Joe
Petko and Lorraine live in Colorado, USA. He was 59 when he was diagnosed on May
17, 2007. His initial PSA was 3.2 ng/ml, his Gleason Score was 3+3=6 and he was
staged T1c. His choice of treatment was Robotic Prostatectomy. Here is his story.
Wow
what a change in life when you are given the cancer diagnosis. What did people
do before the internet? There is just a wealth of information available for research.
My biopsy was on May 11th and my doctor called me with the results on May 17th.
12 core samples were taken and one was identified as cancerous 3 + 3 Gleason.
About a week later I had an appointment to review my options. The treatment options
included, surgery, seeds, external beam radiation, cryosurgery and watchful waiting.
Unfortunately,
around this time it was discovered that I had a very large kidney stone which
required attention first so that its potential for moving down the urinary tract
would not cause damage through that area following surgery or radiation treatment.
I had lithotripsy performed in mid June. That is a procedure where you are given
general anaesthesia and then bombarded with sound waves to break up the stone.
It worked but I had several days of rather painful passing of some of the stone
pieces.
I moved on to further investigation of treatments which involved
a lot of research, talking to people and meeting with doctors. I had 2 appointments
with radiation oncologists. I even went to Johns Hopkins to speak to one of their
doctors. I have attended a local support group since that time and have been monitoring
the Yahoo Groups Prostate Cancer Group which has been for the most part helpful.
In
my investigation on the internet, I found where UCLA had done a research project
on quality of life after prostate cancer treatment. A report was issued by a research
doctor who did not perform any of the treatments and he found that at the end
of two years, the quality of life tended to even out between, surgery, seeds and
radiation. That is not to say that the side effects were not different at times
during those 2 years. In my mind that sort of levelled the playing field.
I
considered most of the therapies before making a decision. I had been told that
I would need to first have a thermal microwave treatment should I choose radiation
or seeds because of my lower urinary tract symptoms. Doubling up on procedures
was not attractive to me. Long airplane trips shortly following surgery was also
ill advised because of the increased risk of blood clots. The proton beam treatment
sounded like it had great promise, but I am still working and do not live near
any of the locations which provide that treatment. I had even researched HIFU
and have in fact talked to a couple people in my local support group but they
have both had continuing difficulties after having that procedure done outside
this country.
It seemed like my decision was narrowing down to either surgery
or brachytherapy. A couple of the doctors confirmed that the cure rates after
10 years seemed to be identical and the UCLA report seemed to suggest that after
two years the side effects would be similar. However the doctors suggested that
after 12 years a divergent pattern begins where the surgery cure rate ends higher.
I am still fairly young and have a statistical life expectancy of greater than
25 more years so I thought this was of some value. However, for me the real reason
was I wanted some finality to this and removing the gland and getting the pathology
was of greater interest to me. I was leaning heavily to surgery.
During
the research, what I had read about the da Vinci robotic procedure interested
me. I also listened to those in the support groups talk about finding a very experienced
doctor regardless of the procedure so I zeroed in on robotic surgery. After getting
some recommendations, I discovered a doctor who had done 1,200 open surgeries
and then after learning the techniques of the robotic surgery had done 400 of
those. After meeting and talking with this doctor I was convinced that this was
the way to go for me. The doctor was very passionate about what he did and about
his quest for trying to improve on the results of the surgery for his patients.
While the doctors, in general, claim that robotic surgery is no better than open,
I found that the doctors who perform it don't believe that. Since the robotic
procedure has only been done for about 5 years there are no studies published
that confirm the fact, but you can tell from discussion with doctors that have
taken the time to learn the new procedure, that they believe complications are
far fewer, recovery is faster and success rates are really good.
I had
robotic surgery on November 13th in Denver and I believe with very good success.
I will write again and talk about my experiences since that time.
I
went to my internist for a pre-op health check and for part of the blood work
he ordered a PSA. It had only gone from 3.2 to 3.5 and that was over a period
of probably 7 to 8 months. I felt like all the pomegranate juice and deprivation
of red meat I did must have helped. So I elected robotic surgery and checked into
the hospital in the morning, went through the prep, kissed my wife and was wheeled
into the operating room. I saw the Da Vinci robot over in the corner of the operating
room and the surgeon console off to the side of the operating table. Once I slid
over onto the table, my surgeon, Dr. Edward Eigner, came over and joked with me
to put me at ease and shortly thereafter it was "lights out".
