Surgery

jminnj said:

Echo the Thought
As Larry stated, welcome to the other side. Wishing you all the best for a speedy recovery.

joe

zakpaga said:

Thank you
Thank you Larry, Joe and Luckyman2. It is good to know that I can always count on the experiences of those you started this journey before me. More importantly,it is good to know that there will most likely be set-backs along the way.


Zakpaga

lewvino said:

I'm no Doctor Winsom only a
I'm no Doctor Winsom only a cancer surviver (7 months) A gleason 9 is a rough one as I'm sure you know. How old are you? Read Dr. Patrick Walsh's book on Surviving Prostate Cancer. You can order online at a good price. There are also other excellent books.

Have you had other tests yet to see if the cancer has spread? Not to discourage you but with Surgery on the Gleason 9 you may still be facing radiation afterwards. Read, research, Ask your Doctor questions and get many opinions from experts.

Good luck and keep us posted.

Larry (Age 55 Gleason 7) 7 months post Davinci Surgery.

lewvino said:

Evagirl,
There are so many
Evagirl,
There are so many things to consider! I've been sharing with you in several threads. Can radiation in itself be the total treatment? That is so hard to know. The thing is that a Gleason 7 is borderline aggressive. I had 12 core biopsy and 5 of the cores found cancer. Three were graded at 4+3 (7) and 2 at 3+4 (7). The 4+3 are worse grade then the 3+4 even though they both equal 7. At any rate what played into my mind was my age at diagnosis of being 54. Being frank....Sex was important to me and my wife....With a borderline aggresive cancer and much ressearh...I opted for the Davinci Robotic surgery.
reasons as:
1. With Surgery they take out the CANCER and can determine spread, margins etc. After surgery they sent the prostate and removed items off to pathology. They downgraded mine to an overall Gleason 7 at 3+4. During surgery they found some spread into the nerve bundles. Men have two nerve bundles that run along the edge of the prostate. During surgery the Doc has to seperate these nerve bundles from the prostate and try and save them for return of sexual function. That is one reason why EXPERIENCE Counts in Davinci. They say seperating these nerves is like pulling a piece of wet tissue paper off an apple with out it tearing it! Doc spared 100% of the one nerve bundle and about 60% of the second nerve bundle. Also during pathology they found That I have a positive margin in the prostate bed. This means that cancer went to the very edge of the surgery site. Now they monitor my PSA Very frequently and if the cancer comes back then I have option #2
2. Radiation - Proton or Other ....This is my backup plan...If my cancer comes back I can then have radiation and Hopefully kill off the remainder. I visited one Doctor before making my final decision that does radiation with Seed implants....He only gave me a 60% chance of being cancer free in 10 years. To low of a chance for me...so that also helped me think of radiation as a backup plan.

Again there are so many choices to make and this is the one cancer where they let you PICK YOUR attack plan! You talk to a Surgeon and they will suggest surgery, Talk to radiation and they say radiate,,,talk proton and they say Proton...Just remember the goal is to GET Rid of the Cancer.

Being frank here again consider how important is sex to you? Following surgery you will have problems with sexual function and urinary since they have to cut the urethra in two places and sew it back together. I've been lucky with the surgeons skill and have been 99.9% dry with no need of protective pads and can get an erection using Levitra.

Also after removal there is no ejaculate but the male can still orgasm and it feels the same. Just no mess to clean up. Some people do not realize this until later.

Keep asking those questions! That's why many of us our on these forums to try and help others as we have been helped and also Keep praying!

Larry

lewvino said:

Evagirl, I'll try and answer
Evagirl, I'll try and answer a couple questions here from a few other threads we have been talking on. My dad had Proton in 1997 at Loma Linda and is doing great. Since then though being frank he still has a need to urinate frequently and when he has to go he has to find a bathroom NOW!! At times he still gets some minor mucus discharge with the bowel movement. He did great sexually for about 3-4 years following Proton and then gradually lost the ability to maintain an erection. He is in about 77 now so how much is from proton or how much from getting older no one will now. He has tried the pills with no luck and refuses to try anything else though my mother would like him to. He is afraid to try the shot to the penis. I've not needed that since the pills are working for me but they say it is similiar to a diabetic giving themselves a shot. It just is hard for some to put a needle in their penis.

