YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

BRONZE

Jim D and Barbara live in California, U.S.A.. He was 56 when he was diagnosed on June 11, 2009. His initial PSA was 8.3 ng/ml, his Gleason Score was 6 and although he says he was staged T2c, this seems to be his pathological staging: his clinical staging seems likely to have been T1c. [It is important to distinguish between clinical and pathological staging if nomograms such as the Partin Tables are used.] His choice of treatment was Da Vinci robot-assisted surgery. Here is his story.

I was considering writing my story pending my results after surgery. It seemed to me that the vast majority of YANA stories that I read, from people who had T2b or T2c tumors did not have positive outcomes from surgery and resulted in further treatments or problems. At this point, my story is nothing but uplifting (and I hope it stays that way). Today's date is Saturday, August 15, 2009. I am one and a half weeks post surgery.

Six years ago, at age 50, I had a PSA test done as part of a life insurance exam, and it was 1.15. That same year, I had a physical. It seemed like the right thing to do in the year one turns 50. All was normal, and I have been completely healthy since. I am in excellent shape, running every other day from 3 to 10+ miles. In April 2009, I was considering another life insurance change, and went through their exam and blood test, and failed with a high PSA. My doctor re-did the PSA in May and got an 8.3. He also did a free PSA test. My free PSA of 13, was suggestive of cancer, as was the high PSA doubling time rate, climbing from 1.15 to 8.3 in six years.

Now it was on to a urologist and a biopsy. My biopsy was done June 4, 2009. The procedure itself was not very bad, but I felt for most of the rest of the day like I'd been punched in the gut. The next day at work, I felt normal. I went back to the urologist a week later, and I had prepared myself for a cancer diagnosis. He did not disappoint me. Ten of my eleven biopsy specimens were cancerous, I was given a Gleason Score of 6(3+3), and my tumor stage was a T2c. We discussed different treatments, and he recommended surgery, which we also agreed with after our internet research. Our big decision was, should we let him do a conventional radical prostatectomy, or should we do the Da Vinci robot-assisted surgery?

We decided on the Da Vinci surgery for 3 main reasons. First, the recuperation time is less, and being self employed, I wanted to return to work quickly. Second, blood loss is less with robot-assisted surgery. Third, and important for me, the percentage of negative surgical margins is higher according to the Da Vinci people. With my tumor stage being a T2c, I had a good chance of not having negative surgical margins, and I was concerned about going through surgery, having positive surgical margins and very shortly afterwards beginning radiation and maybe who knows what after that. Now, having a higher percentage of negative surgical margins with Da Vinci does not make sense to me, or to a physician friend that I talked to, or to my local urologist who made my diagnosis and who does the conventional surgery. He suggested that the Da Vinci surgeons might be cherry-picking their cases to boost their statistics. I know that I was not a cherry-picked case, and that I was pushing the limit being a T2c. We had a consultation and set up a surgery with Dr. Brian Naftulin at Sutter General Hospital in Sacramento. He would be using the nerve sparing technique.

The surgery was done Tuesday August 4, and I was informed that things went ideal, with me only losing two tablespoons of blood during surgery. Unfortunately, that evening I sprung a leak, and lost about a unit and a half of blood through the drainage port. Due to the oozing, I stayed in the hospital two nights instead of the usual one. My pain was not great, and from the second day, until the end of the first week, any pain that I had, was gas and bowel related. By Saturday, I was getting a lot of energy, and by Monday I was walking 5 miles a day (with the catheter in). Dr. Naftulin had had me see a physical therapist, (who had also had his prostate removed 5 to 10 years ago), for the purpose of incontinence therapy. I started Kegel type exercises about a day after surgery and did them for the rest of the week that the catheter was in. Fortunately(?) I mixed up his instructions, doing twice as many Kegel exercises as he asked for.

Tuesday, August 11 was the catheter removal day. Since I was expecting big hassles and discomfort from wearing the catheter, wearing it was nowhere near the dreaded experience I had feared, and it's removal was painless. After it's removal, when I was outside, I blew my nose and forgot to squeeze my muscles. That was surprise leak #1. Two days later, when getting up from a chair I had a little leak #2. I was shocked--that was it!! I was basically dry from day one!!

