TESTING: A routine physical exam revealed a PSA of 4.7 in June 2006. Subsequent biopsy indicated small focus of HGPIN (High Grade Prostatic Intraepithelial Neoplasia), but no cancer. My PSA rose to 6.7 in August 2007 and another biopsy in Janaury 2008 revealed 2 of 10 specimens with cancer. Specimen #1 was 20% Gleason 6 and the other was 30% with a Gleason score of 3+4=7. Both lobes had an affected specimen. Perineural invasion was stated as "absent."
FAMILY HISTORY: My father was diagnosed with prostate cancer in conjunction with a TURP (Trans-Urethral Resection Of The Prostate Gland) in 1992 at age 72. He died in 2002 from a secondary cancer related to his prostate cancer treatment. My brother has symptoms of BPH (Benign Prostatic Hyperplasia) which started in his early 50s, but refuses to seek medical advice.
PERSONAL HISTORY: 5'8" 152 lbs. I am 55 years old, and have exercised vigorously for the last 30 years. I do aerobic sports 4-5 days a week - alternating days of running (4 mile route @ 8:00 per mile pace) and swimming a minimum of a mile at a 32 minute per mile pace. To challenge myself, I'll throw in an occasional organized event, such as a half-marathon or a competitive 3 mile ocean swim.
TREATMENT RESEARCH: After hearing of my diagnosis on January 11, 2008 my wife and I started reading and having consultations with various physicians, including an oncologist, 3 urologists and a radiation oncologist. After doing more research we decided the Da Vinci robotic laparoscopic prostatectomy was the way to go. To our surprise, Kaiser Southern California had not yet entered the 21st century. They don't do it here, and they won't refer and/or pay out of network! The Kaiser Northern California group has a Da Vinci program, but there was an 8 month waiting list! We figured we would just pay out of pocket and sue Kaiser to get our money back. About that same time, I read a patient story on Yananow.net of a man who had great confidence and success with a Kaiser surgeon who performed non-robotic laparoscopic prostatectomies. We drove from home (San Diego) to Harbor City (125 miles) for a consultation with Dr Gohar, the surgeon. He convinced us that his experience (500+ procedures) and expertise would likely yield results as good as or better than the robotic procedure.
THE PROCEDURE: On Tuesday, March 4th, 2008 the non-robotic laparoscopic prostatectomy was performed by Kaiser surgeon Dr Gohar. He had some difficulty separating the gland from colon scarring, so the procedure took over 4 hours. He reported to my wife that he had successfully spared both nerves and was quite confident that he had removed all of the cancer. 24 hours later I was released from the hospital.
THE RECOVERY: Upon Thursday's release, my wife drove me 125 miles home to San Diego. The car drive was awful and the next day (Thursday) wasn't much better, but by Friday I was down to 3 Vicodin a day, able to eat some solid food and walk a mile. Saturday (4th day since surgery) I had my first bowel movement, and easily walked a mile to the drug store to get some Tylenol to replace the Vicodin. By Sunday, I was walking 4 miles and stopped taking Tylenol.
On Tuesday (one week after surgery) we drove back up to Harbor City Kaiser to have the catheter removed and go over the specimen's pathology report. The report could not have been better. It down-graded the Gleason score from a 7 to a 6. The cancer was "organ confined" and there were clear margins.
The nurse suggested I wear a diaper for the long drive home, and the surgeon had advised me to be patient while awaiting my return to continence. I was impressed with the modern diaper, as I was not able to feel any wetness on the three hour drive home. Once home, I went straight to the bathroom and urinated. I looked at the diaper, and there were no signs of wetness. I figured that sitting in the car put pressure on the urethra and kept me from leaking, so I drank 3 glasses of water and took a walk around the neighbourhood - no leakage! Long story short; I'm one of the lucky ones who was dry from the moment the catheter was removed.
It's now 13 days since the procedure, and I am still dry and walking at least 4 miles a day. My main discomfort is the area between my scrotum and anus, which hurts if I sit too long. There is still an occasional very slight stinging when I urinate. I must also get up 2 or 3 times at night to urinate. I understand that these will improve over the next couple of months.
