I had been monitoring my PSA over a ten year period and it had risen to a level that caused me concern (3.5). I did extensive reading on the subject of PSA trends and levels, and decided that I wanted to have a biopsy done to determine if there was cancer present. There was: Gleason 3+4=7 in 5 out of 10 core samples taken in the biopsy.
Active Surveillance was not a good option for me based on the opinion of two Urologists and the information provided in several articles that I read on the subject. I looked into various alternatives for treatment, but decided to concentrate on external beam radiation and robotic surgery as treatment options because these appeared to be the primary, go to, options for most people.
I met with radiation oncologists (2) and robotic prostate surgeons (2) to explore these options. I put a great premium on meeting only with specialists that had extensive experience in their procedure and asked, up front, about the exact number of these procedures they had done in the last 12 months and in total over their careers. Each specialist had extensive experience. The two surgeons had done over 1,000 of the robotic procedures. Once you have elected a treatment option and doctor, make sure that they are the one that is going to perform the procedure. In some teaching hospitals you will get a rookie under the supervision of the experienced person you just talked to.....you don't want this because the cancer eradiction, continence, and sexual function following surgery are very dependent on the experience of the surgeon.
I chose the robotic prostatectomy as my treatment because, following the procedure, you have a great deal more information on the current status of your cancer and you are in a better position to monitor the status of your cancer going forward. Because the prostate is removed in the surgical option you are certain that all of the cancer contained therein has been removed. Second, a pathology report is done on the prostate and all of other items that are removed (e.g. lymph nodes in my case) to ascertain the exact state of your cancer beyond the prostate. Third, because the PSA should be undetectable when the prostate is removed, you are in a better position to determine whether or not there is any cancer remaining now or in the future. The radiation treatment is less invasive, but the state of the cancer, inside and outside of the prostate, is not known with certainty and because the prostate is not removed, the PSA base line is more obscure.
I had the surgery done about two months after my initial diagnose and I am on my second week of recovery as I write this initial entry to my YANA story.
Here is what transpired during my first two weeks at home from the hospital.
During the first week at home my abdomen was sore, but the pain was controllable with Motrin. My main activity during this first week was managing my urine bag from the catheter (i.e., emptying, cleaning, and changing over to the nighttime bag). At the end of the first week, I got the catheter out and received the results of the post-surgery pathology report. I got the very good news that all of the cancer was confined to inside the prostate – no cancer in the prostate capsule, lymph nodes or any of the other tissue that was removed. Further, the Gleason level of the cancer found in the prostate was consistent with my initial biopsy (i.e., intermediate 3+4=7 Gleason).
During my second week at home, the soreness in my abdomen reduced every day; until by the end of the second week the pain was almost completely gone. As a note, the night after I had the catheter removed I experienced very painful bladder spasms, but I was able to address these using a heating pad. The spasms only occurred once, but I ask for a prescription for an anti-spasm medication in the event it happened again; as it was something I did not want to experience again.
So, how am I fairing on the three priorities of the treatment stated by the surgeon (in this order): removing the cancer, maintaining urinary continence and, then, sexual function. At this point, I hope that the cancer has been addressed (PSA test in a few weeks as a double check on it). Regarding the urinary situation, I am wearing a pad, but I am peeing under my control and on a fairly normal schedule. I have some minor "dribbling" into the pad I am wearing, but I have had no incidence of peeing my pants or anything of that nature. I consider this all great progress with respect to continence. Regarding sexual function, it is too early to assess the situation. I am taking 25 mg of Viagra every night before going to bed; as the first stage of a modern protocol suggested by the hospital for promoting the best long-term sexual outcome. I am going to begin using a penis pump in another week on a daily basis as part of this process.
It has been six weeks since my robotic prostate surgery. I got my first post-surgery PSA back today and I am pleased to report that it was undetectable – defined by the lab that did the blood work, using their assay, as <.1 ng/mL. Repeat PSA tests are scheduled every 12 weeks for the next year; with the schedule adjusted annually based on the results.
So, how are things progressing on the other two goals (Eradication of the cancer being the first goal; with continence and erectile functionality being the second and third goals – respectively?)
