Increasing PSA Levels in Master Athletes

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

This is my first time posting here.

I’m a 55 year old master athlete. I’ve been running competitively for the past 24 years and currently run about 48-58 miles a week. I’ve never been sick in my life. The TRUS biopsy was the first time I’ve ever had to stay in hospital – and that was only for a half day.

I have no symptoms of any form of prostate problem. Since I got the results of my last PSA test and saw my urologist, I’ve been swinging between denial and panic.

Previously, as outlined below, I’ve arranged everything around my running, like going to the doctor, and having the TRUS biopsy, on “an easy day”, usually the day after a race. This time I’m resting up for several days before the repeat biopsy next Wed.

There is evidence that high level training depresses f-PSA but I’ve only seen one paper on the matter and it seems very vague on the matter. Cycling is also reported to increase PSA levels but, while there are more reports, the evidence seems conflicting.

I’ve done extensive searching and can find very little relevant info on PSA levels in athletes or other “fitness freaks”. I have come across info on very young athletes and also some on randomly selected marathoners – no indication of training etc.

My Bios:
April 06: PSA 4.3. Went to the Doctor about a long lasting low level chest infection and he said I ought to have my PSA level checked. Competed in a 10k race the day before.

Dec 06: PSA 4.9. I competed in a 4 Mile road race the day before and was diagnosed with shingles – the reason I went to the Doctor - I thought it was just some sort of allergy rash.

Jan 07: Urologist carried out DRE – found nothing untoward, and said that he expected my PSA levels to be back to normal in a few months.

April 07: PSA 6.8 – Forgot about abstention and my wife and I enjoyed ourselves the day before the PSA test. I also spent 7 hours cycling that day – calibrating and measuring our local marathon course.

May 07: Urologist recommended TRUS biopsy.

June 07: PSA 5.71, f-PSA 18%, 12 core TRUS biopsy (first biopsy) – “No indication of cancer”, small prostate gland – size?? I’ll check when I see my hospital records next week. I ran a 6.7 Mile leg of the marathon relay the day before.

Dec 07: PSA increased to 9.4. Competed in a cross-country championship race the day before.

Jan 4th 08: Urologist recommended second TRUS biopsy. He doesn’t feel that it is Prostatitis. The Urologist also told me he doesn’t know what his own PSA level is and doesn’t want to know…and that he doesn’t know any Urologist who knows their own PSA reading! Shocked

Jan 23rd 08: Second TRUS Biopsy scheduled

the urologist wasn’t downplaying this one though, saying that we’ll discuss the options at our next consultation, early in Feb.

I’m probably in denial, but I can’t believe that someone with a health record like mine – 14 sick days off work in 32 years, and can still run 40 Min for a 10K – can have a serious health issue and have no symptoms.

I still haven’t decided whether this is a query, information supply, a rant or a plea – but I’m praying and panicing about Wed!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

Hi--hopefully you don't have PCa. On the one hand, your PSA scores are not proof you have cancer. This is because PSA can be elevated by various things--like prostatitis, or bicycling, sex, or a vigorous prostate exam done before blood draw. And you've "passed" one biopsy.

On the other hand, it sounds like you're aware of activities that can raise PSA and have been avoiding them before your most recent blood draws. Your doctor is pretty sure you don't have prostatitis, and your TRUS seems to rule out BPH ("small prostate gland"). So it's hard to explain why, at age 55, you have a PSA like you do, and why it is doubling so quickly. A single PSA score that's elevated isn't a huge reason for alarm in my book, but a *trend* over time like you're showing is more worrisome.

My understanding of fPSA goes like this: most guys with PCa have fPSAs of less than 15%. So that's one line in the sand. If you have a fPSA of 7% or lower, you *probably* have PCa--that's a bolder line in the sand. If your fPSA is 25% or higher, your total PSA is *probably* elevated by benign reasons. So at 18%, fPSA is not giving you a clear indication either way.

I don't know anything about PSA vis a vis extreme athletes(other than bike riding).

You commented that you are in disbelief that you could have a serious illness and feel fine--but that's usually the case with prostate cancer. Guys don't feel symptoms from PCa until it is far advanced. IF (that's a big "if") you have PCa, at a PSA of 9.4 you would be a long ways from feeling anything from the disease.

