Prostate surgery

mdo53

VascodaGama said:

mdo53; Great news

It is very good indeed. PSA=0.04 ng/ml verifies the success of surgery.

Let's celebrate with a full glass of my lovely red Esporao.

Best wishes for continuing remission.

VG 

Wish everyone here the same

Wish everyone here the same success! 

Enclosed is a link to some interesting reading... The author is a local urologist who performed surgery on my wife's brother-in-law (his PSA's were 18+) who has been in remission for 7 years... http://www.theprostatedecision.com/

 

MK1965

Prostate surgery

LvGuy,

Study all treatments modalities carefuly than try to make your decisio. Surgery is not always best option.

Just had robotic prostatectomy on November 2nd and suffered alredy more pain than in my whole life. Today is only my post op day #5. Recovery is very rough and extremely painful. I was leaning toward radiation but very body that I saw in consultation and every one that I new was advising for robotic surgery.

ROBOTIC SURGERY IS BIG MISTAKE AND VERY INVASIVE. 6 CUTS IN ABDOMINAL WALL = 23.5 CM in lengthy.

JUST BIG SELING PITCH. WOULD NOT RECOMMEND EVEN THE WORST ENEMY.

MK

MEtoAZ

CK Patient here

I was 52 when diagnosed and had potential for involvment in the periphery which would have resulted in removal of one nerve bundle if it was confirmed during surgery. 

You are correct in that the Uroligists who drive the diagnosis and largely the cure for Prostate cancer are driven towards surgery.  I don't think it is for malice or profit motive, I just think it is what they know and they are confident that it will work, if cancer is contained.

Conventional radiation should not really be considered at your age, unless cancer is not contained, so your two choices would be surgery or SBRT like Cyberknife.

I am only 6 months post treatment, everything is working and no ill side effects aside from a kidney stone-like event 2 months post surgery that required taking steroids for a few days.  I have never had kidney stones so not really sure what that was about. 

I get my second blood test next week and expect to continue to see positive progress on PSA level decline. 

There are more immediate risks with surgery and while the majority of men don't have that bad of an experience, if you do, it can really suck, just look for threads of men dealing with some of those side effecs within this forum.  There are those who say that radiation may cause downstream problems which is also possible but haven't really seen someone express that experience first hand.

I only checked out cyberknife from a list of options my PCP had given me more as an afterthought when I was already scheduled for surgery.  When I went there, and then checked out forums like this, I decided to go that route and have no regrets with that decision.

Whichever course you choose, I hope that you have a successful outcome! 

LvGuy1

Update

went and got another digital from a urologist/cancer specialist and he found 3 lumps on the prostate and did tests and found that my gleason score raised to 4+4 =8 and we have scheduled surgery for Dec 13,2016 as my psa has been raising starting at a 4. something to 9.5 and then 11.5 and now it is up to 15 as of a week ago and he said it is agressive now. and he dont want to wait and thinks (like I do ) that removal is the best decision at this time. and then at that time he is going to get a biopsy done on the prostate and see what the real gleason score is as it can change after it is removed. I am hoping for the best and hope everything will turn out good. still scared and lots of emotions and am trying to find a local support group for prostate cancer but here in Las Vegas they dont seem to have very many and very far from me.

hopeful and optimistic

LvGuy1 said:

Update

went and got another digital from a urologist/cancer specialist and he found 3 lumps on the prostate and did tests and found that my gleason score raised to 4+4 =8 and we have scheduled surgery for Dec 13,2016 as my psa has been raising starting at a 4. something to 9.5 and then 11.5 and now it is up to 15 as of a week ago and he said it is agressive now. and he dont want to wait and thinks (like I do ) that removal is the best decision at this time. and then at that time he is going to get a biopsy done on the prostate and see what the real gleason score is as it can change after it is removed. I am hoping for the best and hope everything will turn out good. still scared and lots of emotions and am trying to find a local support group for prostate cancer but here in Las Vegas they dont seem to have very many and very far from me.

