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LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/13/2008 10:13 AM (GMT -6)   
Hi all...again many thanks to those that post here and those that sent me emails.  I have opted to go the robotic route for all the same reasons that those who have gone this route after looking into all the other treatments.  I did have to "interview" several surgeons before making my selection, which for anyone new in this journey, I highly incourage and recommend that you do so.  Honestly once you have a good understanding of the extent of your cancer, the standard prognosis based on the biopsy of your cancer...talking with the surgeons becomes much easier as you can ask the pertinent questions related to your own treatment plan instead of getting the standard run-of-the-mill discussion based on statistics  (I hate statistics..but then they can and will influence the decision making process).
 
Interesting as I read some different view points from the other posts...my surgeon set me up for a bone scan and not because of fear of the cancer having spread, but to provide a solid base line for down the road.  Much like having a base line for PSA.  I thought that was interesting and honestly much appreciated.  Granted he assured me that at my stage and Gleason it would be negative and most surgeons find it unnecessary at this stage, but his thoughts were that it would be easier to interpret a new scan down the road if needed and decide what had changed with a good base line scan to start with.  (I believe that this is a very good thing for everyone to have regardless of gleason score or PSA level or staging.  Just my two cents worth)
 
As far as lymph nodes...yes a few will be taken as part of the surgery (I think he said five) which he also expects also to be normal, but again makes for a good base line down the road.
 
Nerve bundles...he says they will be spared, but honestly he said PCa likes to migrate to nerves, so it is really a call made at the time of surgery.  In my case he says there is no reason to remove them or any part of them from what he can tell based on the biopsy results.
 
Now the caveat.  Because the bulk percentage of cancer was found at the base next to the bladder neck...I get another TRUS and another DRE...oh joy.  He said he wants to know what he going up against.  Funny the other two surgeons didn't mention anything about a potential complication with the bladder neck and cancer.  Another reason to search out the best surgeon you can find or feel comfortable with.
 
Finally...the ED and Incontentence issues. 
 
Well he was frank...ED is potentially based on pre-surgery function...similar function should return in 12 to 18 months...but again age and prior function will have the biggest bearing.  Oh and also...if you were a smoker (in my case a past smoker) the tiny blood vessels are usually collasped and will make recovery longer than a none smoker after surgery.  (For those with longer ED recovery times and had smoked...this could be one of the reasons why)  At my age and function (and smoking history  mad  ) am looking more at the 12 month range or sooner, but then everyone is different anyway. 
 
Incontentance...unfortunately...that is going to be a crap-shot.  Because of the area of the cancer and removal from the bladder neck, this may make the incontinence recovery a little longer to gain control of...OR....I will recover very fast, it all depends on what he finds during the surgery.  I asked what he meant by a little longer and he just added that there are devices that can be installed to help out as necessary.  Didn't like the sound of that too much...but again...I more than likely will be cancer-free and in my book that is a trade-off I can live with.
 
Surgery is scheduled Thursday Sept 18 and if all goes well will be sent home Saturday the 20.  He also only does one surgery on the surgery day (he is not in favor of the "assembly-line" surgery) and always the first thing in the morning. (As said before---"First show of the day") He says minimum two night stay in the hospital...he doesn't like the in one day out the next on major surgery. And all follow-up visits for the next five years will be through his office.  For some reason his personal touch in all this has really put my mind at ease and I am grateful to have a good surgeon at a top ranking hospital.
 
Once I get to the other side...I expect all zeros...here is the clink of the glass held up for the cheers.
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved
Gleason (3+3) 6  Stage T1C
No Treatment Decided yet


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 8/13/2008 10:50 AM (GMT -6)   
Ok, you got a plan and a surgeon you are comfortable with.  Your scoring falls within the early detected and easily fixed range.  The time between now and surgery can be used to increase your physical fitness, lose some weight (we all need to lose a few pounds, I bet), and build up some endurance.  Doing these things will give you a goal, and help the time pass until the day.  Then, its to the other side and whatever is- is.  Don't dwell on that yet, prepare physically and mentally for that surgery.  You're gonna do fine.......,

James C.
Co-Moderator- Prostate Cancer Forum

Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
7/31/08 ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0, 9 mts.-0.


Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted 8/13/2008 11:48 AM (GMT -6)   

LV-TX,

Excellent post.  You are very well informed and have a good plan. I think James C.'s advice is excellent.  Even after you get home after surgery keep walking.

