After careful research and, considering the aggressiveness of my father's prostate cancer, I have elected the robotic assisted laparoscopic prostatectomy (RLP) surgical option with the support of my wonderful wife, Judy.
In 1995, at age 79, my father's cancer was detected in late July, and he died in late October from the complications of his metastasized prostate cancer. I think my father's doctor was incompetent in caring for him and detected his cancer too late - PSA 10 and already in his spine.
My urologist is a 'rookie' when it comes to Robotic assisted laparoscopic - RLP, so I consulted with friends who had experienced RLP and then a couple doctors in the Dallas TX area.
One friend was his surgeon's first RLP case and was under anesthesia for over 8 hours! My Masters swim coach was an early RLP patient at MD Anderson where his surgery lasted more than 4 hours. I met with doctors at Baylor and UT-Southwestern in Dallas who both cited a procedure of 3.5-4 hours in length.
I was then referred to Dr. Randy Fagin in Austin who, according to the Da Vinci system manufacturer, has done more RLP's than any other doctor in TX. Posters to this website and other resources indicate that any surgeon's proficiency is a factor of the volume of procedures one has performed. Dr. Fagin currently does 35-40+ RLPs per month. I have seen a fully narrated RLP procedure of his which ran just a little over an hour and was a nerve sparing surgery. He avoids using cauterization when working near the nerve bundles to reduce the risk of damaging the nerves. He has also developed techniques to improve one's return to continence. If interested, you can learn more about his practice you might like to go to the Prostate Center of Austin website or meet the team here.
My procedure is scheduled for Monday, August 13. I will update when I am post-op.
Prostatectomy completed by Dr. Randy Fagin, Austin TX on Mon. 8/13 - I was brought into the OR at about 12N and returned to my room at 2.45P after spending approx. 1 hr. or so in recovery. Got out of bed around 7P for first walk around the hospital floor - maybe 5-7 minutes. Completed another walk of 7-10 minutes before going to sleep for the night. During hospital stay and since, have taken no narcotics for pain - only Motrin twice a day.
1 day post-op: did a couple more floor walks between breakfast and lunch, received catheter care instructions and discharged early afternoon. Returned to local hotel. Walked up set of stairs to second-floor room at hotel. Took long nap. Completed a 10 minute walk around hotel floor after in room dinner with family - all meals consist of liquid and/or soft foods, e.g. mac and cheese.
2 days post-op: light breakfast, 10 minute walk on hotel floor, sitting and reading, another 10 minute walk including down/up stairs at both ends of hotel floor, soft lunch, checked out of hotel and rode to airport for flight home to Dallas - 45 min. flight better option than 4 hr. car ride. Felt really good until arrival home, then had case of the "blahs" the rest of the day. Daughter-in-law brought tasty potato soup for dinner. Good night's sleep in own bed.
3 days post-op: light meals, took shower, created walking path throughout our house and completed 3 15-min. walks throughout the day and evening, otherwise sitting and reading. Still feel bloated from gas used during surgery which has not dissipated. Have been able to pass gas but no bowel movement - took dose of Milk of Magnesia before bed (issue resolved at 2AM!).
4 days post-op: friend from church picked me up at 1130A to go to church rec center for 20 min. walk, then met another church friend for lunch at restaurant - ate baked potato, small bowl of clam chowder, and piece of gingerbread with whipped cream (my favorite dessert there!). Church choir members brought dinner - fresh fruit, roast chicken, potatoes and carrots, fresh rolls, plus ice cream for dessert. Watched baseball on TV most of the day and forgot to walk around the house - mistake - too much sitting led to sore perineum by bedtime, but have been using donut pillow whenever sitting.
5 days post-op: light breakfast, 20 minute walk around the house, reading and TV (Little League Baseball World Series). Another choir provided meal for lunch - chicken salad on buttery croissants with a few potato chips. Friend picked me up at 120P to gather at a restaurant with a few other former IBMers for quarterly get-together - had to pass on the pizza. Wife picked me up after an hour to go to church for another 20 minute walk - actually did 25. Then came home for an hour nap.
At this point, I feel great - minimal pain/discomfort, have survived 2 sneezes, appetite is improving as well as variety of food I am able to eat. I am still to avoid all gas-producing foods until catheter comes out - scheduled for next Tues (surgery + 8 days). Anticipate returning to work at least half-time the next Monday (surgery + 14 days).
