perineal procedure

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

New Member

Date Joined Apr 2008
Total Posts : 2
   Posted 4/19/2008 2:51 PM (GMT -6)   
Hi all,
  I'm Reed and brand new to all of this. First time to even post on a forum so my apologies as I learn to navigate. 
  A little about me: I'm 47, had a blood test that revealed a slightly elevated PSA of 3.28, but the prostate biopsy showed cancer in 4 of 6 tissue samples.  Gleason score 3+3=6.  I have a very small prostate and my doctor wants to do the perineal procedure. 
  My question: I'm a courier in the morning and already experience minor discomfort just sitting in a car for 5 hours, is it advisable to have an incision that I"ll be sitting on constantly?  I can't imagine that would become tolerable any time soon if ever.  I"ll probably opt for the laproscopic procedure.  Anyone with experience with the perineal surgery?

Regular Member

Date Joined Feb 2008
Total Posts : 467
   Posted 4/19/2008 2:56 PM (GMT -6)   

If my memory is correct, Vafan's husband had that surgery a couple of weeks ago.  She will probably see this soon and respond.

Good luck to you, sir!!!!

Danman Bob
Age 57
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14
Biopsy result - 9 of 12 sticks showed cancer
Despite high Gleason score, cancer was confined to the prostate
Possible post-surgery radiation therapy...decision likely in late April 2008, depending upon PSA at that time
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of March 2008)
Began using Viagra 3 times a week December 2007 to stimulate blood flow
Began using Osbon Erec-Aid Esteem manual pump for therapy mid-February 2008
Will probably begin using bimix injections in addition to Viagra and pump in May 2008

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 4/19/2008 3:09 PM (GMT -6)   
Welcome. 47 here at diagnosis too. Had Davinci - but after all was said and done, there was a lot of hype about it, bu the technique did not seem to matter as much as the surgeon. It all is a pain in the butt! Seems like the perineal is a bit old fashioned - and what are the stats about nerve sparing with that? Those are the questions I would want to know. Keep in touch. This is a great place.
47 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6      (Biopsy 3/07 just suspicious)
10/07 PSA 5.06   (Biopsy 11/07  1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC
Saved both nerve bundles.
Path Report:  Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at six weeks
Pad free on March 14 - (10 weeks.)
ED - Take 100mg viagra every night.
Totally usable erections at 10 weeks.

Veteran Member

Date Joined Oct 2006
Total Posts : 621
   Posted 4/19/2008 3:37 PM (GMT -6)   
Our opinion in this area has always been - if the doctor advises a specifc method of prostate extraction over another . .. perineal; laproscopic; open . . . .we check . . .is this the advised method, or the only method you specifically perform? If it's the later, do your research and choose the one that's best for you and find the surgeon to perform it.

We were recommended to have open surgery . . .upon questioning this vs the laproscopic the doctor admitted HE only did open . . . we asked for a referral to one of his colleagues that did laproscopic. . . .armed with the information we chose laproscopic.

Sitting was not an issue after this type of surgery once the initial recovery period was over.

Good luck to our new friend!

;o) Linda & Bob

Bob (62) - Laproscopic Prostate Removal Sept 27, 2006 at age 60.
2 of 12 malignant biopsy samples - gleason 3 + 3 = 6.
Pathology - cancer completely contained, even a second more aggressive, previously undetected cancer)
PSA UNDETECTABLE Nov 2006, Feb, May, Oct2007.  ONE YEAR!!!! WHOOO HOOOO! 

Bob also has two secondary conditions -- Polycythemia (elevated red & white cells & platelets) and . . Myelofibrosis) -- If anyone has experience with or information on these, please email us.

Post Edited (lawink) : 4/26/2008 6:10:54 AM (GMT-6)

Veteran Member

Date Joined Nov 2006
Total Posts : 1464
   Posted 4/19/2008 3:48 PM (GMT -6)   
Hey Reed,

Welcome, you found the right place for info and support.

