radical prostatectomy or laparoscopic radical prostatectomy

FormerMember
FormerMember
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Hi, i am 45 and with a gleason 6 grade (2 cores from 15 with under 10% cancer in each) so am early stage. My Urologist has suggested active surveillance with a view for surgery if/when things start to progress.

I am keen to gain some more info from people that have experienced surgery radical prostatectomy or laparoscopic radical prostatectomy. What is better is they both achieve the same result ? The post surgery recovery period how traumatic was that ? How have you been affected i.e any incontinence / sexual function loss / mentally etc ?

Thanks for the advice

  • FormerMember
    FormerMember

    Hello Mark,

    I had a Da Vinci robotic prostatectomy 4 years ago when I was 58. My Gleason then was thought to be 3+4 and my Staging was thought to be T2.

    I didn’t really have a choice, as such. I could have had active surveillance but was told I should only go for that short term, no longer than 6 months, if I had something important coming up. In reality my only treatment choice was surgery. Whether that would still have been the case if the MRI scans had shown the true spread, I don’t know. 

    As far as I know both open and laparoscopic surgery achieve the same result but, I was told, the recovery from open surgery is longer. I was also told that the difference between laparoscopic and da Vinci robotic is that although both are “keyhole surgery”, robotic is more accurate when it comes to nerve sparing. Incidentally, although the term “keyhole” is used, it is still major surgery and it will take you time to recover. If you click here there‘s a section on the Prostate Cancer UK site that describes the different types of surgery. 

    To answer your questions about incontinence, sexual function and the mental impact of surgery, we are all different so you’re likely to get varying responses from those of us who have had surgery, but here’s how it was for me.

    I was totally continent from when the catheter came out - i.e. no leakage at all. I think religiously doing pelvic floor exercises helped with that. Four years later and things aren’t quite so good but still no real incontinence to speak of. However, 36 hours after the catheter came out I was back in hospial with Sepsis where I stayed for a week and left with yet another catheter. I had that for about another 2 weeks. 

    As for sexual function, my experience was complicated by going on to have lots more treatment. I’ve had pelvic area radiotherapy, hormone therapy and chemotherapy so it’s difficult to say what’s caused what and by how much. I can tell you that I lost all sexual function from the moment I had surgery and, in the 5 months that passed between the surgery and starting my first lot of radiotherapy I didn’t even get a twitch in my dick. Remarkably, despite all the treatments, things have improved since then but I need pills to have any meaningful attempt at what passes for sex these days. My sex life is a shadow of what it was pre-surgery but DIY is possible with a lot of effort.

    Mentally I’ve more or less come to terms with the massive change that the surgery brought, but it hasn’t been easy. I’d never suffered with depression nor needed antidepressants until after the surgery, then I really needed them as the stark reality hit me. I weaned myself off those after about 6 months but sometimes I still feel like I could do with them, but I’m holding off for now.

    I underestimated the enormity of having my prostate removed, possibly made worse by every health professional I encountered vastly underplaying both the immediate and long term / permanent after effects, albeit in a very well meaning way. Maybe you won’t be affected like I was but losing such a basic thing as ejaculating when you orgasm turned out to be a big thing for me. The doctor mentioned the inability to get an erection but I didn’t appreciate then what that inability really meant. Losing length was sort of mentioned in passing but the significance of that for me was another thing that only hit home after it was too late. I was told I’d be able to have a soft orgasm and that’s true, but a soft orgasm was nothing like a hard one.

    I can understand why you might want the cancer gone and you’re probably thinking surgery would achieve that, but with a Gleason of 6 there’s every chance it might never spread, so think carefully before doing anything too radical. If you’re not convinced by what your doctor is telling you then why not ask to be referred elsewhere for a second opinion? As one of your choices is active surveillance you have time to come to a final decision, so don’t rush it.

    I hope you get lots more replies.

    All the best

    Jim

  • Mark

    Jim is right in everything he says, do not underestimate the side effects of any treatment but in particular surgery.