.

support group las vegas, NV (source: ustoo.com)

http://www.ustoo.org/Support-Group-Near-You

With a extensive cancer, having a Gleason 4+4=8 and a high PSA with 3 lumps, it is probable that the cancer has escaped the prostate, and that additional tests, ie image tests such as a 3T MRI and PET scan is needed to confirm and locate where the cancer  is  located  outside the prostate for more effective radiation treatment.....surgery alone, since it is a localized treatment, is not curative for cancer that has left the capsule, additional active treatments will also be necessary......the side effects of each treatment type are cummulative...........(among all active treatments, the side effects from surgery are the greatest).....as a lay person who has studied this, I suggest that in your case, radiation plus hormone, or homone treatment only is appropriate...surgery is not appropriate for you.

 

 

 

Max Former Hodgkins Stage 3

hopeful and optimistic said:

.

support group las vegas, NV (source: ustoo.com)

http://www.ustoo.org/Support-Group-Near-You

With a extensive cancer, having a Gleason 4+4=8 and a high PSA with 3 lumps, it is probable that the cancer has escaped the prostate, and that additional tests, ie image tests such as a 3T MRI and PET scan is needed to confirm and locate where the cancer  is  located  outside the prostate for more effective radiation treatment.....surgery alone, since it is a localized treatment, is not curative for cancer that has left the capsule, additional active treatments will also be necessary......the side effects of each treatment type are cummulative...........(among all active treatments, the side effects from surgery are the greatest).....as a lay person who has studied this, I suggest that in your case, radiation plus hormone, or homone treatment only is appropriate...surgery is not appropriate for you.

 

 

 

Yes

LVGuy1,

As a man who had RP (DaVinci), I agree with all Hopeful and Optimistic said.

Cases that have likely escaped the gland are ill-advised to use RP.  Radiation is all that is likely curative, supplemented by HT as/if necessary.  Talk to a rad oncologist with lots of PCa experience.

LvGuy1

have just had the MRI part

have just had the MRI part done 2 weeks ago and am getting 2 other tests done next week so far it shows the cancer is still just in the prostate and not the lymph nodes and the bone scan dont show nothing ..yet also had a cat scan with and without the drink they give and that came back ok. Will keep all informed as it helps to talk about this and let it out. and appriciate all the feedback you give. PS i am using Cancer Centers of America if that helps anyone, they seem to care

 

hopeful and optimistic

LvGuy1 said:

have just had the MRI part

have just had the MRI part done 2 weeks ago and am getting 2 other tests done next week so far it shows the cancer is still just in the prostate and not the lymph nodes and the bone scan dont show nothing ..yet also had a cat scan with and without the drink they give and that came back ok. Will keep all informed as it helps to talk about this and let it out. and appriciate all the feedback you give. PS i am using Cancer Centers of America if that helps anyone, they seem to care

 

.

Frankly the cancer center of america does not have a great reputation for treatment, but they do have a good reputation for marketing.

Initially you reported that your Gleason was 3+3=6. What occcured so that your new doc reported a 4+4=8?

Was the MRI you received a T3 MRI, that is, did the MRI machine have a 3.0 magnet, the highest magnet in clinical use that shows the greatest resolutions. This machine is more likely to show cancer outside the prostate than a cat scan or a 1.5 magnet.  The T3 MRI although it can show cancer outside the prostate does not show very small cancers.

The resolution in a cat scan is not as great as an MRI, and is not as effective in locating cancers outside the prostate.

There are various pet scans that are very effective....one of which uses acetate and is done by a doc in arizona, His name is alemeida (spelling). This pet scan is very effective, however it is  considered investigational and cost about 3,000 out of pocket. I live in CA. and I know many men who have had this test so they can know what is going on, and where the cancer is, to enhance treatment. There are also other pet scan tests, that I hope will be discussed by others at this board.

