Soc
Doc and Gypsy live in Texas, USA. He was 63 when he was diagnosed on June 15,
2009. His initial PSA was 9.1 ng/ml, his Gleason Score was 3+4=7 and he was staged
T1c. His choice of treatment was Surgery. Here is his story
I initially
went to my primary care physician March 4, 2009, after experiencing a large amount
of blood in my urine. It was discovered that I was passing kidney stones - a diagnosis
confirmed through CT scan a week later. At the time, I was vaguely concerned about
prostate cancer because of family history (my paternal grandfather and one of
my mother's brothers). My PSA turned out to be elevated (8.8), and the doctor
explained that, while this could have been due to irritation from kidney stone
passage, it needed further investigation by a urologist. The earliest available
appointment with the urologist was April 20 (which seemed like an eternity!).
In the meantime, my primary care physician ordered a Total and Free PSA
test (done April 1 - total PSA 7.9, free PSA 1.30, % free 16.5). These figures
were still in the "gray area" relative to cancer screening. Looking back through
my files, I discovered an earlier PSA test (3.37 - just below the screening cutoff
point of 4.0), done in 1997 when I was 51 (prior to a long period when I was medically
uninsured and stayed away from doctors except in emergencies).
On April
20, the urologist performed a DRE (Digital Rectal Examination) (no indication
of cancer, but a significantly enlarged prostate), and scheduled a cystoscopy
and prostatic ultrasound for May 4. The cystoscopy revealed a large number of
mostly small stones, which the doctor interpreted as bladder stones formed because
of urinary retention from the enlarged prostate. While the ultrasound showed no
signs of prostatic tumors, the technician remarked, "You know you have liver lesions,
don't you?" One test calls for another! That remark sent me back for a liver-specific
CT scan, which clarified the finding of "hypoechoic lesions" on my ultrasound
report. There were 2 areas of lower density (each about an inch across) that the
doctors interpreted as hemangiomas
(common benign lesions - nothing to worry about). That was a big relief, since
both of my parents had died from cancer that eventually metastasized to the liver.
My urologist had been thinking of treating what appeared to be benign
prostate hypertrophy through laser vaporization of prostate tissue. However, in
light of my elevated PSA (9.1 by that time), he scheduled a biopsy to rule out
cancer. The biopsy, done June 8, revealed prostatic adenocarcinoma in 7 out of
10 samples, with Gleason scores ranging from 3+2=5 (1 sample) to 3+3=6 (4 samples)
and 3+4=7 (2 samples). Here is the summary from the biopsy pathology report:
"Microscopic
description: A-J. Sections from several prostate biopsies show foci of prostatic
adenocarcinoma with a Gleason score ranging from 5 to 7. Perineural invasion and
extraprostatic extension are absent."
On June 15, I was presented
with the diagnosis and referred to the surgeon who eventually performed my radical
prostatectomy. In my case, radiation therapy was not tenable because of my severely
enlarged prostate and ongoing difficulty passing urine. Active surveillance was
out of the question. For me and my wife, the stress of waiting and wondering,
with the prospect of countless repeated biopsies and risk of metastasis, would
have more than counterbalanced the foreseeable negative effects of treatment.
In the meantime, however, there were pre-op tests: an electrocardiogram and chest
X-ray done at my family care physician's office, and a bone scan and bloodwork
done at the hospital. Results were unremarkable except for a small shadow (not
seen in prior CT scans) on the chest X-ray. I'll be going back next month to have
this investigated further.
Fortunately, my surgeon (a highly regarded
clinical professor who has performed hundreds of RPs) was skilled in both the
Da Vinci robotic and traditional open procedures. Virtually all of the operations
he does now are robotic. However, he informed me that, because of my prior abdominal
surgery (right hemicolectomy for colon cancer 19 years ago), I might have too
much scar tissue for the robotic procedure. That turned out to be the case. I
was in surgery for 5 hours and in recovery for 3 hours on Thursday, July 23, and
spent 3 nights in the hospital. The doctor reported that there was no visible
evidence that the cancer had spread beyond the prostate. Overall, pain was quite
manageable.
Four weeks later, I am down to 1 or 2 over-the-counter pain
pills a day. The biggest immediate discomfort resulted from failed attempts by
hospital phlebotomists (apparently less skilled than their counterparts in the
family care clinic!) to find veins suitable for drawing blood and inserting the
IV. A nurse explained that the 6 months of chemotherapy following my colon cancer
surgery had most likely resulted in scarring of what otherwise appeared to be
excellent veins in my arms and hands!
In the long run, though, most of
my distress involved the Foley catheter. To begin with, when I awoke in the recovery
room the doctors were replacing the original catheter - on which the balloon had
broken! From that point until the catheter was removed 8 days later, it remained
a significant irritant. The leg and overnight bags were fairly easy to manage,
especially thanks to my wife who emptied them using a urinal that the hospital
gave us. The overnight bag had to be emptied at least twice each night; I found
out that indeed you do pee a lot more when lying down, especially during recovery
when your body is expelling retained fluid. It was very helpful to have a flat-sided
4 or 5-gallon bucket to hook the overnight bag onto so I could have it beside
my bed or carry it around. I was very swollen all over for a couple weeks, with
my abdomen being swollen even longer. I had to buy larger pants to wear temporarily!
Ever since the catheter was removed, I have had significant urinary leakage,
although I am regaining some voluntary control. I have been doing the Kegel exercises
(no more than twice a day, as instructed), and that seems to be helping. I need
to wear some kind of pad all the time (large and small varieties). The doctor
says I can expect improvement, but in my case it may take 6 months or so. This
is due in large part to an atypical (knuckle-like) median lobe in my prostate
that had been partially blocking the urethra for virtually all my adult life,
resulting in a thickening of the bladder wall.
One thing I would emphasize
is the need to pace yourself during recovery. The doctors want you to start walking
around as much as possible right away, and that's good. But don't overdo it, especially
at first! When I arrived at home (still under the influence of prescription pain
medication), I immediately climbed 3 flights of stairs - and then almost fainted
when reaching up to retrieve a file folder. With the passage of time, I have gradually
regained my stamina and energy, and am now close to being back to my previous
level of activity. I continue to be careful not to strain or lift anything heavy
(very important).
On the morning of August 19, the doctor called with
my lab results. The final Gleason score was 3+3=6 - which came as a big relief!
The tumor was large, but confined to the prostate capsule (margins negative).
The seminal vesicles and 17 lymph nodes were removed - all negative. Based on
this information, there appears to be an 85-90 percent chance of a cure (90% chance
of being tumor-free after 5 years). It turns out that my prostate was 83 grams,
as compared with a normal weight of around 25 grams.
I return for a post-op
PSA in early November. The doctor says that a small amount of PSA can be produced
by periurethral glands that are not removed in a radical prostatectomy, but that
this should be negligible. He advises waiting 3 months after surgery for the first
post-op PSA test so that residual PSA will be cleared from the bloodstream.
SocDoc's
e-mail address is: urbanbeat@comcast.net
