Gary
Rich and Joelyn live in Michigan, USA. He was 60 when he was diagnosed on 14 November
2005. His initial PSA was about 6.0 ng/ml, his Gleason Score was 7 and he was
staged T1c. His choice of treatment was Da Vinci Prostatectomy. Here is his story.
Over
the years immediately preceding my diagnosis for PCa, I was fighting an ongoing
battle with thyroid instability, after a total thyroidectomy in 2000. Included
in my treatment plan in 2005 and 2005 was the introduction of topical testosterone.
The use of this hormone, in the face of PSAs that were already hovering
around 4, even with a small, smooth, symmetrical prostate, nothing palpable, meant
my urologist felt it prudent to check PSAs every 4 months. Later in 2005 we saw
a rise beginning, and finally with the PSA reaching slightly above 6 (not sure
the exact number, seems someone organized my papers and I can't locate that yet,
will revise later), it was decided to biopsy, and the result was PCa present,
one lobe, 20%, Gleason of 7, and was staged based on this at T1C.
I was
devastated, but not terribly surprised. Watching the slow rise in my PSAs I anticipated
that eventually I would face this, and was preparing myself for this diagnosis
(if you can call pa Nicky about the impact, and the potential losses to me) Up
to that point, I had good sexual function, with some slight venous leakage, helped
by the use of constrictive rings. PDE-5 inhibitors, and I tried them all, worked
but variously, and gave me headaches.
My urologist told me to make a decision
fairly soon, and left it in my lap (no pun intended). I explored IMRT (Intensity
Modulated Radiation Therapy), tomotherapy (which would have involved 9 weeks of
travel, living away from home, and also surgery (Da Vinci Prostatectomy). My urologist
was OK with the tomotherapy, (even though I knew he far preferred to have it out)but
said I'd need to go on Lupron for 6 months minimum.
Knowing the side effects
of that modality of therapy, and dumping that on top of the thyroid fatigue and
challenges I had been battling, I opted out of that. Since I am a Nurse Anaesthetist,
the option of surgery felt comfortable to me, and after my reading I decided that
Da Vinci was for me. It also limited the post op recovery, once again playing
better into my hand that held a strong thyroid suit (fatigue, weakness, etc).
Minimal surgical insult, OR time, small incisions, limited blood loss, etc.
I
was operated on Jan 8, 2006 at Henry Ford in Detroit by Dr. Mani Menon. Dr. Menon
was my personal urologist's choice and was also featured in a major news magazine
the month before, so I felt I'll get the best result anywhere.
My recovery
was very quick. Home in 24 hours, catheter out at one week with no leakage of
the anastomosis, and done with pads by about 6 to 8 weeks. I have very little
leakage still. I continued with PSA checks every 4 months for 2 years, then every
6 months. They have all been "undetectable".
As for sexual function, well,
that is a different story. In spite of the "nerve sparing" approach, I have found
very little response, no matter what I tried. Orgasmic function also diminished
at first, but has slowly returned to normal now. I do have some filling in the
morning, and some with sexual stimulation (actually a lot of stimulation over
a long period of time, very focused effort), but no where near enough for sex,
penetration. I began within 2 weeks of my surgery what I think was a fairly aggressive
rehab program. PDE-5 inhibitor daily when I had them, VED daily at a minimum,
and Trimix injections a few times a month.
The injections produced erections,
although somewhat uncomfortable, and began to see some curvature, also required
using a ring after injection to maintain the erection. I've stopped those some
months ago, concerned about developing a Peyronie's, and also worried about the
impact on the corpora in terms of scarring/fibrosis as it would impact sizing
of a prospective implant.
I continue however, with the VED daily, and
find it acceptable for both masturbation and intercourse, for up to 30 min. However,
it is a pain in the ass, and after 2 1/2 years of pumping, and recognizing that
I am long past the point of return, I've decided it's time. So I am now scheduled
June 10 with Dr. John Delk at the U of Arkansas Med. Ctr, for an implant. Our
discussion was that it will be an Ultrex 700LGX w/MS release. I am ready for this,
and feel that my diligent pumping regimen has left me with a penis that flaccid
stretches to a size very close to my erect size. So should get an implant that
I'm happy with. We'll know in about 2 months.
My wife has been very supportive,
in all regards, including her support and interest in the implant. Although in
my mind I know that the most important aspect of this cancer treatment plan is
that I don't die from it. And secondly that I have good urinary continence. Having
said this, I have from the beginning been someone who has had a very difficult
time with the changes sexually that this has wrought on me. I went through several
months of depression and continue to have considerable loss of self esteem. For
this reason, and in the light of what appears at this point to be a good result
thus far w/ regard to PSAs and urinary continence, I have decided to deal with
the sexual impact, and finally get what is a very successful, and well received
solution to erectile losses, and get my implant. (I'm a Harley rider, so plan
on renaming my penis, "Harley II".) Gotta laugh about this a little too.
I
appreciate Glen's efforts here, and others that have offered wise and experienced
counsel.
I will keep this site posted as to my progress.
Gary
Gary's
e-mail address is: gary.r.rich@gmail.com