Bottom line? I would stay on top of it. Get biopsied when the doctor recommends it. Continue with frequent PSAs. Biopsies often miss prostate cancer--I was not diagnosed until my third time.

If you have it, you want to confirm it while it's still localized and curable.

Good luck.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

http://www.ncbi.nlm.nih.gov/pubmed/12653581?dopt=Citation

"Effect of Marathon Running on Total and Free Serum Prostate-Specific Antigen Concentrations"

Arch Pathol Lab Med. 2003 Mar;127(3):345-8.

Kratz A, Lewandrowski KB, Siegel AJ, Sluss PM, Chun KY, Flood JG, Lee-Lewandrowski E.

Division of Laboratory Medicine, Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston 02114, USA.

CONTEXT: Prostate-specific antigen (PSA) is an important tumor marker for the most frequently diagnosed cancer in the United States. A major limitation of this marker is falsely elevated results in patients who are found not to have prostate cancer. The effects of vigorous physical exertion on PSA concentrations are controversial. OBJECTIVE: To determine the effects of marathon running on PSA levels. DESIGN: Measurement of total and free PSA levels in the sera of participants in a marathon before and within 4 and 24 hours after the race. RESULTS: None of the participants had elevated total PSA levels before the race. Although we found no statistically significant changes in average total or free PSA concentrations at either time point, after the marathon, 2 (11%) of 18 runners had total PSA concentrations outside the standard reference range. Changes in total PSA levels did not correlate with age or prerace PSA concentrations. Free PSA levels were not statistically significantly changed after the race and did not allow a reliable determination of exercise-induced PSA elevations. CONCLUSIONS: Although it may not be necessary for men to abstain from exercise involving running before blood draws for PSA analysis, elevated PSA concentrations may be observed in some individuals after participation in a major sporting event. In these cases, repeat measurements should be considered at a time significantly removed from such exercise.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

johnw100

Unfortunately there are many areas of PC which are not black and white, with various possibilities.

Most elevated PSA readings in the gray zone between 4 and 10 are related to benign causes.
The MSK chart on "free PSA" for men with PSA between 4 and 10 and "free PSA" % between 15 and 20 indicates that the probability of cancer is 20%.

In cases where a biopsy is clear, if PC is eventually found by subsequent biopsy, it's usually a small tumor with better prognosis.
Biopsy would be more likely to reveal any significant tumor in a small prostate.

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

Thanks for the replies. I suppose I'm looking for reassurance prior to Wed. next.

The area of PSA research is relatively new and there are so many strands and inconsistencies in results, its difficult to find "good" specific information. I often feel, in searching the web for info, that I'm just looking for the answer I want to hear.

JW100: What you've said agrees with what I've come up with, however reading some of the stories here about repeat biopsies showing up PCa on the third, fourth or subsequent biopsy doesn't inspire confidence in me. My rate of increase in PSA is the more worrying aspect. I read that a rapidly rising PSA is more likely to be due to prostatitis - but my G.P. says that he doesn't think it is in my case. If next week’s biopsy is clear (please God!), I’m going to ask if it’s worthwhile treating for Prostatitis, if only to eliminate that.

Replicant: I came across that Marathon article also but found it too vague in terms of activity level. I'd be more accepting if it had gone into detail about cardio-fitness level and age. Many people just "jump into" a marathon, whereas the questions I'd like answered relate to long term endurance training.

I have come across several articles that seem to support the hypothesis that long term endurance training is inversely related to PCa, on the other hand there are plenty that find no relation. If anyone is interested in the relevent links, send me a PM.

One thing that I’ve consistently come across is research showing that vigorous physical activity is beneficial in cases where advanced PCa has been diagnosed. It seems illogical to me that this should be the case but that the research on pre PCa exercise is inconclusive. ………….More research called for!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

I'm kind of surprised the doctor didn't try a round of antibiotics earlier.

My uro tried that, as well as heavy doses of anti-inflammatories, to see if that would help.

Best wishes for the upcoming biopsy. Please let us know how it goes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Otago · Regular Joined: 20 Jan 2008 Posts: 17

Well, I'm over 55 and have been a big biker.

