Yet Another Consequence of Prostate Surgery

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RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/1/2009 7:26 AM (GMT -6)   

I just got back from a visit with a colorectal surgeon. What I thought were persistent hemorrhoids turned out to be an anal fissure. The doctor said this was likely a consequence of the procedures related to prostate surgery. (1) The biopsy punctured the rectum and caused trauma. (2) The prostate gland sits right on top of the rectum; after prostatectomy, this part of the rectum is thin, delicate, and at risk for injury for the first three months after surgery. And then (3) the three courses of antibiotics for urinary infection (I used catheters for 35 days after surgery) killed beneficial stomach bacteria and caused my stool to contain acid that attacks the rectum.

 

My advice to anyone undergoing prostate surgery is:

 

·                               Be aware of the potential problems with your rectum. Be very careful to eat a high fiber diet, and use a bulking agent like Metamucil or Citrucel

·                               Avoid both constipation and diarrhea – both can cause problems

·                               If you are taking antibiotics, follow each dose with some yogurt containing active cultures to replace beneficial bacteria in your stomach

·                               If you have any pain around your rectum, or have blood in your stool, see a colorectal doctor sooner rather than later.

 

I wish I had known all this three months ago.

 


Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule.

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free)

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Currently using 3-4 pads during the day, dry at night (8 weeks after surgery).


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/1/2009 7:37 AM (GMT -6)   
Oyster
A good post and a thoughtful warning not to ignore such symptoms. To his credit, my uro warned me before surgery that damage to the rectum was a relatively rare complication. I'm sorry that you ended up on that rare side.


One question -- how long was it between your biopsy and your surgery?
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 9/1/2009 7:58 AM (GMT -6)   
Thanks for sharing your experience and your warning. What treatment plan did you and the doc come up with for healing?
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
22 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix 30/1/20-.05ml 2X week continues
PSA's: .04 each test since surgery


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/1/2009 8:24 AM (GMT -6)   
A very valid point. Biopsy, surgery, radiation (All types) and just about any treatment, can damage the rectum. My surgeon wrote in my surgical report that he was removing suspicous tissue but had to stop near the rectum to avoid damage to it. In another case, Ralph Valle who is a well known PCa advocate had his rectum puncture during the RRP back in the early 90's. Many have had bowell issues attributed to radiation therapy. It goes with the territory that if you perform surgery anywhwere, you can affect other healthy tissues. Luckily it no longer the norm to cause these issues, but it can still happen and patients need to consider these things on the front end of treatment. If not to affect a treatment modality, but to have realistic expectations after treatment. We talk abou ED and incontenence like they are the biggest worries. but truly looking at the anatomy, you can clearly see what else could go wrong with a treatment modality of any kind.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 9/1/2009 8:39 AM (GMT -6)   
Thanks for the post. My surgery is scheduled for Sept 17th. This is one problem that I had read nothing about. I like many others have been concentrating on the ED and Continence issues. Been doing the darn kegels very religiously. Trying to loose a little abdominal flab and walking my buns off to get ready.

Sure do appreciate the warning.

Sonny
60 years old
PSA November 2007 3.0
PSA May 2009 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

Surgery set for September 2009 with Dr. Mani Menon at the Henry Ford Medical Center in Detroit.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/1/2009 8:43 AM (GMT -6)   
Oyster, sorry you are having to deal with this problem, hope the solution won't be too harsh.

Pre-surgery, my surgeon mentioned the possibility of those types of problems but said they were around the 4-5% range if I remember clearly.

Don't you just hate being the exception? Hope it heals fast for you.

David in SC
 Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/1/2009 9:42 AM (GMT -6)   

James C,

Thank you for your concern. The colorectal surgeon tells me I have a 50:50 chance of the fissure healing itself. We will wait for up to 6 weeks to see if things get better. In the mean time I have a prescription 5% lidocaine ointment for the pain, and 1% hydrocortisone ointment for swelling.

I have ordered Dr Wheatgrass Antioxidant Skin Recovery Cream, which has on-line testimonials for healing anal fissures. I will let you know if it works.

As a last resort, there’s surgery to fix the problem. Just what I need – after surgery that messes up one orifice to have surgery that messes up another.


Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule.

