In 2015, I was having frequent urinations. My family doctor prescribed Rapiflow. No help. I asked to see a urologist and he recommend a local urology clinic. I selected an older urologist thinking experience my help. That doctor did a cystoscopy and said I had urinary retention and must quickly have TURP surgery. He said it is an urgent matter. This came as a shock and I asked for time to get a second opinion.

So I started to do my research and talk to friends who have had similar problems. I went to Dr. P and shared the test results from the first urologist. He said he would want to perform more tests before doing surgery. I was interest in laser surgery (greenlight) and he said he can do it. I asked about urolift implants. He said he does not do them. So I went to the UCLA urology center where Urolift was being done. The urologist there did a rectal scan of my prostate and said I have a "median lobe". This is likely area causing obstruction and retention. He said Urolift my work but unlikely if this is problem. He would need to do more tests to confirm.

My research pointed me to a local urologist (Dr Y) who has excellent ratings as a prostate surgeon. He heads major hospital nearby and heads their urologic oncology research work and surgery center. It too 8 weeks to see him. I shared with him all the reports from the others. He said he was more concerned about my kidneys with back up of urine. He ordered a series of imaging scans, including Ultrascan, CT scans, kidney tests with IV markers, etc. That confirmed I have hydronephrosis of one kidney and a bladder stone. He also said my bladder is "distended" and weakened. He was willing to postpone any TURP or othe surgery until we fixed the kidney/bladder problems. The solution was intermediate catheters. From 2016 to early 2018, I used catherters 3-4 times a day. These insured my bladder was empty. I was tested regularing and did many more ultrascans. I was happy with this Dr because he was thorough and wanted lots of data before making decisions. The bladder stone remained but the kidneys healed. The strength of my bladder may have improved but we did not do hydrotesting.

Early in 2018, my PSA went from 3.5-4.0 to 5.3. Dr Y ordered a "4KScore" blood test. This is a more detailed test for cancer. The test said there is 40% chance I have "stage 2" cancer (Gleason 7+). Dr. Y ordered a MRI with contrast. As I am claustrophic I needed the "wide bore" 3 tesla high res MRI machine. Fortunately, Dr. Y's hospital has one. The results confirmed I probably have stage 2 cancer. My other organs were apparently normal. So Dr. Y ordered an MRI/Ultrascan Fusion Biopsy. This was done in the hospital setting. The pathology report said I have Gleason 3+4 at 3 locations and lower Gleason scores at another 3 locations. The report stated the cancer is likely confined to the prostate gland. This was April 2018. I asked for a bone scan to see if there is any evidence the cancer has escaped the gland. It was negative.

Dr Y said my choices are radiation or radical prostatectomy (RP). He said it is my decision. He referred me a top radiation oncologist at the same hospital system. I met with Dr. T who walked me through the details of his "hybrid" treatment. This would be a 8 week program. One week of "brachytherapy" followed by daily EBRT radiation (1 hr visits). Dr. T shared is many publications (peer reviewed) which show his radiation approach would cure me of the cancer .. at about the same success rate as RP surgery.

Unfortunately, he said, my obstruction must be fixed first. So Dr. Y would need to perform the TURP surgery and they I wait 2 months before beginning radiation.

So I returned to two othe RP surgeons and one radiation oncologist to get a second opinion. One surgeon knew Dr. Y and said he can do the same surgery but Dr. Y is even more experienced. The other wanted to to hydro testing of my bladder to see if will be strong after RP so incontinence would not be a problem. He did the test and he said my bladder muscles are in good shape .. i.e I can pee naturally when it is full .. I already knew that!

The other radiation oncologist was a younger doctor with a good reputation. He claimed to have a more advanced radiation machine and that brachytherapy is overkill. (note Brachytherapy with needle inserts requires surgeon to insert a shield to protect your rectum from radiation damage. Dr. Y would perform that surgery!). Both oncologist agreed I must do TURP first and both agreed the outcomes from radiation or RP would be about the same. None are 100% guaranteed.

Armed with these second opinions I went back to Dr. Y. He has performed over 2500 RPs maybe a record for urologists in my area. He said if I did the RP he would at the same time remove the bladder stone. Surgery in the morning, overnight stay and then go home. So I said "lets do it".

The Dr and the hospital have a prep meeting with me and other patients scheduled for surgery. It was detailed set of lessons of everything I need to do before surgery and after. The surgery nurse said our surgeon is one of the best around. But if the patient does not do his part and prepare as instructed, there could be side effects and results that could be avoided. I got the impression they had been through this thousands of times.

I arrived at hospital at 530 am. I was knocked out and rolled in to the OR at 730 am. The RP and stone removal took over 6 hours. I woke up on another floor in the hospital with other prostate surgery patients. They woke me every hour or so for tests, check IVs, vital signs, and forced me walk to keep my blood pressure up. At 9 am Dr. Y arrived and said you were a great patient and you can go home.

Dr. Y says he got "most" of the bladder stone blasted out of there. Nothing to worry about.

My catheter was in for 8-9 days. It was not fun but not a problem. I even drove the car and went shopping .. nobody could see it. When I returned to Dr. Y, he said I want to be absolutely sure your surgery has healed. So come back in another week. I did and his nursed removed it. For the first time in 2 yrs I could pee normally!

The post surgery pathology report showed a possible low grade cancer near the "surgeons margin". Dr. Y said that is not unusual. "as far as I am concerned you are cancer free".

My first PSA test in January 2019 was "less than 0.10". Dr Y said this is same a zero. I just got my second PSA test in late March 2019 and it was "less than 0.01". So I guess it went down. I will see Dr. Y next week and see what he says. But I think I am in good shape. If the PSA rises to 0.20, I have read that EMRT radiation may be needed. But we will worry about that if it happens.

RP side effects. I do not have any incontinence. I have good control of by bladder and pee normally 3-4 times a day. RP removes the seminal vesicles. So I cannot ejaculate. Dr. Y did "nerve sparing" RP. But my nerves aren't working and I cannot get a full erection. So right now I do not have much of sex life. I had some ED before surgery so I was not expecting much improvement. Dr. Y thinks with exercise and drugs it should come back. But we will see!

If you have questions for me, I'm happy to help if I can.

I am now 18 months from radical prostatectomy including bladder stone removal.

My PSA is "less than" 0.0175. My doctor says that is undetectable.

I'm told frequent PSA tests will continue for 5 yrs after surgery. So far, I am considered cancer free.

My only disappointment is inability to have an erection. Doctor has prescribed Sendafil. It does not seem to help. Doctor says continue as it could take time. If I do ejaculate urine comes through. I was told ejaculations would be dry. So this continues to be a disappointment.

Assuming my PSA remains very low or undetectable, I am pleased with the decision to to RP with robotic surgery. My bladder stone is gone. My ability to urinate is strong. No retention. No incontinence. I have full control of my bladder now.

3.5 yrs after RP surgery, my PSA remains "undetectable". My next PSA test and check up with my urologist/surgeon will be December 2022. The plan remains to check PSA every year. If PSA remains undedectable after 5, he says I am cancer free.

I'm now closing in on 5 yrs after surgery. As of now my PSA is undetectable. So my urologic surgeon says I remain cancer free.

Doug's e-mail address is: dhc AT pobox.com (replace "AT" with "@")