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BRONZE

Don Flieg and Joanne live in Georgia, USA. He was 50 when he was diagnosed on January 7, 2009. His initial PSA was 7.9 ng/ml, his Gleason Score was 9 and he was staged T2b. His choice of treatment was Da Vinci Robotic prostatectomy. Here is his story.

I had no symptoms, I went for a physical (my wife made me go and she probably saved my life). The doctor performed the DRE (Digital Rectal Examination) and told me my prostate is "slightly enlarged, but not uncommon for my age". The next day he called and told me my PSA was "slightly elevated" and I should see a urologist and have it checked out.

The urologist felt a nodule on one side and told me we needed to do a biopsy and that I was at stage T2b. The biopsy came back with 10 of the 12 sites having cancer with scores of 8 and 9. I did go for multiple opinions and see two surgeons and one oncologist. All three doctors were extremely worried about my Gleason scores and the possibility of cancer cells leaking out of the prostate. They all said my situation was not "normal" for prostate cancer and I should educate myself quickly and make a decision on the procedure.

On February 11, 2009, 5 weeks after the biopsy I had the Da Vinci robotic radical laparoscopic prostatectomy. At 5 weeks after surgery I had a blood test and my PSA was undetectable.

It's been 7+ weeks now and I feel excellent. I started walking/jogging 2.5 weeks after surgery and now I am running 3.5 miles 3-4 times a week.

The post-op issues of incontinence and ED I do have. I have very little if any urinary control. I am working diligently on Kegels for the incontinence and using a pump to encourage blood flow back to that area along with using alpha blockers.

 

UPDATED

July 2009

 

 

June 30, 2009. I am now about 20 weeks post-op, my PSA came back Friday as 0.14, which is up from undetectable 12 weeks ago. I knew there was a chance for this but it's still very disappointing.

With the development of the rising PSA, I am making an appointment with an Oncologist today to see what treatment we can start. I'm assuming I'll have the beam radiation treatment. My surgeon told me they will probably do another blood test themselves and that usually they will not start any treatment until the PSA is at a 0.20 level or higher.

I am making progress with the incontinence, I stay dry at night and also stay dry usually if I am just sitting. If I'm lifting, bending or moving, I still leak easily.

There is really no sign of life in the ED department, though I've had 1 or 2 notions of a feeling of growing but it's fleeting and gone just as fast.

Later: July 23, 2009:

Well, I did go see the Oncologist and on July 3, I was put on Hormone therapy (Casodex)for the next 6 months.

In 2 months (Sept. and Oct.), I will have beam radiation treatments while still on the hormone therapy. The reason for waiting 2 months is to let my incontinence issues get a little better prior to the radiation. The doctor said radiation will affect the bladder and so it will be one step forward and 2 steps back in regard to the incontinence.

I've been on this hormone therapy now for 20 days and really haven't seen any of the side affects my doctor talked about (possibly in the last 2 days some tiredness).

 

UPDATED

March 2010

 

 

Since my last update I've started and finished Beam Radiation and finished the hormone therapy as well (both finished on Oct 30, 2010). The hormone thereapy slows down the growth of the cancer and the radiation is the best chance to kill what is there. Beam radiation can isolate very specific areas to treat.

My PSA was low enough that we can't tell where the cancer actually is since I do not have a prostate any longer but it's assumed to be in the prostate "bed" area. I didn't do a 6th month of the hormone thereapy (as previously planned) due to finishing the radiation and wanting to see how effective the radiation was. The PSA test will be artificially low until the radiation and hormone therapy is "out of my system" which I'm told will be 6 to 12 months.

It's been 4 and 1/2 months and I'm still having hot flashes, although they seem to be much more prevalent at night than day (not quite every night, either). Libido is still non existent. I still have the stress incontinence which did get worse with the radiation and is possibly slightly better now after these 4.5 months.

I am getting a PSA test drawn today but it SHOULD be >.1 still because of the therapy affects. In 3-4 months I'll get another and we should start to see a "real" PSA result... I'll let you know.

 

UPDATED

April 2011

 

 

Well, after 11 months since the radiation was completed my PSA test was still <0.10 and we looked at seeing if the incontinence issue could be helped.

After much researching into the AUS and the Sling procedures we decided to have the AdVance sling procedure. The recovery on the sling procedure was more painfull than the robotic surgery I had. Unfortunately, the result was no better if not worse than the before the procedure. I knew the chances were less than most due to the radiation and atrophy in the muscles of the pelvis.

45 days went by with zero if not negative results. On January 17, 2011 I started an off-label use of Cymbalta. Even though I had reservations because of what the drug is normally for (depression) I went ahead and tried it and it's been amazingly beneficial for the incontinence. I would say the improvement is excellent; from 3-4 pads a day to 1 pad a day; with inactivity, it wouldn't even be wet.

On February 1, 2011 my PSA was 0.12, so it's baaaack. No treatment yet, we will get another PSA in 3 months to check the rate of rise in the numbers. According to the doctor, if no change nothing needs to be done but if large change is happening, I'll be put back on hormone therapy....

Don's e-mail address is: don.flieg@maquet-inc.com