Posted 8/13/2008 11:13 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
) 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