Cycling after prostate cancer surgery

[Shoeman]

Diagnosed with bladder cancer in 2017 Bladder/Prostate gland had to be removed. I was on the bike within 6-8 weeks, I do miss the erections but hey I'm alive so it is no big deal.I have had issues with scar tissue (adhesions) but I was split wide open. If you have to have surgery robotic would probably be the best bet.

[veloduffer]

Thanks so much for the kind words and advice. These are the kind of times that make the Paceline a special place.

[AngryScientist]

Hang in there buddy! I'm sorry to hear this, but at least we live in a great area of the country with access to probably the best medical professionals and facilities in the country. I think once you pick a road you will be well taken care of around here.

I think cycling is the fountain of youth for you, i would definitely have guessed you were younger than you are!

[kohagen]

PM sent

[merlincustom1]

I was just diagnosed as well. Gleason 6 so the recommendation is Aggressive Surveillance as per the link below. A friend had a Gleason 7 4 years ago, bilateral positive cores on biopsy and 2 docs recommended prostatectomy which he did and he now has an undetectable PSA, cancer free. I’m on the fence as to what to do. Good luck.
https://ascopost.com/issues/july-25-...-surveillance/

[RobJ]

I was diagnosed in 2016 at the age of 48. I had a Gleason 4+3=7 involving 40% of one core in the dominant nodule and a Gleason 3+3=6 in the secondary nodule. Absolutely no symptoms, except that I caught a huge increase in my PSA on a random blood test I had requested. I had a Radical Retropubic Prostatectomy (RRP) performed at Johns Hopkins and they subsequently tested the surrounding lymph nodes too during surgery. I just hit my 4 year cancer free mark. PSA's have all been 'undetectable' levels.

I would be glad to share my experiences. My father too had Prostate cancer, which eventually resulted in his death.

[austex]

I've "joined the club", too. Increasing PSA over past year; biopsy in August '20 confirmed cancer; Gleason-9 (yikes!) in two cores; bone and CT scans negative for metastasis (yea!, but we'll see). Surgery is tomorrow, DaVinci robot-assisted; would've been sooner, but Covid has caused scheduling backlog for the robot.

[oldguy00]

Originally Posted by austex

I've "joined the club", too. Increasing PSA over past year; biopsy in August '20 confirmed cancer; Gleason-9 (yikes!) in two cores; bone and CT scans negative for metastasis (yea!, but we'll see). Surgery is tomorrow, DaVinci robot-assisted; would've been sooner, but Covid has caused scheduling backlog for the robot.

Sorry to hear, but you can beat this.

About 11 years ago my father was diagnosed, two labs looked at his biopsy, one scored it gleason 9, the other gave him a 10. Stage 3 (forget which level of stage 3, but had some in his seminal vesicles).
He was treated with a combo of IMRT and low dose chemo. He was 'cured', cancer free and still with us in his mid-70's.

[oldguy00]

The following is a really good forum for prostate cancer info/support.


https://www.healingwell.com/communit...f=35#gsc.tab=0

[veloduffer]

Originally Posted by merlincustom1

I was just diagnosed as well. Gleason 6 so the recommendation is Aggressive Surveillance as per the link below. A friend had a Gleason 7 4 years ago, bilateral positive cores on biopsy and 2 docs recommended prostatectomy which he did and he now has an undetectable PSA, cancer free. I’m on the fence as to what to do. Good luck.
https://ascopost.com/issues/july-25-...-surveillance/

I had three areas register Gleason 7 (3+4). Some of the kind folks on the forum called and I got some solid advice. Your diagnosis is early so you have choices. I talked with two surgeons and three radiation oncologists. Bottom line is surgeons like to do surgery and radiation oncologists like to do radiation.

I decided to get treated at Memorial Sloan Kettering and did radiation called MSK Precise - similar to Cyberknife which is high dosage, low frequency. MSK re-examined the biopsy and did upgraded one area to Gleason 6.

There are trade-offs with surgery vs radiation. There is also Focal Ablation (laser) in clinical trials around the country at major medical centers - NYU, UCLA, Mayo.

I finished my treatments in June and had first follow-up in Sept. PSA went from 5.7 to 3.8. It can take up to 2 years to get to my low point and not uncommon to tick up slightly in-between. No ED or urination issues, or other effects. Knock on titanium.

Talk to different doctors in different medical groups. It’s a very curable cancer and success is high (> 90%) with either surgery or radiation. It’s a matter of what you are comfortable with. Good luck. PM me if you want some more info.


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[chuckroast]

Bumping this thread again because now it's my turn. My recent biopsy had 2 instances of Gleason 7 (3+4) and three Gleason 6 (3+3).

I'm onboard with doing a treatment but trying to decide which one.

I don't see in this thread any reference to the "seed" therapy, did any of you consider it? I'm leaning toward a radiation rather than removal procedure.

This thread so far has been very helpful in helping me sort out my options so thanks to all of you.

And for background, I'm 64, my Dad had PC and died at 71. But, he had other ailments as well and was not very healthy the last 15 years of his life.

[austex]

I am 6 months post-surgery. I had Gleason-9 scores in two areas, opted for surgery. Per my uro, "If surgery is not sufficiently effective, we can do radiation/hormone therapy in addition. If opting for radiation first, takes surgery off the table as a follow procedure." Three months post-op PSA was 0.06 ; I get a 6-month PSA tomorrow.

