Dan
Bryant lives in Oregon, USA. He was 51 when he was diagnosed on February 21, 2006.
His initial PSA was 5.5 ng/ml, his Gleason Score was 7 (3+4) and he was staged
T2a. His choice of treatment was LRP (Laparascopic Radical Prostatectomy). Here
is his story:
I
went for a routine physical in November and my doctor felt a lump from the DRE
(Digitsl Rectal Examination). A subsequent PSA came back 6.0 ng/ml and the second
one 5.5 ng/ml. I was referred to a urologist, but we were unable to schedule a
biopsy until February. He took 8 samples, 5 were negative, 2 were suspicious and
one had a Gleason 7 (3+4). The urologist assured us that it was very curable and
recommend Radical Prostatectomy, but he also sent me to a radiologist. The radiologist
recommended External Beam Radiation with a final dose of High Dose Radiation (Brachytherapy).
From all the reading I did, I decided I wanted to explore the da Vinci
option(Laparascopic Robotic Radical Prostatectomy). My urologist was glad to refer
to me David DiMarco though he felt LRP was too new to be trusted. I liked everything
I have been reading about it however. We are fortunate to have just received a
generation 2 machine (da Vinci S) at a nearby hospital, only one of 10 in the
nation. Dr. DiMarco just completed a fellowship at Mayo using the da Vinci system.
He has done 300 of the regular RPs and 20 using da Vinci plus another 50 in which
he assisted. His first surgery with this new machine will be next week.
While
it would be nice to have someone with more experience, my wife and I were very
impressed with his answers to our many questions. His confidence is very contagious.
As an experience surgeon with both techniques, he prefers da Vinci and says I
am an excellent candidate for it. He did a DRE and agreed that I am T2a. With
a Gleason 7, he felt I should not wait too long to do the surgery.
We are
ready to take the leap and will likely schedule the surgery for late April.
David
DiMarco removed my prostate on April 27 with DaVinci. So far, the results look
promising. Reported to the hospital at 6 a.m. on Thursday.
They took me to prep around 7. I declined the offer of a sedative. The prep nurse
asked me if I wanted to see the robot. I said sure so walked to the OR where a
team of 5 was busy getting ready. I think they were a little surprised to see
me. I said that I just wanted to know that they had a live, healthy specimen and
I expected to walk out of the hospital the same way I came in! That got a good
laugh.
They
wheeled me in on the gurney at 7:45. The anesthesiologist decided I was so healthy
that he didn't need an artery line (evidently in case they need to deliver a quick
stimulus to the heart) so that was good to hear. A few deep breaths in the mask
and I was gone. My appendectomy from 1994 gave them a lot of trouble. It took
1 1/2 to get through old adhesions. After that, everything went very well. The
surgeon is very confident that they got the whole cancer, but we won't know for
sure until the pathology report comes back. We were concerned that he would have
to remove one of the nerve bundles on the side of the prostate were the cancer
was, but he was able to spare the bulk of it so that is good news. Surgery was
done somewhere around 4 I gather. I came to around 4:30.
I
managed to sit up but that was about it for Thursday night. I slept well that
night. (good drugs!) Friday morning had a short walk and bit of yogurt and a couple
bites of banana. Took a shower Friday afternoon, ate dinner and checked out! Not
bad for someone who spent 8 hours in surgery the day before. Friday night was
a little tough, however. The doc said I could pretty much eat what I wanted, so
like a fool, I did. Had baked chicken breast and a couple of cookies for lunch,
mashed potatoes and apple pie for dinner. Tasted great! Though I only ate 1/2
of a typical meal, turned out to be way too much. The old bowels were still on
strike from the trauma and by midnight, I was as bloated as a blow fish. Things
finally got moving later this morning so I'm feeling pretty good now. Other than
this dang catheter and a tender side, I almost feel normal.
I
go back on Wednesday to get the catheter out and to get my lessons on the exercises
and other such things I'll be doing to gain all my normal functions back.
Just
returned from the doctor's office where I heard the wonderful words, "This cancer
should never bother you again!" The pathology report showed that my cancer was
fully contained within the prostate. They also removed my catheter, so on day
6 after surgery, I am now cancer free (most likely), catheter free (most definitely)
and almost pain free. Now on to the next stage, regaining control of those other
essential bodily functions!
One
month update.
I
started working half-time in the 3rd week after surgery and full- time the week
after that. Physically I feel 100%, though stamina may only be 80 to 90%. Still
waiting to see if the insurance is going to pay everything. So far they have covered
all but one small charge on the hospital bill after my $2,000 max out of pocket.
I was surprised mostly to discover that they do not cover anything for erectile
dysfunction, regardless of the cause. Even though most of my nerves were spared,
I've not regained much function there yet and 100mg of Viagra does not do much
for me. I found a decent vacuum device from "Dr. Cummings" for under $79 that
helps somewhat. (Contact me if you want more info.) Next I need to try it with
Viagra to see if the combination will do the trick. But I have found that neither
are really that necessary for a satisfying experience for both my wife and I.
So that really helps to take off some of the pressure to "perform" on demand!
On
the other front, I am pleased to report that I am making much better progress
with my incontinence. Initially I found that I needed several pads a day. Now
I am down to one and even then it is hardly full. Night time is no problem whatsoever.