I look at your PSA tests and see that you note extensive activity prior to each one. Seems to me, if this prostate cancer issue is a big one in your book, then you should have taken some time off prior to the tests.
I mean this is important if you have already undergone a biopsy and are going to get another one.

I went from a PSA .8 at about age 52 to 5 years later of 2.9 with no tests in between. However I was concerned about all my biking even though I had taken off 2 or 3 days prior to the higher test. The 2.9 test while still under 4.0 concerned me so after waiting 6 months, I went on vacation for 19 days with no biking and my next test came in at 1.6.
Now I have a different take on the reasons why biking and possibly running might cause a higher reading. I don't think its only because of physical pressure on the prostate forcing more into the blood, such as you might find from a DRE prior to the PSA test (this is the normal thinking)... But rather because of the potential for bicycling to cause a low level chronic "itis" or inflammation in the prostate........which in turn leads to a higher PSA score EVEN when there is no bacterial prostatitius in place. BTW, this type of prostititus will not be helped by antibiotics.
There are many studies that you can find that discuss the relationship between longer term "asymptomatic" non-bacterial prostititis and higher PSA readings. Asymptomatic means even YOU don't really know you have it but it can still cause a high PSA reading.
Its kind of like you are in a chronic state of low level inflammation.
BTW, some of the leading researchers in this field are leaning towards thinking that chronic inflammation of the prostate leads to prostate cancer.
Big names like Dr. Walsh have written about their thinking this is true.

Now, I'm not sure how this might affect your case, since I am a biker rather than a runner, but you do seem to be doing quite a lot of running al the time.
As much as you might hate it, you could take off a couple weeks prior to your next PSA test.....and you could take a low dose of ibuprofen for few days or weeks prior to the test. All in a effort to see if a prostate inflammation is part of the cause. Too bad you have not tried this long before you are headed to yet another biopsy.
You should realize that if you take enough biopsies of enough asymptomatic 55 year old men, you are going to eventually find some cancer.......even when you may not want to find it. Meaning that there is tons of prostate cancer out there and its better that some of it is not found because its not going to end up doing harm.
I know this sounds crazy, but thats why some doctors don't even get a PSA test. If you fish around with thousands of men age 55 you will probably find cancer in 30 to 40 percent of them. Then what? Treat them all.........?

Now having said all of the above, your numbers are getting higher. If you don't get a lower PSA reading soon, you probably should get another biopsy.
It would just be nice to get one test where you had allowed your body and prostate to possibly calm down for a few weeks. Might make no difference at all. In my case, it made a large relative difference.

I should add, that after my first 2.9 test I also made quite a few changes in my diet.........which was already very very good. I just tightened it up even more and added some quasi-supplement items. I'm not a big supplement guy but some things seem fairly good without much downside or cost.
Curcumin, Vit D3, Selenium, and of course, Pomegranate juice.
So did my laying off the bike make most of the difference or was some of it from the dietary changes which also included leaving off the final few, unfavorable items.......meat, dairy etc.
Who knows. My next test after another 6 months, confirmed the lower PSA score and was 1.7. I took off biking about 6 days before that test.

Personally, I think the biggest difference came from the break from biking, but it may just have been that I had a case of typical prostititis.
Who knows. There is no harm in trying the test after a few weeks off.

Personally my thinking is that I do have current prostate cancer and my job is to just slow it down to a crawl. Keeping my PSA numbers down so they won't send me in for biopsy.......which in my mind is gonna show up a diagnosis if its done enough times.

Good luck.

kzimm · Regular Joined: 16 May 2007 Posts: 14

Marathon Man: Considering you're concerned that your physical activities could mask the PSA resulting from potential cancer, you might consider requesting the PCA3 test. This simple uranalysis test harvests shed prostate cells and examines them for a genetic marker that is extremely specific to prostate cancer, and no other cells in the body including normal prostate cells. Bostwick labs offers the test, but not all urologists use it. Some think it will soon be used alongside PSA for better diagnosis and to avoid unnecessary biopsies. It was used to help diagnose my P.C. after three years of elevated PSA and 58 biopsy samples missed anything positive. After the PCA3 test, a 10-sample biopsy nailed it down and I had what is described as likely a "curative" radical prostatectomy last June. So far, so good.

