Despite a family history of prostate cancer, I had avoided getting a PSA test or DRE for a number of years. Dumb! A physical required for a life insurance policy in Feb 2021 found a PSA of 11.9 which, in addition to tanking my ability to get the new policy, immediately kicked off my PCa journey.

I called around and made an appointment with Dr. Cerny at Minnesota Urology. He performed the DRE and confirmed that the left side had "indurations" or small lumps/hard spots. A standard TRUS biopsy followed in early March 2021 which was a little painful but not as bad as I had feared going in. I never doubted that it was going to come back positive for cancer, and it didn't. All 7 cores on the left side were Gleason 3+4 with varying percentages from 35 to 90%. One core on the right side had some 3+3 but that was it.

Next steps were the typical CT and bone scan looking for mets that might make surgery contraindicated. They came back clear of visible mets, although the CT scan did find a nodule in my lung that needed to be rechecked in 6 months, per the pathologist. When it rains it pours I guess.

Dr. Cerny was an experienced RALP surgeon and that was his recommendation given the extent of the tumor on the left side, my family history, and the PSA level going in. He was willing to do nerve sparing on the right side since the biopsy had been clear on that side. We talked about radiation options as an alternative, and I did some reading here and in a reddit prostate cancer group, and came to the conclusion that RALP was my best option due to: 1-The side effects are immediate and get better over time; 2-I wanted radiation available as a future salvage option; 3-Future PSA scores would be an accurate marker for tumors; 4-I just wanted it out of me.

The RALP surgery was performed in mid-May and went fine. There was a "Godwink" moment when I found out one of the operating-room nurses was a woman from our church. It was comforting to know that she (and others) were praying for me during the operation.

I spent two nights in the hospital before my bowel function started coming back. I got constipated at home and had some trouble with bladder spasms due, possibly, to the suppository used to get things moving again. Bladder spasms are not fun. Maybe the closest we men can come to the kinds of contractions women have 10x worse during labor...

Pathology came back confirming Gleason 3+4 (7) with 30% pattern 4 but found a tumor on both the left and right side, and also found extracapular extension into the seminal vesicles. The surgical margins were clear, however, and the four lymph nodes pulled during the operation were also clear, so the final pathology staging was pT3a N0 M0. The right side tumor was smaller, which explains how it was missed in the biopsy (and DRE). Hopefully it was far enough away from the right nerve that the nerve-sparing on that side doesn't increase my risk.

It has been 7 months since the surgery. Incontinence went away pretty quickly once the catheter came out - call it two weeks on pads, four weeks on shields day/night, and now just occasional shields during the day if I am going to be doing strenuous yard work or golfing or something else that might cause a little to squeak out. Very blessed and thankful for this aspect of my recovery. I did do kegels before surgery and after, but mainly I think my long walks every day on rough paths and across fields helped me to learn to control it.

ED has been hit or miss. It was partial nerve sparing, so there is a good chance I can get back some function. I was put on daily Cialis 5mg and purchased a vacuum device to help keep things from atrophying, and I do get erections at night and whenever I want by myself, but so far no real success with my loving and patient wife. It's still the 2nd inning of this game, though!

With my pathology staging at T3a, 3+4 Gleason, and my tumor size, Dr. Cerny is telling me that my chance for biochemical recurrance is around 20% which seems consistent with what I can find online. That 20% chance of future cancer is something I cant help feeling I would have avoided if I had been on top of things every year since, say, 50 years old. I am thankful that we caught it when we did, but 2-3 years earlier would have been even better...

I had a follow-up PSA test at 3 months which came back undetectable (<0.04 in that lab) and a second at 6 months which was likewise undetectable. Very thankful for those results as it gives me a fighting chance of being on the good side of that 80/20 die roll long term.

Follow-up CT scan of my lungs six months after the original CT scan found the nodule had shrunk and calcified, both good signs. So I can focus on beating PCa and not worry about anything else right now.

There is a house I walk by quite often on my daily rounds with a sign that has Joshua 9 - "Be strong and courageous. Do not be afraid; do not be discouraged, for the Lord your God will be with you wherever you go." I thank God every day for his provision and comfort during this process.

Back in May I had my quarterly PSA test and got another undetectable (<0.04 in this lab) result. Doctor called this "No Evidence of Disease" and "promoted" me to semi-annual PSA tests. Glad that things are still looking as good as one can hope for, disease-wise, but I'm not sure I like the idea of waiting six months between tests. Not knowing is worse than knowing, imo. Next test in November. I've stopped researching "what-if" scenarios around BCR and I'm just going to live well and not worry about it. Nothing I can do at this point but wait and pray.

Incontinence is pretty much under control. Havent worn even a shield in months, but do still drop/leak just a tiny bit if I twist the wrong way or pick something up wrong. Very thankful for this aspect of my recovery. Impotence is slowly getting better. Doctor has me on Cialis 5mg for overall penile health/recovery and occasional Viagra 100mg which I seem to respond to better when I need it.

My diagnosis and treatment prompted my younger brother to finally get checked out and he, too, has been diagnosed with PC. Lower PSA but same Gleason (3+4). He's going through all the same questioning and decision-making I had to go through. I'm trying not to come off as a know-it-all older brother and just be supportive. He's got a bit more weight to carry around than me, and I know that weight can affect the incontinence aspect of surgery, so my prayer for him is that he makes the right decision for him and has a good outcome based on that decision.

Keep fighting the good fight fellow warriors.

Just had my 2.5 year post-RALP PSA test a week ago. Thankfully my PSA continues to be undetectable at the levels available in the device used by my urologist (below 0.04). I have no real interest in doing an ultra-sensitive test at this point -- If it came back 0.02 or 0.03 instead of <0.01 I wouldn't change anything or pursue any immediate treatment, so why do it? We are still doing every-six-month intervals, for now, and my Doctor says that if it ticks up above undetectable we'll do another after 3 months and go from there. Good enough for me.

I told my doctor that these PSA tests are very stressful, in part because I know what happens if I do have recurrence. I've read enough stories here and have spent enough time on other sites and forums to have a good idea what it means in terms of radiation, ADT, etc. He said that, honestly, it is better that I do know what it means -- some of his patients are pretty clueless and don't think about it at all which can be even harder if the news is bad and they are blindsided by it.

That said, I know that I am one (or two) tests from going back into the salvage/treatment process with a much-reduced chance of actual cure. I really feel for and appreciate the guys here on this site who share their stories, had recurrence happen, and still continue to post about all the ups and downs of subsequent treatment. You are not alone, and I am not alone. You have my profound thanks and respect.

In terms of side effects, incontinence is basically gone and ED is perhaps 80% gone with a little help from the pharmacy. Can't ask for much more than that with only partial nerve-sparing surgery.

Keep fighting the good fight and loving those around you every day.

Greg's e-mail address is: g10000m-yana AT yahoo.com (replace "AT" with "@")