Is it necessary to see surgeon post op?

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Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 5/17/2010 8:53 AM (GMT -6)   
This question is for guys who have had radical prostectomy and have low PSA test results post op. Do you go back to your surgeon for follow up visits after the first one or two? Is it really necessary to go back to the surgeon if there are no issues to discuss? At what point do you stop seeing the surgeon?

My plan is to 'stay local' and keep my surgeon in the loop by having my PSA test results sent to his office. I see no need to take a long drive for a five minute meeting, except to pick up a few med samples. Is this what you guys do, or do you continue to see your surgeon? Thanks for replies.
Age: 62
Pre-op PSA: 4.1
Post-op pathology:
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 day in hospital, cath out on 9th day
Post-op PSA: at 4 weeks ---> .04
at three month intervals -> .03; .02 (the trend is my friend!)
ED: Improvement is very slow but there are positive signs. Doc has NOT put me on ED drugs yet but I am starting to anyhow.
One pad/day for the first six weeks. Two pairs of underpants, just to play it safe, for a few months.
Surgery: Dr. Jim Hu. Brigham & Women's Hospital, Boston


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 5/17/2010 9:16 AM (GMT -6)   
I'm seeing my surgeon tomorrow for the Two Year followup PSA results.  I guess in theory, I could see someone else in his group...then again - they are in the same or similar office - all of which are within 15 minutes to where I live...
 
If I were you, I'd ask your surgeon what he/she thinks.
Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 5/17/2010 9:17 AM (GMT -6)   
My surgeon is 2.5 hours away from where I live. I went back for my first post surgery PSA and consult and then have transferred to my local Urologist for my follow up testing. The surgeon suggested this but said it was up to me if I wanted to continue driving the distance to see him.
 
Larry
Age 55 / age at diagnosis 54, PSA 5.1
Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
Final Path report:
20% of the prostate Involved
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear, Positive Margin Noted in Right Apex
 
First post Surgery PSA - 0
Six month PSA - 0


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/17/2010 9:27 AM (GMT -6)   
My uro/surgeon is bout 2-3 blocks away from where I live. I have been seeing him 1 1/2 years before surgery, and now almost 1 1/2 years post surgery and post radiation. After my difficulties with salvage radiation, I was sent back to his care, which I am thankful for, as he knows more about my situation then any other medical person.

I, too, would talk it over out of courtesy and respect for your doctor, if the only reason you would be seeing him is for post PSA tests, it would seem like you could get that done somewhere more convenient for you, and have copies sent to him. See if you can use the same lab though, so that you are always apples to apples.

All my test results go to my GP, my radiation oncologist, and even my original medical oncologist for a totally unrelated cancer from 10 years ago.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 5/17/2010 9:47 AM (GMT -6)   
My uro is my surgeon, so looks like we are stuck with each other, at least for a while. At some point, we ned to discuss me moving back to my FP for routine care and testing, saving him for the future strictly uro needs. They both practice less than 2 miles from me, so it's a wash as far as distance.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN

Post Edited (James C.) : 5/17/2010 12:13:48 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/17/2010 10:25 AM (GMT -6)   
Red Nighthawk said...
Do you go back to your surgeon for follow up visits after the first one or two? Is it really necessary to go back to the surgeon if there are no issues to discuss? At what point do you stop seeing the surgeon?
 
Hi!  Similar to you, my surgeon is some distance away from where I live...takes me close to 2-hours to drive.
 
Here's what I do:
I have my PSA blood draw locally at Quest; they fax the results to the surgeon's office, then I email the surgeon for the results.
 
After my catheter was removed, I have only returned once.  He requested to see me after my 6-week and 3-month PSA results, but I blew off the 6-week appointment.  I emailed his Physician's Assistant about the need to come in, and he said only if I had unanswered questions or concerns, since my PSA was "undetectable."  I went at 3-months, mainly because I felt guilty about cancelling the 6-week appointment, but it was pretty much a wasted day.
 
I have no plans to see my surgeon again, unless results unexpectedly turn unfavorable, but my PSA tests results will continue to be sent to him and I will continue to email him for results.
Perhaps a similar arrangement might work for you...?
 
Any change in status regarding addressing sexual function rehab with Dr Hu, or are you taking that local?  My recollection is that he (Dr Hu) is not a big believer in rehab...

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 5/17/2010 10:30 AM (GMT -6)   
I see my surgeon every 3 months for now. However, he as told me that I can see my local Uro for follow-up if I like. I prefer seeing my surgeon and will probably continue, but it's a matter of my choice at this point.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
Aril 10 MRI and Bone Scan show lesion on lower spine, no SRT


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 5/17/2010 11:22 AM (GMT -6)   
That explains why my Uro/Surgeon is always triple booking appointments and why a simple 15 minute (or less!) consultation take 30-60 minutes of waiting around past the appointment time. If he is constantly accumulating new patients and they all go in for their 15 minutes of fame every quarter, half or year something's gotta give sooner or later.

