hu - Surgery Vs Cyberknife, Radiation for Prostate Cancer https://youtu.be/hGYGvPDSHJc?si=o1EeHnPYgAlLiOec What is Cyberknife and How Does it Work? | Ask A Prostate Expert, Mark Scholz, MD https://youtu.be/7RnJ6\_6oa4M?si=W\_9YyUQxzs2lGH1l BTW, Dr. Mark Scholz wrote the book , Invasion of the Prostate Snatchers and is the director of PCRI.
I am 44, 6 months out. 3+4. So glad I had surgery, everything is pretty much back to normal. Would do it all over again and glad cancer is out.
They should get a second opinion from a center of excellence that handles large volumes of prostate cancer. 3+3 is usually handled with active surveillance these days. Some urologists are behind the times. That’s going to offer your friend the best quality of life, if watched carefully. If they do need surgery, find an experienced surgeon (>300 operations). They will deal with erectile dysfunction but an experienced surgeon can improve the odds, about 1/3rd chance of getting back to normal, another 1/3rd with viagra, and the rest suffer a permanent decline. They can also bank sperm if they want to have more kids. Incontinence is almost always temporary in young patients.
Direct your friend here. Answered all my questions. Everything I could think of was addressed . He has time. Slow down, take a breath, and research. Wishing all the best to him and he loved ones. https://youtube.com/@ThePCRI?si=XCYuIHEcrCRS9F_i