An explanation of nerve saving

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BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 8/1/2010 10:23 PM (GMT -6)   
This may help explains what goes on and shows the difficulty of the procedure:

vimeo.com/6599375

Bill

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 8/1/2010 11:10 PM (GMT -6)   
Incredible! No wonder this surgery is hard for surgeons to master.

dogbot
Regular Member


Date Joined Aug 2009
Total Posts : 147
   Posted 8/2/2010 1:52 AM (GMT -6)   
That`s all way beyond my IQ. The surgeons deserve respect.
 
All the best from England.
Diagnosed February 2009. Gleason 6, Psa 7.2, 12 core biopsy, and then Mri scan, which showed organ specific.
DaVinci at Addenbrookes, Cambridge, England 18th May 2009.  Nerves removed one side.
Catheter in for 8 days, no pain, no post op problems apart from an infection, cleared with antibiotics.
Some aching around the penis, which still occurs.
6 week psa 0.1, post op pathology all good, confirming pre op tests. Ed a problem, no treatment as yet.
Light ladies pad during the day, just to control a slight dampness and a Tena for  men pad at night for occassional leakage.
Awaiting 3 month consultation at the moment.
Sept 09 - still awaiting consultation. 99% dry during the day, tena pad at night just in case.
Sept 18th 09. PSA less than 0.1
Sept 29th follow up consultation at Addenbrookes. Staff happy with progress.
Nov 11th update. One small stress dribble in the last 2 months. Still some muscle stiffness in pelvic area.
March 20th psa less than 0.1 Very occassional stress dribble. No pads for several months.
 

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 8/2/2010 4:45 AM (GMT -6)   
Yikes. The guy talks faster than the disclaimers at the end of a Toyota ad.

Now I see why I am sitting here soft and leaky. My PCa was in both lobes and the apex. This makes me wonder if the surgeon had spent an extra half hour could the nerves have been reconstructed. We'll never know...
Thank,
Jeff
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 3+4=7, 3+3=6. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day. Try controlling fluids.
12/11/09 5 months: 3 pads per day, 400-450ml/day
02/26/10 7 months: 3 pads but leak is now 320 ml (5 day avg.)
03/22/10 8 months: 3 pads per day, 280 ml/day (5 day avg.) PT says all muscles are tight and working properly. "There must be another issue."
5/22/10 10 months: 2 pads per day, 190 ml/day Scope on June 15 "Short sphincter"
7/15/2010 one year: 2 pads per day. 140 ml/day, dry in bed.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04
1/14 6 months - 0.05 (Siemens Centaur)
4/14 9 months - 0.04 (Siemens Centaur) and <0.01 (Roche ECLIA).
7/12 1 year - 0.03 (Siemens Centaur, direct chemilum); <0.01 (Roche Cobas 601 ECLIA)

Post Edited (Worried Guy) : 8/2/2010 7:26:57 AM (GMT-6)


RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1247
   Posted 8/2/2010 5:37 AM (GMT -6)   
Bill

Thanks for a great link.
PSA 2007 - 2.8
PSA 11/24/2008 - 7.6
Pc Dx 2/11/09; age at Dx 62
RLP 4/20/09
Biopsy -  Invasive moderately differentiated prostatic andenocarconoma; G 3+3=6; PT2C; No evidence of Seminal Vesicle or Extraprostatic Involvement; Margins clear; Tumor identified in sections from prostatic apex.
70 gram prostate.
Immediately continent after removal of cath.
ED - Trimix works well; viagra @ 70%
PSA - 7/31/09 <0.06
PSA - 12/1/09 <0.06
PSA - 3/29/10 <0.06
 
 
 

vam4710
Regular Member


Date Joined May 2010
Total Posts : 89
   Posted 8/2/2010 5:41 AM (GMT -6)   
Good post Billy.... my surgeon deserves an Academy Award for best performance. This puts the surgeons skills into a new prospective for me.
Diagnosis June 1, 2010 @ age 50
PSA 1.7 Sept. 2008
PSA 2.14 Sept. 2009
PSA 2.75 April 2010

May 11, 2010 - DRE Negative - PCA3 Test
May 18, 2010 - PCA3 Results 39 (cutoff = 35)
May 25, 2010 - Biopsy 1 of 12 cores positive; Gleason 3+4 = 7 25%; Stage T1c
June 04, 2010 - CT and Bone scan - All Negative
July 07, 2010 - Da Vinci Robotic Lap. Surgery

PATHOLOGY
Tumor involvement - 15% both right and left halves
Gleason Down graded to 3+3=6
Seminal Vesicles - Negative
Lymphnode - Negative
Subcapsular perineural Invasion - Present
Bladder Neck Margin Positive (right posterior) - Microscopic invasion-1mm Focus
pT3a-N0-MX

