Omigod, six specimens, a sextant biopsy! I thought that those went out of
style years ago.

I do not believe that any PCa medic who knows his business would *ever* do
a sextant biopsy these days. It has a huge potential to miss tumors, and is
IMO very nearly malpractice.

Regards,

Steve J

a physician's view:
Erectile function is unlikely to ever be improved by RP. The prostate is an important component in
the very complex system which allows an erection to occur and to subside appropriately. Erection is
blood under pressure filling very specialized tissue - the corpora cavernosa in the penis and lower
pelvis. Cutting (pun intended) the prostate out of the equation, even with sparing of the lateral
neurovascular bundles, inevitably disrupts a whole raftload of other tiny nerves and blood vessels
which are directly involved in regulating vascular tone, allowing blood to flow in and stopping
blood flow out of the corpora to make it swell. So it's more or less inevitable that some decrease
in erectile quality will occur. Some of it may improve with time, but remember, for most men,
erectile function declines with increasing age whether the prostate is there or not! Having RP
probably always accelerate that process - it sure isn't likely to slow it down!

a patient's view:
No, it's not the same. It works well enough - my wife is a reasonable and understanding human being,
so we're still able to have a great time. It's not as hard or big as it was. Too bad. There are
mechanical devices and drugs available if need be but I haven't yet felt the need. The cancer is
gone and I'm grateful to have any sex life at all after RPP, let alone one which is satisfying.  I'm
54 and having PCa helped me realise that my former fully erect member was not the most important
thing in my life! But that's a very personal valuation which each of us has to figure out.

In my case there are more changes than just impotence.  The feeling down
there is gone.  Even with the help of the injections, intercourse is not the
same.  The sensitivity, or pleasurable feeling, is just not there.  It also
takes over an hour of stimulation to achieve orgasm.  No, nothing is the
same after the surgery.

Or for that matter after radiation, external or with seeds.

The answer is is that with any method there is a wide variation,
depending on many factors, with age being the most important.
                     There are certainly men who notice no difference
as there are who experience complete impotence.

But I think you are asking the wrong questions.  For example, ego and
folklore aside, size is pretty irrelevant.  The real issue is whether
after treatment, the man and his partner can function in a manner
satisfactory to both.   The answer to that is that it does happen in a
very large number of cases for men in their later fifties in the hands
of a skilled physician.

I think you are correct.  There are many men who return to an active,
self-initiated sex life.  But, I cannot remember anyone saying they were has
long, as hard and as virile without medication and rarely with medication.

Steve,

I have to agree with you about the specific treatment recommendations
being posted here and to submit my apology for my tendency to preach. I
think we're all prone to doing so as we have each made  difficult
decisions and will, as a result, tend to back our personal treatment
decisions up with alot of energy and committment - as if it is the only
way.

You are right - each of us is different and unique and has the right
and responsibility to evaluate our options using the best unbiased
professional information we can find. For some these decisions will be
difficult. For some they will be easy.

In that context, let me explain my sextent biopsy comments. Our PSA
histories are very similar alothough I was somewhat older. My research
as I approached biopsy led me to the viewpoint that I was going to
treat the biopsy as a cancer detection process, as opposed to a cancer
quantification process. In other words, if cancer was detected, and
given my PSA levels, it was coming out regardless of specific Gleason
or stage (of course either at extremes might have added to my treatment
regime) and I would wait for accurate pathology reports regarding the
gland, the lymph nodes, and the seminal vesicles to make further
decisions.

I had the choice of several UROs and my selection process considered
many factors beyond the treatment. The URO I chose had an excellent and
extensive record (I found his bedside manner to be lacking). Regarding
diagnosis and treatment he stated that if the DRE had been positive,
give my PSA level and history (an order of magnitude increase in one
year) he would have recommended beginning curative treatment WITHOUT a
biopsy inorder to spare me from the stress caused by the process. As it
was, my DRE was totally normal as was the size of the gland. He was
still sure I had cancer, but he felt it necessary at that point to
prove it.

Now for the biopsy. The cores are about 1/4 inch long and about a
pencil lead in diameter. they are taken from a gland about 1 to 1.5
inches in diameter. If you do the math a sextant biopsy you are
replacing about 5% of the gland with scar tissue, not to mention the
damage to the large intestine and urethra. Those numbers double with a
12 sample biopsy. Sure, you are improving your chances of detecting
cancer, and sure the gland is probably gonna come out (or be killed)
anyway, but what if you don't have cancer, and what about the damage to
the organs that have to remain (I've had a colonoscopy after the biopsy
and the scar tissue ain't pretty). Let's try this another way and try
to look at it without numbers. We want to be absolutely positive that
we do or don't have cancer so why not 24 cores, or 36, or 48, or ...
You can see where this is going. The absolute proof would sample all of
your prostate (nothing left) but then you would be absolutely sure (and
prostate-less, to bad if the results were negative - but then you know
for sure).

Anyway the sextant detected it as he expected and the numbers were
gleason 7 and T2a (although he gave no real credence to the staging
analysis coming from the biopsy). When the gland came out the pathology
indicated gleason 6 (3+3) in two tumors, one in each lobe, one about
the side of a dime and the other the size of  BB with no breach, and no
lymph node or seminal vesicle involvement.

So to your point.  If you're going to use the biopsy as a mechanism to
determine your treatment plan (beyond cancer detection) then more cores
may be appropriate. I am a deterministic guy and radiation does not
give deterministic results (lymph nodes, seminal vesicles, surface
breach etc.). I was willing to risk the SEs of surgery. Those are
personal decisions and I (we) have no right to push our viewpoints on
others, particularly since none of us are professionals medically
speaking.

I am years behind you in the progression of my treatment. 10 months out
with 5 PSA readings beginning the third month and monthly thereafter
for obvious reasons: 0.24, <0.1, 0.12, <0.1, <0.1. After the last
reading my Uro gave me a 3 month respite so that my needle tracks can
heal and pronounced that he thinks I maybe cured (but we'll know after
5 years). I smiled, knowing your history. I'm prolly not out of the
woods yet!

At least the colonoscopy gave me a 10 year free and clear!

You've given our newbie some great recommendations and I commend you.

TW,

I agree with Mr. Jordan.  I believe in my initial response to you, I
mentioned surgery.  If so, I did so in reflection of your post.  At your
age, the whole world of PCa treatment is open to you.  My salient point was
that inaction was counterindicated.

That is borderline scaremongering. A competent surgeon has far, far
better statistics than those. My surgeon quotes 5% with some leaking
(2% serious); 30% functionally impotent (like most, he counts those who

need pills as potent).

Individual surgeons tend to be overly optimistic as to their
accomplishments. Only the studies are reliable.