Posted 12/31/2008 8:38 PM (GMT -6)
Had davinci 12/22. Got my catheter out and my pathology report today, just in time for the New Year.
I chose surgery because the long term outcome seemed to be slightly better than brachytherapy, for the psychological peace of mind of removal over kill in place, and to maintain sexual function. Surgery seems to cause short term problems which improve over 1-2 years (to anywhere from near same as before to reduced but functional with injections), while brachytherapy seems to not cause problems initially but there is a cumulative negative effect which I believe will be permanent. I chose davinci over open radical prostatectomy because it seems to have an equivalent cancer control outcome (though it is a bit of a projection because it has not been around that long) and is less intrusive to the body. Experience is critical to optimum outcomes, so I chose a surgeon that had done at least 150 procedures (some sources say 300, he has actually done >350).
The davinci went well, a 6 hour procedure. Normal time for my surgeon is 4 1/2 hrs, but I had a humongous prostate (79 g). Home the next day, a couple of days of feeling tender around my midriff, then I was fairly mobile. The catheter was a bit of discomfort, and I treated it very gingerly, but the psychological effect was larger than the physical effect. I am extremely blessed in that even with the catheter in I had several nocturnal erections. The catheter has been out for 6 hrs now, and I have peed several times feeling pretty much like I used to and still seem to have a dry pad, so I believe I may be extremely blessed in that as well.
The pathology report was also as good as I could hope for. Bilateral cancer, but less than 5% involvement. Surgical margins clear, negative lymph nodes, no seminal vessel involvement. A T2c. Gleason 3+4, a slight uptick from biopsy.
Newly diagnosed men who find HW, find hope in my story. There can be a very good outcome.
The one choice I made which may be of interest is that I chose a surgeon at a teaching hospital (University of Washington). I stipulated that he do the procedure, not an intern, but what struck me in hindsight was that he normally spends 4 1/2 hrs on a procedure, and spent 6 hrs on me. The average davinci procedure time I saw in published literature was like 162 minutes, or slightly under 3 hrs. I think I benefited from the fact that my surgeon was not on the clock, with a need to get 2 to 4 procedures done in a day as might be the case in a private practice. I am ever so grateful that he spent all the time he wanted. As my operation was just before Xmas, I told him I did not want him distracted with visions of sugar plums dancing through his head, just pay attention to MY little sugar plum. I think he did just that.
Thank you HW for being a source of advice and wisdom, and my sincere wishes for the best of New Years for all those who find their way here.
This moment, here and now, is nothing less than the totality of existence.
I can't control my life, but I can influence this moment.
PSAs 1.6, 1.8, 2.0 at yearly intervals
Mild DRE finding (hindsight unrelated) lead to biopsy
3/08 1st biopsy, 18 core. Pathologist 1, HPIN and ASAP, 0.5mm 1 core. Pathologist 2, carcinoma
7/08 2nd biopsy, 16 core. Pathologist 1, 1 core carcinoma. Pathologist 3, 3 cores carcinoma
Urologist retired. Referred to another Dr. in same practice, not experienced enough.
Robotic da Vinci performed 12/22/08, Univ of Washington Med Center, Dr. William Ellis. Both nerves spared.
Catheter out 12/31/08
Final path report:
79 g prostate gland
1.5 cm^3 cancerous, Gleason 3+4, bilateral, T2c
Margins clear, seminal vessels clear, 14 lymph nodes negative