Good Luck!
_________________
Kzimm

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

Well, Otago, I think I've had my head in the sand - probably still do! Embarassed

I've rested up for Wednesday's biopsy, so while I'm not really expecting my levels to plummet, at least it will reduce the influence of heavy training/racing on the PSA result.

Kzimm: I've read about the PCA3 test but will look into it a bit more. I get my results from Weds biopsy on Feb 6th. Hopefully the option of further tests won't be academic after that.

As I've always said to my other half....."What if.......?" is an awful burden!

One thing I intend to do when I go for the biopsy this time, is to write down [u]everything[/u] on my charts - I hate being drip-fed information!

Otago · Regular Joined: 20 Jan 2008 Posts: 17

[quote="Marathon Man"]Well, Otago, I think I've had my head in the sand - probably still do! Embarassed

I've rested up for Wednesday's biopsy, so while I'm not really expecting my levels to plummet, at least it will reduce the influence of heavy training/racing on the PSA result. [/quote]

Well, I wish you the best. I've never had a biopsy but from what I've heard they're not fun.
Now, if they give you another PSA test prior to your biopsy, I have my doubts that few days off will allow much possible inflammation to have subsided such that if low level inflammation is part of the cause of the higher PSA readings you might not see any change. Of course inflammation can also come from more typical bacterial prostititis.
The one area that a few days off might have a potential effect is if somehow your significant running agitated your prostate in a such a manner as to cause a physical effect on the prostate like a DRE is thought to do.
Personally I've not read of running causing this type of effect.
I differentiate that type of effect from activity such as cycling or possibly running setting up a chronic low level inflammation. Even at a level that you are not aware of.
As I said, there are several studies and papers on asymptomatic inflamatory prostititis.

My concern for most men, especially those at lower PSA levels is that if you biopsy them enough after reaching age 50, you will find prostate cancer in "most of them" even when "most of them" won't benefit from treatment.
Now, I want to be clear, I think treatment is beneficial and possibly lifesaving for many men. I'm guessing I may choose surgery at some point in the next 20 years should I be diagnosed.
On the other hand, if we looked hard enough at every man over age 50 we'd find so many additional cases of prostate cancer that their would be lines outside every surgery room.

As I tell all my friends, this is still a very messy area of medicine.
We don't always know which cases benefit from treatment and which don't.
Last April a very close friend had surgery. Another had surgery in December. My father had prostate cancer but was limited to radiation.
He lived 25 years and died of something else.
So even though I am still under 2.0 PSA, I am very interested in the subject. My aim is to slow the (probably already present) prostate cancer down to a crawl via diet and other methods.
My efforts may amount to zero influence but they're the only tools I have.
There is a fair bit of information suggesting that large changes in diet and lifestyle may have a impact that reduces or slows growth.
To me, thats all that is important since autopsies show that almost all men who die in their 80s and 90s have prostate cancer.
So its all about keeping it quiet and small without surgery or radiation or postponing that for years.

On the other hand for my friend in April, I was all for his surgery given his set of numbers.

Wish you well on Wednesday.

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

Well I got the news this morning. Not what I was hoping for but not unexpected either.

Second biopsy - previous one in June 2007 was clear): 10 cores, 3 positive (two are 3/3 and one 3/4), Stage is T1C. Because the amount of 4 is so low, Urologist is calling it a Gleason score of 6 (rather than 7).

PSA dropped back to 8.73 and free psa is 0.73 (not sure if that should be 0.27 - asked what free PSA was and he said 0.73 - struck me as high but I forgot to ask him to clarify, before we left) Gland size is 23cc.

The Urologist discussed the options with us and we're due to go back to him in two weeks, having considered them. Apparently, in Ireland, only two surgeons are doing the robotic procedure, having trained in Australia and have apparently, carried out a relatively small number of procedures to date. As a result of this, my preferred option is RP.

The urologist painted a bleak picture wrt both continence and sexual function but, having read around the subject, I feel that he may have been painting a worst case scenario for the longer term but a pretty accurate one for short term.

