Making a decision of treatmemt.

[pjg263]

Hello! I am a 45 year old man diagnosed with prostate cancer on 11/28/03.I am waiting to sit down and talk to my oncologist and radioligist.Last test performed was an endo-coil rectal MRI, which showed that the cancer is within the capsule of the prostate.My PSA has remained 50-55 for the last six months,the cancer is at a stage T1 but moderate.There was no tumor felt during a DRE, my Gleason score is a 7. I am not a candidate for seed implantation PSA is to high. I think my only options are,surgery or hormone & external beam radiation. The prostate is very enlarged. In reguards to having a radical prostatectomy the surgeon does not know if he can salvage the nerves until he is inside.On the other hand, I could have hormone therapy for 3 months and 3D conformal radiation therapy for 8 weeks combination.I do understand there are side effects for both treatments, incontinence and impotence.I had told the Doctor's that I still want to be able to have an erection.The nerve sparing sugery is a gamble that could leave me impotent for life at age 45.I'm quite not sure if hormone and radiation could do the same. I do know while having this treatment I will be impotent,but after this treatment will everything return back to it's somewhat normal state after time.How much time, if it does.The Doctor said I could get a penile implant if impotence happens. I do not want a penile implant, I want a natural erection.What would you do at the age of 45 if you were me, in reguards to salvaging your erections in the future. Or are there no options.Is this a decision to make on the quantity  verses the quality of life. I really don't know what to do.All support groups for this prostate cancer are all older men. There is nobody to compare me with, I still am in shock and dis-beleif that I have cancer period. I have no symtoms now, except in June I had gross hemauria once.My wife is understanding and doesn't mind if I am impotent, but I do,I'm just too young for this disease.Just wanted to know what option to chose in reguards the least chance of impotence.
                                    Sincerly,
                                     PJG263

[Kevin Pho, MD]

Regarding surgery, the most common complications are urinary incontinence (uncontrolled leakage of urine) and sexual impotence (the inability to have an erection sufficient for sexual intercourse). Advances in technique in recent years have reduced the incidence of both these conditions by sparing the nerves responsible for urinary and sexual function, although a nerve-sparing prostatectomy is not possible in all men.

The likelihood of experiencing sexual impotence after radical prostatectomy also increases with age. In one review, the potency rate after surgery was 100 percent for men in their 40s, and 55, 43, and 0 percent for men in their 50s, 60s, and 70s, respectively.

Comparing prostatectomy to radiation, it does have a higher rate of impotence.   One study shows that men undergoing prostatectomy had a more than two-fold higher risk of urinary incontinence compared to those treated with external beam radiation therapy (9.6 versus 3.5 percent) and were more likely to be impotent (80 versus 62 percent).  

These are certainly issues to think about and discuss with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

Bibliography:
Klein.  Patient information: Treatment for early prostate cancer.  UptoDate, 2004.