Prostate surgery

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 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/

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 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.

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.

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?

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

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

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.

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