Incontinence - Dry at night, 2 or 3 pads during the day

ED - Total flat tire.... no spare, not even a donut

First PSA scheduled for 10/14/2010


Northern NJ

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 8/2/2010 6:30 AM (GMT -6)   
Holy Carp.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Listed on patholgy as PT3, but with extraprostatic extension,
microscopic invasion of the bladder neck, PT3A is perhaps the case.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain! Update 7/14/2010: When I tried changing this sig a few days after creating it, system was broken. My new rad oncologist are discussing IMRT.. though he says he can see why waiting a bit and watching the PSA on super sensitive basis might make sense. I am leaning towards IMRT.. thinking is my body is pretty strong now, i'm 51, and if I can rid my body of this while trying to minimize the side effects.. I dunno. No really Good answers. When I said I didnt want radiation to the point of being a veg.. I really meant there is a limit as to where I wish to go in order to realize only a small increase in life expectancy.. and not that I am an unreasonable person. I do, after all, have an obligation to my wife and kids.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/2/2010 8:04 AM (GMT -6)   
Great post Billy.

No wonder my surgeon won't take credit for the fact that by some miracle I had no ED. He went in me to cut wide margins, but due to difficulties, couldn't get enough clearance on the right side, so that bundle was left intact and noted "damaged" on the surgical report. A true nerve sparing op is complex, and there is so much that can go wrong, probable explains why we got guys right here that went to "great" doctors and had nerve sparing and still have total ED two years later. Wouldn't take much for anything to go wrong. Thanks for posting.

David
Age: 58, 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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 8/2/2010 9:34 AM (GMT -6)   
Here's a thought. I am under the impression that nerve fibers have small voltages going through them as they send and receive signals. Imagine there was a probe sensitive enough to detect these small impulses. The Agilent 34420A Nanovolt meter is down in that level.
This can be attached to the cutting edge of the tool. If current is detected, a tone would sound to warn the surgeon. I understand sometimes the nerves have to be cut but I can easily see how sometimes they can be cut just because they are mixed in with the rest of the tissue and are not discernible from the mass.

This looks like a worthwhile study. If someone wants to go for the grant, I'll participate by supplying the electronics. At the very least we can characterize the current flow.

Jeff

I did more research.
"Each nerve fiber in a nerve is capable of generating an action potential which can be propagated along its length without any loss of amplitude or velocity..." Imagine a low level AC electrical signal, 40 kHz at 1.0 mV, is injected continuously into the prostate. The nerves would conduct this signal better than the surrounding tissue. The DaVinci front end would have a filter tuned to the sending signal. This can be sensed inductively or by direct contact. If the tool detects the sending signal it sets a warning tone.

Post Edited (Worried Guy) : 8/2/2010 9:50:19 AM (GMT-6)


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 8/2/2010 10:14 AM (GMT -6)   
HiBill,
 
Thanks for the great post. I now have more respect than ever for surgeons, especially when they're successful in removing all of the prostate without destroying all the nerves. Seams to me an almost impossible task. I now understand a little better why so many guys are having some problem with ED.
 
Mag

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 days - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09=0.05; July 09 <0.04; JAN 10 <0.04; Jul 10 <.04

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 8/2/2010 11:09 AM (GMT -6)   
An interesting post, and a heart stopping video. I think I'm glad I watched this after surgery, not before!

As for Jeff's idea --- best I understand it --- of going at my prostate with an electrically charged knife, a al "the chair" at Sing Sing I'm really glad I'm not the guinea pig on that one! However, once Jeff has perfected this device (and he should charge a royalty based on use, not sell the technology) I'll be quite happy to take a cut of the winnings.

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
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 8/2/2010 12:05 PM (GMT -6)   
Hey Sheldon,
I probably should have spelled out what I was thinking. I meant a high frequency electrical signal at around 40 kHz, but at an extremely low voltage. Only a millivolt or so. It does not have enough energy to do anything and cannot be felt You are hit with 100 times that all the time from the lights in your house, the TV and radio stations in your neighborhood and the cars driving by on the road outside.
I'm just using the signal as an indicator.

I have lots of 40 kHz stuff around my house for a government project already. Why not use it for a medical project too?
I am thinking along the lines of SawStop (click on the video). However, instead of stopping the cutting or interfering with the surgeon's movements it makes an audible beep when the tool touches the nerve. The technology would help even the best surgeon identify what is nerve material and what's not.

Jeff (Missing at least 1.5 nerve bundles.)

Post Edited (Worried Guy) : 8/2/2010 12:10:18 PM (GMT-6)


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 8/2/2010 1:28 PM (GMT -6)   
This reminds me of the comment from Dr Dwight Harken (the U.S. Army doctor from WWII who pioneered open heart surgery).

When describing his heart surgery research in an interview he said:

All of his first 14 subjects died.
Of the second group of 14, half died.
Of the third group of 14, only 2 died.
Of the fourth group all survived.
The first 3 groups all of the subjects were lab animals ... (dogs).
The last group were all human patients.

Practice, practice, practice .. but not on me!

(Do urologists count lab animals among their 'surgeries total count' ? ;-)

Jim
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).

