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Going for first surgical consult

HappyBaker
Posts: 6
Joined: Sep 2011

My 61 year old husband was recently diagnosed through biopsy after a physical exam demonstrated a palpable bump on his prostate and an elevating PSA. Three positive samples (3+3, 3+3 and 3+4) with an additionl one suspicious. PSA 5.3. Because of the "4" in the gleason score and the bump that can be felt, his urologist is recommending surgery - robotic. I called a urologist that I trust who practices where we lived for many years, and he said that because of the path report we could not wait any longer, and that surgery was definitely the way to go. We will have the slides re-read as well as see a medical and radiation oncologist as well as another urologist, but I'm thinking will end up with the surgery. My biggest question is about the difficulty of the surgery, amount of time that people are generally kept in the hospital, and specifically the aftercare requirements. We are considering going back home for the surgery, and need an idea of how long it would be before we could get back here. It's a 2 hour flight, which could take all day the way things are now. I am not well and am not able to drive or do errands - he's been doing that for many years, so we have to figure out the best way to handle everything. We're pretty much on our own and need to plan very carefully. We're fairly sophisticated medically but it has always been about me - this is a whole new thing and we absolutely do not have room to make mistakes. So - my question is - what do you think about being away from home for the surgery, how long would you expect it to be before we could fly back, how difficult is this?

VascodaGama's picture
VascodaGama
Posts: 1535
Joined: Nov 2010

Baker

Welcome to the board.
I wonder what was the Clinical Stage attributed to your husband’s case?

I agree with your decision in getting second opinions on the diagnosis of your husband.
When visiting the doctors he should take a copy of the pathologist report, any chronology of PSAs, results of other tests and image studies, which you did not describe in this thread. A List of Questions is a must and you can include some items regarding the matters you should consider for a treatment done at a distant hospital.

Surgery and radiotherapy are the only treatment options that can assure cure. However, the cancer must be contained. The fact that DRE was positive it indicates that cancer is palpable and close to the prostate capsule, and at that location it has high probabilities for extra capsular extensions.
Positive DRE, it stages his case in B1/B2 but with capsular extension it would be stage C which cases are classified “Localized” but not Contained. In this status surgery has very low rates for success. Radiotherapy is usually recommended.
Gleason grade 4 is aggressive so that it “pays” to get a proper diagnosis to address a proper treatment.

All treatments have their risks and side effects to which your husband should be aware of. These are considered in the decision of a treatment because they are nasty and may be permanent. Treatment on top of treatment means superimposed effects.

Here are generalities regarding prostate cancer;
http://www.drrajmd.com/conditions/prostate/cancer/prostate_cancer.htm

I had open surgery and stayed in the hospital 17 days. 3 for preparations before T day and 14 for after care until the catheter was taken out. I never experienced any complication/infection, pain, etc., from surgery and was never incontinent. The long stay was part of the protocol I choose and gave me the luxury of being attended daily by a series of specialists.
Davinci-robot procedure is done with a purpose for a quicker healing process (lesser incisions) therefore with shorter periods of stay in the hospital. Patients are supposed to take home the catheter urine-sac attached to their leg and visit the hospital 7-10 days later for a check-up. The procedure gives the possibility for guys to return to their job the soonest. Any infection or pain is supposed to be handled by a local PA in cases similar to yours. Surgeons do not like to follow surgeries done by others, so that you should investigate locally how to care in case of complications.

Here is a list of questions you can adapt to your case when visiting the doctors;
1. How aggressive can we consider his case taking into account his age and other health complications and symptoms?
2. How far advanced is it, Contained or Localized?
3. Should I get a second opinion for all choices?
4. What are all options?
5. Should I consider do nothing and just monitor any advance?
6. What treatments are best for my husband?
7. Can such treatment lead to other problems or interact with other medications?
8. What can be done to cope with the side effects?
9. Will my husband have to stay in the hospital for treatment? How long?
10. Will treatment keep him from doing certain things and look after himself?
11. How often will he be checked after treatment?
12. Can he go back to normal daily activities after treatment?
13. What experiences have other patients had with similar treatment regimens?
14. Is there any new type of treatment or trials that might be beneficial?
15. What has been your experience with prostate cancer patients similar to his case?
16. How many surgeries do you and your teams perform annually?
17. Can you recommend any patient support groups in my area?
18. Are there materials I can read about this cancer?
You can call the doctor’s office to request later for specific answers on your first consultation if you have doubts on any opinion.

Here is a site with detailed descriptions on what it should be considered in the preparations before and after surgery;
http://www.prostate-cancer.com/robotic-prostatectomy/cancer-treatments/Robotic-prostate-surgery.html

Wishing you both peace of mind.

VGama

HappyBaker
Posts: 6
Joined: Sep 2011

Thank you for all of your information. The urologist said that he was classified as T2a at this time. I am concerned about the location of the bump as far as spread, and will be asking about that today. There have been no image studies, and his psa began changing in 2004 - he was 2.13, rose a pinch each year, then 2010 was 4.5 and 2011 5.3 with the bump. I will print out your list - again, thanks.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

HappyBaker.
So sorry to read about your husbands cancer. I will try to answer some of your questions.
I was 54 when I had my surgery. You haven't mentioned if you are looking at Traditional Surgery or Robotic Davinci Surgery for your husband. I travelled about 3 hours by car to Vanderbilt at Nashville Tn for my Robotic Surgery so can only talk about my experience.
I had to be in Nashville the day before surgery for pre-admission and tests they wanted to run.
My surgery was at about 10am the next morning. I spent that night in the hospital and was discharged the next morning. My wife drove us home (3 hour drive) The trip was harder on me then I thought it would be and slept most of the time on the way home.

I would suggest staying 2-3 days post surgery at a local hotel if possible before attempting to fly. Do you have a family member or friend that could go with you to assist?

Again I can only comment on robotic surgery aftercare. I had a catheter for about 10 days. It was not as bad as I thought it might be. Once the catheter was removed (your local urologist should be able to do this) I improved very quickly. Walking is very important asap following surgery. My first walks were in the hospital halls and very short but each walk got better.

If you decided on Robotic Davinci Surgery make sure and get a very experienced surgeon. Look for one that has done at least 500 plus with the Robot.

At 7 weeks following my surgery my wife and I went on a cruise to Bermuda for my Son's wedding. While in Bermuda we rented a moped and Rode around the island one day on the Moped. Did very well though that excursion on the moped did tire me. My
profile picture on this forum was taken in Bermuda at the Wedding reception.

Lewvino
age 57
Gleason 3+4 (7)
PSA Pre treatment - 5.3
no bumps found
Current PSA 0

HappyBaker
Posts: 6
Joined: Sep 2011

Thank you for your response. Yes, he is looking at the DaVinci Robotic procedure, and I am concerned about additional treatment required because of the palpable bump. I guess we will find out more today and go from there. Again, thank you.

robert1
Posts: 82
Joined: Apr 2011

Hello HappyBaker:

While surgery may end up being the choice, I urge you strongly to closely examine your options before making a decision. Talk to 2 top raditherapist and 2 top PCa surgeons (1000+ procedures in their field as a minimum). So many guys wish they would have! You only have one chance to get it right the first time, and you have lots of weapons at your disposal. Consult with many survivors of both surgery and radiotherapy. Lot's of great truths live with these guys.

With a Gleason of 7 and a positive DRE,it may be wise to simply assume cancer cells are outside the capsule. Even if this is the case, the odds are very high that these cells haven't yet traveled very far. Given this, ask what type of margins around the prostate the surgeons and radiotherapists will treat.

Good luck with your decisions!

Best wishes,

robert1

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