Good results with surgery?

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Gleason 6
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   Posted 5/10/2011 2:56 PM (GMT -6)   
After seeing the Urologist I am thinking more about surgery while waiting for my appointment with the RO. The stats the Urologist gave me were that 90% of patients are continent 6 weeks out. ED can take a year or two, but will come back if he can spare the nerves (and he can spare the nerves 80% of G6).

It doesn't seem like the discussions here back up those stats, but maybe the people with no problems don't post. Any thought?
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6 (3+3)
CT bone scan neg
6/18 areas positive - 2 in left base, 4 left apex. 6/40 cores pos. 33cc.
Stage T1C
Meeting with Dr. Wehle @ Mayo 5/4/11

Steve n Dallas
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Date Joined Mar 2008
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   Posted 5/10/2011 3:07 PM (GMT -6)   
Sounds like he was using nice round numbers cause he can't predict with 100% accuracy what YOUR results will be.
Did you like the guy? Was he open - friendly and seemd to really be concerned with you and your situation?

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Date Joined Jan 2010
Total Posts : 7089
   Posted 5/10/2011 3:28 PM (GMT -6)   
And yes, if you spend as much of your time as some of us do on HW, it is because you have bigger issues than the average patient, or you just like to help the new guys. Maybe both.
A lot of men have surgery and in a matter of months, they move on. Happens often at my support group, where primarily younger guys are there and gone in a few meetings.
My uro told me 98% get most continence back in a year. But then I knew better. So at 18 months out I am still in the 2%. Then you need to ask him, "Precisely, what do you mean by Continent? Leak Free, Pad Free (i.e. no drips ever); a guard pad to catch the occasional leak, one pad used a day, two pads a day", etc. You will find that many uros think you are continent if you don't leave a yellow trail in the snow. For me, dry meant stone dry. I wasn't expecting to have to invest in Depends. So in that discussion, I'm not as happy as I would have liked to have been.
DaVinci 10/2009
My adjuvant IGRT journey (2010) -

Regular Member

Date Joined May 2011
Total Posts : 33
   Posted 5/10/2011 3:54 PM (GMT -6)   
I had three Dr. opinions as well as speaking to as many people as I could who have prostate cancer and read volumes of information before deciding. Whatever you decide, go in with a positive attitude. Also do your homework on the surgeon or radiologist that would do your procedure, if you decide to go that route. Just my humble opinion.

I have absolutely no regrets, and I wish you well on your journey.
Age: 55 Ontario, Canada
PSA: 1.2
Dec 2010: Family Dr. found lump on routine physical (not there 1 year prior)
Feb. 6 2011 biopsy: 3 of 11 cores, T2a, Gleason 6 (3,3)
Urologist recommended "watchful waiting" ...back to my family doctor he recommended surgery.
Back to Urologist asked him to refer for third opinion (he did so reluctantly)
3rd opinion: Urologist recommends surgery
April 15: open radical prostatectomy
April 27: catheter removed...absolutely no ED issues and a little incontinence.
May 6 2011: Pathology report excellent, cancer confined to prostate, Gleason score remained at 6!

New Member

Date Joined Feb 2011
Total Posts : 3
   Posted 5/10/2011 4:13 PM (GMT -6)   
I'm one of those people.
 I had open surgery in Boston on 3/15. Home on the 17th and catheter out on the 25th. Very happy to report that even with 9 cores positive and palpable on the left side my surgeon was able to spare both nerves, pathology came back clean and my 6 week PSA was 0.001! I really couldn't have written a better outcome. I did wear pull ups for a week or so then went to a pad but really never noticed any wetness. Finally after about 7 weeks I stopped wearing that and am completely dry.
ED is my last hurdle. Not much happening yet but I can see (and feel) more tone down there so  I am optimistic that it won't be too much longer. 
I went from "What The *#@&* "in January to taking calls from new guys looking for advice. What a ride!