HOPES AND EXPECTATIONS: I expect to be able to start running and swimming by early to mid April (4-6 weeks post surgery). At my current rate of recovery, I don't see a problem. I feel like I could do it now, but the doctor insisted I wait 30 days post-op before putting that much stress on my internal tissues.
I expect to remain continent.
I don't dare expect too much in the ED department. Though encouraged so far with the use of Levitra, time will tell.
Most importantly, I pray for an undetectable PSA next month.
My first PSA results came back as "undetectable" on April 28 '08. I'll have it checked again in July.
At 5 weeks post-surgery, I had my first leakage/accident. I had too many "adult beverages" before bedtime, and awoke to wet underwear a couple hours later. I've been more careful and have had no problems since.
At 7 weeks post-surgery, I am only able to run an 8:30 pace over my 4 mile course. I hope to be back under an 8 minute pace within the next 2 weeks.
One of my incisions (JP drain) was not healing, so I went back for debridement (the surgical excision of dead, devitalized, or contaminated tissue and removal of foreign matter from a wound) of the wound and reclosed with steri-strips on March 27, '08. As a result I have been unable to get back into the swimming pool to re-establish that aspect of my fitness routine. By next week (week 8) it will be completely healed, and I will get back into the water.
In the mean time, I've been doing pull-ups, sit-ups, and push-ups to regain upper body strength.
ED is completely resolved with Levitra. I'll see what happens without Levitra when my prescription runs out later this month.
I was nervous about the possibility of a bad outcome with my 3 month PSA test, so I put if off. The Urologist's office called twice and shamed me into having it done, so I finally went for the test on August 1st. I was quite relieved when the PSA results came back as "undetectable."
My weight, strength, and fitness have returned to their preoperative levels. I'm only running once a week, because favorable ocean conditions have allowed for open water swimming at least 4 times a week. I'll start running more in a couple months, when the ocean cools and becomes less inviting.
Levitra is still necessary for consistent results in the erectile department. Without Levitra, I'm not the same as pre-op, but getting better.
I have no leaking, even if I over-indulge in "adult beverages." If I drink fluids up until bedtime, I can still expect to get up 3 or 4 times at night. If I stop drinking fluids a couple of hours before bedtime, I get up at least once, but never more than twice.
Mentally, I'm still recovering. While I'm generally in good spirits, I don't have the same "happy-go-lucky" zest I exhibited in my first 54 years - before the PC experience. I don't know if it's a bump in the road, or if it's a permanent result of now being able to see my mortality. All in all, I know that I am a lucky guy.
Not too much to report at this time, as my PSA remains "undetectable" and I continue to maintain a fitness level (based upon running and swimming paces) at or above what it was before surgery.
One improvement since my last writing...I am able to sleep through the night without getting up to urinate. If I drink just before going to bed, I'll get up once, but never twice.
ED is resolved without drugs. However, I really like Levitra. I wish I experimented with this stuff years ago!
My mental outlook is still good, and I don't often think of the PC experience like I did a year ago. I still count myself as being very lucky, in that as I mentioned before, I was continent from the time the catheter was removed, and suffered almost no ED.
It's been over 4 years and I rarely think of my PC experience. About the only time I'm reminded is when another article is published about the treatment/over-treatment of prostate cancer. Since my outcome was pretty good, I don't let the thought that I may have been treated unnecessarily linger for long.
My main permanent side-effect is a slightly lessened bladder capacity. While removing my prostate, the surgeon thought he saw a lesion on the bladder neck, so he removed it for pathology's review. It turned out to be a scar from a misdirected lidocaine needle, done during one of my original biopsies.
A slight decrease in erectile function may be another side-effect, but as previously noted, it is resolved completely with Levitra. That slight decrease is just as likely due to age (I'm now 60).
I'm as physically active as ever, though increasing age and decreasing performance seem to be related. My running pace has slowed to 8:30 per mile over a 4-mile course, and it takes almost 36 minutes for me to swim a mile.
It's been over 7 years since my surgery, and all is still great. I'm still running and swimming, but still getting slightly slower as I age. I rarely think about my PC experience anymore. I was only reminded of it a few days ago when a friend announced that he had a biopsy subsequent to a PSA test. That biopsy came back at a Gleason score of 7, and he is awaiting his surgeon to set an appointment.
Eddie's e-mail address is: elofdahl AT cox.net (replace "AT" with "@")