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Correlations

Grinder
Posts: 438
Joined: Mar 2017

There seems to be a correlation that should be brought to everyone's attention... though it may be nothing or something.

And that is the length lost versus the size of the prostate.

In my case, people seem a bit incredulous when I insist I lost two inches off my business length when the prostate was removed during Da Vinci surgery, and the urethra was pulled up and re-attached to the bladder neck.

After surgery, in the post-op report, my prostate had shrunk, but still weighed out to 197cc, when a normal prostate is only 25cc.

I joke about it, call my prostate "Godzilla" and now call my business "Stubby"

.. But I am wondering if there is a correlation between the size of the prostate during surgery and the length of the urethra removed, leaving a much shorter penile length than normal.

Perhaps someone with a walnut sized prostate had a smaller length removed than someone who has a softball sized prostate, and has a large portion of urethra removed, losing 2 inches instead of the standard half inch.

Recently, "Shorty" came on the forum and complained about his extreme loss of length, but also mentioned he too had an enlarged prostate. And another person on this site has complained the same, and had a TURP procedure done, meaning be also had an enlarged prostate during surgery.

It probably will not be a perfect correlation... depending on position of the enlargement in respect to the urethra .

But if there was a correlation then cancer patients with hideously enlarged prostate could better decide what effects that will have. I'm not trying to be flippant here, but if a patient starts out short he may want to opt for an alternative procedure. Or if he feels he has enough to spare and wants to get the massive prostate out, he can opt for surgery .

Considering how negatively this has effected some PC patients, it should be considered. And if I'm wrong, so what?

 

Georges Calvez
Posts: 247
Joined: Sep 2018

Hi there,

My prostate weighed in at 46g with a size of 5 x 4 x 4 cm and I would say that I have lost very little off my non erect length. I had some partial erections before beginning hormone treatment and I would say that I had lost very little of my erect length as well.

Best wishes,

Georges

eonore
Posts: 42
Joined: Jun 2017

I have long felt that that size of the prostate correlates to lost length.  In my case, my prostate weighed 225 grams, and I lost more than half my length.

MK1965
Posts: 174
Joined: Jun 2016

My prostate weighed 38 grams after RP and I lost 2+ inches after surgery which never was recovered during extensive penile rehabilitation. My Uro, when I asked him before surgery, answered, it might be some small loss up to 1 cm which is less then 1/2 of inche, and that might be recovered during rehab.

I lost 5x+ his max loss of length. 

If I would be told the truth, I would avoid RP like a plaque. Definitely, RP totally ruined my life at age of 51.

MK

Grinder
Posts: 438
Joined: Mar 2017

I no longer recommend this site to friends and relatives facing prostate issues, especially PC... despite all the important information relayed by de Gama, Max, Rob et al. That's also why I rarely come here anymore...

 

Since MK will not listen I am speaking to others now. With my background in research, I know for a fact that anytime you are dealing with differing outcomes, you have to consider what VARIABLES led to different outcomes.

Many robotic prostatectomy patients have had great outcomes, recovering from their incontinence and erectile dysfunction issues, some very quickly.

If some have a great experience, and it saved their lives, and some had worse experiences, and their incontinence and ED issues persisted... then there are VARIABLES that are diffetent between successful surgeries and unsuccessful surgeries.

Our goal in this forum, at least my goal, is to DISCOVER WHAT THOSE VARIABLES ARE so future patients can judge whether RP is their best option, or another procedure is their best option.

To express moral outrage at RP in general is intellectually dishonest. If MK will not help future patients figure WHAT WENT WRONG with his RP that resulted in his ED, he is not helping them. Only by discovering what went wrong can a future patient compare his VARIABLES to MK's and if there are similarities, opt out... or if there are no similarities in those VARIABLES, then RP is an important procedure to have.

It is NOT ENOUGH to condemn it wholesale because the existence of so many SUCCESSFUL SURGERIES says something went wrong in MK's surgery that made it unsuccessful. 

The size of the prostate may be a variable that someone with a massive prostate should consider when weighing their options, especially if a two inch loss of penile length would be catastrophic for a patient... How can anyone argue about that?