9/12 cores positive
Gleason 3+3-6
Stage T2a
Palpable nodule left side

Post Edited (Seeker317) : 5/10/2011 3:25:43 PM (GMT-6)

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Date Joined May 2009
Total Posts : 2692
   Posted 5/10/2011 4:23 PM (GMT -6)   
I hope you have also seen a radiologist and discussed Brachytherapy. For a G6, I think you might be happier quicker. The apical cores could indicate a positive margin potential. BT can be more effective because it can penetrate beyond the capsule.

Be careful with stats. 90 % in my opinion is a little high. As 142 pointed out, some doctors have different definitions.
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

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 5/10/2011 5:16 PM (GMT -6)   
There are a lot of QOL studies for both surgery and Brachy. You will have no problem finding them on Pub Med or The New Prostate Cancer Infolink.
This is just one of the many head to head comparisions at 5 years:

Do your own research and come to your own decision as you and not others will have to live with the choice as there are no "do overs"
On an individual basis many patients do very well and on the other end of the spectrum others have horrific results. The key to happiness is to have realistic expectations going into treatment. 90% continence at 6 weeks and 80% potency may be realistic for a 40 year old with an expert surgeon; but is not a realistic outcome for most patients.

66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

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Date Joined Jun 2008
Total Posts : 1804
   Posted 5/10/2011 6:45 PM (GMT -6)   
Gleason 6, I get nervous when I hear doctors quoting percentages especially about ED and incontinence. The surgeon really has no idea what he's facing until the actual surgery...for instance, if the cancer is close to the edge and the doctor decides to cut a very wide margin, the patient could lose part or all of that nerve bundle, or the nerve could be damaged.

I wouldn't term my husband "incontinent" at 3 years post op but he has days when his bladder is very active and he struggles to control it. If he's at work or will be away from home for long periods, he will still use a pad just in case. But, neither would I term him 100% continent (in terms of where he was prior to surgery) but he's not unhappy with the overall results.

As far as ED, my husband still has both nerve bundles but is not able to achieve a complete erection without the little blue pill.

I agree 100% with John T...we were given similar statistics by the surgeon and, because we did not know better, were relieved that the side effects would be minimal and wouldn't last long. While we are grateful that the surgery has been a success in terms of cancer control, we now know that ED and incontinence are two of those things that no one can predict.

Regular Member

Date Joined Sep 2010
Total Posts : 225
   Posted 5/10/2011 6:47 PM (GMT -6)   
I had successful surgery last August 2010 with no complications: So far PSA is <.1, I have no incontinent from the moment they took out the catheter and have no ED.

And as I continue to have no issues, it seems I am posting less and less as time goes on. Speaking of that, I notice davidg is not posting much lately either?
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Organ confined, negative margins, Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason 4+. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 no incontinence, no ED. 3/2011 PSA: <.1

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 5/10/2011 6:54 PM (GMT -6)   
Four years post surgery, no incontinence, ED and cancer is in remission in spite of advanced staging. It's been a ride but I wouldn't change the approach.

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

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.


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Date Joined Feb 2011
Total Posts : 4093
   Posted 5/10/2011 8:46 PM (GMT -6)   
I had surgery.

I have not used a single pad since the day the catheter was removed. I get erections with and without meds and am 4 months out of surgery.

In retrospect I look at the surgery and think it was easy.

I believe our age, fitness, sexual "health" heading into surgery and mostly, the skill of the surgeon improve chances for successes with quality of life issues.

I have spoken to a number of patients of my surgeon and we're all doing well.

In my experience, because of my results, surgery was a no brainer. But you must be comfortable with it and with your potential surgeon.