Continence – I continue to wear a pad, but I have reduced the size of it to what is referred to as a medium absorbency pad. The amount of "dribbling" I am experiencing is going down. I continue to get some stress dribbling (moving quickly / walking briskly), but I believe that things are improving toward a good outcome. The bladder activity also seems to be impacted by what I drink and eat (acidic and spicy items are probably not the best). Some unanticipated benefits of the surgery relating to urination are that, without the prostate, my stream is extremely strong and my bladder empties quickly. Additionally, I believe that I am getting up less frequently at night to go to the bathroom.
Erectile Functionality – Since I had the catheter removed, five weeks ago, I have been taking 20mg of Viagra every night before I go to bed (You can get generic Viagra at a very reasonable price through some legitimate on-line pharmacies and some urologists in the US that have access to generic Viagra). I have also been using a penis pump once and a while to stretch and keep the vessels and other mechanisms in the penis active and vital. I am very cautious about the penis pump. I feel that the pump is helping out, but I also know that if it is used too aggressively I can do some penis damage. I am very happy to report that I have had a 80% erection and intercourse with my wife – the one time we tried it – about five weeks after the surgery.
I cannot stress, enough, the importance of getting an experienced surgeon to do the robotic prostatectomy. The success of the urinary control and erectile function is a direct result of the experience of the surgeon with the procedure. To repeat something I have already mentioned in my story, my surgeon had done over 1,000 robotic prostate procedures. He is a guy in his mid 40's with, I believe, solid hand-eye-knowledge coordination.
Regarding my activity level – I ramped up and now try to walk one hour a day on a treadmill at the local YMCA. I have also been doing all of my weight machine exercises starting last week, BUT WITH ONLY 10 (TEN) POUNDS ON ALL OF THE MACHINES. I started swinging the golf clubs one week ago and I am comfortable swinging all of the clubs today. I will be golfing my first 18 holes at the post-surgery seven week mark.
As an add-on to my last update, and something very important that I mentioned earlier in my story, make sure that the surgeon you are talking to is the one that will actually be doing the procedure. There are teaching hospitals that will have inexperienced surgeons doing the procedure under the supervision of an experienced surgeon. You want to get assurances, in writing if possible, that the doctor you are talking to will be preforming the surgery.
It has been eight weeks since my robotic prostate surgery. I just returned from a one week vacation. I am an avid golfer and during this vacation I golfed five times and hit golf balls at a range a few times in between rounds. I did not experience any pain or discomfort relating to the surgery. I did have some stress incontinence while swinging the club, but I consider it minor in the bigger picture and believe that I am making good progress on the urinary front. Still wearing a small pad, all the time, and monitoring the leakage because I get some dribbles on occassion.
Leading up to the vacation, I started swinging a golf club (indoor simulator and golf dome) at about the six week mark as a warm-up. It was difficult to pin down the surgeon or find something definitive in the literature about a timeline for returning to normal activity – everyone hedges on the subject – perhaps because everyone is so different from the standpoint of pre-surgery physical health. (Six weeks out from surgery seemed to be mentioned most frequently in the available information as a "return to normal activity" point.) Yesterday, for the first time, I did a full half hour on an elliptical machine at the YMCA. I am going over to the Y when I complete this YANA update to do a workout using 30 pounds on all of the machines for the first time since my surgery.
Regarding erectile function – I continued taking a small dose of Viagra (generic) every night before bed while on vacation. However, I discontinued using the penis pump (did not want to cart it around on vacation). I did not try having sex while on vacation. Having returned from the vacation, I am doing everything I can to keep my penis "active" – occasional use of the penis pump, nightly low-dose Viagra, and I am going to try out the tri-mix injections (self administered shot to the penis to stimulate an erection). Why try the shot? Well the penis pump is a hassle and only so-so effective for me, I am not put-off by needles and I have heard that, for some, the tri-mix shot is great for both surgery rehab and on an ongoing basis as an alternative to using Viagra. (I am also hoping to get "lucky" this evening – give it a go anyway.)
Glenn's e-mail address is: firstname.lastname@example.org