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Comes Down To Pee or To Poo?

I'm 64 years old, I take no medicines, in very good shape, I exercise and eat healthy. My dad was diagnosed with prostate cancer at around 85, he had radiation, lived to about a month ago.

PSA was low, but biopsy showed a different story

I live in the LA area, in California, and belong to Kaiser. I am an engineer working from home, probably till next spring-summer when we plan on returning to our offices. My surgeon is Albert Aboelkhair Mikhail. My radiologist is Dr. Barry Goy. My PSA has been 1.0 for last few tests.

A rectal exam in September yield an inflame prostate and some nodules. I made the mistake of not pushing for an MRI first (none suggested by urologist either) and went directly to a biopsy. Biopsy revealed a 3+4, and seems to be located on the left bottom side. Will be doing an MRI this Saturday. The surgeon was quick to push for surgery (a bit concerned he never mentioned MRI, but my radiologist was the one, he said we needed one).

Making my treatment decision based on expected side effects

Sorry for the title of the post, but given two avenues have been recommended, surgery or seeds radiation. Putting the risks of surgery aside, it seems I have to decide to deal with embarrassing incontinence or unpredictable bowel movements. My dad, because of radiation, had many embarrassing uncontrolled bowel movements and soiling just about everything. I am very actively sexually, so I am not sure which is the best option for the ED side effect and recovering from it.

What do I need to consider before making my final decision?

Am I missing anything? What else do I need to consider? Those of us with HMO medical insurance, seems we have to go with what's available unless we decide to pay out of pocket. So how do I do my homework on the surgeon and the radiologist? Especially the surgeon if I go the surgery route. I am not even sure if Kaiser is the right place either for these procedures. Help in this area is also appreciated. I don't panic or stress about things, but usually, I have more in my control to do research and in this case, I am not sure what other research to do, whether I should pay for second opinions, or what exactly to consider or not.

Thank you, thank you, I know when my wife, 31 years ago, was diagnosed with Lupus, these type of forums gave us the information we needed and gave us hope.

  1. I opted for the radical robotic surgery solely because of the bowel issue. One of the biggest post surgery issues for me was insurance coverage.

    Your doctor may likely put you on a half dose of Cialis. Most insurances don’t cover it as a post prostatectomy treatment. I had to eventually be bumped up to the full daily dose which is roughly $330/mo. You’ll want to look into apps like RxSaver that will give you a coupon code for participating pharmacies.

    Every step for me required patience, and a full year later, nothing is back to “normal.” I don’t regret my decision.

    1. Absolutely look for a second opinion. Find a well regarded urologist and oncologist in another medical group.

      Too many doctors just work with what they know or have at hand.

      1. So agree GuyM - and I think that with the growing dependence on virtual visits etc we will see more things missed by MD's and patients alike in the months and years ahead. I also suspect even after there is a vaccine for COVID medical offices will still want to use the internet (due to lower costs) to meet patient needs.

    2. Just to expand, radiation treatment has been advancing rapidly. I think you will find the side effects have changed for the better.

      At 73 I was diagnosed with Gleason 7 (3+4) with nerve involvement, located at one of the neurovascular bundles that control erections at the capsule.

      One of my main goals was to retain full sexual function. Too many "maybes" involved with surgery regarding maintaining sexual health and the location pretty much made it unlikely so I went with radiation and hormone treatment.

      Hormone treatment is temporary chemical castration to temporarily eliminate the testosterone that the cancer thrives on. In order to sexual function after treatment I religiously kept up sexual activity while castrate.

      Three months after having 28 sessions of radiation and 6 months hormone treatment I am pretty much back to normal with just memories of treatment and sensitive nipples.

      1. I agree, radiation treatments have come a long ways. I've had 35 treatments with only 4 to go. I had some side effects initially, fatique and loose bowel, but I'm now good. No pains. I did have some bad S/E from taking apalutamide hormone med. I had an allergic reaction to it at 6 weeks and had to stop taking it. It took a while to wear off. Worse S/E was severe rash over most of my body. Had to take Prednisone to get rid of the rash, but at the expense of more S/E, raised sugar. Raised BP and cramps. I have these under control now. After radiation I will try another hormone med Zytiga. Hope it's S/E are minimal. Cancer is really a bitch, but I'm going to beat it.

    3. I went into this whole thing really uninformed, I was sent to a urologist who said “ based on your history etc... I’m not going to treat you I’m just sending you to see Dr. Merrick.” Had no idea who that was but was surprised that he was an oncologist. From that point I just followed my oncologists directions. Had radiation, hormone therapy, and brachytherapy.
      If you consider this route make sure you doctor uses Space Oar, this is to protect your bowel etc... from the radiation. I’ve had no bowel problems, urinary problems yes, pain and dysuria but not incontenance. I really had no advice going in, I probably would consider a second opinion. Though I’m not unhappy with the treatment I received. I was at stage 3 Gleason 4+3 with perenueral invasion I felt I needed to move quickly.

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