Regular Member

Date Joined Dec 2009
Total Posts : 154
   Posted 5/10/2011 8:54 PM (GMT -6)   
g6, i`m one of the surgery posterboys, no continence issues from the getgo and very little ed. i am now at 15mo. post surgery and my last psa was 0.00 and ed is mostly a nonissue. there is light at the end of the tunnel and it isnt a train.
Dx at 50 in 12/09 Merry Christmas its cancer....
3 of 12 positive, right side only, psa at dx 2.6 free%14
gleason 3+3=6
routine physical, no symptoms
Da Vinci performed Feb 2k10 by Dr Marc Milsten [hes got mad skills]
99% continent from cath out, mr happy fully functional at 2 weeks out!
path showed same gleeson with no other blips other than one slight margin, organ confined 20% right, 5%left, 34grams
Hernia repair Mar 2k10, hernia was side effect of the surgery
30 day psa 0.03- 90 day psa 0.01

Gleason 6
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Date Joined Mar 2011
Total Posts : 876
   Posted 5/11/2011 7:51 AM (GMT -6)   
I did ask the doctor what his definition of continent is and he said dry, no pads. He did qualify it by saying that "If you were at a party and had a couple of drinks and someone asked you to help move a piano, you may leak a couple of drops." In my mind I took that to mean that if you lift some heavy weights, you may leak a bit. I'm a pretty active guy and I wonder if leaking would be in the back of my mind (no more khaki I guess).

The Urologist I saw was not associated with the first Urologist. He is a Mayo doctor and has done over 500 robotic surgeries. He did say that a positive attitude helps.

I do have an appointment scheduled with a RO next week at the Mayo.
Age 61 Active. No other problems (except small hernia)
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6 (3+3)
CT bone scan neg
6/18 areas positive - 2 in left base, 4 left apex. 6/40 cores pos. 33cc.
Stage T1C
Met with Dr. Wehle @ Mayo 5/4/11
Appointment scheduled with RO Dr. Buskirk at Mayo 5/17/11

Regular Member

Date Joined Sep 2009
Total Posts : 464
   Posted 5/11/2011 7:52 AM (GMT -6)   
I was diagnosed in 2007 with Gleason 6 with psa of 4.5 and had nerve sparing robotic surgery in sept of 2007.  I have had no ED issues and was getting rock solid erections from the day the catheter was removed, and without drugs.  Continence wise, I used pads for 3 months but was 99% dry after that. I still have stress drips now and then, but nothing I can't live with.  

Regular Member

Date Joined Nov 2009
Total Posts : 254
   Posted 5/11/2011 11:22 AM (GMT -6)   

Operation January 2010- As my doc said goals are

1.  Cancer

2.  Continence

3.  ED

I was very fortunate that I was 3 for 3 and 2 and 3 were within 3 months. 

One word of advice would be to find out what he thinks he can offer in regards to number 1.  Thats what really important.









Regular Member

Date Joined Apr 2011
Total Posts : 43
   Posted 5/11/2011 1:28 PM (GMT -6)   
My decision to proceed with surgery has been largely based upon the above logic:

1) Treat the cancer (with as aggressive a method as possible).

2) Deal with continence issues (IF they occur).

3) Deal with sexual side effects (IF they occur).

Treating the cancer as aggressively as possible is my first priority. I actually called and discussed this (for the xth time) with my wife before posting it. She 100000% agrees with our approach in spite of the fact she'll be "suffering" through the potential side effects with me.
DX 4/26/11 (Age 36)

6/15/09 PSA 2.1
3/17/11 Lost my father to Prostate Cancer that had metastasized to his bones (Age 59)
3/30/11 PSA 2.5 & Abnormal DRE (Nodules felt) found during post-op for extracorporeal lithotripsy procedure
4/18/11 Biopsy
4/26/11 Biopsy Results = 3 of 12 Cores Positive (both lobes) with Gleason 6 (3+3)
5/5/11 CT & MRI = Negative for metastatic cancer

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 5/11/2011 2:42 PM (GMT -6)   
I went in the exact same way as you, Architect. I came out greatly relieved. There is no reason you shouldn't do great on all three fronts, no reason at all. Things will be a little different for some time but I wouldn't classify it as bad. It's a process, one you have already started and one you will gain confidence in within days after your operation.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX
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