My TULSA prostate cancer adventure

[joesxm3]

As promised, here is the after action report on my TULSA PRO procedure.

I decided to leave out the most graphic details. If you are seriously considering TULSA and want the full report send me a PM.

It is now almost exactly 72 hours since I hit the recovery room. So there will be more to say going forward. But so far I am happy I chose TULSA.

My prostate cancer story began in early 2020 when my primary care doctor called to report that my blood work was fine, except for . . .

My PSA had increased to what he said had a 25% chance of indicating prostate cancer. He gave me the choice of being referred to a urologist or taking my chances. Since it was in the middle of covid and I was about to start taking care of my mother I decided to put it off.

I forget exactly what went on in between, but in the spring of 2022 my PSA spiked to about 10. My primary told me that I had to see a urologist, which I had already decided to. Not knowing much about the subject, I selected a group that got good reviews online and was affiliated with the conveniently located hospital. I had read a couple books prior to this and felt that I should have an MRI before the biopsy.

I had my first visit with this group and was surprised that it was only the APRN. I did not hit it off with her. She jumped right into wanting me to have a random pattern biopsy. When I pushed for MRI she sort of talked down to me and grudgingly admitted that could be an option. I think I scheduled a follow up visit to be after some blood work.

While I was waiting for the second visit, my friend who works for GE servicing MRI equipment sent me a podcast interview of Dr. Busch in Georgia. Dr. Busch is one of the early adoptors of TULSA. I was impressed with the interview and searched for a place where I might have TULSA.

I found that Yale was the only TULSA center anywhere near me. I also saw a bio of a urologist who was a pioneer in using the Artemis System to to MRI guided fusion biopsies. It said that he had done over 600 of these, so I decided that he was the guy for me. I cancelled the appointment with the local place and booked one with this doctor.

 

[joesxm3]

My first appointment at Yale also put me with an APRN, but she was a much better fit personality wise. When I asked if an MRI guided biopsy would be possible, she said that is how they do it there. So we set up the MRI appointment.

The MRI itself took about 30 minutes not counting dressing etc. The MRI result came back and it said that there were two lesions. One was PIRADS 3 (inconclusive) and one was PIRADS 4 (likely clinically significant cancer). I had a call with the urologist and the biopsy was scheduled. This is summer 2022.

When I arrived for the biopsy I asked about the Artemis System and was told that they no longer use it. They had just installed a new type of high frequency ultrasound machine that would also blend the MRI image. Since the prostate moves when they put the ultrasound probe up your rectum, computer software accounts for the shift and overlays the previous MRI images over the ultrasound.

I had heard horror stories about how painful the biopsy would be. In my case, he would do 10 targeted cores based on the MRI and also do the random 12 core pattern. Dr. Busch only does a few targeted cores, but books I read said that doing it this way added 5% pushing the probability of detecting any cancer to over 95%.

This biopsy did not hurt as much as I was expecting. But the one a year later did, maybe because I was expecting it not to hurt.

I forget exactly what the results were, but I think I had 2 or 3 cores with Gleason 6 (aka Grade Group 1) and one core with 20% Gleason 3+7 (aka Grade Group 2). That got me classified as favorable intermediate risk.

I considered sending the pathology to Busch or Epstein for a second opinion, but my doctor said that the guy at Yale was as good as Epstein and said if they differed, we would need a third opinion. If it were a local hospital I probably would have pushed for a second opinon, but I figured Yale was a top tier institution.

The tissue from the worst core was sent out for a Decipher genomic test. Decipher looks at 22 mRNA biomarkers and puts you in a group of people with similar biomarkers. I was put in a low risk category.

The urologist told me that they recommend active surveillance for people in this situation. So we scheduled PSA at 6 months and another biopsy at 12 months.

Yale is runnign the CAPTAIN clinical trial where 33% get RP and 66% get TULSA. I asked about getting into the trial and was told that my lesion is too close to the urethra to meet the trial criteria. I asked how many TULSA procedures had been done so far and was told it was seven.

 

[joesxm3]

Well this September I had the biopsy and there were three cores with Gleason 3+4 and one core with 60% Gleason 4+3. I was told that it is time for treatment.

In the meantime I had been doing extensive research into the topic and had concluded that I should push for a PCMA PET/CT. But before I could ask for it my doctor said that I would be getting one. He answered almost every question I had before I could ask it. We seemed to really be on the same page. So I was comfortable dealing with him.