Like Linda and Paul said, look around for various procedures before making a decision. Then pick the best surgeon you can find. I had open surgery and had very little pain except for the belt buckle. I went back to work teaching school 3 weeks after the surgery.

Good luck in your quest and please stay with us. We can all get well together...

Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."

Veteran Member

Date Joined Nov 2006
Total Posts : 883
   Posted 4/19/2008 4:04 PM (GMT -6)   
Reed, I am 44 right now. On Feb. 22nd I had a bladder sling surgery due to my incontinance. This proceedure is done with a perineal incision that ran from the the base of the scrotum down to the edge of the anus. I'm sure your incision would be about the same. For my prostate surgery I had the open RRP. I would say that the perneal incision was worse than the the RRP. It does get better but it took three to four weeks to be able to sit upright. Like the others I have not looked into the stats of incontinance and ED recovery from studies of the perineal RP. I think a second opion with a RRP or LRP (Robotic) Doctor would be a wise choice.
We all have to make the decision that is right for us.
Good Luck,

    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second Opinion Consultation for Incontinance at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 4th, 2008 - Appointment with Original Dr. to discuss options and recomendation for surgical fix for incontinance.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
    March 27th, 2008 - Sling not working, Little or no improvement.  Will probably try Collagen injections one more time around the first of May.  If no improvement after that will start looking for a AUS Doctor.
    April 18, 2008 - Collagen injection.

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 4/19/2008 6:35 PM (GMT -6)   
I also had a small prostate (so I was told!) and had a RRP.
No trouble sitting slouched back, which I did rather a lot of! Sitting erect was different. No bottom pain, but abdominal pain meant I didn't want to sit like that for more than half-an-hour at a time (for the first four weeks post-op).
My erect position was for playing piano. Driving is more laid back, but not quite as far as my normal slouch. So if you feel comfortable (and safe!) driving with your seat tilted back a little more than usual, you may find that option works for you -- I think it would have for me. And as a courier, I imagine you would be in and out of your vehicle a bit, so that would ease the discomfort.
As I said, I had a RRP, not a perineal -- in any case, and as always, your mileage may vary :-)

Age 63. Other than cancer, in good health
Left hemi-colectomy April 2006 (colon cancer)
PSA 5.7, Gleason 4+5=9
RRP 7 March 2008, non nerve sparing
Histology showed clear margins and lymph nodes
Two nights in hospital
Catheter and staples out after 7 days
Continent, no pads needed from the get-go
No erections (of course!)
Experimenting with VED and Bimix

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 4/19/2008 6:51 PM (GMT -6)   

  tongue    Hi ~ Reed and Loved Ones,


Welcome   to…   ~ HealingWell ~




A   Special   Warm Welcome  to  You !


Knowledge gives us POWER….  POWER takes away the fear.


~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~     ~


 Click  on  link  below for important information that will help you ~ help us!!


  >>  Welcome New Members ~ to HealingWell


The information (link) listed above is to help you get around the forum! 


v       This is a journey best traveled with friends. 

Welcome ~ New Friend from all the members here... on


v      IdahoSurvivor ~  Moderator for Prostate Cancer Forum


v      TC-LasVegas ~  Moderator for Prostate Cancer Forum


v      bluebird ~  Moderator for Prostate Cancer Forum

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 4/19/2008 7:07 PM (GMT -6)   

Hi Reed,
Welcome to Healingwell.  You can help us all help you by adding a signature to your posts. You have given us some good information, by adding it to your signature members can respond better.  I put the link below.  The experience of the surgeon, I think, is more important that the procedure.  I had a great surgeon and a great facility that did daVinci LRP.  The surgery went well proceduraly.  When you can, add your information to your signature.  You will find many like you to respond.

For signatures instructions, click below

Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
Prostate Cancer Forum Moderator

Veteran Member

Date Joined Apr 2007
Total Posts : 823
   Posted 4/19/2008 7:46 PM (GMT -6)   
HI Reed. When I was looking into treatment for PC last year I met with a Dr. that did perineal and she told me two things. I would be impotent and incontinent the rest of my life. I opted for the open procedure and was very pleased with the outcome. Take care and get all the information you can, make your decision on treatment and don't look back. Take care.

age at dx 54 now 55
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
wear one for insurance now
ED still a problem
last PSA undetectable

Regular Member

Date Joined Mar 2008
Total Posts : 203
   Posted 4/19/2008 8:19 PM (GMT -6)   

Hi Reed!

