John
Heights and Rita
live in Quebec,
Canada. He was 50 when he was diagnosed on November 2, 2007. His initial PSA was
9.10 ng/ml and his Gleason Score was 3+3=6. He was staged T1c and his choice of
treatment was Laparoscopic
Radical Prostatectomy.
Here is his story:
I am rarely ill. The only visits I made to a doctor in the last 30 years were
those required for job and life insurance applications. On my 50th birthday, I
decided schedule my "first" annual check-up. The digital rectal exam indicated
a normal prostate.
The blood test for the check-up was done on Sep. 5,
2007. I was shocked when the blood test results showed a PSA of 8.43.
My
family doctor referred me to a Urologist. Before seeing the urologist, my wife
and I did some research. From what I read, a Free/Total PSA ratio test is a better
indicator of prostate cancer. When I met the urologist, I insisted on a "Free
PSA" test before having a biopsy. This test was done Oct. 17, 2007. The Free/Total
PSA Ratio was 7.36; the Total PSA was 9.10. Not only was the Free/Total PSA Ratio
dangerously low, but the total PSA had risen slightly in only 6 weeks.
The
biopsy was performed Oct. 29, 2007. A week later I was told that 5 of 10 samples
were positive with a Gleason 6 (3+3).
In retrospect, it should not have
come as a shock since my father died of prostate cancer at 71 after being diagnosed
at age 64.
To
continue my story, some details about my state of health prior to diagnosis. I'm
6' 185 lbs. For the past five years my only exercise has been walking the dog
once or twice a week, mowing the lawn, or shoveling snow off a long driveway.
Thanks to my wife, I generally eat healthy, well-balanced meals. Since my university
days, I rarely drink alcoholic beverages (an occasional glass of wine or beer).
My
doctor told me that being fit before surgery generally improves recovery rate.
As a result Rita and I bought ourselves a treadmill for Christmas and I began
running about four days a week. I was up to 3 miles in 30 minutes prior to surgery.
Since
I mentioned that my father died of prostate cancer, I'll quickly summarize his
story here. He was diagnosed after he noticed blood in his urine. His PSA was
normal. From other tests (DRE, biopsy, and MRI) he was told that he had a tumor
that is now attached to the pelvis. He was treated with external beam radiation
and ADT (his doctor advised that it was too late for surgery). The prostate cancer
symptoms disappeared; but a couple of years later he had several tumors in his
spine and ribs.
After diagnosis, my initial research revealed a multitude
of treatment options. It seems to me that this diversity results from not having
one clearly optimal solution. As a result, I agonized for several weeks over my
choice of treatment and physician.
After consulting with five urologists,
I made my first decision, which was to have a radical prostatectomy. The reasons
for this were,
(1) if necessary, I could still have radiation therapy (whereas
surgery after radiation therapy is generally not possible),
(2) all the urologists
agreed that prostatectomy was the preferred option for my situation, and
(3)
I liked the idea of removing the cancerous cells from my body.
This was
based on the assumption that the cancer was well encapsulated within my prostate.
My
next decision was to select the surgeon/technique (i.e. open, laparoscopic, or
robot-assisted laparoscopic). From everything I read and have been told, experience
and track record are the most crucial factors in selecting a surgeon for this
procedure.
Recovery from open surgery is much longer than from laparoscopic
(minimally invasive) surgery. Therefore I leaned toward laparoscopic prostatectomy,
if I could find the right surgeon.
After watching some videos of robot-assisted
and "traditional" laparoscopic prostatectomy, I found the robotic form much more
appealing. In the Montreal region (where I live), there was only one surgeon who
performs robot-assisted prostatectomy; but he had performed only 25 prostatectomies
using the robot (Da Vinci) system. Unfortunately, this level of experience did
not give me the confidence I needed to select him as my surgeon.
This narrowed
my choice to two surgeons: One uses the traditional open technique; the other
has been performing laparoscopic prostatectomies since 2001 and performed open
prostatectomies for several years before that. I chose laparoscopic since the
surgeon has a lot of experience, is highly regarded by other physicians, and was
extremely well rated on www.ratemds.com (I found this site very useful). Surgery
was scheduled for Friday, Mar. 14, 2008.