I went for the PSMA PET/CT. That involved being injected with a radioactive isotope and sitting for an hour to let the cells absorb the isotope. The cancer cells bind to the isotope. Other parts of the body also do, but they supposedly know how to tell the difference. It took about 30 minutes inside the machine.

The PSMA PET/CT looks for cancer both inside and outside of the prostate. There was none found outside my prostate. Supposedly there is a 90% detection rate. The lesions on the right side of my prostate were detected. But, surprisingly, there was some uptake of isotope on the left side as well. The MRI and biopsy had not detected any clinically significant cancer on that side.

My biopsy was sent for Decipher again and this time I came back in the 85% bad group, ie. only 15% worse than me.

My information was also sent to the TULSA team to evaluate if I was a candidate for TULSA.

I continued my research and narrowed it down to TULSA and another ablation therapy called irreversable electroporesis. IRE inserts electrodes and uses electricity to open pores in the cells that kill them. It was interesting, especially since it was said to be less destructive than techniques based on heating or freezing.

We first discussed only doing the right side of the prostate, but eventually settled on doing the entire prostate because I was worried about the PSMA uptake on the left side. That ruled out IRE, which is only used for partial (aka focal) ablation.

 

[joesxm3]

I was approved as a candidate for TULSA. But as I may have mentioned I was not eligible to be in the clinical trial. Even if I was, I would not have wanted the 33% chance of having to have a RP. This means I have to pay out of pocket for what the insurance will not cover.

The clinics like Dr. Busch don't take insurance and charger about $35,000. I have not seen the price for my procedure but was told that they have been able to get Medicare to cover a lot of the hospital charges. I might only have to cover the amount that Yale has to pay Profound Medical for each use of the equipment.

TULSA stands for Trans-urethral ultrasound ablation. This is a process developed by Profound Medical (PROF), a Canadian company spun out of the research by Dr. Klotz.

The process is done inside of an MRI scanner. Profound supplies the robotic equipment and the third party workstation.

The equipment that goes inside the patient consists of a rectal cooling unit and a set of ten ultrasound emitters and a cooling unit that goes up the urethra. The cooling units protect the urethra and rectum from heat damage. The ten emitters rotate and the lenght of the ultrasound beam can be controlled. Crossing the beams creates heat which kills the cells.

Once the hardware is inserted into the patient, the process is pretty much computer controlled. The first step is to use the real-time MRI image to map out the area that is to be ablated. Once this is done, the machine takes over and runs the process.

The MR scanner is able to measure temperature, so they can see every 5 seconds or so how hot the area is. This allows them to be certain that it has been heated enough to kill the cells or that an area to be preserved has not gotten too hot. From reading the notes from my procedure, it seems that the process was stopped several times and rerun over an area that might not have gotten hot enough.

They also had to play with turning off the urethra cooling device to get some tumor that was close to the urethra.

The whole gland ablalation, in my case, is more or less equivalent to a radical prostatectomy. However, it is done from the inside and does not remove and reattach the urethra to the bladder as the RP does.

A recent Profound Medical video pointed out that previously focal (partial) techniques that were done to avoid damaging extra stuff are not as necessary since the TULSA can do the entire prostate and still avoid damaging things.

The advantage of TULSA is that there are no incisions and you are in and out on the same day. The long term side effect profile is much better than RP. I was told that there is a 2.6% rate of urinary incontinence and an 20% rate of erectile problems. The trade off might be that the recurrence rate might be higher than with RP. That is what the CAPTAIN randomized clinical trial is testing now.

The safety trial that led to the 2018 approval had a 30% recurrence rate. I discussed this with the principal researcher on the CAPTAIN trial in the recovery room. If there is calcification in the prostate it blocks the ultrasound beams and prevents complete ablation. The 2018 trial rejected patients with greater than 1.0 mm calcifications. Since they they have changed this limit to reject patients with greater than 0.3 mm. This may have been part of the reason for the high recurrence rate. Also, the 2018 study was performed at many institutions, each early in their learning curve.

 

[joesxm3]

So far, it seems that the preparation for the procedure and the recovery from the procedure are worse than the procedure itself.

I did not realize that I would have to eat clear liquids only for two days, then nothing at all the day of the procedure.

I also did not realize that I would be put under heavy general anesthesia with a breathing tube. I thought that it would be more like a colonoscopy. I am not sure if all TULSA clinics do it this way. My throat was sore for two days after.

