Les and DB get bad news from biopsy, now what?

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Regular Member

Date Joined Jun 2004
Total Posts : 231
   Posted 10/26/2007 3:35 PM (GMT -6)   
Hi Kids,
Well after 10 days we finally heard, one core positive, gleason 3+3.  I have no idea what that even means but that's what I will learn from you guys.  We meet on Tues to talk. 
  1.My hubby has been constipated for 30 years severely, and I know this is not going to help healing after surgery.  How can we start to work on that now, and through the healing time.  He takes 2 stool softeners each day and milk of magnesia every third day. The pain meds are constipating aren't they.
  2.I think he is going to get the robot surgery. Do they have any comparison charts as to the difference in incontenince, ED, getting all the cancer out, between the two types of surgery?
  3.Before the surgery should they do a bone scan or CT?
  4.What questions do we ask the doc at our meeting? I know the surgeon has done around a hundred by now with the robot.  We live in the wild west so that is probably the best we can do as far as experience.
  5.How and when do they check the lymph glands and are they in the legs, or abdomine?
 DB is so scared and me too. Thanks for any info and help.
Les (Hopeso) 

Cedar Chopper
Regular Member

Date Joined Mar 2007
Total Posts : 432
   Posted 10/26/2007 4:26 PM (GMT -6)   
Les & DB,

It sounds like you two have done a lot of research already.  I didn't catch DB's age.
I don't think it is relevant for the questions you asked.

1) Constipation will require some strategy from your surgical team - and it can strain the urethra sutures some.
     Opiate based pain killers do cause constipation.  I'm not certain about synthetics.
    It will likely require less pain killers with Robotic.

2) One member here has a doctor who was keeping records to prove the open surgery had better recovery rates from both incontinence and E.D.  His last report was that he had proven Robotic had better healing rates for both.  One doctor does not a statistic make.....   The consensus I've read is that an experienced open surgeon is usually a better bet than a beginner robotic - especially both a 'beginner robotic & novice open...."
Experience being the key word. Your surgeon's 100 robotic surgeries is not the magic number everyone here asks for.  However, if he/she has done 1000 open and has great success rates with incontinence and E.D. (especially with the 100 robotic!), I personally would not hesitate.

3) Some believe the bone scan and/or CT are stat. 
  However, with your low numbers and plan to remove it, many like you do not receive either.

4.) Ask about recovery rates for incontinence and E.D. 
   Ask how long the catheter will stay in.  (Many surgeons remove it in one week.  Some in 3 weeks.  They may leave it in 3 weeks if constipation strains the urethra sutures.)
   Read Bluebird & Buddy's Journey and as many others as you can for questions. 
   There may be a thread on questions in helpful hints.  I recall Swim always seems to have the best short list of questions.
    I always suggest a second opinion from the best facility you can manage.  Even if you have no intention of using the second source, it is a great place to field questions and reaffirm what you believe/plan.

5) There are lymph nodes in so many places. I'm not certain but I believe in an RP they check those nodes in the "pubic" cavity (not abdominal) and some of the lower glands they check while there might be inside the thighs.  If they do check yours, the decision to do so is often done while they are inside.  I'm not certain it is always done, especially with low numbers and apparent containment visually verified while inside.

"Hope is the thing
with feathers
in the soul
that sings a song
and never stops
    ....at all.."
(paraphrasing Emily Dickson)  [It might be a "Bluebird!" eyes ]

2 Years of PSA between 4 and 5.5  + Biopsy 23DEC06 
Only 5 percent cancer in one of 8 samples.  +  Gleeson 3+3=6
Radical Prostatectomy 16FEB07 at age 54.
1+" tumor - touching inside edge of gland.  + Confined:)
Pad Free @ 14 weeks.  Six Month PSA <.003  :)
At 6 months, ED treated with Pump Exercises & 50mg Viagra Daily
Texas Hill Country FRESH Produce Department Manager
Have you had your 5 colors today?

Regular Member

Date Joined Jun 2004
Total Posts : 231
   Posted 10/26/2007 5:57 PM (GMT -6)   

DB is 56 and believe me he has tried every regimine to get the bowels going.  The docs have tried many things and to no avail.  He would drink a half gallon of apple cider each day. (gained weight doing that one)  He ate bags of raisins, oatmeal, prunes, wheat germ, all experiments lasted several weeks, and no help.  DB eats good food and is very active in sports.  He just poops rocks. Don't tell him I said that.  We went up and got Dr Walsh's book but it dosen't cover the ins and outs of robotic surgery.  Any books on that?