Just for the record, I have no interest in MK and his supporters ganging up on me now, and couldn't care less. If anyone cannot see that there are VARIABLES that make the difference between SUCCESSFUL surgery and UNSUCCESSFUL surgery, then there is no discussion to be had.

It is very disappointing that I cannot recommend this site anymore, otherwise future patients will be scared away from robotic prostatectomy without consulting with their doctor which procedure would be best for them.

 

 

MK1965
Posts: 174
Joined: Jun 2016

Grinder,

Why writing about own experience and saying that RP ruined my life is dishonest? Did I say anything about your and other people RP?

No, I did not.

i wrote in details about my recovery and RP aftermath. I don’t have anything hidden. Any one can go back and read my notes.

Here are my variables:

Age 51@ time of diagnosis and surgery. -  good variable 

Very good health with no chronic conditions. -  good variable 

Very good physical shape excercising 4-6 times a week and still do it. - good variable 

No signs of ED before RP ( never tried any ED drugs). -  good variable 

TURP( actually mini TuRP for bladder neck resection for urinary obstruction)  - bad variable 

Erection first night post TURP with catheter still in  - good variable 

No erectile problems after TURP, only retrograde ejaculation. -  good variable

Small prostate, only 38 grams post RP. -  good variable

Bilateral nerve sparing -  good variable 

Also pelvic limphnodes were removed - total of 8  (negative)

No qualitative descriptions of nerve sparing like excelent, very good, moderate or satisfactory -  possibly something happened 

Extensive bladder neck reconstruction -  could be negative variable ( lightwood had also extensive bladder neck reconstruction and recovered erectile function to 75% of pre RP quality and he is approx 15 years older)

Surgery took 5.5 hours, longer then planned. Prostate shape changed, possibly by previous surgery-  bad variable 

Severe pain post op for a week.

Never gat any other explanation from my surgeon then everything went good.

At 6 weeks post RP visit, my surgeon asked if I already popped one (erection) which i felt as an insult.

My first orgasm after RP was at 6 months post RP which usually happens way earlier to many patients.

Did not have any feelpings in my penis and genital area for about 6 months. Was not sure what I was pulling out of my pants until seeing it.

Never experienced any feeling and spontaneous response for 22 months. Not a smallest sign of life after RP.

I was shorter right after RP and my penis continued to loose length. I lost 2+ inches after RP and also girth. It was just like pre-pubescent 

penis despite aggressive penile rehab.

Comparing my total pre RP state, health, physical shape and erectile function, I was in the 85 percentile.

Recovered urinary continence by 13 weeks post RP with still stress incontinece present by this date.

if any one on this forum thinks after reading this post that I SHOULD PRICE RP AND MY OUTCOME USING SUPERLATIVES , I will do that for sake of others, but then, that will be DISHONEST from me.

MK

Grinder
Posts: 438
Joined: Mar 2017

Variables that MAY play a role in successful vs unsuccessful robotic prostatectomy... "unsuccessful" defined as side effects the patient is unwilling to live with. Not defined as removal of cancerous cells, since the debate over RP in this forum revolves around side effects, with no regard for its efficacy as a cancer treatment (strangely).

This is just a few of the top of my head that may or may not...

- Excessive size of the prostate. Before operating on my massive prostate, the urologist asked me if I wanted to undergo hormone treatment to shrink it prior to surgery. I am wondering now if he recommended shrinking the prostate before surgery, not because it would facilitate the surgery but possibly to reduce the severity of side effects... mainly size reduction.

- Experience of the surgeon and his record of side effects / successful surgeries. This is self explanatory. There used to be sites that reported the stats on surgeons and their record of side effects, such as Surgeons' Scorecard... I dio not know if these exist anymore.

- TURP procedure prior to RP. MK says his prostate was not large, yet he had a TURP procedure done? And why are men getting TURP procedures done just months before having their proststes removed? In what universe does this make sense? I would not return to a urologist who performed a TURP and then recommended a prostatectomy only months later.