I also did not realize that I would have to have a catheter for seven days. I mean I found this out before, but did not find this stuff from the Internet videos and my research.

I had to stop NSAID's and vitamins for a week. That was quite a problem because I hurt my back and was taking Motrin.

I don't think this is the case in all clinics, but Yale had an impressive team lined up for the procedure.

There were two interventional radiologists, one as the attending physician and the principal researcher who supervised and approved the mapping.

There was also a urologist who installed the hardware and an anesthesiologist plus several nurses and other people. The control room next to the MRI looked like NASA.

I was told that there would also be a technician from Profound Medical on hand to deal with any computer issues. I never saw that person, so it might be only for the cases that might impact the clinical trial results.

They rolled me in and a bunch of people swarmed over me making me breathe oxygen and injecting things into me: antibiotics and anesthesia and who knows what else. They said it would all be a dream and they were right. I was dead out for all of the painful stuff.

As an aside, I think that being knocked out with my back straight for four hours helped my back problem. The actual ablation was about one hour but the setup takes more time.

I woke up in recovery with a catheter in me. I got there at 10:30 am. I think I went into the room between noon and 1 pm. I was on my way out the door around 7 pm.

They gave me prescriptions for antibiotics to protect agains UTI and one called Flomax that is used for BPH. I have to take the Flomax for 90 days. They gave two other ones for bladder cramps and such but I did not need them. I am also taking Motrin or Tylenol. At this point I think mainly for my back and leg pain that I had before the procedure.

The worse part of the afterwards was the throat soreness and having to have the catheter.

 

[joesxm3]

will get the catheter out next week and if I can pee I will be all set on that.

On the right side they ablated right up to the capsule wall next to the erectile nerve bundle, but the doctor said that the nerve bundle did not get hot enough for ablation. On the left side they left half an inch of prostate tissue near the nerve bundle. So, since I still have some prostate tissue intact I will not have a super low PSA. We will have to see what my new baseline ends up being.

The follow up is PSA at 3 months and 6 months and MRI and biopsy at 12 months.

When I first spoke with them about TULSA in 2022 they had done six cases. The principal researcher told me that he had done the first two cases of the safety trial in 2016 at another institution and now with the CAPTAIN trial he had done about sizty cases. So the year of active survaillence made a big difference in getting an experienced team.

I will be happy to answer questions or to respond to PM's. I guess I will have to update this as time goes on to report any side effects or whether or not I have a recurrance.

If you suffered through reading this far, thanks for your attention.

 

[Katsmeow]

I know nothing about the procedure you had done. I wanted to commend you for the detailed and informative report. I hope your recovery goes well.

 

[wallygator69]

Wow great write up. Sincerely appreciate it. Good Luck!


Wally

 

[pacergal]

Best wishes for a great recovery.
Thanks for the detailed info for those who may need it.

 

[aja8888]

Joe: I wish you the best!

And thanks for documenting this procedure and experiences for future reference for other guys here.

 

[Masquernom]

Really appreciate you taking the time to write this up so well. You've done a lot of great research. Hope I never need the procedure, but great to know about it.
Hope it works out well for you. Let us know your longer term results please.

 

[GaryInCO]

Thanks for the excellent writeup!

My brother and I got diagnosed within about 2 months of each other in 2019. His was a bit worse than mine and he was kind of panicking ("Get it out get it out get it OUT!!!"), so he went with RP. I think he's having some long-term issues with that -- incontinence, ED, that kind of thing.

Mine was Gleason 3+4. I chose brachytherapy (inserted radioactive pellets). The procedure was no problem, as I slept through it. My catheter came out right away and it felt like I was peeing razor blades for a few days, but nothing intolerable. I had to sit cautiously for a few days because I had an "internal sunburn" where the sun don't shine, but that totally cleared up within a week. Minor effects to the colon for a few months, and within 6 months all side effects were gone. Haven't had any issues since.

I got special ID cards from the radiation doc saying I glowed in the dark, and I shouldn't hold babies in my lap or similar close contact for a while. I thought that might be a problem on planes, but this was early 2020 -- just a month or two before all air travel shut down. And in fact I haven't been on a plane since, due to Covid and immunity issues.

So I had some side effects &etc but not terrible, and it's supposed to be 99% effective for 10 years. But I might have chosen TULSA if it was available at the time.

