I was diagnosed with prostate cancer in September 2007. A biopsy was performed as a result of two successive PSAs of 4.1 and 5.2, about 16 months apart. The diagnosis was a pT2 stage tumor [Pete provides his pathological staging here. His clinical staging would have been T1c - see Staging. It is important to understand this distinction if using nomograms like the Partin Tables in the decision making process. All references to staging in those tables are to clinical staging.] and Gleason scores of 3+4=7 and 3+3=6 on two of twelve samples with total volume less than 2%.
I selected Dr. Kevin Slawin in Houston for the biopsy and subsequent surgery based on favorable experiences of two friends who had open radical prostatectomy. Both had minimal incontinence and other related problems and most important, no recurrence of cancer after 5 years. Dr. Slawin was formally Director of the Baylor Prostate Center and is currently Director of Vanguard Urologic Institute and the Texas Prostate Center in Houston.
After investigating various treatments and expectations, I opted for robotic-assisted surgery because it was minimally invasive and normally required one overnight stay in the hospital. Since my cancer was detected relatively early and appeared contained, I was quite optimistic, especially given Dr. Slawin's +600 Da Vinci cases. Additionally, I was concerned about local tales of post radiation issues, including continued bowel problems, recurrence of elevated PSA after five years, and several cases involving artificial urinary sphincter valves. I also appreciated that after surgery my PSA would typically be non-detectable and if otherwise, treatment could commence immediately.
Dr. Slawin performed the procedure at Memorial Hermann – Texas Medical Center, on October 8, 2007 and I was released around noon the following day. I experienced severe lower back pain after surgery which soon abated after walking the hospital corridors. Surprisingly, I had no back pain for several months following surgery although it recently returned with a vengeance. After surgery, I required very little pain medication; the JP drain was removed after three days and the catheter after eight. I experienced some stinging and burning for several weeks and intermittent pressure in the rectum, uncomfortable but not particularly painful.
Continence was pretty much restored within 30 days with occasional dampness at night and minor stress leakage. At present I feel I'm about 99.9% provided my bladder doesn't get too full. I'm taking 100mg Viagra twice weekly for therapy so we shall see how that goes. My PSA at 8 weeks was .003ng/ml and hopefully will be the same when I have my check-up next week. Pathology of 20+ samples taken during surgery indicated no extra capsular extension; seminal vesicles were negative as well as lymph nodes and surgical margins. The report further mentioned the primary tumor was a pathologic stage pT2c and Gleason score of 7, thus confirming Dr. Slawin's diagnosis.
I feel quite fortunate that I was essentially pain free and have had very few related problems throughout the whole ordeal. The staff at Memorial Hermann couldn't have done a better job and were very attentive to all my needs. Urinating pressure is much improved and I'm now getting up only once or twice nightly rather than three to four times. Unfortunately, I seem to be having more hip joint stiffness, especially after playing tennis, walking or sitting for prolonged periods (like now) but this could be more an age thing.
Until this episode, I really didn't considered prostate cancer to be particularly serious, just something older men usually got and unless terribly aggressive, rarely serious enough to be life threatening. I'm now much more cognizant of the seriousness and ramifications of prostate cancer and acutely aware that recurrence is always a possibility.
Results PSA test 5 months following surgery: less than 0.003 ng/ml.
Most recent PSA in June 2008 was .008 ng/ml. Doctor advises although slightly higher than previous readings of .003, it is considered in the nondetect range.
In mid July I was diagnosed with pulmonary embolism. Subsequent CT scans revealed lymphocele that possibly resulted from prostate surgery and the cause of the emboli. It was drained and appears to have decreased in size. The CT also revealed an indeterminate sclerotic lesion which will entail a full body bone scan this Thursday.
Warfarin was prescribed to combat the pulmonary emobolism. Treatment consists of 5 mg Warfarin daily.
PSA as of March 18, 2009 is .003. The full body bone scan previously reported was negative and Warfarin, prescribed to combat PE, was discontinued several weeks ago.
My next appointment with the urologist is in 6 months.
My most recent PSA, as if Oct 7, 2009, was less than 0.003 ng/ml.
I'm currently experiencing what's been described as an overactive bladder and occasional feeling of pressure in my rectum. The urologist prescribed 5 mg tabs daily of Vesicare. After three weeks of treatment, there's been minimum relief so the dosage is being increased to 10 mg.
I'm not aware if these symptoms are related to my prostate surgery.
PSA as of March 31, 2010 is less than 0.005. No prostate related issues at this time.
PSA as of November, 2010 less than 0.005. No prostate surgery related issues since last update.
PSA April 2011 .006 ng/ml.
In response to a reminder, Pete said:
My 5 year checkup will be in October at which time I'll update. There has been no change since May, 2011.
Thanks for all the great work keeping YANA up and running.
As of October, five years with non-detect PSA. Annual testing from this point forward.
Almost seven years following prostate surgery and my overall health is excellent with no negative side effects. Still playing tennis three times a week and walking several miles on non-tennis days.
Annual special PSA test due in October. Currently, occasional very minor stress leakage.
It's been nine years since prostate surgery and I still feel great, albeit a few years older.
Pete's e-mail address is: firstname.lastname@example.org