Old Salt

LvGuy1 said:

Update

went and got another digital from a urologist/cancer specialist and he found 3 lumps on the prostate and did tests and found that my gleason score raised to 4+4 =8 and we have scheduled surgery for Dec 13,2016 as my psa has been raising starting at a 4. something to 9.5 and then 11.5 and now it is up to 15 as of a week ago and he said it is agressive now. and he dont want to wait and thinks (like I do ) that removal is the best decision at this time. and then at that time he is going to get a biopsy done on the prostate and see what the real gleason score is as it can change after it is removed. I am hoping for the best and hope everything will turn out good. still scared and lots of emotions and am trying to find a local support group for prostate cancer but here in Las Vegas they dont seem to have very many and very far from me.

Have the biopsy slides reviewed

The difference between the first and the second biopsy results warrants review by a highly respected pathologist. There's time to have that done. Also, even though we don't have exact dates to go with the PSA assays, there's a possibility that the very rapid rise is due to prostititis. Has that been discussed and ruled out?

VascodaGama

Upgrading cancers on-the-fly

LVGuy1,

The second opinion from the urologist/cancer specialist you post above is not clear enough. Why did he upgraded the cancer classification to Gleason score 8 (4+4)? Have you or did he obtained a second opinion on the previous biopsy slides from a pathologist, or repeated the biopsy?  Urologists have no clue on pathologist's affairs to upgrade cancers on-the-fly. What surprised me was the comment regarding the positive DRE which finding may relate to existing extra capsular extensions. Such would upgrade your initial clinical stage to T2c with high probabilities of being a T3 if spread is confirmed. The negative image studies classify your case localized but not contained. Surgery should never be chosen for the intention of analysis of the gland. This is done in disected speciments (surgeries) to confirm the stage of such a case.

The newer diagnosis is very different from the initial one and may limit the benefit of the surgery in a curative approach. Recurrence is highly expected which would require salvage radiation therapy later. In view of the above you may disregard surgery and choose radiation from the beginning as the solo treatment. The concern of cancer invading bladder at prostate base is still unclear. If existent then you may opt for a combination therapy with neoadjuvant surgery plus adjuvant radiotherapy. Two radicals will increase the risks and the side effects. I wonder why you reserved surgery that fast, however, you can always delay its schedule if you think you would want to investigate further. No clinic would reject such request. 

In the end, whatever you choose will be the best. You only need to consider your family's opinions, be confident and take the action.

Best wishes for a successful outcome.

VGama

LvGuy1

I had the first set of

I had the first set of everything done thru the VA and the 2nd set done thru cancer center. THis is not the same one as in Arizona this is in Las Vegas i made a mistake in the name it is Cancer Care Center, i just saw cancer center and assumed. I have to go to where the VA sends me for outside care so dont have much of a choice. when they found the lumps (3) they redid the biopsy of the lumps. I dont really know what type of MRI machine it was. The Dr did tell me that it is soly in the prostate. at the moment they cannot guarentee that it has already spread outside but they havent seen any evidence of that.     

hopeful and optimistic

LvGuy1 said:

I had the first set of

I had the first set of everything done thru the VA and the 2nd set done thru cancer center. THis is not the same one as in Arizona this is in Las Vegas i made a mistake in the name it is Cancer Care Center, i just saw cancer center and assumed. I have to go to where the VA sends me for outside care so dont have much of a choice. when they found the lumps (3) they redid the biopsy of the lumps. I dont really know what type of MRI machine it was. The Dr did tell me that it is soly in the prostate. at the moment they cannot guarentee that it has already spread outside but they havent seen any evidence of that.     

.

Most doctors use a two dimension ultrasound machine to take the cores in the biopsy. This is probably what was done in your case; not a MRI.

In some cases at advanced centers of excellence there is an MRI guided biopsy; first an MRI is taken, then the patient has another appointment where directed cores are taken using a three dimensional biopsy machine that has the ability to lock into the MRI results....this set up, I would estimate cost the hospital in excess of a million dollars.

http://www.radiologyinfo.org/en/info.cfm?pg=prostate-biopsy

VascodaGama

Gleason 8 (4+4)

LVGuy1,

Thanks for sharing the details. The last biopsy and upgrade of cancer aggressivity is for concern. Gleason grade 4 at the prostate shell (bumps) is highly indicative of extraprostatic extensions. Radiation therapy is the recommended choice, however, the bladder neck problem (if any) could make it difficult to treat the area with RT. This is a difficult case which I think it be proper for a combination approach (surgery plus radiation). The risks increase but one should try to kill the bandit if our goal is cure. As commented before, I am not a doctor and my opinions are only based on experiences, which opinions you should not follow if not 100% comfortable with them.

