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positive 1
New Member


Date Joined Sep 2010
Total Posts : 7
   Posted 10/10/2010 3:53 PM (GMT -6)   
Hi all -- I've been perusing this site since my dad was diagnosed about 2 months ago. On Monday (10/4) he had an open RP. The doctor had to take the lymph nodes and nerves on the left side, but was able to keep the right side. He still has the catheter in, but has recovered very well. The doctor said he had the lowest amount of blood loss he's every seen in 30 years of doing this!

My question is -- with nerves on one side, how likely is it that he'll return functioning in regard to continence and ED?

His stats are:

Age: 67
2009 - PSA = 6.5
2010 - PSA = 8.5
Gleason was 6 (3 + 3) on one side and 7 (3 + 4) on the other. We don't have post-op gleason or PSA yet.

Thanks!

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 669
   Posted 10/10/2010 4:02 PM (GMT -6)   
Post-surgery ED is quite variable -- there are even cases where neither nerve was spared, yet no problems with ED (although that is very rare). A friend of mine who had a robotic prostatectomy said that his surgeon's technique was to emphasize retaining blood flow to the tissue during the procedure, and to minimize blood loss. If he is right, that could bode well for your dad as well. I had both sides spared, yet have had my share of ED problems (although there is life down there). I would say that the vast majority of men will say that they are never again as good as they were before the surgery, but again, that is quite variable. He should keep a positive attitude toward the whole healing process and not let setbacks get him down (more easily said than done). Requires a good bit of patience all around.
All my best
Jeff
Gleason,3+4;PSA,7.9,Nerve-sparing RRP,03/2008(Age 48 then),confirmed 3+4 Gleason,pT2c, 60g, neg margins; perineural & lymphatic invasion present;3 lymph nodes removed,clear seminal vesicle invasion:absent;Gleason 4 was 5-10%; PSA <0.1 until Oct 09:0.1; retest <0.1; scans clear;monthly results from Jan 2010:0.2,0.2,0.17,0.17,0.24,0.31,0.29,0.41, IGRT SRT started 8/4/2010, PSA@5 weeks into SRT:0.17

positive 1
New Member


Date Joined Sep 2010
Total Posts : 7
   Posted 10/10/2010 4:16 PM (GMT -6)   
Thanks for the quick reply Jeff. One thing to note -- I don't think his doctor's "technique" was to retain blood flow, I think it was just ironic that it worked out that way. At least that's how his reaction appeared. BUT -- I'm really glad to hear that it might help my dad! Do you have any thoughts on continence?

TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 10/10/2010 6:09 PM (GMT -6)   

Hello Newbie,

Regarding your Dad's recovery, first things first. open surgery requires a significant time to recover from and then there is the catheter period, then there is the continence control period and then....there is consideration of the ED issue. There is no guaratee, even with both sides spared...BUT there are techniques and technologies to help in that department. Nevertheless, take from many here that the last thing on the spectrum of recovery is the ED issue.  Be there for him while he recovers...

Ted


positive 1
New Member


Date Joined Sep 2010
Total Posts : 7
   Posted 10/10/2010 6:58 PM (GMT -6)   
Thanks Ted. Perhaps I should have explained a little more. Prior to the surgery, at my dad's pre-op appt, the doctor did not think he'd be able to salvage any of the nerves (based on his expectation of the size of the tumor). My dad, who is normally a very happy-go-lucky person, was SO depressed from that point on. I had never heard his voice so lifeless. So, we were just thrilled when we learned that the doctor was able to save 1/2 the nerves. We're not trying to rush his recovery, we were just wondering what others' experiences have been when 1/2 the nerves remained intact.

T40
Regular Member


Date Joined Oct 2009
Total Posts : 103
   Posted 10/10/2010 8:33 PM (GMT -6)   
Well, I'm a lot younger then your dad. I'm 42 now and with 1/2 the nerves spared at the 14 month mark I see good results with Viagra and recently was able to function without any supplements at all. I can certainly confirm that eating a high fat dinner will delay and even cancel any benefit that Viagra can help with. Doggone her chili was good eating though.
Age 40
Pre-op PSA was 5.8 from wellness test on May 19, 09
Follow up test from uro was 4.6 with a 9.3% free psa
Gleason 3+3 in one core, 3+4 in second core of 12 samples taken
Surgery performed 9-19-09.
One side nerves spared. Nerve graft on other side.
One year mark Viagra works 100%. Pump works 100% new PSA on 9-10-10. Last PSA .005

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 10/11/2010 5:04 AM (GMT -6)   
Welcome to the site and glad to hear your dad is recovering.

It's a bit impossible to predict outcomes, but all I know about erections it that they need a combination nerves and blood, so if your dad had very little blood loss this should mean that there was very little damage to the blood vessels, which may be helpful in the future.
As for the nerves it is more complicated. There can be all manner of nerves around the prostate, it's not simply a case of one down the left and one down the right both of which deal with erections; there may be as many as fifteen different nerve groups.

Continence is not controlled by these nerves. The problem with continence after surgery is due to the fact that you can't remove the prostate without removing the muscle at the bottom of the bladder as well. This only leaves the muscle in the pelvic floor to squeeze things shut, something which may or may not work adequately. Kegel exercises help train and strengthen these muscles, but shouldn't be done when there's a catheter in.

