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PROSTATE CANCER SUPPORT SITE

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DJ and Judy live in Texas, USA. He was 56 when he was diagnosed on June 2, 2006 His initial PSA was 4.4 ng/ml and his Gleason Score was 7. He was staged T1c and his choice of treatment was daVinci Robotic Prostatectomy. Here is his story:

I had no symptoms and no findings on the DRE. My PSA had gone from 2.9 ng/ml in October of 2004 to 4.4 ng/ml in January of 2006. However, in April of 2006, it was repeated when I had my first uro consult and it was 5.7 ng/ml with a free percent of only 8. Had a biopsy at the end of May, with 4 of 12 samples positive for cancer, with the worst of the lot having a Gleason score of 4+3=7 and the thickness of this area was 5mm. This site, however, was in the base (area nearest the bladder), not the apex. Therefore, my doctor thought I would be a good candidate for the daVinci robot-assisted laparoscopic radical prostatectomy.

He compared the recurrence rates of this with cryotherapy, external beam radiation, and brachytherapy. Watchful waiting was not an option with a Gleason of 4+3; this would be watchful dying. With the estimated cure rate of 91% for the radical surgery, compared to around 75% for the other choices, this was a no-brainer.

The daVinci procedure was done on August 23, I was out of the hospital in 2 1/2 days, and had no real surgical pain (the terrific gas pains I had from the pelvic inflation by CO2 for the proper view of the surgical field was another matter, but passed when I started walking around the hospital floor).

I had a deep vein thrombosis in my arm, not my leg, and this caused me to be re-admitted for anticoagulant therapy for twice as long as I was in for the surgery. Additionally, I had to have the catheter in for four weeks because of the clot and that there was a pinhole leak in the urethrovesicular anastomosis, that the doctor wanted to let heal a little longer.

Two or three days after the catheter was removed, I was about 90% continent of urine. Erectile function was another matter.

The final pathology report indicated negative surgical margins, cancer contained within the gland, negative lymph nodes and negative seminal vesicle involvement. However, the right neurovascular bundle was involved and had to be cut into. My doctor did plastic surgery on the nerve with a collagen tube to act as a scaffold for the nerve to bridge in its regeneration. This meant to me that it would be 6 months to a year before I could expect any return of erectile function not induced by a vacuum device. I was put on 25 mg of Viagra every day, six weeks after surgery, and 100 mg of Viagra once a week as a kind of trial balloon to see when erections might be possible. I use the vacuum pump daily for 5 min to maintain elasticity of the erectile tissues.

I had a post-surgical PSA of undetectable at 2 months after surgery with another to be measured March of 2007. So, this brings me to this point.

 

UPDATED

May 2008

 

 

DJ Says: Robotic surgery appears curative. However, now treated with Testim 1 and 1/2 tubes a day and 50 mg DHEA for low testosterone which I had before the surgery for several years. I believe that low T is a risk factor for PCa.

I am very grateful for the success of the surgery. I have had six or seven consecutive PSAs of <0.003, which my doctor says is the lab's equivalent of undetectable.

I have been continent basically since the catheter was out, because my doctor also did a bladder lift (like some women have to get). The continence is fortunate, because I know a lot of men have incontinence for a long time. But, it kind of went the other way, because I sort of have to push sometimes to get the urine out.

However, the erectile dysfunction persists after about a year and nine months, and it responds to Viagra about twenty percent and with MUSE about 30 percent. My doctor is trying to talk me into using the shots but I have got to psych myself up for this.

Another unexpected follow up was a navel hernia at the site of the largest robotic input. I don't know if I got this as a natural consequence of the surgery, or if it popped out because that particular area of the abdominal muscles is weakened and then, because I am about 40 pounds overweight. I take care of it right now with an abdominal wrap which works pretty well.

The real nuisance to me in follow up of the surgery, because it is constant, is this burning sensation in the lowest part of the pelvic cavity. My doctor says this is neuropathic pain possibly from the manipulation of the nerves during the surgery. I have found that the drug Neurontin helps this a lot. Otherwise, sitting for a long time would be no fun. I have not found information on this neuropathic pain online, and I wonder how many people have had this follow up result. .

 

DJ's e-mail address is: docjkl@msn.com