I'm so glad I checked and saw your post.

My husband had the perineal and we are so glad he did. Usually the doctors recommend this in patients that are obese because you can get to the area easily. This is not the case with my husband. He is 5'8" and 175lbs. The reason our doctor likes it is because he specializes in this kind of surgery and done over 3000 of them. He feels there is less blood loss, less healing time and shorter surgery time. It only took 1 1/2 hours and he was out of recovery within an hour. Home in less than 24 hours. Now, it will be sore there for awhile as Kent is finding out because they cut on both sides and there is a fat little area that will rub together as you walk. When the hair grows back where the incision is, its not comfortable either. Its been 10 days since his surgery and he is still alittle sore. He walks like he has been on a horse sometimes but thats just if he has been sitting awhile. :)

I did alot of reseach before we made the decision to do it this way. Mostly our decision was made after reading about our doctor and what he had done. We also spoke with a few patients that he had done this surgery on which was a big help.

I don't know alot about the other procedures but ICi know others on here can tell you about their experience. I know that everytime I had the "silliest" question, no matter what it is, they are always there for me. I could not have gone thru this without the help of this wonderful forum. No question is wrong. All questions are important. All of these people have been thru so much and this forum is a wealth of information.

Don't know if I answered what you needed to hear but all you have to do is post or email directly. (edit)  I will be more than happy to answer anything. I'm kinda new here too and I might not have given you what you need. Just ask!!

One more thing, our doctor is not all worried about incontinence or ED. My husband already is feeling like things are going to be back to normal and he hasn't even gotten the cath out yet. His was nerve sparing. I don't think mvesr's doc that said you will be incontinent or impotent the rest of your life was completely correct or gave enough info to work with..just my opinion....

Age 51 Kent
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 anpther round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th.
Cindy (the wife!!)
Surgery preformed and doing great. Only took 1 1/2 hours. Will know in two weeks about pathology report. Surgeon feels he he got all cancer and confined to prostate. Both nerves were spared.
Home 4-11


Post edited to mask e-mail... Sign On... and Click Here...> VaFan  

Post Edited By Moderator (bluebird) : 4/26/2008 10:18:53 PM (GMT-6)

Johnny Canuck
Regular Member

Date Joined Jan 2008
Total Posts : 88
   Posted 4/19/2008 10:19 PM (GMT -6)   
Reed said...
Hi all,
  I'm Reed ...I'm 47, had a blood test that revealed a slightly elevated PSA of 3.28, but the prostate biopsy showed cancer in 4 of 6 tissue samples.  Gleason score 3+3=6.  I have a very small prostate and my doctor wants to do the perineal procedure. 
Hi Reed,
If you'll forgive me saying, with those numbers I would investigate the possibility of brachytherapy as a treatment.  Do you have a staging at this point? Is the tumour detectable by DRE? There are a number of different options open to you...if your cancer is contained within the capsule at this point and it's all early stage.
All the treatments give you basically the same good shot at surviving this nasty business at the earliest juncture, so it's all about the side effects. I don't wish anyone to second guess their own treatments, but I dispair at some of the grief my brothers on this site have to deal with...and that I've been spared. The biggest deal is a feeling of urgency when it's time to pee. That could count as a courier...but I don't see it as any worse than those resulting from other treatment options.
This site, as has been said, has a lot of folks who chose surgery. I've been cheerleading for brachy. I'd do it again. My thread is as follows:
also, two more fine threads that inspired me:
Good luck in your investigations, stay close and let us know what's doing.
Age: 54
Gleason Score: 3+3=6
PSA: 3.33
Biopsy:7/8 Positive
Stage: "Bulky" T1c
Prostate Size: 27cc
Diagnosed: December 05, 2007
Brachytherapy: on February 26, 2008
  68 seeds, (Iodine 125). 