I
woke as I was being taken from recovery to my hospital room. We came across my
wife in the same elevator as we were headed up there. She had been told that I
was being moved to my room. I was not too out of it from the anesthesia because
I remember Lorraine telling me that the doctor said everything went very well.
There was very little blood loss, he was able to spare the nerves and the surrounding
area looked good. I had tolerated the surgery well and was on my way to recovery.
I spent 2 nights in the hospital, in part due to the fact that my surgery did
not start until noon on the first day. While I was getting shots of morphine,
I felt surprisingly well. Actually my throat was my biggest complaint due to the
intubation during anesthesia. I had six incisions and all but one of them were
very small. I also had a wound drain bulb attached to my abdomen.
Of
course the catheter was there, but it did not seem to bother me (at least at first).
I was amazed at the color of the fluid - clear yellow (not blood red) in my catheter.
In my walks around the hospital I saw a couple of people whose catheter bags were
blood red, which I had been told to expect. I was released to home less than 48
hours from surgery and I was happy to get outside and into the fresh air. We had
been given our discharge instructions, had the IV removed and gotten dressed.
I remember that you had to plan on extra time to do anything because it seemed
to take longer to just get ready.
The
ride home was pleasant but I remember complaining about the potholes in the road.
Holding the incision sites helped. When I got home I changed into a night shirt
and took off the leg bag. It was already full, most likely because I take water
pills in the morning. I put on the catheter bed bag (much bigger capacity) and
got settled into our recliner. I had read where another surgery patient had used
a small bucket to carry around the catheter bag and I was quite comfortable with
that. I bought a pair of warm up type sports pants that snapped up the side of
both legs. I could then allow the tubing to come through the side and into my
bucket. When I went for walks outside I carried a small shopping bag with the
catheter inside. You would have to look quite closely to see the tubing from my
leg into the bag. It was great to get a shower, but required a little ingenuity
to find a place to hook up your bag while you were in there. A phone call from
my doctor gave me the news that the pathology showed clean margins all around
the gland. My family and I were thrilled. The normal time for catheter removal
fell on Thanksgiving or the day after, but the doctor's offices were closed so
I had to wait till the following Monday. While I found the cath a little irritating,
it certainly was not a big deal and was removed just 1 day short of two weeks
after the surgery. Not really an experience I hope to repeat, but certainly one
that makes you feel free.
I
got a copy of the pathology report. It showed cancer in both sides of the gland
and in fact in the anterior, lateral and central lobe of the left and right side
of the gland. Additionally it was upgraded from a 3+3 to a 3+4 in most of the
areas. Even the bladder neck area contained some tumor. While the tumor was very
close to the capsular margin, the seminal vesicles, the capsular margin and the
prostatic urethra were negative for tumor. A cause for a big celebration. There
was one hiccup that I experienced. The catheter was removed during my appointment
around lunchtime. The waterworks system did not function properly after that.
I was told to drink a lot which I did, but for some reason I could not void. I
ended up back at the hospital that night fearing that they were going to put the
catheter back in because it was getting quite painful. While I was in the ER waiting
room at about 8:30 that night, hoping to be called in because I was almost doubled
over in pain I walked around. During this time, I felt some wetness in the pad
they had given me that afternoon. I went to the bathroom and was able to pass
urine. What a relief! I did see the ER doctor and actually went again while in
the exam room. I did not have to have the catheter reinserted.
One
of the greatest areas of concern with this procedure are dealing with the issues
of incontinence. There is so much written about it that I can certainly understand
why it causes a lot of thought. Frankly, it was a non-event for me. Yes there
was dribbling and during the first couple of months post surgery an occasional
involuntary "squirt" caused mostly by unusual movements or at times the strong
urge to urinate, but these never involved enough volume to even make the pad wet.
I wore them for the first couple of months only because I wanted the confidence
they provided. I put a clean one on every day, but I never once had to change
a pad during the day or night. I can't say whether this was a result of the precision
of the robotic procedure in the hands of an excellent surgeon, the fact that I
began the Kegel exercises 3 months ahead of the surgery or a combination of them
both.
On
the sexual side there are some signs of life but I am told it will take quite
some time for recovery. I have been taking Cialis 2 to 3 times a week to increase
blood flow and believe that with the success I had on the urinary side that it
is only a matter of time until this function returns as well.
PSA
checks are done with regularity, first at every 3 months and now on a 6 month
rotation. Everyone has been less than 0.1 which makes me happy. Hopefully that
will continue.
Joe's e-mail address is: joe.petko@level3.com