I think your dad needs to do what most of us do here which is to reckon that priority number one is kicking out the cancer, priority two is getting control over the continence and three is dealing with erections. That said, the penis should not be ignored. There's no harm in giving it regular gentle reminders about what it does, anything that gets a bit of blood flowing in it will help keep the tissue supplied with oxygen and nutrients and keep it healthy. Don't expect miracles, but don't sit back and do nothing either.


Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/11/2010 10:19 AM (GMT -6)   
positive

i am on the rare group, right side nerves only, and have never experienced a single day of ED, nor have used any pumps, ED drugs, or injections My case proves it is possible.

david
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

positive 1
New Member


Date Joined Sep 2010
Total Posts : 7
   Posted 10/11/2010 1:44 PM (GMT -6)   
Thanks to all of you who've responded. You've definitely educated me on some things that I wasn't aware of. I know with man, little is possible -- but with God, all things are possible. So I know that my dad is in good hands. :-)

I hope and pray that all of you experience complete healing and comfort from the only One who can provide it!

Warmly,
Positive 1

MslaBob
New Member


Date Joined Oct 2010
Total Posts : 5
   Posted 10/11/2010 2:49 PM (GMT -6)   
Hi Guys,
Pre-newb here with a question
I just got a call from my GP saying my routine annual PSA results were 4.24. Last years was .91 so she is referring me to a Urologist. I am 56 male with no symptoms and my DRE was fine last week during my annual physical. I have no family history of Prostate problems.
I had my PSA test done about 15 hours after my DRE,can this cause a high reading?
During my physical and DRE last week my Doc told me she was just getting over Strep. Could she have caused this spike in the PSA?
Thank you.4

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 10/11/2010 3:22 PM (GMT -6)   
<she was just getting over Strep. Could she have caused this spike in the PSA?>
 
Were are a bit OT for this thread ..  You will likely find many treads on this subject..
 
But - to your question --  From what I know - Absolutely no way !  
PSA - Prostate SPECIFIC Antigen (Check other threads), results from Prostate cells being 'angry' - you might say..  
What may have been warranted, would be to wait a few weeks and just get another PSA, but ensuring that there is no  yeah   for two days minimum.
 
Naturally -  ejaculation "Excites" the Prostate and can (will) raise the PSA.
Inspite of a possible repeat PSA of say  3,  you would want to start looking more closely at your situation.
A jump like you have seen, would warrant close watching
 
The trip to the Urologist would still be reassuring but there are some who think that unnecessary Biopsies can be hazardous, in themselves.
 
Moderate all choices with past family experience with PC..   If you have PC in the line, act sooner than later.
 
 
Have a look at some of the threads at the top of the pile..  and use the(Google) SEARCH facility on the top line.
 

PSA values for each age group:  (I think these are still current)

1.7  +/- 1.1 ng/ml for 40–49 years

2.0  +/- 1.2 ng/ml for 50–59 years

2.9  +/- 1.7 ng/ml for 60–69 years

3.5  +/- 2.0 ng/ml for 70–79 years

   You can find the report here: http://www.springerlink.com/content/b7p26t840570q0x5/

 

 

Whatever - just understand that whilst it's YOU, that is being trialed and tested, there are a great many of us out here, and early detection of a problem can be a true   'Life-Saver'..  .... I hope that it saved MY life as it did, my Brother.

At age 60, I had NO indication of a problem, and the finger was negative, and an ultrasound (Bx) showed nothing,, BUT - viralent cancer was there.

.

PS - Don't respond - You could start a new thread if you seek more comment
.

Nov 09 = First-PSA 5.3 @ 60yo - Asymptomatic - DRE-Non-Palpable
Jan-2010 = TRUS Bx DX - AdenoCar T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
May25-2010 = RRP- Nrv-Spare
Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
Margin-Involvement (extensive) Posterior , Grade3 x 8mm
+8week PSA<0.01, ED-85%, Incont-30%
+16W PSA<0.01, ED -85%, Cont -5%
+17W First 'DRY' day. ED -90%

Post Edited (BuiDoi) : 10/11/2010 3:47:37 PM (GMT-6)


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 10/11/2010 9:32 PM (GMT -6)   
I lost one nerve bundle and some lymph nodes with big blood loss during open surgery and have had no problem with ED from day one and I was fully continent after one week
Age 64 From UK now in Thailand Baby boy born 2/14/2009
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/09 24 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear 
Open surgery 7/27/09
Prostate Gland weighting 34 grms lost one nerve bundle
Gleason upgraded to 3+3 Tumour not close to prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
First PSA Nov 2009 was 0.06 April 2010 0.08 
Continence 99% occasional stress dribbles no ED from first day after catheter removed

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 10/12/2010 12:50 AM (GMT -6)   
As others have indicated, continence does not depend on nerves being spared. I had no nerves spared, and was fully continent from day one.

ED however is another matter! 2 1/2 years out, I have seen some recovery in erectile function, but nothing like it was before surgery. I now rely on a pump, and while sex is different to before it is still very enjoyable. ED is not so bad -- there are far worse things that can happen.

So even in the worst case, (no nerve function) your father should still be able to do what he enjoys. And as he has had some nerve sparing, he will very likely end up better than I am, so there is plenty to be positive about.
Pre-op:
Age 63 at diagnosis, now 65.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve-sparing open surgery on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
25-month: 0.2 (yes, bummer)
27-month: 0.2 (not up; glad about that)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. At 18 months, "graduated" to just the pump.
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