Sir,
I come to this discussion with an unalterable bias. Please put all that follows in the proper time context. Much has changed in the field since I was involved. I was radiated for prostate cancer in 1997. (Yup, 23 years ago.) It didn’t get the job done. My follow up was with a doc who had seen radiation fail frequently. He watched me like a hawk. It took about 2 years before PSA started to move, but when it did we knew I had not been cured. It took almost 8 years before PSA got to 2.0, which, back then, was the watershed for deciding what’s next, if anything. There weren’t many options then but I did qualify for a salvage resection, which is what they call resection following failed radiation. Very few guys qualify for a salvage. (Interesting way to describe it, huh?!?! But it does get your attention when you realize what’s being salvaged is probably your life.) The reasons for not qualifying are individual, but at that time, anyway, it was very rare to qualify. In 2005, doing prostate resections with instruments and camera inserted through your abdominal wall was just getting going. My surgeons had done about 500 of them, but had never done a salvage through the ‘scope. I was their first. Not many had been done anywhere in the world. Long story short, I walked in one morning at 6:30 and walked out (very slowly!) the next day before noon. I had one urologist advise strongly against it, telling me “it’ll be 10 years before you’ll see symptoms”. That was over 15 years ago. Again, not knowing what’s going on in the field today, I believe I’d likely not be here today had I not taken the opportunity I had.
There are many opinions regarding best prostate cancer treatment. Every doc and every patient has their own narrative. People talk about the negative things that can come with surgery. Been there, done that with all of them. So, it’s true for sure, but given the perspective I have now, none of those things even move the needle. I’ll deal with them. I just turned 78 a few weeks ago. I’m doing 350-450 TSS weekly on the trainer purely for cardio pulmonary benefit. I see no reason to change that as far out as I can see. I’m not conversant with the status of treatment options in field today. My best advice is fully own yourself and your decision. There will be no lack of voices offering their point of view. Nothing wrong with that at all, but make your own choice for your own reasons.
Subsequent note: It may come through that I feel very strongly about calling one’s own shots on this. The reason for that is that I didn’t do that when I was radiated in '97. I had many voices in my ear and an uninformed imagination of my own running in my head. Essentially I took what looked like the easy way out. I think often of how lucky I was to have it all work out the way it did. Very low chance of even qualifying for a salvage and then to run onto a place that could do it without open surgery. Very, very lucky guy here. My decision to do the surgery was made against unanimous advice to not do it or at best significant doubts about it. Outside of the operating surgeons, I didn’t have even one voice telling me to go for it and even they realized they couldn’t make any promises so they didn’t push it . If I had “owned myself” in '97 and had the surgery then, none of what followed would have been necessary. This is never an easy decision. I get rather fervent about the issue since I’m one of a very small number who have had two chances at it. Stay strong!
Thanks!