The combination treatment can be done for the full protocol at once (interval of 4 months between radicals for recovery), or sequential allowing time for confirmed recurrence. This means that surgery is done initially followed by a period of remission (if any) controlled with a PSA lower than 0.03 ng/ml; and at confirmed recurrence (constant increases or PSA higher than 0.2 ng/ml) then radiation should be done to prostate bed and localized lymph nodes, under the guidance of a pre image study done at the occasion (Ga 68 PSMA PET scan is the best).

Please understand that I and the survivors above are providing you with the best information we have in hands. Everybody is trying to pass you the best information. You need to digest it and produce a final conclusion or get help from various specialists (urologists, radiologists, medical oncologists).

Best wishes and peace of mind.

VG

 

LvGuy1

VascodaGama, This is what my

VascodaGama, This is what my Drs. are also suggesting. but they want to take out some of the lymph nodes for safety. You all have been very helpful and will continue to keep updating info. Radiation and chemo really scare me but you people here have made my fears less. My wife and I have both been reading up the questions here and also a few other sites that have been recommended. and your results altho vary gives a truer picture than some Drs. that like to surgar coat things. I gave my Primary Dr. this site for other people that have questions and want to talk to survivors and also those that are still fighting. but i figure that as long as we are still fighting that we are surviving and one day as some here have stated the PSA will go down and stay around 0.1 or so and will not spread to other parts of my body, but will deal with that if and when it happens. I have some great Drs. that i trust and i do ask a lot of questions, but is 2-4 hours for surgery normal ? seems like a long time to take out something so small. My Drs say that you cant rush some things if you want great results. i am going thru a lot of emotions at the time, Hot Flashes and get tired real easy and i thought that that was just after the procedures..lol guess my body is just getting me prepared for what to expect. Thank God i havent lost my humor.

 

VascodaGama

Natural emotions

You are confronting a difficult time in your life. It is natural to be emotional and scared. We all deal with the unknown initially, become surprised and question "why me?". Soon you will turn this page of the bad chapter of your life and be at peace.

Robotic surgery takes usually 2+ hours but the doctor may want to dissect some lymph nodes deeper in the iliac so that they usually stop the robot and use their hands making the surgery longer. There is also the delicate area at the bladder neck that he will do it with his hands.
I had open surgery and it took 5.5 hours. I was roled down to the theater at noon and awaken around 9pm in the recovery room with my wife staring at me and smiling. The epidurial anesthesia doesn't last that long but they confirm if we need more of the stuff while in the procedure. I recall the doctor whispering my name inquiring if I was feeling alright, I open my eyes and saw a nebula of three or four silhouettes on the top of me and answer that I wanted to pee, then heard the doctor saying to "give him more" and fall a sleep again. No pain at all before and after OP. The team of doctors in charge of the treatment come to visit me next morning and did a series of "inspections". From the second day on I started to walk in the hospital corridors.

Approximately ten days after OP your doctor will measure the PSA. It should be much lower. You should request (if not used at that clinic) sensitive PSA tests with two decimal places (0.XX ng/ml) because that is proper for guys without the prostate gland. (0.1 is three times higher than 0.03 = remission)
In your next consultation you can discuss the details of the procedure which will be much appreciated by the surgeon (they like to talk with PCa educated patients). You can inquire about the time that the belly fat will take to heal; when are the drain pipes drawn; what king o cream should you use in the penis tip to avoid irritation/dryness of catheter's tube; You can inquire if they check the sphincter "V" neck formation with ultrasound image after drawing the catheter; inquire about diets or supplements; etc.

Best wishes for a smooth sailing.

