Plans for Prostate removal

When I was first diagnosed, I started educating myself on treatment options and as you are doing looking for folks that have first hand knowledge of curative treatments (Radical Prostatectomy (RP) and radiation).  Once I decided on the treatment option (RP), I started looking for a surgeon.  In my case, I was sent to a physical therapist to see how strong my pelvic floor muscles were.  They had a machine, I scored 4 of 5 on.  They still wanted me to start kegel exercises and I did.  They started me on sildenafil (viagra) prior to surgery.  The surgeon said think of that as fertilizer.  You need to understand what they are removing (in my case, prostate, seminal vesicles, urethra shoretning, bladder neck reconstruction, pelvic lymph nodes).  Some of the side effects are erectile dysfunction; incontinence; urethra shortening).  You will be catherized and carry a bag with you for a few days after the surgery.  Once that is removed, you will probably be incontinent.  You will need to wear Depends or Tena's; pads; thins; until you get control of your urine flow.  You will probably experience erectile dysfunction.  For a lot of folks that is a work in progress and may very well take a long time to recover from.  My advice there is to engage it as much as you can.  Your PSA will be tested probably for the rest of your life.  Ok.  Enough for now, I will tell you I am 70 years old;  My gleason was 4+3=7.  I had a RP 3/18.  At this time my PSA is undetectable; I am continent;  As with most men, I try to have sex as much as I can, if I can catch my wife.  She is awfully fast.  Remember the decision you make is yours.  Take your time; do your homework and move on.  Please keep quality of life in front of you.  Best of luck on your jouney.

I wonder about what diagnostic tests that you have done.

With a large volume of cancer found, it is possible that the cancer has escaped the capsule. If so robotic surgery which is a localized treatment may not achieve your desired results..There is a T3 MRI that may indicate extracapsular extension if it exists. 

I wonder also to your age. An expert surgeon can do the exact same surgery to a man of 50 and to a man of 70. Since success to surgery is age related, the 50 year old will have no side effects while the 70 year old may..

Best of luck

hopeful and optimistic said:

.

I wonder about what diagnostic tests that you have done.

With a large volume of cancer found, it is possible that the cancer has escaped the capsule. If so robotic surgery which is a localized treatment may not achieve your desired results..There is a T3 MRI that may indicate extracapsular extension if it exists. 

I wonder also to your age. An expert surgeon can do the exact same surgery to a man of 50 and to a man of 70. Since success to surgery is age related, the 50 year old will have no side effects while the 70 year old may..

Best of luck

CAC,

Robotic prostetectomy is probably the most common choice for first-line curative treatment of PC, although radiation options are likely about as common.      When the doctor removes the gland, he will test it for positive margins (signs of disease escape from the gland), and also remove numerous adjacent nodes ('sentintinal nodes') to test for escape.   IF there is escape, curative radiation would be ordered later, after recovery from the surgery itself.

As Hopeful noted, ASK your surgeon how confident he is that there has not yet been escape from the gland, and why.   The T3 MRI is never a bad idea before treatments begin.

Also, do receive formal training in Kegels prior to surgery, as they will assist in more rapid recovery of continence.    And also expect at least six months or so of impotence, possibly longer.   

I had robotic in 2015, and have been well pleased.

max

CAC5615 said:

Thanks for sharing the

Thanks for sharing the information and your experience. I've started doing kegels already. Haven't thought about the physical therapist before surgery, that's a good ideal, I'll have to look into that. My urologist is here in town an has pretty much turned me over to the surgeon for now. My surgeon is out of state so communication with the surgeon is mostly done by email. 

Sounds like you had a good outcome from your surgery once you got over the hurtles. For now I'm trying to build my knowledge and trying to stay positive. Thanks again!

I would say yes.  I have overcome the hurdles of side effects for having a RP.  My Pathology report (pretty much as clean as a whistle).  You need to get this post surgery for RP.  If that is the route you take.   If possible let us know what treatment you take.  Good luck on your journey.

CAC5615 said:

Thanks for sharing the

Thanks for sharing the information and your experience. I've started doing kegels already. Haven't thought about the physical therapist before surgery, that's a good ideal, I'll have to look into that. My urologist is here in town an has pretty much turned me over to the surgeon for now. My surgeon is out of state so communication with the surgeon is mostly done by email. 

Sounds like you had a good outcome from your surgery once you got over the hurtles. For now I'm trying to build my knowledge and trying to stay positive. Thanks again!

Hope I did not scare you off wth the surgical procedure.  Anyway, good luck on your journey.

CAC5615 said:

Thanks for sharing the

Thanks for sharing the information and your experience. I've started doing kegels already. Haven't thought about the physical therapist before surgery, that's a good ideal, I'll have to look into that. My urologist is here in town an has pretty much turned me over to the surgeon for now. My surgeon is out of state so communication with the surgeon is mostly done by email. 

Sounds like you had a good outcome from your surgery once you got over the hurtles. For now I'm trying to build my knowledge and trying to stay positive. Thanks again!

Clevelandguy said:

Do’s and Don’ts

Hi,

Do find the best surgeon around your area and also find the best facilities for Robotic Surgery in your area.  The better the doctor and facilities the better the outcome.  My robotic surgery was pretty uneventful with a 10 day internal catheter which was the worst part of the whole ordeal.  I had no infections and very little pain which meant no heavy drugs, I managed my pain with over the counter pain reliever.  I did laps around the inside of my house right after surgery to get the blood flowing.  Erections and urine leakage improvement took me about 1.5-2 years to reach a plateau and I just drip a couple of drops during heavy lifting and erections are back at about 90% level.  Some people heal faster than this some longer.

Do keep doing your Kegels after your surgery for months or years to come, I still do about 100-200 squeezes per day five years later. As stated by Lighterwood do your Kegels as a prep for surgery.  I had help from drugs like Viagra after surgery to help getting blood flow back into your genital area.  Also start being sexually active as soon as your doctor OKs it.  You might be dissapointed at first but it should continue to improved the more you use it. I feel the use it or loose it really applies in this case.  Good luck and let us know if we can help with our experiences.

Dave 3+4

Hi Dave,

Thanks for the details about urinary and sexual function.  Quick question, I'm new to this, and have bladder cancer.  With your surgery it sounds like you keep the bladder and remove only the prostate. Is that correct?  I'm told I need to have the bladder removed, and the prostate goes with it.  There's a dearth of communication specific to bladder cancer.  I appreciate any guidance/info.

Bernard