I had a pre-op blood test on
Mar. 3. The PSA from this test, was 11.2 as compared to 9.1 from Oct. 17, and
8.4 from Sept. 5. This increase was in spite of having spent the past 3 months
exercising regularly, eating better (more fruits, vegetables and fish; less red
meat), and drinking 2 cups of pomegranate juice each day.
According to
the surgeon, surgery went well and both nerves were spared.
I stayed in
the hospital for three days after surgery. The pain was quite bearable. I didn't
really need the morphine pump that was provided for pain management. Lower abdominal
region was sore and stiff, but only painful if I pressed on it or when twisting
to get out of or in to the bed. The most annoying pain was at the tip of my penis,
caused by the catheter. The hospital gave me Tylenol and Colase (stool softener)
regularly. I walked up and down the hallway outside my room (about 50 yards) 3
times a day. By Monday, I could pass gas but no bowel movement. Went home Monday
afternoon.
Tuesday morning had first bowel movement. Fortunately, stools
were quite soft, and I didn't need to push too hard. However, while pushing I
also had the urge to pee, which was very strange since I still had the catheter.
I
found that the swinging motion of the tube when I walked caused irritation and
pain at the tip of my penis. The solution for me was to wear briefs style underwear
and tuck the tube under the testicles, then bring the tube up slightly so that
it comes out through the leg hole. With this setup, the tube moved only outside
the underwear; the tight fitting briefs and leg hole stopped any movement of my
penis and the tube from my penis to the leg hole.
Catheter and staples
were removed on Mar. 25, eleven days after surgery. To remove the catheter, the
nurse put a measured amount of water in my bladder. The tube sort of slide out
on its own as I expelled the fluid. It was an odd sensation, difficult to describe,
but I wouldn't say it was painful.
30-Mar-2008
After
2 weeks I have absolutely no flow control. It's as though the catheter was still
in place, since urine dribbles continuously if I am standing or walking. There
is no leakage while I am sitting or lying down, but the urine starts flowing as
I'm in the process of standing to get out of the chair or bed.
I do pelvic
floor muscle exercises (kegels) regularly, 3 times a day: In the morning while
lying down before getting out of bed, at lunch time while sitting, and in the
evening while standing (usually in the shower). Each time I do a 2 sets of 10
kegels. For the first set I would not tense fully, but try hold while breathing
out slowly. For the second set I tense the muscles as hard as possible, and not
bother trying to hold it. The instructions I received from my doctor was to hold
each for 3 seconds. I can barely hold for 2 seconds for the first 5 kegels, and
not at all for the remaining ones.
19-May-2008
I now have
some flow control. I can walk around the house, slowly, without leaking. When
I get the urge to pee, I can (usually) make it to bathroom without leaking. If
I take it easy, I can go a whole day without leaking! However it doesn't take
much to cause a squirt or two: A cough or sneeze, even walking fast. This new
found control didn't come suddenly. It's been a very slow, but steady, progress
over the past 8 weeks.
Prior to surgery I drank 4-5 cups of strong coffee
a day. My urologists advised me to stop drinking coffee while trying to re-gain
urinary continence. He said that coffee has double whammy; it acts as a diuretic
and caffeine irritates the bladder. I did as he advised for the first 2 months,
but now that I've re-gained a significant amount of control, I've started drinking
coffee again. However, if I drink more than 1 or 2 cups a day, in the evening
I have frequent leaks and squirts for no apparent reason.
17-Jun-2008
Urinary
continence continues to improve! I can now walk up and down stair without squirting.
Most days I don't wear a pad. Still need the pad to mow the lawn or go for a run;
still can't drink more than 2 cups of coffee a day It's been 4 months since surgery.
29-Jul-2008
Today
I got the results of my first PSA test since surgery. It was zero!
I can
now run without draining my bladder. Sprinting is out of the question, but I can
run for 2 miles at 5 mph then get off the treadmill and go to the bathroom to
empty my bladder. Most days I no longer worry about leakage. As I result I've
stopped doing kegels.
The cancer's gone, urinary continence is back, now
to start working on the erections....
John's
e-mail address is: rita.heights@gmail.com