Post Edited (JimStars) : 8/2/2010 9:26:39 PM (GMT-6)


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 8/2/2010 2:26 PM (GMT -6)   
Thanks for the post. With my Gleason 8 and the fear of EPE which turned out to be the case, I told my surgeon to go wide and not worry about preserving the nerve bundles. So far, I'm happy with that decision.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/2/2010 2:48 PM (GMT -6)   
It's still pretty hard for me to equate open and robotic. I just can't imagine the surgeon being able to do as well without the robotic advantages.

Could be however, that accidents happen when he meant to go left but told the robot to go right. Kind of like when I rent an excavator. Peiodically I will move the lever the wrong way. Doesn't hurt the dirt very much, but glad I'm not around microscopic nerves.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

gold horse
Regular Member


Date Joined Nov 2009
Total Posts : 360
   Posted 8/2/2010 3:02 PM (GMT -6)   
skull idea shocked no wonder my jr was sleeping for several months. I admire the surgeons and the technology. yeah
DIAGN=46 YEARS
GLEASON=3+3
FATHER HAD PC,THEN I THEN MY BROTHER STILL HAS TWO BROTHER PC FREE.
MARRIED,TWO CHILDREN.AGE 13 AND 8.
LAPROSCOPY SURGERY 6/2005
PATOLOGY REPORT.
GLEASON=3+3
TUMOR VOLUME=5%
LYMPHOVASCULAR INVASION=NEG
PERINEURAL INVASION=POSI
TUMOR MULTICENTRICITY=NEG
EXTRAPROSTATIC INVASION=NEG
SEMINAL VESICLES BOTH=CLEAN
MARGIN ALL=NEG
PT2ANXMX
DEVELOP SCART TISSUE AND NEEDED A SECOND SURGERY BECAUSE COULD NOT URINATE,
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09
0.04,10/09,0.04
 

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/2/2010 3:54 PM (GMT -6)   
I have seen a couple dozen RP and RALP procedures. I've started to understand what they are doing, but I have to say that you can see why the more experienced the doctor, the better the results. Tewari is very well known for his work with RALP. I saw one of these videos on Youtube before I chose a doctor. So I chose a guy with 1500 behind the belt...

Or is that under the belt?

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/2/2010 5:15 PM (GMT -6)   
goodlife, its funny how all of us see things differently.

i see the opposite, i don't see how the surgeon could be as accurate without having his hands in there and having that tactile "real flesh" feel with an open surgery. as it were, I didnt have a choice to have robotic, but was real eager or interested in trying it even if i could. some people toot the "better magnification" with robotic, hard to argue that point with a huge LCD?LED screen in front of the console, but my surgeon said that hey have really improved magnification in most modern hospital OR's over the years, and that he too, has a large screen to watch on as well as he eyes when he's inside a patient. no right or wrong, robotics is definitely the prefered way by sheer number. even this urinary diversion surgery i am considering can be done robotically.

david
Age: 58, 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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 8/3/2010 11:10 PM (GMT -6)   
Mine was removed and my nerves were spared. It was done perfectly and "Mr. Happy" is working very well.
I searched for an experienced surgeon and thank God I found one. After getting the cancer removed, my greatest fear
was having no more erections. Five days post op I woke up with my first beginning erection. A little over two years later
I am just as pre op minus the semen. But everything else, erections, stimulation, orgasms etc are fantastic. If pc is found early and removed by an experienced surgeon the chances are good that you will be "back in the saddle agian".
    1. Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Open Surgery. Northeast Georgia Medical Center, Gainesville Ga. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible (less than four months post op) with the assistance of Cialis.  Post Op Biopsy : No malignant cells in lymph node. Gleason 3=4=7. Tumor on both lobes. Urethral margins/apex free of neoplasia. Right and left seminal vesicles free of neoplasia. No invasion of prostatic capsule of the resection margins are noted by the tumor. Tumor occupies 10 to15% of the prostate gland. Path staging T2c, NO, MX- Group staging II.  Focal areas of perineural invasion by tumor are noted. 80% natural erections and full erections with 10mg Cialis. 9/22/08-Took 10mg Cialis on Monday night, had very usable full hard erection at night, the next morning, and the following Thursday morning, 60 hours after original dose !! Orgasm quality Excellent.!!!!! I am pleased with the progress so far. Married to same wonderful woman for 39 years. She is still beautiful and sexy as ever. A great help in my recovery !!: 3/12/09: Full natural erections with penetration. 10mg Cialis makes them easier to maintain but I have had several med free full erections lately, Yipieeee !!!!!!!  3/24/09: One year PSA <0.1.  3/28 & 3/29: had sex with full naturals with no meds. Erections are gained and maintained with very little manipulation. Getting more like pre op every day. 5/30/09, I take only 5mg Cialis every 2 or 3 days. This greatly assists my full naturals and provides great staying power and no manipulation required and allows sex anytime !! Lenght and girth are back to pre op size due to regular "workouts". 9/09 PSA <0.1. 11/10/09: Full naturals without meds. I will sometimes take 5mg of Cialis if my wife and I have a big weekend or evening planned, but spontanous erections are fine even without. 3/27/10 PSA <0.1.
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