VG

Max Former Hodgkins Stage 3

VascodaGama said:

Natural emotions

You are confronting a difficult time in your life. It is natural to be emotional and scared. We all deal with the unknown initially, become surprised and question "why me?". Soon you will turn this page of the bad chapter of your life and be at peace.

Robotic surgery takes usually 2+ hours but the doctor may want to dissect some lymph nodes deeper in the iliac so that they usually stop the robot and use their hands making the surgery longer. There is also the delicate area at the bladder neck that he will do it with his hands.
I had open surgery and it took 5.5 hours. I was roled down to the theater at noon and awaken around 9pm in the recovery room with my wife staring at me and smiling. The epidurial anesthesia doesn't last that long but they confirm if we need more of the stuff while in the procedure. I recall the doctor whispering my name inquiring if I was feeling alright, I open my eyes and saw a nebula of three or four silhouettes on the top of me and answer that I wanted to pee, then heard the doctor saying to "give him more" and fall a sleep again. No pain at all before and after OP. The team of doctors in charge of the treatment come to visit me next morning and did a series of "inspections". From the second day on I started to walk in the hospital corridors.

Approximately ten days after OP your doctor will measure the PSA. It should be much lower. You should request (if not used at that clinic) sensitive PSA tests with two decimal places (0.XX ng/ml) because that is proper for guys without the prostate gland. (0.1 is three times higher than 0.03 = remission)
In your next consultation you can discuss the details of the procedure which will be much appreciated by the surgeon (they like to talk with PCa educated patients). You can inquire about the time that the belly fat will take to heal; when are the drain pipes drawn; what king o cream should you use in the penis tip to avoid irritation/dryness of catheter's tube; You can inquire if they check the sphincter "V" neck formation with ultrasound image after drawing the catheter; inquire about diets or supplements; etc.

Best wishes for a smooth sailing.

VG

Yes, normal

Lv,

My DaVinci two years ago was performed with a doctor who had at that time done over 900 DaVinci's.  My operation took over two hours, and he said there were no complications, so two hours under cannot be an issue. The issue is not the size of the gland, but how hard it is to get at.  With DaVinci, the doctor opens ABOVE the naval, and then has to stretch tissue to get all the way below the bladder...a long way to travel inside a person. The muscle, etc., has to be stretched far enough to allow placement of the camara, lighting, etc.

It is a braver than normal man who will admit his fears; all men have them, but many do not admit.  You are similiar to me in a way: I read perhaps too much, pondered too long.  There is no such thing as a 'perfect' treatment choice for PCa.  If you are resolved for surgery, do whatever you have decided upon, following consulations and weighing the options as you have.

I woke up in post-op with terrible pain, and had the thought "DaVinci hurts less ! Less that what ! "

But by the next morning I was walking, and went home a few hours later. I needed perscription pain pills for another day or two, but that seems not very extreme.  Vasco's description of fast recovery from open surgery is amamzing. All men differ in pain tolerance; as Clint Eastwood used to always say, "A man's gotta know his limitations."

"Waking up" from RP is virtually a certainty. In the US, only 1 in 1,000 men dies during RP, and they are mostly viewed as guys who were likely poor surgical candidates to begin with (this data is a few years old now, and the liklihood today is probably even lower). 

Most guys fear surgery much more than radiation, which for a long time now (way over a decade) has been very, very safe for PCa treatments. And, radiation causes no pain, most guys say afterwards.

Your case, if you use surgery, would demand through 'farming' of the sentintinal nodes....testing them for disease.  Insist upon it beforehand if you go the surgical rouute.

max

mdo53

My experience with robotic

I woke up in pain and it only lasted for about two days.  The whole ordeal lasted 4 hours including recovery room. I only took one pain pill on my first day out of the hospital.  The pain wasn't bad compared to my knee operation.  Nine weeks have passed and no longer wearing a pad and my PSA is 0.04. Glad I chose Da Vinci.

