Diagnoised with Prostate Cancer.

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Krish - 19 Apr 2005 13:43 GMT

Hello All,

One of my friend who lives in India, has been diagnoised with prostate
cancer(Age 60, PSA - 12 and Gleason Grade of 4 + 3). I did some
googling and understood that the numbers are not very promising.
Fortunately his cancer has not spread to the bones, which he confirmed
by doing a bone scan.

His doctor has adviced him to go for Radical Prostatectomy(removal of
prostate and testicals surgically). Though there are various other
treatment options like Radiation, Hormone Theraphy the doctor prefers
surgery because he believes that this is the best cure for prostate
cancer.

A few renowned cancer institues in India perform this operation, but
some say that the post operative effects are high, like incontinence
of Urination etc..
Hence he has been adviced to come to the USA for surgery.

I guess the number of such surgies performed in the USA are high, but
I have no idea about post-operative effects, like incontinence of
urination etc..
Does such complaints persist in USA too ? I have been reading feedback
from patients who have undergone similar surgeries in the USA, and its
not very promising. They also seem to complain about such adverse post
operative effects.

I will appreciate if folks in this forum can throw some light on this
issue.

Thanks.
- Krish

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Ed Friedman - 19 Apr 2005 18:02 GMT

> Hello All,
>
[quoted text clipped - 28 lines]
> Thanks.
> - Krish

Krish,

Check out http://www.prostateweb.com for a promising alternative.

Ed Friedman

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jhhtexas@ieee.org - 19 Apr 2005 18:48 GMT

I had a nerve-sparing RRP a year ago at age 66 with a Gleason 6 and am
now 100% continent and can have erections capable of penetration using
20 mg of Levitra. Do your research and find a competent surgeon with a
good track record. John Hopkins in Baltimore is one place to look. I
also have a friend with a Gleason of 8 who was cured with brachytherapy
(10 years of low PSA readings afterwards). He went through several
miserable years of urinary tract infections, however, as a result of
seeding.

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Stephen Jordan - 19 Apr 2005 19:01 GMT

> One of my friend who lives in India, has been diagnoised with prostate
> cancer(Age 60, PSA - 12 and Gleason Grade of 4 + 3). I did some googling
> and understood that the numbers are not very promising. Fortunately his
> cancer has not spread to the bones, which he confirmed by doing a bone
> scan.

> His doctor has adviced him to go for Radical Prostatectomy (removal of
> prostate and testicals surgically). Though there are various other
> treatment options like Radiation, Hormone Theraphy the doctor prefers
> surgery because he believes that this is the best cure for prostate
> cancer.

Here in the USA, a radical prostatectomy (RP) procedure involves removal of the prostate. It does *not* include removal of the testicles (orchiectomy).

Orchiectomy is intended to reduce the production of testosterone (T) to virtually zero, although a small amount is produced by the adrenal cortexes.
It is, of course, irreversible. Another method that is commonly selected is "chemical castration," which is reversible. Side effects (SE's) are sometimes very bothersome.

The reason for reduction of T is that it encourages the proliferation of prostate cancer (PCa) cells. NB: castration, however done, is NOT a local therapy. It is a systemic treatment usually resorted to when it is suspected that cancer cells have escaped from the prostate. I simply cannot understand his doctor's reasoning.

> A few renowned cancer institues in India perform this operation, but some
> say that the post operative effects are high, like incontinence of
> Urination etc.. Hence he has been adviced to come to the USA for surgery.

Incontinence is almost always a side effect (SE) of RP. It is caused by the removal with the prostate of one of the two muscles that control urine flow. It can be and usually is controlled over time -- from a couple of weeks to many months.

(snip)

> I will appreciate if folks in this forum can throw some light on this
> issue.

The subject is complex and the effects on patients are not uniform. Each man experiences his own unique reactions.

For objective and authoritative information, I recommend the Prostate Cancer Research Institute at http://prostate-cancer.org/index.html

Regards,

Steve J

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Leonard Evens - 19 Apr 2005 19:18 GMT

> Hello All,
>
[quoted text clipped - 3 lines]
> Fortunately his cancer has not spread to the bones, which he confirmed
> by doing a bone scan.

You might look at a book lke Patrick Walsh's "Guide to Surviving
Prostate Cancer". There are tables (Partin Tables) which give an
estimate of the likelihood that the cancer may have already spread based
on data such as what you give. In the case you describe, the odds are
21 percent that cancer would be found in the seminal vesicles or lymph
nodes. Depending on the age of the patients and other factors, that
might be a marginal case for surgery, but you have to rely an an
experienced clinician to help make a decision about such things.

The chances of permanent serious incontinence after surgery in the US
are fairly low---just a few percent---but it can take a while for full
function to return, perhaps as much as a year. Also, a higher
percentage of men experience minor so called stress incontinence, which
is annoying but not really a serious problem. The best surgeons can
preserve potency in a high percentage of men under 60, but have
increasing difficulty doing so in older men. Less experienced surgeons
don't do as well.

> His doctor has adviced him to go for Radical Prostatectomy(removal of
> prostate and testicals surgically). Though there are various other
> treatment options like Radiation, Hormone Theraphy the doctor prefers
> surgery because he believes that this is the best cure for prostate
> cancer.

The doctor knows the case and is in a better position to offer advice
than anyone in this newsgroup.

> A few renowned cancer institues in India perform this operation, but
> some say that the post operative effects are high, like incontinence
[quoted text clipped - 8 lines]
> not very promising. They also seem to complain about such adverse post
> operative effects.

Try not to judge these things by reading anecdotal information on the
internet. It is not likely to give you a balanced idea of the true
situation. Also, beware of any recommendations you get here. There
are different approaches to treating prostate cancer and some few of
them are controversial.

> I will appreciate if folks in this forum can throw some light on this
> issue.
>
> Thanks.
> - Krish

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