That Big Decision

The urologist entered the examination room, looked at my chart, then said “So, you have prostate cancer, what do you want to do about it?” This wasn’t what I was expecting! I explained I wanted to know what the best treatment options were for my PC status.

He replied, “We don’t know what treatment is the best for any one patient and we cannot predict the severity of the side effects.” Those words were like a knife in my gut! Months later, I realized that he was just being totally honest and preparing me for this unwanted journey.

Evaluating treatment options

My options were doing nothing, active surveillance, surgery, radiation, and high-intensity focused ultrasound (HIFU) ablation. To determine if I wanted to be treated for prostate cancer, I scheduled an appointment with my pulmonologist to evaluate the condition of my chronic asthma. The doctor felt my lung condition was stable, so I ruled out doing nothing as an option.

During the first year that I was on active surveillance, I established my outcome goal as “to minimize the chance of having urinary or fecal incontinence, or erectile dysfunction.” My quality of life was more important than longevity.

Surgery

My urologist suggested the benefit of surgery could be that the whole gland is removed and the PSA level should remain undetectable. He explained even with robotic surgery, there is a risk of incontinence and erectile dysfunction.

Also, by having the gland removed, two inches of the urethra could be removed, thus shortening the penis. Having had two inguinal hernia surgeries, I knew that it took my body up to five years to heal to the point where I was pain-free. Also, I was told the surgery side effects can be immediate and that it could take a few years to determine their severity.¹

Radiation

I scheduled an appointment with a radiologist to review the radiation options, which were CyberKnife™, brachytherapy, and external beam radiation. With any of these radiation treatments, I was advised to have the Space OAR™ procedure to minimize the potential damage to my rectum from the radiation. With brachytherapy, there is one session, five for the CyberKnife™ with a low residue diet, and 44 with the external beam radiation. The side effects could include fatigue, urination burning, ED, diarrhea, and bowel/bladder damage. Similar to surgery, there can be long-term side effects.^2,3

I seriously considered the CyberKnife™ and brachytherapy. Having the Space OAR™ procedure’s hydrogel placed and then absorbed in my body was a negative in my decision-making process.

While trying to make a treatment decision, my best friend was diagnosed with bladder cancer, which his doctor attributed to his radiation treatment for prostate cancer ten years earlier. I also discovered that when my father died of a bowel obstruction, the coroner ruled that his bowels stopped working due to his radiation treatments for prostate cancer. Before we placed my father in hospice, his doctor informed us they were unable to operate since irradiated tissue doesn’t react like normal tissue.

High-intensity focused ultrasound (HIFU)

The last option I considered was high-intensity focused ultrasound (HIFU) ablation. My local hospital did not offer this treatment, so I would have to travel 300 miles to the closest hospital that offered this procedure. Fortunately, I’m retired and could make these trips. At my initial consultation with the HIFU urologist, he thought that I was a good candidate for HIFU. However, he suggested that I could stay on active surveillance, which I did for another year.

There wasn’t a great deal of online information on the long-term success of HIFU. My urologist stated that the results they’ve seen were that HIFU had a little higher recurrence rate than surgery, but it was comparable to radiation treatments. The things that I liked about this option were that it was a one-day procedure, the Space OAR™ was not required, it didn’t eliminate the future possibility of surgery or radiation in this area; also, the procedure can be repeated, and it has shown lower rates of incontinence and ED.⁴

The negatives were that I would have to have a urinary catheter for at least a week, and there is the potential of temporary scrotum and penis swelling post-procedure.

What I ultimately chose

I decided to go with HIFU. In May 2022, they ablated 85% of my prostate using the HIFU procedure. As of my writing this, my PSA was stable at 2.3, and no evidence of cancer. I had bladder spasms with a little urine leakage for about four months, no long-term incontinence, and no fatigue. My sexual function started to return within three months with penetrable erections after about nine months.