 

[joesxm3]

I was considering high dose rate brachytherapy, but Yale does not offer either kind. The closest place would have been NYC and that seemed too far away for me. I also did not want to get into a 30 session EBRT and was worked about rectal damage from the radiation.

One thing I have not completely figured out is what the inside of my prostate is now and later.

They said that they left something like 2 cm of tissue around the prostate. So I wonder if it is just like a hose stretching over an open hole.

My doctor said that my prostate is like a well done steak when we spoke in recovery. So I am thinking that there may be dead tissue acting as a support. The prostate will shrink considerably as the dead tissue is absorbed by the body. The other doctor told me that it will take three or four weeks for the prostate to collapse. I am hoping that when that happens it will also support the urethra.

I am doing ok today. My main worry is that I don't get a UTI and that I will pee properly when I get the catheter out.

Thanks for all the well wishes.

 

[joesxm3]

I am not only a patient, but an investor.

Talk about hands on research

I asked one of the team doctors on the clinical trial if she felt that TULSA would become the new standard of care. She said that it would become an option, but felt that it would not become wide spread because of difficulty securing time in the MRI scanner. At Yale they only do TULSA on Tuesday and have averaged three a month.

Profound Medical places the equipment for free and charges about $6000 per use. This video implied that an MRI scanner costs about $70,000 to $100,000. So, perhaps places dedicated to prostate could set up.

The place in Germany that is the world leader says that they have fine tuned the process and do six TULSA per day.

Here is a longer video targeted at investors, but it starts out with some interesting testimonia!s from doctors and patients.

 

[joesxm3]

These two YouTube channels had tons of information

https://m.youtube.com/c/ThePCRI/videos

https://www.youtube.com/@GrandRoundsinUrology

 

[Texas Proud]

Hope all is well in the end...


But I hope that I do not have to find out about any of these procedures...



My dad had prostate cancer in early 60s... and I read that most men will get it if they live long enough.... but still...

 

[Car-Guy]

Hope all is well in the end...


But I hope that I do not have to find out about any of these procedures...



My dad had prostate cancer in early 60s... and I read that most men will get it if they live long enough.... but still...

I've heard/read that several times that too.

 

[joesxm3]

For those interested in a really detailed presentation on TULSA I found this one today.

 

[joesxm3]

Well it has been almost two weeks since I had the TULSA procedure so I figure it is time for an update.

To put things in perspective I need to mention that my situation may not be typical because a couple weeks before the procedure I picked up a 42 pound package the wrong way and hurt my lower back, causing cramping in my left leg that made it very difficult to sleep properly. So part of my experience may be due to issues caused by lack of good sleep.

I have felt dragged out, even up to today. I am not sure if this is related to the procedure, a UTI or just lack of sleep.

One thing that I did not realize was that you are required to do clear liquid diet for two days prior and to have an enema the night before and the morning of. This makes sense since they need the rectum nice and empty to put the cooling unit in.

I think that I underestimated the recovery time by quite a bit. As I said, this might be partially due to my back pain. I had to have a catheter for eight days and this was not pleasant. Part of this might be because they may not have left enough slack between the penis and the leg attachment.

The videos say that you should be back to normal activities in a couple days. I found it challenging to be doing things with the catheter, even with the small leg bag.

I did not realize that I would be given an antibiotic for ten days and Flomax for 90 days. The antibiotic was expected, but the Flomax was a surprise.

I had thought that if I got someone to watch my step father the day of the procedure I would be able to care for him myself after that. This is definitely not the case. It was lucky that he is in the rehab hospital. That is the main reason I grabbed the opening even though I should have healed my back pain before having the procedure.

I was able to pass the void test when they took out the catheter and the nurses pushed me out the door. I have not had any leaking, but my urination is different. It is more like gravity feed than spraying under pressure. I also feel the need to urinate every hour or two. They gave me a prescription for "urinary urgency" but I was not clear what this meant so I have not taken any.

It took three days before I was able to have a bowel movement, but that might be expected having emptied out prior to.

The video I just posted says that it could take up to three months for urinary and bowel functions to return to base line. Another post I saw on inspire.com said that her husband took three weeks to lose urinary urgency.

Before the procedure I had a nice talk with the attending physician and in recovery the principal researcher doctor came to see me and gave me his cell number. I replied instantly the two times I texted him. But I feel that there should have been more post-procedure follow-up than I have had.

I would have liked a discussion along the lines of "here is what we accomplished during the procedure compared to what we planned", "here is what to expect regarding urinary symptoms, your symptoms are normal", etc.

