is it common to have tenesmus/proctitis after RALP??

JP63

I had my RALP more than a month ago.

At the beginning I felt all the typical stuff in the perineal area etc etc.

But what is bothering me really bad now is the feeling of incomplete evacuation after a bowel movement, like cramps, pain, sensation of fullness, etc.

I don't think that's very common after RALP, although the prostate and rectum are really close.

Since I also have Crohns, maybe it is just Crohns acting up. Or maybe it is because of the new muscles that we have to use to control urination.

I just hope it is not Colorectal cancer!!!...lol

If it does not get better during this week I thing I should go maybe to urgent care for them to take a look.

Just wondering if this is more or less common after RALP.???

I had Stage 3TaN0M0, with EPE adjacent to the rectum but with clean surgical margins.

VascodaGama

Hi,

The symptoms you describe seems to be related to Crohns disease. I doubt that they are related to the prostatectomy, but surgical site infection (SSI) can happen.

As you commented, the muscles and nerves in the lower body are cut and it will take some time (typically two months) to recuperate to a normal status.

pT3a pathological stage signifies that you need to be vigilant checking the PSA periodically. Can you tell how many lymph nodes were dissected/checked?

Best wishes for full recovery and a future in remission.

VG

JP63

Hi there VascoDaGama!!!!

Thanks a lot for getting back to me.

Well I am kinda lucky I think for everything (except for the staging I assume.)

The surgeon took 9 limph nodes 3 from 1 side and 6 from the other side. they were benign. The seminal vesicles were clear too. The surgical margins were free. But I had EPE (present focal posterior) no intraductal carcinoma, cribiform glands present and high grade pin. Gleason 3+4=7 pattern 4 30%. Tumor 12 mm They did a Decipher test from the biopsy and it was 50. Not too bad, not too good. It is what it is.

I consider myself very lucky because I went to see an urologist in December and he told me...everything is ok!!

PSA 2....but free PSA % only 10....hmmm I read about it online and he tells me that if PSA is less than 4 that does not matter.....hmmm....

Went to see another urologist and he orders a 4K score test....20

So 1.5T MRI....everything is ok but AI program differs and marks 2 areas of interest.

So Fusion TRUS biopsy and 16 cores, 2 are positive from where the program said to check. Big shock. It takes time to seep in. They offered me HIFU....no surgery because extensive previous surgeries in that area because of Crohns....anastomosis right there probably a lot of adhesions etc etc. Thanks God another member in this forum told me....HIFU not good, my urologist the same....and common sense....if the biopsy was 1mm capsule and 5 mm cancer, adjacent I always though...its too close for HIFU to take it away, they can not go outside the prostate.

So finally I found an excellent surgeon that told me, if I can do it I will know that in the first 10 minutes, if too complicated lets abort the surgery. the last thing you want to have is a fistula. Well the guy was able to take it away and thanks God he cut enough that the margins were clear. Since the cancer was abutting the capsule towards the rectum in the apical area I think.

Its interesting that in a 3T MRI the radiologist was able to see the lession but it seemed it was confined within the prostate....no EPE....!!!....MRI has its own limitations

Before when I could not find a surgeon willing to take it out I was ready to get radiation and the radiologist gave me Casodex for a month.....now my hair is growing back after being bald for the last 30 years lol, not everything is bad about hormone therapy

So it seems that they will just monitor my PSA and they wont do adjuvant radiation or hormone therapy....only salvage radiation if the PSA goes up. I am a little bit worried about that since my PSA was never high, the last readings were 1.7 I think....it seems this cancer was really small or did not produced a lot of PSA.

Well we will see in 2 months how the PSA goes. Hopefully it will be close to 0 but I am ready for the possibility that in the future that may change.

It is what it is.

This tumor was small but it was in a bad spot (abutting the capsule close to the apical area posterior)

And I am happy that they were able to take it out. The only bad thing is my Crohns relapse. I was on Biologics but the radiologist wanted to stop them. Now on 60 mg of prednisone....My inmune system will be depressed and I want it to keep fighting if any cancer cell was left behind, but thats a bad combo...Crohns and Prostate cancer. It seems they go a little bit hand in hand (too much inflamation)

One interesting thing is that since I started the biologics my neutrophils lymphocite ratio was less than 1 for more than a year. I had a reactive lymphocytosis. They were not monoclonal. As soon as they took away the prostate the lymphocytosis dissapeared. either it was the cancer what was producing it or an infection in the prostate I assume. Too much of a coincidence. By the way the ones that were high were the killer T cells lymphocytes CD8 (I think those are the ones that take care of viruses and.....cancers....!!!) well probably just a coincidence.!!!

So I will be on top of the PSA for life. But I am not stressed about that.

Again it is what it is!!!! probably I have a 50/50 percent chance of not having a recurrence.

Hopefully I will stay in remission!!!