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free)

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Currently using 3-4 pads during the day, dry at night (10 weeks after surgery).

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/1/2009 9:49 AM (GMT -6)   
Hope you are in the 50% positive group in that statistic.
 Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/1/2009 10:02 AM (GMT -6)   
David,

Thanks for the best wishes. You and I both have been on the short end of the statistical curve for complications from RP surgery. Let's hope things even out. We're both due.

Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule.

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free)

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Currently using 3-4 pads during the day, dry at night (10 weeks after surgery).

 


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 285
   Posted 9/1/2009 6:17 PM (GMT -6)   
May your recovery be swift and very glad the doctor finally sorted it out for you. Your post might be very timely for me as well. I had a bad infection after my biopsy and had to cancel a vacation. Also, after my LRP last November, I've had regular constipation problems and minor bleeding. A couple weeks ago during my 9 mo. checkup with the urologist, I was told I had a bacterial infection and was put on an antibiotic (Macrobid due to bad reactions to sulfra and cipro drugs). Today I provided another urine sample since it appears from the sting after urination, the problem wasn't solved. With the information from your warning post, I will at least have a direction for the urologist to pursue (he did not warn me of this possibility) if my infection doesn't clear. I had also thought that the infection may have been the cause of my psa to go from .1 to .2 so I hope that by fixing the infection my psa will drop.

Once again, many thanks and look forward to hearing that all is right!

Best regards,
JaKe
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/1/2009 7:43 PM (GMT -6)   
Geezer,

There was exactly four weeks from my biopsy to my surgery, which I now know to be on the short side.

Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule.

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free)

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Currently using 3-4 pads during the day, dry at night (10 weeks after surgery).

 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 9/1/2009 8:38 PM (GMT -6)   
Oyster, good post and a concern we should all be aware of. Thanks!

As for colorectal surgeons, their convention in Montreal produced this song, now found on YouTube which I think you'll enjoy --- and you can hum it to your doc the next time you see him/her.

http://www.youtube.com/watch?v=_N0w2rORwSc

I don't think the link will show up live, but you can cut and paste into your browser. And, if you'd like one for your anesthetist the Laryngoscopes' song, Waking Up It Hard To Do can be found at:

http://www.youtube.com/watch?v=WOrjcLJ2IE0&NR=1

Cheers, Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/1/2009 8:51 PM (GMT -6)   
Oyster,

That's one of the shortest from biopsy to surgery times I have ever seen. My uro/surgeon said no less than 6 weeks no matter what and 8 weeks would be better. In the end, due to the hospital OR schedule, it was right at 9 weeks. Was there any particular reason for the rush?

David in SC

P.S.  See you are in the Atlanta area, I am close to Greenville SC, perhaps we could hook up sometime in the middle, somewhere like Commerce, GA on 85 if you ever have the time.

Post Edited (Purgatory) : 9/1/2009 8:54:35 PM (GMT-6)


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/2/2009 6:27 AM (GMT -6)   
David,

There was no reason at all for a rush. The biopsy results came back after a few days, and I was stage T1C with a Gleason 0f 3+3=6, which all pointed to very early stage cancer. I talked with my Urologist, then a week later talked with a Radiation Oncologist. After a few more days of research and consideration, I decided to go with open RP surgery. When I told my Urologist of my decision, he said he had an opening in a week and we could go then. That turned out to be 4 weeks to the day after the biopsy. At the time I asked specifically if we should wait, having read Dr. Patrick Walsh, who literally wrote the book on prostate cancer.

Dr. Walsh recommends 6 to 8 weeks or longer from the time of the biopsy to surgery, for exactly the reason of protecting the rectum. He found "no significant difference in the long-term cancer control rates" of men who waited a few months to have surgery.

It looks to be about 130 miles from Greenville to Alpharetta where I live. You are right that Commerce is about half way -- about an hour from each end. There's a Ruby Tuesday just off I-85 at exit 149. Please let me know if you are open for lunch some time after Labor Day. Thanks for the suggestion.

Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule.

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free)

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Currently using 3-4 pads during the day, dry at night (10 weeks after surgery).

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/2/2009 6:57 AM (GMT -6)   
Oyster, will do. Just don't tell the wives, because being a mega shopping outlet exit, I don't want to go broke.

David
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