From the video above, it shows that erectile function will drop off considerably for the first few months but then recovers to an 80% chance of working properly. So I can't comment on that. But I am pleased to not be leaking urine.

The next big milestone will be whether I have some sort of recurrence. I guess only time will tell. The existing studies seem to show a 20% to 30% recurrence rate for TULSA, but that includes recurrence in prostate tissue that was spared by a focal procedure. I had almost a whole gland ablation.

The recurrence rate for RP is not 0%. I think it is something like 20% to 40% in the 10 to 15 year time frame. So maybe I am trading an extra 10% chance of recurrence for a significantly lower side effect profile.

So far I am satisfied with my choice of TULSA. Ask me again in a year.

 

[Koolau]

Well it has been almost two weeks since I had the TULSA procedure so I figure it is time for an update.

To put things in perspective I need to mention that my situation may not be typical because a couple weeks before the procedure I picked up a 42 pound package the wrong way and hurt my lower back, causing cramping in my left leg that made it very difficult to sleep properly. So part of my experience may be due to issues caused by lack of good sleep.

I have felt dragged out, even up to today. I am not sure if this is related to the procedure, a UTI or just lack of sleep.

One thing that I did not realize was that you are required to do clear liquid diet for two days prior and to have an enema the night before and the morning of. This makes sense since they need the rectum nice and empty to put the cooling unit in.

I think that I underestimated the recovery time by quite a bit. As I said, this might be partially due to my back pain. I had to have a catheter for eight days and this was not pleasant. Part of this might be because they may not have left enough slack between the penis and the leg attachment.

The videos say that you should be back to normal activities in a couple days. I found it challenging to be doing things with the catheter, even with the small leg bag.

I did not realize that I would be given an antibiotic for ten days and Flomax for 90 days. The antibiotic was expected, but the Flomax was a surprise.

I had thought that if I got someone to watch my step father the day of the procedure I would be able to care for him myself after that. This is definitely not the case. It was lucky that he is in the rehab hospital. That is the main reason I grabbed the opening even though I should have healed my back pain before having the procedure.

I was able to pass the void test when they took out the catheter and the nurses pushed me out the door. I have not had any leaking, but my urination is different. It is more like gravity feed than spraying under pressure. I also feel the need to urinate every hour or two. They gave me a prescription for "urinary urgency" but I was not clear what this meant so I have not taken any.

It took three days before I was able to have a bowel movement, but that might be expected having emptied out prior to.

The video I just posted says that it could take up to three months for urinary and bowel functions to return to base line. Another post I saw on inspire.com said that her husband took three weeks to lose urinary urgency.

Before the procedure I had a nice talk with the attending physician and in recovery the principal researcher doctor came to see me and gave me his cell number. I replied instantly the two times I texted him. But I feel that there should have been more post-procedure follow-up than I have had.

I would have liked a discussion along the lines of "here is what we accomplished during the procedure compared to what we planned", "here is what to expect regarding urinary symptoms, your symptoms are normal", etc.

From the video above, it shows that erectile function will drop off considerably for the first few months but then recovers to an 80% chance of working properly. So I can't comment on that. But I am pleased to not be leaking urine.

The next big milestone will be whether I have some sort of recurrence. I guess only time will tell. The existing studies seem to show a 20% to 30% recurrence rate for TULSA, but that includes recurrence in prostate tissue that was spared by a focal procedure. I had almost a whole gland ablation.

The recurrence rate for RP is not 0%. I think it is something like 20% to 40% in the 10 to 15 year time frame. So maybe I am trading an extra 10% chance of recurrence for a significantly lower side effect profile.

So far I am satisfied with my choice of TULSA. Ask me again in a year.

Feel free to update at any time. We're all (well half of us) are potential candidates at one time or another should we live so long. Thanks for the thorough narrative and thanks for the frankness of the discussion.



Best of luck to you in all aspects of your recovery!

 

[Car-Guy]

Feel free to update at any time. We're all (well half of us) are potential candidates at one time or another should we live so long. Thanks for the thorough narrative and thanks for the frankness of the discussion.

It just occurred to me that "some women" have had preemptive surgeries to avoid potential cancers in their future. (e.g. higher risk genes identified) But it doesn't seem to be so common for men to take such actions when they may be identified for higher risk male conditions.

 

[aja8888]

Well it has been almost two weeks since I had the TULSA procedure so I figure it is time for an update.