The doctor I picked has performed around 2,500 Davinci surgeries and also performs the traditional surgery He chooses which he things is best for the case. He told me there was a chance they might have to switch from robotic to traditional depending on some previous surgery I had but all went well and they did robotic 100%. The skill counts as I have said. I actually found several online videos of the Davinci Surgery and watched them after watching 2 other doctors I found one with My Doctor perfoming the surgery. I watched it 3 times and then it clicked with me...The doctor I picked movements were so graceful with the robotic tools compared to some of the others I watched! So I tend to slightly disagree with the statement about it being smart enough. One thing that really impressed me on my robotic research was that the urethra passes through the prostate. So the Doctor has to cut this section out and then stitch back together. This is very deep inside the male anatomy and I read that when stiching the urethra back together that one part is actually done 'blind' since the surgeon can not see that area because of other things in the way. With the Robot they move the camera and the surgeon has a 360% View of what he is sewing back together. Also think of the surgeons large hands in side of you versus the robotic insturments. The robotic is 100% controlled by the Doctor and they also have built in where the robotic movements will not jerk or slip if the doctors hand would.

It is a gamble though on the sexual return and urinary contol return. Some men do not get the sexual return back and others do. Some men get quick 100% control of the urinary function back and others have to use pads. Each individual is so different.

One thing on the Proton is that there is no pain per say during the treatments but the patient does get tired as each treatment progresses.

Also in case you did not know I believe that you can ask for your husbands biopsy to be sent off to John Hopkins in Baltimore for a second opinion. Not sure on how to do that but I know of others that have done it.

Ask the Doc those hard questions...I did! My local urologist does traditional surgery and he told me the truth on every question i asked. I verified his answers! he also told me that he had several patients that went with Proton and several that went with Robotic. He would support me and give me local follow up care regardless of my choice.

I just spoke with another man this morning that had traditional surgery with the local urologist and is doing great 2 years post surgery. My wife works at the local hospital and got the 'scoop' on the local Doctor. If I had gone with traditional surgery I would have let him operate but felt that robotic was the best plan of attack for me.

Larry

zakpaga said:

Thanks Mark,
I had the
Thanks Mark,

I had the cathether removed yesterday. I am moving around well but I still have some pains for which I take Tylenol. My pathology report was a good one so to speak. The Gleason was downgraded from 4+3 to 3+4. The limph nodes are negative. I am glad you talked about the PSA since I was suprised that it was not in the pathology report. So if I understand, it is after 5 weeks that the PSA is checked.

I have an appointment with teh surgeon in five weeks but there was no mention of PSA test. I will ckeck with them to see if I need to have the PSA test before the appointment.


Victor

zakpaga said:

Thanks Randy
Very good
Thanks Randy

Very good explanation for the reason for not testing PSA before 6 weeks. I am still learning and even more after the surgery as I am confronted with the post operative side effects.

As for the post op. grading of my cancer, I should say that the first reading was Gleason (3+4) but the second opinion had it at 4+3, which is what I tend to use as pre surgery Gleason score.

Yes, I am taking only Tylenol because the doctor told me that other pain medication will make me constipated. I wish I had a stronger one.

Victor

randy_in_indy said:

Victor - Good pain Meds
I don't want to sound like a drug pusher but Tramadol-APAP 37.5-325 MG TPAR was a Godsend for me. Some people do not want to take pain meds just because they are against it...I rarely ever take any drug...have not had many asprin or tylenol, Ibuprofin's in my life time..I just don't take pills...but the Tramadol was FANTASTIC! My surgeon team said it will not make you constipated and wow..talk about totally wiping out the pain it completely made it non-existant but without feeling drowsy or sleepy in any way....I had to be careful because it made me feel too good and I could easily over do it. I have never ever had any ki8nd of antidepressant in my life but I would wake up in the morning each day and have such a good outlook and feel so positive that I really felt like it was the pain meds doing that....very strange...I would recomend trying to get them to write a script for that...I was using 100mg stool softners twice per day(morning and night) and never had any problem being constipated...but then again I have been accused a time or two of being full of it! lol

Hope this helps.