I know every case is different, but for a pretty fit 55 year old with no other health isssues, what do you guys reckon?

Urologist gave all the options from WW to RP (didn't mention cryotherapy though) in a frank mannner and made no recommendation at this stage, wanting us to come back in two weeks to go through the options in detail and come to a decison. At this stage, we feel RP is my best.

I'll make my own mind up, but I'd like to hear opinions from some of you guys.

brainman

Hi Marathon Man, I have been following your story since you first posted it but Replicant and John know so much more than I do about Prostate Cancer and both of them where giving you good information that I did not reply Embarassed

. I do know enough to tell you that you should rejoice a little with the results your received. Your PSA, stage, and Gleason Score are all relatively low. Usually, they treat cancers based on the most aggressive cell type they find so I do not really understand why they are talking about you having a Gleason 6 since one of the samples was a Gleason 7. Do you know if it was 3+4=7 or 4+3=7? A 3+4=7 is very similar in terms of aggressiveness to a 3+3=6.

If you possibly can, get in to see one of those two doctors that use the robotic surgery procedure. From all that I have read, it is the away to go.

You are in my thoughts and prayers.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

Prostatectomy sounds like a pretty reasonable route, as long as you've also explored all the others to make sure there's not one that's better for you.

You'll know your Gleason for certain after surgery, as well as the stage. That's a big benefit of surgery--having a pathologist look the thing over.

I wouldn't go the robotic route UNLESS the surgeon has done at least 30 and optimally more than 70 procedures.

The worst thing for me after surgery was the catheter. The hospital, apparently trying to save money, gave me these little adhesive pads with velcro hooks that, along with some heavy duty tape, were supposed to secure the tube to my thigh. But they just weren't good enough. Finally a nurse dug up a regular catheter strap--a large, jock-strap-looking thing that went all the way around my leg snugly, and had a very secure part for holding the catheter. That made ALL the difference, and I would suggest buying one of those before surgery, just in case! Once I had that strap, I could move around the hospital, and my house.

Look for something like this (link provided for illustration only):

http://cgi.ebay.com/Dale-Foley-or-Tubing-to-leg-bag-Catheter-strap-AU_W0QQitemZ320215217416QQihZ011QQcategoryZ19264QQcmdZViewItem

You'll also want to have some very baggy pants--like sweats, but ones that you can cut at the ankle for more room. This will help you with the catheter bag. You'll need those pants for leaving the hospital.

At night, you'll need something to hold the bag (you'll switch the bag at night to a large one) by your bed. I used a new, sturdy plastic trash can.

A box of alcohol wipes will be needed for wiping down parts of the bag and tubing when you empty or switch bags.

I don't mean to scare you. It's just that I wasn't mentally prepared for the catheter. Now if I needed one, I wouldn't be so freaked. After a couple of days at home, the catheter just became an annoyance, mainly when trying to sleep at night (you can't roll around!)

In case you're wondering, most men say it doesn't hurt to have it taken out. That was true in my case. A little uncomfortable, but a relief to be done with it.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Otago · Regular Joined: 20 Jan 2008 Posts: 17

[quote="Marathon Man"]
PSA dropped back to 8.73 and free psa is 0.73 (not sure if that should be 0.27 - asked what free PSA was and he said 0.73 - struck me as high but I forgot to ask him to clarify, before we left) Gland size is 23cc.

Apparently, in Ireland, only two surgeons are doing the robotic procedure, having trained in Australia and have apparently, carried out a relatively small number of procedures to date. As a result of this, my preferred option is RP.

The urologist painted a bleak picture wrt both continence and sexual function but, having read around the subject, I feel that he may have been painting a worst case scenario for the longer term but a pretty accurate one for short term.

Urologist gave all the options from WW to RP (didn't mention cryotherapy though) in a frank mannner and made no recommendation at this stage, wanting us to come back in two weeks to go through the options in detail and come to a decison. At this stage, we feel RP is my best.