    I had radiotherapy 9 months ago and It takes some getting used to, a dry orgasm and erections that are more feeble than previously although sex is still possible. From what I have read it seems that u are more likely to have erection problems with surgery than radiotherapy plus the pitfalls of a shorter penis.

    Consider all treatment plans carefully and if you can stay on active surveillance it is a good option. I wish u well with whatever u decide.

    Steve

  • Hi Mark,

    I had a laparoscopic radical prostatectomy in July 2015 with nerve sparing on one side only.

    I was told I had to have treatment quickly as the tumour was pressing on the edge of the prostate, in the end it had breached the capsule and I was restaged at T3a, with an initial Gleason of 3+4 being upgraded to more like 4+4.

    I was only offered surgery or external beam radiotherapy. Brachytherapy was not an option nor was active surveillance.

    I recovered quickly after the operation getting the catheter out at day 11.

    I was immediately dry at night with small amounts of leakage during the day especially when exerting myself a little. I was more or less completely dry a few weeks later.

    I have never managed to gain a useful erection since and that is despite cialis and a vacuum pump device.

    This has been made a lot worse as I have since had salvage radiotherapy and am currently on hormone therapy.

    Jim is right all the doctors play down the side effects somewhat but there is no easy choice here. All current treatments have fairly strong side effects no matter what route is chosen.

    You have to have the correct mindset to be able to deal with active surveillance.

    I assume you would have regular biopsies, PSA testing and MRI scans to keep an eye on things?

    At some point you may have to make a decision so looking at that and asking questions now is a good idea.

    Some guys just want the cancer out no matter what.

    I would be asking your urologist and any oncologists about what their thoughts were on treatment.

    Best wishes, Ian

    Ido4

  • FormerMember
    FormerMember in reply to Ido4

    Thanks for the responses very informative. I am going on active surveillance to start with and will have annual biopsy's and MRI with quarterly PSA and DRE to monitor things. Not quite sure when my urologist would recommend the surgery, when i move to a gleason 7 or PSA goes above 10 i think is what he said.. the prospect of surgery does not sound good to me but is it the best shot of ridding myself of the cancer. I am torn between doing this sooner to get done and be able to get on with life or running a slight risk whilst on active surveillance but without side effects of treatment. My urologist said at my age surgery would be best option, be interested on your thoughts on that ? 

    I am struggling with anxiety around this all, sweats and shakes and need to get on the meds for that - hopefully this will ease off once its really sunk in and i have had a few quarterly checks to see no progression etc

    He did say i could be on active surveillance my whole life and there are many people out there who have PC but dont know it for their whole life and its never a problem so thats my glimmer of hope in all this. Its the living with knowing thats the issue

  • Hi Mark

    U havn,t said what your PSA is? Also another thing to consider if u are going on active surveillance is the size of the tumour in millimeters,thats worth knowing I reckon. Anything around 3 to 5 mm ish would make u a good candidate for a/surveillance

    regards

    steve

  • FormerMember
    FormerMember in reply to Grundo

    Steve, my PSA is 5.7. Not sure of tumour size not been told that info. Is brachy seeds a good option for a 45 year old or surgery ? A/S is recommended by my Urologist but next week i see the Oncologist to discuss to radio treatment options as well. Does Brachy have a better change of succeeding early stage if so then maybe thats better than waiting for it to get bigger ? thoughts welcome

  • FormerMember
    FormerMember

    Hi Mark

    As you probably suspected when you originally posted, everyone’s experience is often so vastly different it is quite likely that you feel no more informed about the best option for YOU. I had exactly the same questions and whilst I found this forum extremely informative, the varying experiences of seemingly the same situations made my own decision no less difficult.


    I absolutely agree with the other responders in that the mental side is a huge consideration and one that, in my case, was the clincher. I am 58 and in August this year was given a similar diagnosis as you. Gleason 3+3, PSA of 4, 5 small positive cores out of 19 samples, no node or bone metastasis. As my Dad died of PC aged just 60 I decided straight away to have surgery. The thought of “living with it” was not something I thought I could cope with mentally.


