READER'S QUESTION: My 48 year old friend had prostate cancer surgery which has gone so bad he wants to do himself in. For some reason he did not listen to me when i suggested he get a second opinion and look into radiation instead of surgery, but now it's too late. What should he do at this point? (adapted from Monroenews.com, Nov. 16, 2008)
ANSWER BY RABBI ED:
I was saddened by your report about another prostate cancer patient who had unsatisfactory results from a radical prostatectomy (surgery) after he was diagnosed with localized prostate cancer in his late 40's. Here are some responses that occur to me.
It is important to clarify with your readers whether this unfortunate patient had open or robotic surgery, and to clarify the nature of its current outcome. I would not want others to get the impression that surgery is generally a poor choice, since the robotic laparoscopic approach worked well for me and most of the 70% of all U.S. prostate surgery patients who opt for robotic surgery annually. Nor would I want your readers to get the impression that surgery's curative effects are any less or more effective in the long run (two to four years later) than radiotherapy of different types.
In stating that this young man now "wants to do himself in", you've implied he has suicidal ideation. Is this because of physical or emotional pain? For instance, did he have no physical complications but suffers from ED or incontinence? Or has he found that physical pain following surgery has not abated?
Every prostate cancer treatment has its risks and benefits, and 90% of patients are satisfied with their treatment of choice, whatever it may be. Incontinence is generally experienced right after the trauma of surgery, but with the exception of 5% of patients tends not to be a problem within a few months of surgery. If it's a problem, surgeons have a way of correcting prolonged incontinence, such as implanting an artIficial sphincter to "stem the tide"!
If the patient has discovered that he's among the 50 to 70 percent of men who experience some degree of ED or impotence after surgery and his ED has been prolonged or is now deemed permanent, could it be that his surgeon was unable to spare his nerve bundles, whether due to error or because the man's prostate cancer margins were positive? If so it's possible for him to consult a surgeon (maybe a different one!) to attempt a nerve graft, which has a high success rate.
If his nerve bundles are intact, surely one of several methods, such as prescribed drugs like Viagra, use of a vacuum erection pump, or in some cases opting for a penile implant, should be explored. He and others can review some of these approaches in Chapter Ten of my book, Conquer Prostate Cancer.
Apart from these remedies, the patient in question should get professional guidance for what sounds like depression and suicidal tendencies. He can still review his situation with other competent urologists and, in time, get feedback from a support group in his area. I wish him well.