Three months off the bike post surgery (was winter at least), back on the bike with no issues other than fitness level; minor initial urinary incontinence is fully resolved with pelvic-floor P.T.; lingering ED - no - (may go on for a while, Viagara ineffective, trying injection therapy soon).

Wish you the best,

[mjbrekke]

@chuckroast:

I'm going through this right now, too, and last week I scheduled brachytherapy (the seed therapy) for June. In the end, the decision seemed easy for me, but it took me a while to get there. (In contrast, my wife, a former hospital nurse, came to the same conclusion after the first conversation with the urologist after the biopsy.) Read on if you are interested in the path I took. Also feel free to PM me if you want to talk privately or more in depth.

My stats are similar to yours, though my cancer is lower volume from the sounds of it. I'm 64, PSA = 9.47 in January, no family history of PC, no abnormalities on digital rectal exam and ultrasound, biopsy yielded one Gleason 7 (3+4) (50% of cells) and one 6 (3+3) (5% of cells) out of 10 samples. Bone scan and chest x-ray both normal. I may or may not yet have a CT or MRI; every doctor I've talked to has said it is very unlikely (1% at most) that either will show any metastasis but my urologist would prefer to be thorough and is talking it over with my oncologist. So, it appears to be intermediate stage, low volume, and contained to the prostate.

My urologist recommended researching and talking to specialists regarding three options: active surveillance, surgery (radical prostatectomy), and radiation. His recommendation was either surgery or brachytherapy, the latter being the radiation seed therapy you mention. He did not recommend active surveillance because of the grade 4 component to the Gleason 7 score. He gave me the names of a surgeon and a radiation oncologist and said "go do your research and talk with lots of doctors, as much as it takes for you to make an informed decision you are comfortable with."

I did a fair amount of research on my own, including a book my urologist gave me (100 Questions & Answers About Prostate Cancer), University of California San Francisco (UCSF) and Stanford websites, and discussing it with three friends who had PC treated 2-13 years ago. My friends all opted for prostatectomy. All had worse Gleason scores and/or family history of PC, and one just couldn't be comfortable with the organ still in his body. They are all cancer-free with no remaining side effects. A brother of one, though, has severe incontinence from a prostatectomy done last fall (at UCSF). After all of that, I was completely on the fence between surgery and radiation.

I then talked to surgeons from UCSF and from Stanford, two of the best cancer centers in my area, if not the country. One recommended either active surveillance or surgery, leaning a bit toward the latter, but not much. The other said that there is no right answer for someone with my stats, and which of the three options to select really depends upon your personality. The study statistics he quoted (from a randomized study in the UK) had the same 10-year survival rates (99%, where many of the active surveillance patients eventually had treatment). Both surgeons described some pretty high rates of side effects (mostly incontinence and sexual dysfunction) and a pretty long recovery time (at least 8 weeks off the bike) with radical prostatectomy. I left those visits less than excited about the surgery option.

I then talked to the radiation oncologist recommended by my urologist. He recommended low-dose, permanent brachytherapy (not high-dose temporary; the difference is a yet another discussion) guided by ultrasound and has done over 6000 of them. Advantages over surgery he cited include: it spares the organ--in fact, no tissue is removed (in that sense, it is less invasive than even the biopsy); if done right, it does not damage the urethra or surrounding tissue, so it has a comparatively low rate of incontinence and sexual dysfunction; the seeds can be "mapped" to cover the entire prostate capsule, so the "margins" are covered more easily than surgery; a meta-analysis of studies including thousands of patients over 5 to 20 years post treatment indicates that there is a higher probability of remaining cancer-free with brachytherapy than with surgery (see prostatecancerfree.org); it is a two-hour procedure (the patient experience is similar to a colonoscopy); and, best of all, normal activities can be resumed within 3-4 days, often the same day (biking even the same day is OK if you use a saddle with a large cutout). If the therapy fails (i.e., PSA does not go to nearly zero), "salvage" options include another brachytherapy, hormone therapy, and cryotherapy. I left that visit having made my decision.

As I said, in the end the decision to have brachytherapy was easy--it just made sense given everything I had learned. That is not to say it is the answer for everyone. Regardless, I highly recommend doing enough research and talking with enough doctors to find the treatment you feel best about.

[chuckroast]

Hey thanks to both of you, these are great overviews. I'll discuss the low dose seed therapy when I go in for follow up next month.

I also have that 100 Questions book you referenced and I'm working my way through it. I have to stop every once in a while because I keep clinching up down there as I read!

[Dave Ferris]

OP here. Happy to report after 8 weeks of radiation at City of Hope in S. Pasadena, last session on 12/31/14, I've had six annual checkups and the PSA is normal.

I wanted to mention I did have the female hormone shot, Lupron, a month before the treatments began. This was on advice from Dr. Helen Chen, who was my Radiation Oncologist at City of Hope. She said having the shot reduces the risk of the cancer returning from 10% to under 3%. I said...give me the shot.

At the time my wife was working for the Auto Club and we had great insurance. I think out of around 260K cost, we paid something like $1700 total.

The effect of the Lupron shot did linger longer then the 3 month period they said it would. I felt reduced strength and energy for a solid 9 months afterwards....just fwiw.

But again, everything has looked great the last 6 years. My best to anyone dealing with this right now. The key is early detection and like mentioned...make sure it doesn't get outside the prostate capsule....that's when complications set in.