@ Alexander_Hardy Hopefully you don’t have it developing. One of my physicians said that it’s believed that prostate cancer can start in the 30’s, or earlier, but the quantity and type determines the lethality. They also said that it’s not exactly true that there are two different types, they can both spread and once outside the prostate can be hard to deal with. I never thought that I’d end up with it, but it does seem to be an eventuality for the majority of men. I’m shocked now to hear of so many men that have had it, have died from it, and have never had it at all. (Lucky guys!) Get tested (and establishing that trend graph) is the most important part of dealing with it. I get a yearly physical and they do a PSA as part of it. I’m surprised how many men don’t get physicals. Ignorance is not bliss…
Keep an eye on your PSA levels. Looking at the trending levels is what got my docs attention. Do not rely on ‘the finger’ for a diagnostic tool. If it’s warranted, get an MRI. That is becoming THE test to replace the finger, and even ultrasounds. My MRI showed ‘changes’ consistent with possible cancer, so the next visit was a biopsy. It’s a shot in the dark, because they could miss potential cancer, but they take so many samples, the chances of missing it are kinda small IMO.
But I guess the best thing to start is to get an annual PSA test. If it’s high, have them do the other tests that try to suss out how likely it might be a real number (there are two types of tests. One is usually processed ‘in-house’ and one was always sent out at my local hospital), and follow up with your doctor(s). Some men have been found to have elevated PSA results and already have metastasized cancer, and sadly some have ‘normal’ results and still have cancer too, although I think that is very rare. Pre-op, they had me do a PET scan to verify that I wasn’t already more advanced. (Kinda scary) Also If surgery is warranted, look for a younger and robotic surgery trained surgeon. The one I found did a fellowship in robotic surgery and had a lot of experience doing it. He’s got videos showing his process, and travels to train and lecture other urologists on proper technique. There are single port and multi-port types of robotic surgery also. There doesn’t seem to be much of a difference in outcomes to either method, but most men prefer single port. (It’s the number of incisions they cut to introduce the tools for the system during surgery)
Prostate surgery has made leaps and bounds improvement over the past 10 years or so. Originally it was done ‘old school’ through the belly, and then rectally too. (It’s in an awkward place)
Why robotic? It allows fine incisions and is easier to identify nerves that should be saved. With that procedure being a rather brutal operation**, having all of the help to save those nerves is priceless. (As for post-op ED, as the nerves reattach/recover/rediscover, you will feel what feels like vibrations ‘down there’ which is a really odd feeling. (After I started riding again, they went away) My surgeon says that it may come back, but I may have interrupted the recovery too. For young men that want to make sure they can procreate, collection of semen would be vital, as the seminal vesicles and end of the vas deferens are removed with the prostate. There might be ways to get sperm post-op but I never asked.
But younger men don’t need to panic, but should follow up on more testing if indicated and not put it off. Unlike other organs, the prostate does not exist in a capsule, so any cancer can spread through a wide variety of ways, and usually spread to bones and the brain first but can hit a lot of areas spread out in the body eventually. The sooner it’s identified and addressed, the better chance of a continued life and better quality of life.
RISKS As with any procedure there are risks. Among the risks are total urinary incontinence, bladder leaks or blow outs, separation of the urethra (it’s cut to get the prostate out), infection, bowel perforation, post-op abdominal wall rupture (hernia), narrowing of the urethra as it heals, sloughing of the bladder plugging up the urethra, lifelong ED, etc; but if it all goes well and it hadn’t spread pre-op, you are cancer free, which feels pretty damn good…
** They go through the abdominal wall into the bladder, then core out the bottom of the bladder to expose the prostate. Then it is cut away from the urethra, and its then stitched back together, with the surgeon closing everything as they go back out. Urinary incontinence is common as the patient has a foley catheter for at least a month, and sometimes longer. It’s to allow the bladder to heal with no pressure inside. The tubing relaxes the valve at the bottom of the bladder, and through ‘bladder retraining’, you can get most, if not all of it back. I still leak occasionally when I have increased abdominal pressure like coughing, laughing, etc. It’s gotten better over time. Pre-op I was having minor leakage, so I’m happy it’s better.