To put things in perspective I need to mention that my situation may not be typical because a couple weeks before the procedure I picked up a 42 pound package the wrong way and hurt my lower back, causing cramping in my left leg that made it very difficult to sleep properly. So part of my experience may be due to issues caused by lack of good sleep.

I have felt dragged out, even up to today. I am not sure if this is related to the procedure, a UTI or just lack of sleep.

One thing that I did not realize was that you are required to do clear liquid diet for two days prior and to have an enema the night before and the morning of. This makes sense since they need the rectum nice and empty to put the cooling unit in.

I think that I underestimated the recovery time by quite a bit. As I said, this might be partially due to my back pain. I had to have a catheter for eight days and this was not pleasant. Part of this might be because they may not have left enough slack between the penis and the leg attachment.

The videos say that you should be back to normal activities in a couple days. I found it challenging to be doing things with the catheter, even with the small leg bag.

I did not realize that I would be given an antibiotic for ten days and Flomax for 90 days. The antibiotic was expected, but the Flomax was a surprise.

I had thought that if I got someone to watch my step father the day of the procedure I would be able to care for him myself after that. This is definitely not the case. It was lucky that he is in the rehab hospital. That is the main reason I grabbed the opening even though I should have healed my back pain before having the procedure.

I was able to pass the void test when they took out the catheter and the nurses pushed me out the door. I have not had any leaking, but my urination is different. It is more like gravity feed than spraying under pressure. I also feel the need to urinate every hour or two. They gave me a prescription for "urinary urgency" but I was not clear what this meant so I have not taken any.

It took three days before I was able to have a bowel movement, but that might be expected having emptied out prior to.

The video I just posted says that it could take up to three months for urinary and bowel functions to return to base line. Another post I saw on inspire.com said that her husband took three weeks to lose urinary urgency.

Before the procedure I had a nice talk with the attending physician and in recovery the principal researcher doctor came to see me and gave me his cell number. I replied instantly the two times I texted him. But I feel that there should have been more post-procedure follow-up than I have had.

I would have liked a discussion along the lines of "here is what we accomplished during the procedure compared to what we planned", "here is what to expect regarding urinary symptoms, your symptoms are normal", etc.

From the video above, it shows that erectile function will drop off considerably for the first few months but then recovers to an 80% chance of working properly. So I can't comment on that. But I am pleased to not be leaking urine.

The next big milestone will be whether I have some sort of recurrence. I guess only time will tell. The existing studies seem to show a 20% to 30% recurrence rate for TULSA, but that includes recurrence in prostate tissue that was spared by a focal procedure. I had almost a whole gland ablation.

The recurrence rate for RP is not 0%. I think it is something like 20% to 40% in the 10 to 15 year time frame. So maybe I am trading an extra 10% chance of recurrence for a significantly lower side effect profile.

So far I am satisfied with my choice of TULSA. Ask me again in a year.

Thanks for posting this Joe. Even though I am on Tamsulosin (Flowmax) and have no prostate issues other than having a "low flow" situation, I'm 80 now and still concerned that maybe someday things will go south in this area. My PSA has always been < 1.0 but I know that's not a 100% indicator. Colonoscopies have been good so far.

 

[Koolau]

It just occurred to me that "some women" have had preemptive surgeries to avoid potential cancers in their future. (e.g. higher risk genes identified) But it doesn't seem to be so common for men to take such actions when they may be identified for higher risk male conditions.

I suppose it all comes down to risk vs benefit. At some point, perhaps the men will catch up to the women on preemptive surgery. For now, even the PSA test is considered "controversial." I'm guessing that genetic testing for PC would be even more controversial but I've never heard a discussion on that (or other male-only cancers.) Interesting thought, though.

 

[Teacher Terry]

It just occurred to me that "some women" have had preemptive surgeries to avoid potential cancers in their future. (e.g. higher risk genes identified) But it doesn't seem to be so common for men to take such actions when they may be identified for higher risk male conditions.

To me the difference is that the surgeries don’t cause a woman to not be able to have sex or difficulty controlling her urine like treatment for prostrate cancer does for men. Even the radiation seeds caused both these issues for my ex.

 

[Car-Guy]

To me the difference is that the surgeries don’t cause a woman to not be able to have sex or difficulty controlling her urine like treatment for prostrate cancer does for men.

I guess men need to consider that and the potential of it happening "later anyway" and of course the risk of an earlier death. Again for identified higher risk individuals.