August 11 was also the pathology report day. I learned three main things from the pathology report. First, my Gleason Score was upgraded from a 6 to a 7(3+4). Second, my Tumor Stage was upgraded from a T2c to a T3a. I had looked up my numbers in the Partin Coefficient Tables, to see what my odds were that my cancer was contained in the prostate. With my old numbers (6 and T2c), I had a 43% chance that the cancer would be contained within the prostate. With my new numbers, the percentage dropped to 11%! But the third thing I learned from the pathology report was that I had negative surgical margins!! Apparently my cancer had slightly penetrated the capsule in one area, but enough extra tissue was removed during the surgery, to still give a negative surgical margin in that area. I feel that I am VERY fortunate to get this pathology report, and that my inattention to PSA testing came close to giving me a different result. I should have been on top of my PSA level, as my father-in-law died from prostate cancer. He had a PSA of 700 when diagnosed and the cancer had spread throughout the bones. Forty per cent of my prostate ended up being cancerous. I feel that if I had caught it 6 months later, I would not have had this result. I know that future PSA tests will be the test of cured prostate cancer, but the surgeon basically said, "Have a good life", and mentioned 20 or 30 years.

I told my wife, that I never once asked, "God, why me?", when I was diagnosed with cancer. But I am now asking, "God, why me?", when pondering the pathology report. To me it is like two cars, with five people in each one, crashing into each other. Nine people die, but I walk away from the accident. The Partin Tables were giving me one in ten odds of getting the result I got. Hopefully, my story will give someone some encouragement, and my job as a dentist will give me opportunity to ask many 50 and 60 year old males if they know what their PSA is.

At the one week post op appointment, I asked the surgeon about sex, and he said to try whenever I wanted. He started me on Viagra that day, and I guess I'll be taking it about a year. Today, I was able to ejaculate without an erection. It was not very forceful, but I just started laughing, just thinking that I might recuperate fast in the bedroom department also.

I plan to go back to work in 4 days (two weeks post surgery). I can think of three things to credit my fast recovery, and my surgery outcome. First, I was in very good physical shape before surgery. Second, I believe my surgeon is very skilled. Third, there were a lot of people praying for me, and I am blessed that their prayers were answered.

I will update my story after my PSA test results in about a month.

 

UPDATED

October 2009

 

 

October 25, 2009. I did not have a follow up PSA test a month later, like I had thought. More on that later.....

I went back to work part time at 2 weeks, and full time at 3 weeks, with no problems. I started running again at 3 ½ weeks. All has progressed amazingly well.

The only slow progress is with the impotence issues. I am taking 100 mg Viagra 3 times a week. Fullness is increasing slightly with time, and I have maintained a minimal erection long enough for intercourse 3 or 4 times, but it usually "deflates" prematurely. My urologist feels I will probably be pretty much back to normal in a year.

I had a follow up PSA test on October 9, 2009 (9 1/2 weeks) and my consultation with my urologist October 21, 2009 (11 weeks), and he gave me the news that I wanted to hear: PSA <0.05! Praise God!!! My next test will be in March.

I had one follow up question for my urologist: "What are the chances, that my cancer will come back sometime in the future?" He said that if my Gleason Score had remained a 3+3 after the surgery, I would have about a 90% chance of remaining cancer free. With my Gleason Score changing to a 3+4 after surgery, my percentage dropped to 85%, definitely good odds and good news..

 

UPDATED

April 2010

 

 

I had another follow up PSA test in March and my result was again <0.05! My next PSA will be in August at the 1 year follow up.

As for the impotency, I saw no improvement from months 2-5, but from months 5-7 after surgery, the fullness definitely improved. I have still been using Viagra 100mg three times per week, but I just tried some Cialis 20mg samples and I will be switching to Cialis do to it's longer duration and effectiveness for me. Occasionally I have not used a pill but it is noticeably more work! My urologist says that improvement is to be expected past the 1 year point even to the 2-3 year point as the nerves continue their slow healing.

I will update again in August.

Jim's e-mail address is: jbdecker50@yahoo.com