Dec 16, 2011 - 9:44 am
I was diagnosed in early October with prostate cancer. My PSA was 5.5 and a DRE revealed a nodule. Subsequently, I had a biopsy - of the 12 samples, 3 were positive with one containing 40% "low volume cancer" and two others with a trace of cancer. I am 62 and my urologist outlined the options ranging from doing nothing ("watchful waiting") to removal, radiation, cryotherapy and HIFU. Because of my relatively young age, he did not advise me to do nothing. He emphasized that I had time to make an informed decision and was confident that the cancer was confined to the gland. I purchased several books on prostate cancer, spoke to quite a few men who have it and searched the internet. I did get a second opinion from a radio oncologist who said that radiation would be an effective treatment for my case and would have the same outcome (statistically) in 10 years. I elected to have the radical removal using the laparoscopic robot assisted technique. My urologist is also a surgeon and has been doing this procedure for 4 years. The way my mind works, I wanted to get the cancer out - and I liked the idea that if it had spread, there are options after the gland is removed for further treatment (external radiation). I had the procedure done Monday, December 5 - I had a one night stay in the hospital and was up and walking 4 1/2 hours after I woke up from surgery. The pain was very manageable - I did take pain medication for three days as needed, then stopped. The most annoying issue was the catheter, which stayed with me for 7 days. I was discharged with instructions and a bag that strapped to my leg during the day and a larger bag for use while I slept. The catheter was removed Monday, December 12 (along with the staples in my abdomen from the surgical wounds)- not at all painful. I was warned that incontinence would be an issue for some period of time - ranging from several months to a year. However, my doctor said that most patients regained full control although some continued to have stress incontinence when lifting something heavy. And, the second issue is the possibility of impotence. My doctor said if the nerves are spared (which they were) that I should regain the ability to have an erection. I am very pleased to say that after 4 days from the catheter removal, that incontinence issues are minimal - I am sleeping through the night without problems and really don't have much of a problem during the day. It is clear to me that I will regain full control over the next few weeks. I believe however, that I am somewhat of an exception. The impotence recovery remains to be seen at this stage. And, I am still waiting for the final pathology report which will determine if I need further treatment or not.
After determining that my cancer was in an early more treatable stage, that I am relatively young and in good health, I and my doctor believed I was a good candidate for radical removal. Given this, and the way my mind works, surgery seemed to be best option for me. Then it boils down to the skill of the surgeon - it was important to me (and confirmed by what I read) that the surgeon had at least 150 robot assisted surgeries under his/her belt - 300+ is preferable. In addition, my surgeon, who is 56, started with the "traditional" open surgery and had done maybe 1,000 of these - so my guy was very experienced.
Last comment: The decision for my treatment was left up to me - I asked my urologist what he would do in my shoes and he did say he would opt for removal. I asked the radio oncologist the same question and he refused to answer - all he would say is that both radiation (internal and external) and removal were all good and effective.