I'll make my own mind up, but I'd like to hear opinions from some of you guys.[/quote]

Final RP results in the hands of a excellent surgeon are about the same as robotic surgery from most of the current data. Now, that may change over time. The famous surgeon Patrick Walsh still only does RP. Put it this way, I'd rather have a excellent surgeon do a RP than a average guy doing robotic.
You need to find the best surgeon possible. Especially one who is skilled in the "nerve sparing" methods pioneered by Dr. Walsh. Since there is no huge rush, you should spend a fair time doing this search. Asking and investigating.
I don't know if your urologist does this surgery, but you don't have to have him be the one. Not a time to be polite. You want the best surgeon you can get. Ask about numbers......numbers of surgeries performed, and how often they do this particular surgery. How trained and experienced they are in "nerve sparing" surgery.
I think your doctor is doing you a service being more negative than what is normally found, where doctors under play the outcomes.

Your doctor may be overly negative but on the other hand too many doctors gloss over the true outcome realities.
True data may influence your treatment choice.

Let me give you a link to a forum where many of the reality issues are discussed in depth. Note...that forum is a fairly biased in favor of the surgery option and especially [b]overboard[/b] about the robotic choice.
Still, there are several posters who have non-robotic RP and they discuss their outcomes, problems and successes.

Let me once again emphasize that there is little data to show, that in good hands of a excellent surgeon, that regular RP is less successful than robotic surgery in terms of outcomes and post surgical problems.
Everyone likes the latest and greatest, but the proof is ultimately in the outcome data. The jury is still out on that. Like I said, Patrick Walsh still only does open RP.....and the very wealthy and influential still seek him out. Billionaire, and former presidential candidate, Senator John Kerry had Walsh do his RP... He was back on the campaign trail a few weeks later and seems to be living his life well.

That .73 free psa may have been .73 of 8.73 total or about 9%. Lower free psa is more indicative of prostate cancer. Either way, you've been shown to have Gleason 6.

I don't know who pays for what in Ireland or how many choices you have.
Perhaps in one of the University medical training hospitals, there are experts who train others but who still do surgery.
Begin asking and searching, asking and searching.......Ask other medical doctors, dentists, nurses, and such. You may begin to hear the same name suggested. Even then check out his current surgical methods.

Everyone can't get the best surgeon, but that doesn't mean you can't get him.
My very close friend had robotic surgery last April. He has resumed normal activity without any long term incontinence problems. He does still need to use some drugs and/or injections for erections but is doing better with time.

OK........sorry you are faced with the need to make a choice, but in good hands you should do well.

Otago

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

Many thanks for the replies and info. I have a good deal of helpful info for the recovery period from other sources and will take them - and yours all on board.

I've been trying to come to terms with things and, maybe, be a bit too upbeat. One particular friend that I told yesterday said "PMA is everything - and you're friggin' full of it!" So....... hopefully.

Thankfully I have enough insurance to get me the best. We have a public patient regime here in Ireland and, believe it or not, it can take up to 4 years to get a biopsy!! I wouldn't have had a chance!

Anyway, as I wrote yesterday (?? time flies when you're having fun!), I was in with the Urologist on Wed and, while getting the low-down, didn't think to ask some Q's, so I rang him today and asked about having the surgery in July, after a holiday - vacation to you guys - in June (wife is a teacher and gets hols then), and also queried how aggressive the cancer was.

He effectively answered the second Q by saying that he wouldn't leave it more than a few weeks after our next consultation. My rapid rise in PSA is what's concerning him, considering the 3+4. btw, the 3+3 cores are 45% and 15%, while the 3+4 is 35%.

Lots of friends have suggested brachy, but U isn't keen - my own feeling too. The LR guys here apparently have a lot less than the 30 Replicant suggests, while the RP guy has done several thousand and does nerve sparing. I'm talking to several survivors over the next few weeks and I'm lucky that I have several relatives, friends, neighbours and acquaintences who are medical people. Hopefully between them, you guys and my own research, I'll be able to make the right choice for me. At the mo, while Brachy and LR seem appealing in terms of recovery, I'm strongly leaning towards RP.

I've never been in hospital in my life, except for the two biopsies, so this is going to be a culture shock!

I've got say this also - you guys on this site are fabulous - the way you give advice and support. Thank you and well done! You guys... and gals..are in my thoughts and prayers!

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