Luckily for me, my Uro did not even book a new appointment for me after the year visit -- (but my stats were on the lowest of the low end ). My yearly checkup should cover it for now on... and just use my Uro/PA for ED work ...
Age 59, 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
11/2008 Biopsy: 1 of 12 cores 5%, Gleason 3+3 - Sona showed size 140+ cc (110 grams post op).
02/03/09 open RRP surgery ,Nerve sparing, 1 day in hospital.
02/18/09 Cath out -- passed 1 cm oblong bladder stone (not kidney!).
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
04/09, 07/09, 10/09, 01/15/10 PSA <0.1
03/2009 Levitra@20mg / Viagra@100mg/Cialis@20mg -- (nocturnal stirrings started 02-03/2010).
08/09-09/09,02-03/10 MUSE@1000mcg 80-90% (with some ache )
10/09-11/09 TrimixGel@(500/300/100mcg): 60,70,80%,
02/10-03/10 TrimixGel@1000/300/100mcg - 80-90% - just @ usefulness.
Gel + MUSE 500mcg -- 100% for 30-60 mins and 80-90% for hours after that).


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 5/17/2010 11:47 AM (GMT -6)   
I decided that I would see my surgeon for 6 months just in case any complications came up related to the surgery, and then switch back to my URO who is only 40 minutes from my home.I did have post op problems and my surgeon was worthless in that regard so after 6 months it was back to  a number of specialist closer to home. That long drive to Atlanta and battling the traffic is and will never be fun to me.
Michael 
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5 on 11/28/10
Starting IMRT on 1/18/10, Completed 39 tx at 70 gys on 3/12/10
6 week Post IMRT PSA .44 a drop from .5 but maybe more
Great family and friends
Michael


Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 5/17/2010 12:11 PM (GMT -6)   
Thank you all for your thoughtful replies. I really appreciate it.

You guys who practically live across the street from your uro are lucky.

I will write a note to Dr. Hu and ask him what he thinks about me not visiting him in the future unless there is an issue that needs his guidance. Either way, I'll continue to have my PSA tests done locally and sent to Dr. Hu in Boston.

Casey, you have a good memory. You are correct, Dr. Hu does not believe taking meds post op does any good and is a waste of money, UNTIL NATURAL IMPROVEMENT OCCURS. He believes once our bodies have healed a little bit on our own, then taking the meds has value. Therefore, I am now taking one-half of a generic V every other night to help things along. Personally, I don't think the generic V is as potent as the real deal was, but that may be me and not the drug from India. Dr. Hu's young protege told me that it usually takes a year to a year and a half to see real improvement in the ED area.

Thank you all for your help.

peace,

john
Age: 62
Pre-op PSA: 4.1
Post-op pathology:
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 day in hospital, cath out on 9th day
Post-op PSA: at 4 weeks ---> .04
at three month intervals -> .03; .02 (the trend is my friend!)
ED: Improvement is very slow but there are positive signs. Doc has NOT put me on ED drugs yet but I am starting to anyhow.
One pad/day for the first six weeks. Two pairs of underpants, just to play it safe, for a few months.
Surgery: Dr. Jim Hu. Brigham & Women's Hospital, Boston


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 662
   Posted 5/17/2010 12:51 PM (GMT -6)   

I’m going to transition back to my primary care physician after my June appointment with the surgeon. I love the surgeon, however I feel like it is somewhat of a waste of time for him…he needs to be available for the new members of our group that unfortunately are going to need his services.  I do plan to keep sending my PSA results to him as it is important for him to have a reliable data base of patient outcomes.

jnm


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09 Non-Nerve Sparing on Rt.
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate involving 20% of the Gland. Surgical Margins Free of Tumor,
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. Extracapsular extension is absent Perineural Invasion is Identified, Vascular Invasion is not identified.
Post-op PSA 12/10/2009, Undetectable  <0.01
Post-op PSA 05/03/2010, Undetectable  <0.01
I hate this crap
Moved by individuals like Living1963

 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/17/2010 4:35 PM (GMT -6)   
I last saw my surgeon/uro in Feb '09. In/out wham,bam, thank you ma'am. Ka-ching. Bit of idle chit-chat to fill in time to justify his fee for the consultation. I thought my local GP can do this at a far lower cost. If everything is fine, including PSA, what is the point of seeing a uro or surgeon for the result when your GP can very effectively do the job. I get my GP to order the ultrasensitive PSA test, give me the result and a copy is forwarded to the surgeon/uro as a courtesy for his records. If I could arrange the test and get the result myself I would go that way. Unfortunately, in Australia, as the test is fully paid for by our universal health system, a medico must authorize it.
Bill

Tim-from-Maine
Regular Member


Date Joined Apr 2010
Total Posts : 83
   Posted 5/17/2010 5:43 PM (GMT -6)   
The irony o f this process......