- Nerve bundle damage. This is a variable that itself is also influenced by other variables. I myself am having surgery-related minor pain in the abdomen and groin. Apparently, there are phantom pains that can appear months or even years after surgery as the nerve bundles continue to heal. They are not a big deal, just something to be aware of.

"Symptoms of iliohypogastric nerve entrapment include burning or lancinating pain immediately following an abdominal operation. The pain extends from the surgical incision laterally into the inguinal and suprapubic regions. Discomfort may occur immediately or as long as several years after the procedure and may last for months to years. This discomfort may derive from the formation of scar tissue in the region." 

There are probably many more variables that should be considered, and if anyone eants to contribute to a list of variables that should be considered when new patients consider RP it would be great to share them... same goes for Cyberknife and radiation procedures, as colostomy bags are also a terrible side effect. 

But if the same thing happens that happened last time I mentioned variables, save it. If I want to get verbally abused, I can always go on Facebook for that.

Georges Calvez
Posts: 247
Joined: Sep 2018

Hi there,

You have missed me off the list!
I have written seriously about radical prostatectomy, radiation and ADT, all of which I have enjoyed.
To be honest I would say that I have suffered less side effects than many men but they were still not pleasant.
If you have the misfortune of being diagnosed with prostate cancer that requires serious treatment then there is a good chance it will impact your life in a serious way.
I have not verbally abused you or anyone else, I try and treat everyone with caring respect as I know that we all face difficult issues associated with this disease.
BTW, when they chop out a prostate they take the piece of the urethra that was asssociated with it so big prostate more shrinkage than if they took out a small one.
Radiation  is not a walk in the park either and if you are seriously ill then whether you have RP or radiation or the two together you will have ADT, which is not a bundle of laughs.

Best wishes,

Georges

Grinder
Posts: 438
Joined: Mar 2017

Georges...

I did not mean to implicate you in my reference to verbal abuse. I probably should have used a more delicate term...

Before you joined in mid 2018, Da Vinci surgery was a hotly contested subject. I was being adamant that variables MUST be considered in a patient's choice of treatment. And those variables, some of them listed above, could help guide the patient's decision.

I was then involved in a controversy that was being driven by emotions rather than reasoning... which was a disservice to future patients that might come to this forun looking for advice.

For example, what you just mentioned, that I am pointing out and have never heard correlated... the size of the prostate is a variable in the length of urethra that will be surgically removed, affecting the penile length.

Maybe I missed it, but I have not heard of any urologist informing PC patient's of this variable. But I can see it make a HUGE difference in the decision. 

Permission to speak freely... someone with "limited length" to begin with, and an enlarged prostate of massive size, should seriously reconsider RP as a treatment, due to deleterious side effects.

Anyone who remembers me knows I am big on Da Vinci RP because it was the perfect solution for me... but I weighed all the variables in my case. Someone with a different set of variables may come to a different conclusion. Two of those variables could be pre-op penile length and prostate size.

I am not sure why I am not explaining this properly... but in my experience, don't expect your Uroligist to cover all these variables and how they will weigh in potential side effects, and how that would influence a patient's decision... Experience and expertise of the surgeon being very important but rarely stressed.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3280
Joined: May 2012

Grinder,

Anyone who has been at this Board, or other Boards (like me), at times feels it has become worthless.  Personalities differ.  I have been at the Lymphoma Board several years longer than here at PCa.  More than once I have butted heads with a few individuals there, whose views differ from mine, and left for times.  I've even been asked to leave on one occasion.   I hope you hang around, but understand either way.   When an interesting, thoughtful person goes away, it leaves a void.  Some of you remember Kongo -- a wonderful man; sort of 'another Vasco' in his knowledge level.  One day he was there; the next day, not. No one knows why.  Bless his memory.