Thanks and please keep posts coming. 

Les and DB

Veteran Member

Date Joined Oct 2006
Total Posts : 626
   Posted 10/26/2007 6:20 PM (GMT -6)   
Les and DB,

Your question about what a Gleason of 3+3 means and one core positive has not been answered yet. Those results are exactly what mine were. First, the overall indication from these results is that the cancer has been caught early and it is curable. The Gleason of 3+3 means that the cancer is moderately aggressive. If you were to take an average of all the biopsies done and the results that average would be 3+3. Your uro will discuss treatment options with you. Sounds like you are leaning toward surgery. One advantage of robotic over open is that there is less pain therefore less need for pain medication. I never had to take any pain medication with my surgery. I am sure that the surgical team will handle the constipation fine. Of course, for two to three days he will be on a liquid diet. In my case the protocol followed by my surgeon was nothing by mouth, not even water or ice chips, for for several hours. I came out of recovery at 2:00 PM and did not have anything by mouth until 7:00 AM the next morning. When I asked why I was told it was extra precautions to avoid any problems.

We are here to help as you go on your journey.

Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07
Began injections in April '07
Undetectable PSA on 6/25/07

Regular Member

Date Joined Sep 2006
Total Posts : 211
   Posted 10/26/2007 7:22 PM (GMT -6)   

With recent more extensive screening, more men are being diagnosed with early stage PC, moderate Gleason scores of 3+3 in only one or two samples. It's rare to have a Gleason score of less than 6.

Biopsy readings are subjective: it's worth obtaining a 2nd reading of the slides if that hasn't already been done.

Selection of a top surgeon is more important than the method used. 

Dr Scardino discusses robotic in one section of his book but I don't know of any comprehensive publications on it. There's plenty of online information: for example  Dr Stricker who is a top surgeon has details on nerve sparing robotic surgery in the news and treatment sections of the St Vincent's Prostate Center website. 

Veteran Member

Date Joined Apr 2007
Total Posts : 823
   Posted 10/26/2007 7:48 PM (GMT -6)   

Hi.  Narecotic pain killers can cause constipation.  Ask you Dr. about having an epidural.  I had one and it helped me to stay away from the pain killers and I was not groggy at all after surgery.  Good luck to you and let us know how things go.



Regular Member

Date Joined Aug 2007
Total Posts : 120
   Posted 10/27/2007 10:42 PM (GMT -6)   
The meds in the hospital have a tendency to stop all body functions, that is why patients sometimes stay an extra day to get things moving again. My surgery was on Tuesday 1PM, lasted 5 hours, soft food diet for the next 6 meals ( Jello, Juice, Italian Ice, Tea, Coffee, ) you get the idea. Dr. would not release me until BM or gas passage. Sore for a couple of days, but did not have my pain meds filled. My Gleason score was higher than your hubs. I suggest you go to my thread and read the posting there. I believe it will give you a good idea about what to expect as you travel this road of many twists. A positive attitude is the next best thing to a great surgeon. I feel like I have had a very easy time with it and would not hesitate to do it the same way if I had it to go through. Remember you have a few weeks to work and study as most surgeons do not like to operate until the inflammation is resided from the biopsies. Good Luck and God Bless, Uncle Dan
Age 67
No symptoms, DRE negative, 10 - 06 PSA 5.44, 01 - 07 PSA 6.47
5 - 07 CT and Bone scans negative, 05 - 07 Biopsies, 2 of 6 positive
Gleason Score (3+4) 7 Stage T1c
08 - 14 Dr. Dasari - Baptist Hospital, Nashville da Vinci RAP, five hours surgery
Some right nerve and all left nerve removed,
Hospital discharged 8 - 16
Pathology report Negative margins, Encapsulated, 50% left side
Lymph nodes 2 R & 1 L - Negative, R & L seminal vesicles - Negative
Gleason changed (4+3) 7 closer to 8 than 6
9 - 26 Great PSA 0.000, 9 - 27 Starting on meds for ED
10 15 Dry most of the time, occasional leak (dribble )
Viagra no help yet, will try Lavitra ?

Regular Member

Date Joined Jun 2004
Total Posts : 231
   Posted 10/29/2007 9:22 PM (GMT -6)   

Thanks all,

Seeing doc tomorrow for more info. 

Les and DB


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