Mike M lives in Texas, USA. He was 63 when he was diagnosed in November, 2017. His initial PSA was 11.29 ng/ml, his Gleason Score was 7b, and he was staged Unknown. His choice of treatment was Surgery (Robotic Laparoscopic Prostatectomy). Here is his story.
I am recently diagnosed with Gleason 7B (4+3), so I am still feeling my way through all of this. I will post updates as my situation and my treatment progress. I am a Medical Technologist MT(ASCP) and have been in the Medical Field for over 35 years, so the lingo does not intimidate me and I am pretty familiar with the pathology of the diagnosis. I never thought I would have a cancer, I'm breaking new ground in my family history. Two years ago (August 2015) my PSA was 3.5 and my DRE was normal. One year ago (August 2016) my PSA had increased to 7.8 and my doctor's opinion at that time was that the value of the PSA as a test was somewhat questionable and lead to many expensive and painful biopsies that were unnecessary. DRE at that visit was normal, so we opted for a wait and see approach. At my last annual exam in August 2017 my PSA had increased to 11.29 and my doctor's impression of the DRE was that the prostate felt somewhat spongy. Off to the Urologist who repeated the DRE and said the DRE was not suspicious at all to him, but in light of the doubling of the PSA he felt that a biopsy was the only prudent way to determine whether there was a cancer involved. He did 10 biopsies, not as unpleasant as I had imagined, but not a lot of fun either. At that time, he said that the size of the Prostate was about what he would expect for someone in my age group and that he saw no focal areas of concern. He assured me that he felt confident that all would turn out well. However, 2 biopsies returned as Prostatic Adenocarcinoma, Gleason Grade 4+3=7 (Prognostic Grade Group 3), one involving 88% of the tissue and the other 50%. I have an appointment with the Urologist to discuss treatment options on Wednesday November 8, 2017. I am leaning right now towards Robotic Laparoscopic Surgery but Gleason 7 might, from what I've read, require open surgery so that they can test a few sentinel lymph nodes for metastasis. [That is not correct -- all of that can be done using the robotic surgical techniques]. I will know more after I speak with the Urologist on Wednesday. I am most worried about the prospects of urinary incontinence, and of course the possibility of a metastasis. All methods have their upsides and their downsides. Surgery, if nerve sparing, seems to offer the best chance for full remission, assuming that the capsule of the prostate has not been breached and no cells have moved into the blood stream. At least with the prostate out of the equation, my PSA will become a better diagnostic indicator of metastasis. Other tests may be recommended, I will update this as soon as I speak with the Urologist and as my treatments progress. Many posts recommend a second opinion, even a second opinion with a different kind of doctor (i.e.: surgeon vs radiation vs Chemo). My Urologist is a surgeon and I assume he will lean towards some aspect of surgery. My Urologist is a little suspect right now since he described my DRE as not suspicious at all after my primary care doctor had reported slightly spongy. Maybe I'm being nit-picky, I have never felt of a Prostate so it is probably a real art.
Since my last update, I have spent three weeks anticipating all sorts of bad news and complications, none of which have come to pass so far. I met with my urologist, who refused to be anything other than optimistic about my prognosis. He said that I should not panic. Well, too late, that horse was already out of the barn. He spoke about my options, Surgery (traditional or robotic), Proton Therapy, Chemotherapy (not recommended at this point), active observation (not in my game plan, I want the tumor just gone), something called Cryoknife (experimental edge), radiation therapy, and on and on. Nothing he outlined made me doubt my decision to have robotic surgery. I asked him if either surgical method had advantages over the other. He said that robotic surgery had a much faster recovery time. I asked if the lymph nodes could be biopsied with the robotic surgery, and he said "certainly" (score one for Mr. Editor). I told him that I would go with the Robot-assisted radical prostatectomy. My reasoning is that I, personally, want the tumor removed. What I see as the advantages is that once removed, my PSA should go to somewhat undetectable (0.01ng/ml) or at least stable near the lower detectable limit and offer some reassurance that the tumor was contained. If my PSA does not go to undetectable then I know soon that there were possibly metastatic cells that escaped and I can start pursuing treatment sooner rather than later. I met with the surgeon, who looked amazingly like Jim Carey. He was very optimistic about the surgery and also tried to calm my fears. The three weeks before surgery seem to be when your mind wants to mess with you a little (or a lot). My dreams starred Jim Carey waking me from surgery and telling me the bad news. The day of surgery arrived all too soon it seemed. I will skip some of the pre-surgical details, not because I want to, but because I was given Versed (midazolam) prior to surgery and the memories just aren't there. I remember the surgeon pointing out the robotic device, but I don't remember seeing it. White goes to black. When I awoke from surgery, I remember intense nausea and tried to throw up (Versed apparently does not block nausea memories!), then things go black again until I am being moved from a gurney into a bed in my hospital room. I suppose the pain of being moved re-stimulated my memory center. I remember someone asking me to grade my pain on a pain scale by my bed, and sissy that I am I claimed the 10 ticket and promptly fell back into blackness. When I awoke again, I noticed I had a catheter and five new future scars on my belly. Four of them look like a dashed line along where my beltline is, and a vertical one above my naval, all about an inch long. Also, it feels as though someone inserted a golf ball under my bladder when I try to sit normally. I think I bit my tongue during surgery, as the left side is tender and swollen, and the anesthesia tube gave me a sore throat, but not intolerable. Later, the surgeon came to visit and I was told that the surgery went very well, that he felt that the tumor was completely contained within the prostate, and that he felt very confident that the Pathology report on the prostate would confirm that. He also said that he examined the lymph nodes and did not see any reason to biopsy them, said they appeared perfectly normal, and that he did not feel it was worth the risk of bleeding to mess with them. Post surgically, the catheter was pretty uncomfortable for the first day, and I felt like I had been punched in the gut. I walked around the hallway to prove to the nurse that I could, and then I walked a second because it made things kind of settle back into their slots inside. Sleeping in the hospital was beyond my grasp, too many lights, too much noise, too many things squeezing my legs, and too many aids checking my temperature. To make matters worse, my mouth was bone dry and I could not seem to work up any spit. I drank a few quarts of water and chewed ice until I was sore in the jaw. My mouth tasted ugly and I assume it smelled as bad as it tasted. The second day, I was getting used to the catheter and it wasn't such a big deal. The pain in my belly was much improved, at least until I had to cough. That episode felt like I was tearing myself in half. I walked about four laps every 2-3 hours on day two and catnapped between walks. I got sent home the second day, so less than 36 hours after surgery. Apparently all that walking paid off. I was feeling a little sleep deprived so I begged my doctor for some Ambien to take home and he prescribed five. My wife drove me home and I think she plotted a route that had multiple speed bumps to cross and at least one curb to jump, maybe I should have been nicer to her before surgery. However, I made it home, got in my bed, and fell asleep without taking the Ambien and slept for 11 hours straight. Day three after surgery, I was feeling much improved, the sleep seems to have mended a lot of complaints. I got to take a hot shower, and that made me feel human again. Now I will wait for the Pathology report to see if the tumor was contained. I feel like I am in the eye of the hurricane, the skies are blue!
Mike's e-mail address is: 9hranch AT gmail.com (replace "AT" with "@")