I respect any writer who supports his views with data, and who is open to the bigger pictures in life.  I have never been an 'Advocate' of any form of treatment here, and of course most of the other men here are not either.  But when someone becomes rabid in their statements, and forever just repeats the same sad song, it is hard to see how they have something of benefit to share.   Worse than that, they are presenting 'information' here that is false as regards the most common outcomes, and this could skew readers' thoughts.   Such writing is a disservice here.  You are correct to express frustration with such individuals, and ultimately, not caring what they share is the healthiest response.  I hope to continue encountering you here, if I myself am around.  No one appointed me Hall Monitor of this elementary school, but everyone in the class at times feels like shouting, "Shut up !"

max

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3280
Joined: May 2012

Georges, Grinder, et al,

I am aware that removal of the gland requires pulling the urethra a bit (I have had DaVinci).  However, I do not believe that this is the action that reduces the size of the penis.  I believe this explanation to be apocryphal and false.  Not intentionally misleading, but wrong.  To adduce it, I say provide some anatomical proof.

DaVinci RP never touches (except perhaps incidentally) the penis, testicals, pelvic bone, or much in the musclature around the base of the penis. And the urethra is a highly elastic tube, very capable of significant stretching.  

I speculate that perhaps it is the removal of the glandular mass that allows tissues to move about a bit, to fill the void (no pun) left after the gland is gone; this, after all, is now empty.  But this is a speculation on my part.

As most have mentioned above, radiation also has an assortment of side-effects, such as urinary stricture and even impotence. but at low frequencies.   How could turning the gland into a charcoal brick NOT have side-effects ?  How is that more 'natural'? Prostate cancer is probably one of the few forums on earth where men argue that high-dose radiation is more healthy than an incision.   And other people fear use of cell phones due to 'carconigen effects.'

 

When RT effects occur, they are usually very slow to emerge, rather than instantaneous, as with RP.  The proverbial 'frog in the heating pot.'

For the record, I am not opposed to any treatment choice, and never have been. A man wishing to choose RT -- go for it.  It is usually successful in eradicating the cancer,

max

hewhositsoncushions
Posts: 269
Joined: Mar 2017

https://en.wikipedia.org/wiki/Normal_distribution

Some people have issues because their RP failed them in many ways. They say RP is bad. They are on the extreme end of a bell curve.

Some people have issues with RT because it failed them in many ways. They say RT is bad. They are on the extreme end of a bell curve.

There are many cases of people in both situations.

Both sides blame the process and refuse to acknowledge that their case IS SPECIFIC TO THEM precisely due to VARIABLES.

RP AND RT HAVE A BELL CURVE OF SUCCESS AND FAILURE BOTH FOR OUTCOMES AND SIDE EFFECTS. WE ALL FALL SOMEWHERE ON THAT DUE TO THE WHIM OF THE GODS.

The success / fail bell curve is roughly the same for both treatments. The side effects bell curve is similar in shape but the specifics are different.

If one or the other was significantly worse it would be stopped.

Saying treatment X failed and those were the cards that I was dealt and have to deal with is a healthy perspective.

Saying treatment X failed thus treatment X as a modality is a failure as a whole is not a healthy perspective. The perspective needs addressing not the outcome.

I have been dealt a crap ton of bad hands in my life, possibly more than many here - cancer, mental health, bullying, receipt of violence, blah blah blah. It has taken me a long time to realise that I can do rubber duck all about the hand dealt - all I can do is control how I deal with it up to and including facing death. I will fight battle this until I drop off the perch.

I recently saw my dearest friend and mentor die of pancreatic cancer too late for any treatment and even on her death bed she was more concerned with the welfare of her students and friends, not complaining of her condition. She did not have an easy journey but she damn well had a dignified and courageous one. That is the gold standard for how I see I need to deal with my sh*t.

Do not go gentle into that good night,

How can we follow that creed if we are focussed on what has gone and we cannot change?

Surely accepting what is and looking forward and facing our future is more important than being angry over the past?

This is not a medical challenge but a philosophical one.

I buried my friend today and I have drunk a bottle of very good French wine in her honour (she was French) so I may be sinking ships with loose lips but I stand by the fact that how we deal with this crappy disease as men is fundamental to our mental and spiritual wellbeing.

