Scott covers some important ground in his post. They do rate it on a Gleason score; I don't actually recall what mine was. Some of the events of that time period after hearing "you have cancer" are kind of a blur. When I got the results of my genetic test (I think it was called a Prolaris test) the urologist gave me some information about the stages of prostate cancer. Stage 1 was called active surveillance, where no intervention was necessary and just monitoring the PSA for changes was in order. Stage 2 was surgical intervention, when the cancer should be treated with either removal or the implantation of radioactive seeds, and Stage 3 was when the cancer had metastasized and spread to other parts of the body.
My urologist recommended the prostatectomy over the seeds in my case. He fell that it was a more sure fire way to eliminate the problem permanently. He also told me that many patients he had treated had a less tolerable recovery from that surgery than from the prostatectomy. Also, if the seed implantation failed to kill the cancer, they couldn't later do a prostatectomy, though I'm still unclear on
why.
He was pretty clear that sexual dysfunction and incontinence could by side effects of the surgery, and that so much of that would depend on the architecture of the patient's prostate. Everyone's is a little different, and some can be removed with no issues and some can't. Frankly, at 59, the sexual dysfunction would be a drag, but it wouldn't significantly alter my lifrstyle. It would be more of a psychological burden for me. The incontinence was more of a hurdle for me, because that really would alter my lifestyle though my urologist told me that 90 percent of men report no problems with that after 6 months. A lot of the issues with incontinence are due to how your bladder is constructed. When they remove your prostate they have to cut your urethra and then reattach it to your bladder afterwards. How large the opening is on your bladder can determine how good or bad urine control will be. Surgeons have no way of knowing until they actually get in there.
I also talked to my family doctor about his opinion, and he brought up a point that a lot of doctors don't really cover; the psychological toll that having cancer can take on you. For some people, just the idea of cancer in their body is a heavy load to bear, if there's another alternative. My family doctor is in his 40's, so for him being able to retain sexual function would have been more important and he would have opted for the seed implantation. But for me, I already had a form of cancer about four years ago. I had a neuroendocrine carcinoid tumor in my lung. That was a pretty simple fix, they just removed one of the lobes of my lung and that was it. But having had cancer once already, I found that I couldn't take a "wait and see" stance with it. If there was a way to remove it, then that's the way I wanted to proceed.
Believe me, recovery is no picnic. I'm only four days out from the surgery, so I have no idea how it will all turn out for me and what my new normal might be. But since the cancer is out of me, I do feel like a load has been lifted. I wouldn't try to advise anyone what to do if they find themselves in my shoes.