I do have several helpful tips.
First, find the pads made for men! 90% of the pads on the shelf are for women,
though they do not say that on the package. Men's pads are wider where you most
need it.
Second, no one warned me about urine burn on the tip of your penis. Whenever I
feel it, I know that I have not been drinking enough water. Yeast infection on
your scrotum comes from the moisture. My wife was quick to diagnosis this. Monistat
7 did wonders to clear it up.
Lastly, do the Kegels! My doctor gave me a good routine, start with 10 quick Kegels,
then 10 slow and 10 more quick, rest a bit in between each set. Do this 2x/day.
(I do it before I get out of bed and before I go to sleep.) Increase by 5 each
week. Being impatient, I started with 20 and am up to 35.
In
sum, for those guys who worry about incontinence and impotency, I am pleased to
discover that both have turned out to be relatively minor issues for me and I
am only one month out so know they will continue to improve with time.
Just
back from my 3-month checkup. PSA levels were undetectable as expected. (YEA!)
In addition, I stopped wearing pads several weeks ago, but still carry them with
me for those times when I am on my feet a lot and begin to leak. Otherwise, I
remain completely dry.
My
urologist wants me to start doing kegels 3 times a day (50 short/ 50 long/50 short)
so that I can build up the muscle even more and hopefully end all leaking. So
now the biggest hurdle is just the ED and there too I am making continual progress.
I began using MUSE about 6 weeks ago and it was somewhat helpful, but still not
sufficient for intercourse at first. The directions indicated that standing aids
in blood flow to the penis and I found that indeed did make a difference. As luck
would have it, but the time I put all the pieces together to get a sufficient
erection for intercourse, my wife had to have a hysterectomy! She's doing great
and we have just another week to go before she gets the green light. In the meantime
I discovered that standing also improves the effectiveness of Viagra so I think
we will be able to have intercourse without the MUSE, though we may have to be
rather creative to get it done. MUSE is not easy to administer, rather disruptive
to the whole process and leaves me with a good ache in the penis so I'm hoping
to do without. It is also expensive, about $28 per dose. If Viagra alone does
not work, I will try the injections. My urologist assures me that it is very effective
(biggest problem is using too much causing the erection to last too long).
In
sum, I am feeling great, relatively certain that I have been cured and the plumbing
is coming along well, though not recovering quite as fast as I had hoped with
this surgery. But that really has not been a problem. The only bad news I've received
was when the doc told me that for my 6-month checkup he would do a digital exam.
I asked why since there is no prostate to feel. He said, "We just want you to
feel that you are getting your money's worth!" :-) Evidently a few cancers can
return before they show up in the PSA test so he is just being cautious.
I
remain a big believer in DaVinci for younger men.
Busy
schedules of patient and doctor meant that I did not get in for my six month check-up
until my seventh month anniversary. Nothing but good news. My PSA remains undetectable.
The digital exam was normal. My incontinence problems have virtually disappeared,
just an occasional wetness if I push or lift and forget to squeeze.
The
ED has been improving but not fast enough so DiMarco initiated me into using the
Tri-mix injection. My wife went with me and was very helpful to the process. The
results were absolutely amazing and quick! Easier to administer than MUSE, less
painful and faster and better result. So I am now shopping for a good pharmacy
to fill my prescription. I remain hopeful that I will regain my natural abilities
in time as I see steady though slow improvement and can achieve a reasonable erection
after continual stimulation for 20 to 30 minutes. Viagra, Cialis and Levitra all
help somewhat, but nothing works as all as the Trim-mix.
First good news: Just returned from my 12 month checkup. After a slight
bump in my PSA two months ago (.03), it returned to .01, the lowest possible score
that my lab reports. Big relief!
Second good news: The tri-mix was giving me a lot of ache so I switched
to bi-mix. It did not produce a very good erection so I started drawing 5 units
of tri-mix and then added 20 of bi-mix. That worked very well with no ache. I
plan to ask my pharmacy to make me a new batch with that ratio.
Third good news: In March I was able to have intercourse for the first
time without any artificial aid. Yea! Since then we have managed to repeat the
experience 3 more times. It takes a lot of stimulation, at least 10 to 15 minutes
before I can get a decent erection. Viagra helps a little. So I keep the injections
handy for those times when nothing seems to help. My wife prefers intercourse
without injections as she says I actually get too big when I use the needle.
After
the brief scare with the rising PSA, I starting reading up on supplements to lower
the risk of cancer. I decided on the following combination: 1 oz pure pomengranate
juice (the equivalent of 15 pomengranates) Vitamin C, 500 mg Vitamin E, 400 mg
Fish oil, 1000 mg Selenium, 500 mg Lycopene, 15 mg (substitute for tomatoes which
I have never liked)
Erectile
function is pretty decent. I am able to have intercourse without any aids, just
need a lot of stimulation. Viagra gives me a little boost so I do use 50 mg about
once a week. Just got some new samples from the doctor and am experimenting with
Cialis and Levitra as well.
I still do a routine of 150 kegels every morning before I get out of bed and have
very little problems with incontinence.
Dan's
e-mail address is: danbryant@mac.com