I saw my Surgeon/URO ( 2 hours away) each quarter for the first year - then my PSA started to rise so he referred me to a Rad Onc. My insurance Company said a specialist cannot refer you to another speciialist so they had me go back to my Primary Care Physician locally to get the referal to the Rad Onc. Does this make sense to anyone!!
PSA Feb 09 - 9
Dx age 62 - March 2009 - Gleason 7
Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9
Started VEGAN diet June 2009
3 month PSA - <.04
6 month PSA <.04
9 month PSA .05
12 Month PSA  .16
SRT began May 3, 2010 - will do about 41 treatments
 
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/17/2010 5:58 PM (GMT -6)   
Tim, I guess that is one of the reasons medical care is so expensive everywhere. Protocol and everybody's hands in your pocket.

Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 5/17/2010 6:38 PM (GMT -6)   
Tim, good luck with those treatments. Please keep us in the loop.

Thanks again to all responders who replied to my post. You guys are great!
Age: 62
Pre-op PSA: 4.1
Post-op pathology:
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 day in hospital, cath out on 9th day
Post-op PSA: at 4 weeks ---> .04
at three month intervals -> .03; .02 (the trend is my friend!)
ED: Improvement is very slow but there are positive signs. Doc has NOT put me on ED drugs yet but I am starting to anyhow.
One pad/day for the first six weeks. Two pairs of underpants, just to play it safe, for a few months.
Surgery: Dr. Jim Hu. Brigham & Women's Hospital, Boston


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 5/17/2010 6:48 PM (GMT -6)   
Red,
 
I have about an hour drive to may chosen big name Hospital and made the trip once after my surgery and saw the Surgeon with a couple of students in tow.  The second trip I did not get to see my Surgeon and that was that.  I stay in concact by email and get the script for my PSA every six months because of the bad margin.  I don't even have a local Uro guy.  I promise my self to get one.  If I need radiation treatments I may choose a local community hosp because of employment issues but I hope I never will.
 
I feel that if you feel its important to see the main man then they truly do too.  If you don't, its ok with them.  I do feel its very important to keep in touch with your surgical hospital so they can track your progress.  This will only serve to help those that follow us. 
 
If your surgeon actually wants to see you, I would in a heart beat, but I am not driving the distance to chit chat with a young man who would rather I did'nt come in.
 
Frank
Currently 56, surgery at 54
Normal , 2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
PSA @ surgery 6 
clinicaly Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008, University of Chicago.
Catheter out in 7 days normaly expected leakage
Post Pathology T2C, Gleason 7, (3+4) 10 % of both portions of prostate
Seminal vessels clear, fat tissue clear, single positve margin at apex measuring less than 1/2mm. 
PSA 6 week< 0.1, 4 month<.05, 6 month<0.01,9 month<0.01, 1 year <.008, 18 month .010, 2 year .010 undetectable
Watching PSA @ 6 months for (long time),  will do SRT if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. Tried Levetra about the same as Viagra.  Tried Cialis, think I will stay with the Viagra at 50-100 mg.  Side effects worse at 100 mg.  
 
 
 


Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 5/17/2010 7:32 PM (GMT -6)   
Frank, the same thing happened to me. I expected to see my 'big name' surgeon but in walked a very young doctor, instead of Dr. Hu. That's when I started to have doubts about the wisdom of going to such effort to get to the appointment.

I don't have another uro, but I do not think I need one at this point.
Age: 62
Pre-op PSA: 4.1
Post-op pathology:
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 day in hospital, cath out on 9th day
Post-op PSA: at 4 weeks ---> .04
at three month intervals -> .03; .02 (the trend is my friend!)
ED: Improvement is very slow but there are positive signs. Doc has NOT put me on ED drugs yet but I am starting to anyhow.
One pad/day for the first six weeks. Two pairs of underpants, just to play it safe, for a few months.
Surgery: Dr. Jim Hu. Brigham & Women's Hospital, Boston


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 5/18/2010 5:48 AM (GMT -6)   
Like others here, our uro was also the surgeon. For the first year, John saw him every 3 months. The first couple of visits were spent checking out the incisions and discussing ED and incontinence, along with a few samples of various ED medications. After the first year, uro said John didn't need to see him each time he had a PSA so we moved to once every 6 months. After the first year, most of the "visits" with the uro are over the phone - he is very accessible and has never failed to return our calls. We are fortunate in that he is patient (with both of us) and answers all our questions.

On a side note, John's "regular" MD (the one who had been monitoring PSA and recommended the urologist) told John right after the surgery that the urologist would take over for a while. The two doctors stay in touch (in fact, the regular MD is a patient of the urologist) and share information. Of course, John goes to his regular MD for annual physicals and non-PCa related issues.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!

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