All the best,

- John


Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/13/2008 1:30 PM (GMT -6)   
Thanks Navy and James,

Yep exercise will be one of the things to continue with. Had a small bump along the way...right knee needs replacement, so walking for any distance is out of the question for now. At least I was able to get onto a trial of injections for the knee to relieve the pain, especially going off all anti-inflamatories for the time being. But the I can still ride the exercise bike for the time being...next best thing I guess. But all in all...I feel good about the direction I am going and that "little" cloud that was hanging over me is gone for now.
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
Robotic Surgery scheduled Sept 18, 2008


norskie
Regular Member


Date Joined Jan 2007
Total Posts : 376
   Posted 8/13/2008 2:02 PM (GMT -6)   
LV-TX

It sounds like you have all the plans in place and have done your research and are ready to go. As stated before use this time to work on walking getting in the best shape you can and work those kegals. Here's hoping you great success and will look to hear from you and how it all goes with your recovery.

Good Luck
Norskie
norskie
Current age 50, Age at Dx-48 PSA 6.22 on 9-26-06
Biopsy 11-01-06, 2 of 13 cores 10% cancer, 2 other cores abnormal Up-dated 20% prostate cancerous
Gleason score 3+3=6 After Surgery Pathology report 4+3=7 a couple agressive Grade 5 cells found
Da Vinci surgery 01-09-07 UW Madison
Pathology Report- cancer 100 % capsual contained 1-18-07
1st & 2nd Post PSA Blood Test .1 and less - Undetectable
3nd Post PSA Blood Test 01-17-07 .3
March 27th PSA .422 Begin Salvage Radiation April, 14 2008
Radiation Complete June 4, 2008 36 treatments
August 5, 2008 PSA .09 or < .1 again
Incontenence-Pad free since end of May 07 4 1/2 months post surgery 
ED back to 95% prior to surgery - no medication required.


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 8/13/2008 4:22 PM (GMT -6)   
You did your research well. Now just sit back and let it happen. I'm sure you will be fine. I'm an ex-smoker too. That never seems to affect my recovery or healing time as they always predict. The day I was diagnosed with PCa I bummed a cigarette in the medical clinic parking lot. I figured I was owed that one
Diagnosed 10/08/07
Age: 58
3 of 12 @5%
Psa: 2.3
3+3=6
Size: 34g
T-2-A
 
2/22/08
3D Mapping Saturation Biopsy
1 of 45 @2%
Psa:2.1
3+3=6
28g after taking Avodart
Catheter for 1 day
Good Candidate for TFT
(Targeted Focal Therapy)
Cryosurgery(Ice Balls)
Clinical Research Study
 
4/22/08
TFT performed at University of Colorado
Medical Center at Denver Fitzsimmons Campus
Catheter for 4 days
Slight soreness for 2 weeks but afterward
life returns as normal
 
7/30/08
Psa: .32 
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 8/13/2008 5:46 PM (GMT -6)   
Cheers to you and your game plan! It sounds like a great one! We look forward to celebrating with you on the other side! I hope you are able to relax a little prior to surgery! Best wishes for an uneventful surgery and a lifetime of zeroes!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 8/13/2008 9:31 PM (GMT -6)   
Hey LV-TX, Are you in Texas? You have done all you can do. Now go for it! If problems come your way we will be here to support you.
Good Luck,,,
KWinOKlahoma......;)
    43 at Dx and Surgery
    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. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
    March 27th, 2008 - Sling not working, Little or no improvement.
    April 18, 2008 - Collagen injection.  Back to using 4-6 full pads a day within a week.
    May 14, 2008 - Another collagen injection to try to Band-Aid the leaking for our June cruise.  Will start making conusultation appiontments for AUS after we return.
    July 14th, 2008 - AUS consultation with Dr. Morey at UT Southwestern (Dallas).
    July 30, PSA 0.00.
    Aug. 22nd, 2008 - AUS Surgery by Dr. Morey
     


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4825
   Posted 8/14/2008 7:57 AM (GMT -6)   
LV-TX, sounds like you found a Doc that you feel good about.
 
Good luck to you. Thoughts and prayers will be with you. 

Age 53   - 5'11'   205lbs
Overall Heath Condition - Good
PSA - July 07 & Jan 08 -> 1.3
Gleason - 6
(biopsy done March 4, 2008-> 2 of 12)
 
06/25/08 - Da Vinci robotic laparoscopy

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