I hope this somewhat blow-by-blow dialogue is helpful for others considering the DaVinci procedure for resolution of your prostate cancer. Post inquiries if any questions arise or you would like other info I may have overlooked in the above.
Aug. 21, 2007 - received surgery pathology report: all negative margins, Gleason grade 7 carcinoma in left hemisphere as indicated in original biopsy, also Gleason grade 6 in right hemisphere. No cancer in excised vas deferens or seminal vesicles. Lymph nodes not removed. With cancer totally encapsulated in prostate, liklihood of recurrence is less than 1%. Catheter removed today - surgery + 8 days.
September 11, 2007 - returned to work (desk job) halftime at 2 weeks post-op; fulltime at 3 weeks post-op; down to 1 pad/day for incontinence; restarted regular exercise program at 4 weeks post-op, i.e. light weights, fast walk/jog, swimming; continuing Kegel exercises on a daily basis.
October 15, 2007 - first post-op PSA less than 0.10 ng/ml, right where we want it!
I am now nearly 9 months post-op and recently competed in the US Masters National Swimming Championships in Austin TX. I swam on two age 65-69 200 meter relay teams representing the Plano (TX) Wetcats competing with other relay teams from all across the US. We earned one 2nd and one 3rd place medal in our relays. Another member of our relay team is an 11 year PCa survivor (prostatectomy).
Had second post-op PSA yesterday, exactly 9 months post-op, reading came back "less than 0.1" - YEEHA! as we say here in TX - mild incontinence persists, ED improving - next PSA in November.
Recently had third post-op PSA as part of my annual physical in Nov. - 0.1. Right where it needs to stay!
Most recent PSA (November 2009) still undetectable (< 0.1) - mild incontinence persists - ED still improving with assist of Viagra.
Dec, 2010 - received updated PSA during annual physical, less than 0.1, "undetectable" - also had successful heart ablation procedure in June 2010 to correct atrial fibrillation condition unrelated to prostate cancer.
Have begun using injections as oral meds (Viagra) produced unsatisfactory erections - working with clinic to find correct prescription blend to produce erections of sufficient firmness and duration.
PSA from blood sample taken during recent annual physical came back < 0.1 again - now 4.25 years post-op.
I also want to pass on some useful information for those with light incontinence. A company in Canada is now selling men and women's underwear with a built in pad that is washable and reusable. While expensive to purchase initially, over time, the elimination of having to purchase disposable pads will offset the initial cost of the underwear. I have been very pleased with the performance of this underwear. (P.S. I get no commission nor free product from this personal endorsement.)
Dec 2012 - PSA taken during annual physical - results undetectable.
August, 2013 - had testosterone level checked due to low libido, came back at 300, began bi-weekly T-shots
September, 2013 - T-level improved to 700, PSA unaffected at undetectable, libido somewhat improved, Cialis provided some help with ED but not as much as desired, continued bi-weekly T-shots, next check of T-level and PSA scheduled for January, 2014.
Most recent PSA still <0.1, testosterone level now at 700, doc wants to reduce supplemental T-dosage as red blood cell count a bit higher than he would like (6.1 vs 5.7 threshold), will reduce from 200 units to 150 every 2 weeks. I am likely going to pursue insertion of an AMS sling to corral incontinence - getting tired of pads after 7+ years even though only using 1/day. May also pursue penile implant at same time as no pills work, injection dosage difficult to set for reasonable duration, pump is inadequate - manual stimulation sometimes works but not with enough regularity to be satisfactory.
Most recent PSA (2/2016) still undetectable. Had AMS sling and penile implant done in Aug. 2015. The sling has not worked for some unknown reason and may need to be redone but not until Aug. 2016 at the earliest. The penile implant is working as advertised but need more time to assess ongoing level of satisfaction. Have stopped taking supplemental testosterone - experienced no noticeable benefit.
Second male sling inserted October 2016 also failed, so opted for a artificial sphincter which was "installed" in November 2016 - wish I had done this years ago! I have progressed from 1-2 pads per day even with the slings, so that I now just use a simple, thin shield just in case. I do not use nor need the shield while sleeping. I can now go for several hours without any leakage nor the need to void. If anyone in the US would like the name of my surgeon who inserted my artificial sphincter, just email me directly, and I will be happy to share his name. He practices at UT-Southwestern in Dallas, Texas.
Most recent PSA checked in February 2017 is still undetectable!
Tom's e-mail address is: email@example.com