New Member

Date Joined Apr 2008
Total Posts : 2
   Posted 4/26/2008 2:56 AM (GMT -6)   
Hi All,
Thanks for the wonderful feedback. I'm meeting with a da Vinci doctor who has performed hundreds of these here in Seattle, after talking with a patient who had the procedure 10 months ago and is very high on it.
As to the brachytherapy my doctor felt it exposed surrounding organs to radiation which could potentially bring back cancer 20 years down the road. Since I was so young he advised the surgery.
And yes, the perineal is his choice because he doesn't do the laparoscopic. But that doesn't necessarily make it my choice as a courier and seated woodwind musician.
I've attempted to add a signature though I'm not real clear what they are asking for. Hopefully, it is sufficient.

Thanks again,


Regular Member

Date Joined Mar 2008
Total Posts : 203
   Posted 4/26/2008 5:52 AM (GMT -6)   

I was told when this all started for us to take your time, get a second opinion and think it thru. Thats the best advice we can all get , I believe.
You will know when you have made the right decision for you.
As for the signature (I had trouble figuring this out too!). When you sign in, go to the upper left corner and you will see Control Panel. Click on that. Then you will see a line that has edit profile. Go to that and you can see all the different questions. At the bottom they ask you to write personal info about your journey...(gleason score, date of biopsy, etc..) So when someone reads your topic they don't have to go back to your first post. Its all right there for them and it makes it easier to answer your questions.
Hope this helps.
Cindy and Kent
Age 51 Kent
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 anpther round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th.
Cindy (the wife!!)
Surgery preformed and doing great. Only took 1 1/2 hours. Will know in two weeks about pathology report. Surgeon feels he he got all cancer and confined to prostate. Both nerves were spared.
Home 4-11 - incision looks completley healed on the outside by 4-25
Cath out 4-22 dripping some
Cancer confined to one side of prostate.
Cialis 5 mg at night to start
Outlook very positive!!

Veteran Member

Date Joined May 2006
Total Posts : 2542
   Posted 4/26/2008 11:24 PM (GMT -6)   

   tongue   Hey ~ Reed & Loved Ones,


We’re glad you found all of us!!!


I know we can “all” make “Your Journey” smoother ~ just by being here for you!  

Thank you for reaching out!!! 


You’ve just made your own journey a lot smoother.  There are a lot of Helping Hands here… and just by reaching out like you did ~ you will have a much easier time.  We’ve been where you are now…. Knowing you aren’t alone… makes a big difference in psyche and spirit.


We will always be here for you… This is truly a great forum!!! ~ You have joined! You are now part our forum family ~ a group of wonderful individuals who are so willing to share their journey with you!  Please take time to follow the links in your Welcome Message above… it will help to ease some of the unknowns…


It helps “all of us” ~ to help you ~ if we know where you are on your path.

So ~ Please stay with us and take our hand when you need it!  Keep posting.... OKAY!!   


KNOWLEDGE IS POWER... and POWER conquers fear



~ and ~

Your decision will be the right decision for you!!!



Buddy & I invite you to visit our personal thread “Our Journey”… listed in our signature below.

Hoping our experience can help you over at least one stepping-stone on your journey.


Our thoughts and prayers will be with you as you continue to move forward in your search for answers… Stay Close!

In Friendship ~ Lee & Buddy

mama bluebird - Lee & Buddy… from North Carolina


v          We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

4th PSA 2-13-2008 (23 months) Less than 0.1 Non-Detectable :)

New Topic Post Reply Printable Version
Forum Information
Currently it is Thursday, August 16, 2018 2:48 AM (GMT -6)
There are a total of 2,993,190 posts in 328,027 threads.
View Active Threads

Who's Online
This forum has 161218 registered members. Please welcome our newest member, tekneighstfrv.
199 Guest(s), 2 Registered Member(s) are currently online.  Details
Landyandj, tekneighstfrv