Mic drop

lighterwood67's picture
lighterwood67
Posts: 204
Joined: Feb 2018

I have read at least 2 folks discussion, one why they would never have an RP and one why they would never do anything but have an RP, if they could go back. These folks are telling their story.  Although, I read a lot on this site.  I asked a lot of questions.  I let the decision come down to the doctors.  I knew going in that surgery (RARP) would be permanent.  The physical removal of the prostate; seminal vesicles; parts of the urethra; lymph nodes; and bladder neck reconstruction.  I knew about MK's situation prior to my RP.  I am a good bit older than MK, but I certainly valued what he had to say.  He is explaining what happened in his test tube.  Also, I read what happened in Grinder's test tube.  MK and Grinder have provided a good deal of info on PC.  There are a  lot of contributors to this site.  I pretty much read all of them.  So MK I hope you keep posting.  Grinder, I certainly would hate to see you go.  Personally, I am not here to convince someone that RARP is the best way to go or not the best way to go.  To me that position is irrelevant on this site.  I am here to tell my story, as I am the only one who can do that.

Clevelandguy
Posts: 443
Joined: Jun 2015

Hi All,

Good discusssion on the topic but there are no good or bad procedures when it comes to treating Pca.  I feel it’s a personal decision that each individual must make based on their specific set of “conditions”.  Everyone is different with the doctors they have to choose from and the facility’s and equipment that will be used by those doctors.  The results will vary based on what I have just stated. I had robotic surgery and would do it again, others have had bad experiences with surgery and the same can be said for the different forms of radiation treatment.  Pick your poison and learn to live with your decision because when the “procedure” is done there is no going back.  Don’t be bitter but learn on how to live with the result and move forward. My surgery was not perfect but if I have to wear a light pad for the rest of my life to catch the occasional dribble so be it, I have adapted and don’t let it slow me down.

Life is too short to dwell on the past and let it start to consume you.

Dave 3+4

Grinder
Posts: 438
Joined: Mar 2017

Everybody has given sound advice here... I certainly did not want to give the impression that I did not want anyone to voice an opinion. I only would hope that, when an opinion is voiced, that it is done in a reasonable way, keeping in mind there are future PC patients that may be reading this... I know because I have suggested this forum to many people, and know of one person at least who went through the whole PC/RP process gleaning information from this site.

I don't want to lose this site as a recommendation because we are being unreasonable. What HWSOC said is very true... in EVERY surgical operation, there will be a bell curve, the most common outcomes forming the center high point, and the most UNcommon outcomes forming the lowest side points. This is just matter of fact. 

Dude... so sorry to hear about your best friend. There are no guarantees, and we need to be grateful for every breath we successfully draw. Every day I wake up, I thank God that:

1) I am alive

2) I am not in jail

3) I am not bedridden in a nursing home wearing a diaper

4) I am not in the hospital facing a terminal illness and pumped up with morphine.

If I am none of those, then I hope I am good to handle some of the easier stuff coming my way.

Grinder
Posts: 438
Joined: Mar 2017

Max, I have the greatest respect for you. And thank you for your generous words...

Now hear comes the part where I respectfully disagree and have to get more information...

The Urethra is actually divided into three categories...

- The Prostatic Urethra

- The Membranous Urethra

- The Spongy (Penile) Urethra

You are correct that the Membranous Urethra is not removed, but is stretched and reattached to the bladder neck. Howver it is my understanding that the Prostatic Urethra is entirely removed with the prostate. The prostate could not be removed without taking the Prostatic Urethra with it. 

I could be wrong about that, but I can find no evidence that says the prostate can be removed while leaving the Prostatic Urethra behind. If the Prostatic Urethra can remain, then why would they need to reattach the Urethra to the bladder neck? They have to reattach because the Prostatic Urethra has been removed with the Prostate.

And that prompted my question about variables... If the Prostate is enlarged, even massive as was in my case... that would require an even larger Prostatic Urethra to be removed... assuming that the Prostate had grown in both length and width proportionately.

But I COULD BE WRONG about the removal of the Prostatic Urethra... if there are any surgeons out there, it would be nice to know.

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