    I subsequently saw several senior urologists and of course each were duty bound to discuss the other treatment options. There were times, I have to admit, when thinking about some of the possible and even probable side effects of surgery, that I seriously wavered from my “surgery” decision. Active monitoring was a really viable option for me but, in my mind, I felt that the mental side of “living with it” would be worse than accepting and dealing with the surgery outcomes. My wife and family who clearly know what I am like, all supported the surgery option to avoid possible years of monitoring, tests, waiting for more test results, etc, etc. 


    I subsequently confirmed my surgery decision to each urology Consultant I saw. I had already researched the Da Vinci robotic option and wanted to pursue that route. Each Consultant I saw said similar to what yours said to you, that, at my age, relative fitness level and diagnosis then robotic prostatectomy would be the better option. Indeed they all said, if it were them, that would be their decision too. 


    My local Health District do not yet have a Da Vinci so I was referred to Guys in London who I have to say were magnificent. The Consultant there gave me an honest opinion of likely outcomes for ME given the diagnosis including the percentage chances and extents of likely after effects. I agreed a date for surgery and was booked in.


    In November 2017 I had my surgery. I was home with catheter by next day. Went back to have catheter removed a week later and have been dry from day one. I was lucky to have dual nerve sparring so started getting involuntary erections soon after. Admittedly not quite as strong as before but possibly 7/10. I hope to improve that score with medication; my GP seems very positive about that. I had my follow-up review with my surgeon earlier this week and was told that my PSA is now undetectable and confirmed that my cancer was all contained within the removed gland. I will now have a 6 monthly PSA review but other than that, I am done.


    So of course I appreciate my experience is just that, “mine”, and others, as you have read, will have very different outcomes from the same treatment but for ME it was the right route to go. I have absolutely no regrets over my choice as, mentally, I knew living with it was not for me.


    All I can say is good luck Mark. I firmly believe that whatever decision you do take will be the right one for YOU at the time given all the circumstances in the mix. Of course at a later date you may look back and wish that you took a different option but hindsight is not available to us so, do your research, ask questions, speak to your family and make a choice.


    Stay positive my friend

  • Hi Mark, my tumour was ultimately breaching the capsule when I was diagnosed. The oncologist told me brachytherapy wasn’t an option because of the size and where the tumour was. As Tuff has said each person and their cancer are different so you would need to hear what your oncologist says about this. Another factor taken into account by oncologists when looking at brachytherapy is the potential for urinary symptoms due to the treatment. I think any treatment will have a better chance of success if the cancer is totally contained within the prostate. Hope this helps. Come back and let us know what the oncologist says.

    I know all of this is difficult, there’s so much information and so much to think about. I used a buddy system in the Edinburgh area where I had a conversation with a man who had surgery and another man who had external beam radiotherapy. I knew I couldn’t ask them what they thought I should do but talking to them about their experiences with the treatment and the recovery/side effects was immensely useful. I have been trained to be a buddy to give something back. If there is such a thing in your area I would recommend using it. My urologist and oncologist gave me the details at my appointments, may be worth asking next week.

    Best wishes, Ian

    Ido4

  • FormerMember
    FormerMember in reply to FormerMember

    thanks for the post there, very informative. Looks like you have got off lightly on the ED front which is a result. The Da Vinci robotic option does seem like the better surgery option, I may hold fire this year and stick with active surveillance to see hows things progress but the moment it changes take the treatment. The brachy treatment is also looking good but just not sure about the longer term impact of that. Hope your recovery continues to go well. I am east side of London so could end up in Guys myself

  • Mark

    your PSA is still very low, as u say, stay on a/surveillance for a while, see how it goes.

    Next time u see your consultant u could ask the size in mm and if its near the capsule edge.

    I was on A/Surveillance for 5 yrs and they didn't tell me that the tumour was near the capsule edge otherwise I might have acted sooner. lets hope they go it in the nick of time.

    I have to say A/surveillance can be very stressful and I think it depends what is more important to u, quality of life or just being alive regardless of side effects but having said that not everyone has bad side effects.

    steve