LvGuy1

I have decided on Open Surgery instead of the Di Vinci as when i talked to the surgeon that with the open Surgery he can better see the situation when he gets in. He did say that he recomends Desitan for the dryness and Polysporin for tip where the catheter is, he also stated to get some stool softener for in case i get constipated as he dont want me to strain. He stated tho that open surgery takes longer due to they look all over and want to make sure they get all that they can see but that if it has spread outside the prostate he preferes to leave it in and do other options. But stated it is still up to me as to what i decide. all he can do is give me the facts and give his opinion. I also had Radiation person there also and they recomended putting pellets in the prostate. He did state that if after the surgery about 3 or 4 weeks that he will do another PSA and see what the numbers are. He said that it should read 0.01 and if it is over 1 that he will have me do hormone and some medication that starts with a L but forgot to write it down. for safety. Hope this clarifies my situation as of this date and he is great at answering me back if i call about questions, His Nurse informs him when you call and what you are calling about.        

VascodaGama

Doctor's suggestion makes sense

It makes sense to me what the doctor has told you and leaves me with the impression that you can trust him.

Open or Robot surgeries do not differ much when done by experienced surgeons. Open takes longer time in operation and requires more days in the hospital but it allows better access to the lymph nodes deep into the abdomen, assuring better outcomes in guys with probable extracapsular diagnosis. It is also better in cases where the bladder neck is involved requiring delicate work in the reattachment at the sphincter (lesser probability for a case of incontinence). The doctor should also confirm and repair any inner hernia that is so common to exist at the region of the operation (groin). Hernias may produce no symptoms so that one could have it without knowing. Its repair could be included in the surgery protocol. I recommend you to inquire now with the doctor if he can check it (a simple ultrasound can do it) to be included in the operation, if any.

His comment "...but that if it has spread outside the prostate he preferes to leave it in and do other options...", is typical in open surgeries. The doctor dissects firstly some localized lymph nodes, send them for immediate check by the pathologist in the hospital, and if these are confirmed positive to cancer then he aborts the operation moving the patient to a RT option. This positive result is conclusive that surgery would not be practical for such a patient. It would not assure cure, so that aborting operation will avoid certain risks and side effects that the intervention could cause. Only good doctors act like this in placing the patient's quality of living first. I also noticed that his surgery threshold outcome standards (PSA=0.01) are quite low signifying him to be very restrictive. He likes to operate when success can be assured with high marks. These qualities provide trust and represent a good doctor.

Accordingly, the radiation would be done at a later date after healing. The radiologist you met was suggesting brachytherapy, but before you decide you should get informed on the details of the several RT modalities suitable to your case. You should have a colonoscopy done earlier to check for any ulcerative colitis at the area of influence. It would also include a protocol of hormonal treatment (recommended by your doctor above) done with "L" (Lupron?). This is also typical.

You can still formulate some inquires and consulting by phone. I would propose the fact about Hernias; also that long surgery require blood transfusion so that you can ask if you can give now a portion (400 ml) of your own blood for the operation; it is typical to be admited to the hospital a couple of days before surgery for preparations (diets, tests, etc) so that you should ask about a list of what you need to bring in or what is prohibitive.

I wish you a fantastic operation and the best outcomes with the lesser side efects.

Sincerely,

VGama

Max Former Hodgkins Stage 3

mdo53 said:

My experience with robotic

I woke up in pain and it only lasted for about two days.  The whole ordeal lasted 4 hours including recovery room. I only took one pain pill on my first day out of the hospital.  The pain wasn't bad compared to my knee operation.  Nine weeks have passed and no longer wearing a pad and my PSA is 0.04. Glad I chose Da Vinci.

Nigh identical

My post-DaVinci experience was essentially idential to yours, mdo, as my post above suggested.

I wore a diaper a day and a half following cath removal, then liners for a while. Urinary control was extremely fast.  I have tested the beloved "undetectable" for two years now, which is what matters most.  Spontaneous sex without pill assistance took well over a year, but with Cialias sex was relatively good well before then.   Numbness in the pelvic region for quite some time following surgery seems to be common, however, I would note for recent guys who had surgery, or are approaching surgery now.

Best of luck to you Lv with your open RP choice,

max