YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

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Mike C and Ellen live in Columbus, Ohio. He was 67 when he was diagnosed on November 16, 2009. His initial PSA was 4.95 ng/ml, his Gleason Score was 7 (3+4) and he was staged T1c. His choice of treatment was Surgery (Da Vinci). Here is his story.

My GP thought my prostate was a little too firm and when the PSA came back at 4.95 recommended a check by a urologist. The urologist thought the change in the prostate was "marginal", but said the slight change and the PSA score recommended a biopsy. When the biopsy came back with a Gleason score of 7 (3+4) the question became choice of treatment. The three urologists I consulted all said watchful waiting wasn't a good option, but if I wanted to wait. . .

After reading everything I could find on the PCRI, PCI and Sloan Kettering websites, and plugging my scores into the Sloan Kettering Katten nomogram, surgery and IMRT (Intensity Modulated Radiation Therapy) seemed to offer the best probabilities of 5- and 10-year non recurrence. I chose surgery because radiation is possible after surgery if there should be a recurrence, but surgery usually isn't an option after radiation. Also, examination of the prostate, seminal vesical and the lymph nodes after surgery can tell if the cancer already has spread. That is, you know with a good deal of certainty after surgery if the cancer is gone. With radiation you are guessing, at least until the first post-op PSA scores come in.

My surgery was by Da Vinci method by Dr. Rashmi Patel at Mt. Camel West Hospital in Columbus. The pain was virtually non existent and I was in hospital from noon one day until 6pm the next day (including the surgery).

Since the catheter came out I have had the expected incontinence, but I'm down to one pad a day after seven weeks, and seem to be improving daily, though it's some times seems two or three good days are followed by a not-so-good one. I haven't had an erection since, but Dr. Patel put me on to Viagra at my six-week check up and said not to expect much result for several weeks, so I'm very hopeful. My wife and I have learned there can by a sex life without erection.

My first post-op PSA score was a nice fat zero! Perfect! I've resumed my normal activities, and even went snowboarding seven weeks after the surgery to celebrate my 68th birthday. I'm happy with my decision, especially as I know that, except for the possibility of micromets (stray cancer cells), I'm cancer free with, according to the Katten nomogram, only a 1% chance of dying from prostate cancer within 15 years.

 

UPDATED

June 2010

 

 

At my second post-op check up today, June 7, 2010 (surgery was Jan. 28, 2010), my PSA score remained at less than 0.1, and Dr. Patel was pleased. (The six-month check-up was three weeks early because of travel plans).

Incontinence is no longer a significant issue. I generally have no leakage, even when I cough or sneeze, except when I have to lift something heavy while also twisting (such as dragging my 135lb Laser sailboat out of the water on to a dock, and then on to my dolly). Then I sometimes have a tiny squirt. This is a huge relief. In five months I actually used just over half a package of men's pads. Now, if I know I'm going to be particularly active, as when sailing, I steal one of my wife's panty liners, and that's more than enough. I'm still working hard at the Kegels, with help from a rehab center. I learned that I haven't been doing them correctly, and even after two bio-feedback sessions, I'm still not sure I always get them right. Dr. Patel emphasised working at them.

There is still no progress on the ED front, even with the Viagra -- not even a hint of an erection. Dr. Patel said not to worry since it was just over five months after the surgery, and said nerve repair and regeneration can take up to a year. He recommended I use a pump daily in the meantime to keep the blood flowing in the penis. Anticipating this from info on the web, I bought one last week and I'm awaiting delivery. Nevertheless, Ellen and I have an enjoyable sex life.

Since my first post-op visit I have received the post-op pathology report. It upgraded my staging to T2c, and the tumor was described as "multifocal and bilateral with the largest focus of tumor in the left posterolateral region of the gland and measuring 1.4cm in the greatest dimension." The gland itself weighed 65 grams, was 3.2cm apex to base, 4.3cm from front to back, and 4.9cm in width. As mentioned in my first report, there was no lymph node invasion or seminal vesical invasion.

In short, I'm feeling 100% and reassured, and still confident I made the right decision for me. I still can't get over how pain free the Da Vinci surgery was.

 

UPDATED

September 2010

 

 

At my third post-op check up today (Sept. 10, 2010), my PSA was undetectable. I was able to tell Dr. Patel that incontinence was a non-issue. I have not had any leakage in more than a month, despite vigorous exercise including cycling, sailing my Laser sailboat (and hauling its 135lbs out out of the water on to its dolly), and crewing for my son in a 3-day regatta which saw us on the water for five hours or more a day.

ED is a different matter. Despite 100mg of Viagra every three days there has been no improvement at all. I do, however, have three of the side effects -- blurring of vision, nasal congestion, and upset stomach. Dr. Patel suggested trying 25mg daily for six days and 100mg on the 7th day, and I'll try that. I bought a penile pump to preserve the penile tissue, and use it daily, and my wife and I have used it for reacretional purposes and it is satisfactory for both of us. So if nature doesn't repair the nerves there is an an acceptable substitute. Of course, there are also injections and even implants in necessary, but so far I'm not considering them.

 

UPDATED

January 2011

 

 

On January 12 Dr. Patel gave me the good news. As the anniversary of my surgery approached (Jan. 28, 2010) my PSA remains undetectable. My next check-up is now in 6 months time.

As before, incontinence is not an issue, and hasn't been since about 12 weeks after the surgery (lots of Kegels before and after the surgery, and still).

ED, however, remains a problem. With stimulation, Viagra has some slight effect -- on a scale of zero (no effect) to 10 (maximum effect), Viagra produces perhaps a 3 (that's up from zero at first). I'm tired of waiting, so I told Dr. Patel I wanted to try Tri-mix, and he gave me a shot right then and there.

Wow! Not a 10, but close to a 6, which I'm told you need for successful intercourse. Since this was the minimum dose, I'm very hopeful that a slightly larger dose will do the trick. Next Tuesday Dr. Patel will up the dose and teach me how to inject myself. The injection itself was a non-issue, though injecting myself might be different (shaky hands?). Overall, I'm satisfied with my decision, and if the Tri-mix results improve just a little, I'll be totally satisfied.

 

UPDATED

November 2011

 

At my 18-month check up in July my PSA was still undetectable, and my bladder function is totally normal. I never worry about it, no matter how active I am being.

ED, however, is still an issue, though even here there is slow improvement. Since I increased the tri-mix dose a little I get a great erection, not a 10, but at least an 8. I suspect a 10 would be too much as I have read others describing their tri-mix erections as painful. Mine are entirely satisfactory, and I find they last about two hours, so one can relax and enjoy some romance beforehand.

I use the trix-mix twice a week, and I use 50mg of Viagra four times a week to help stimulate repair of the critical nerves. It seems to be working as I can now get a reasonable erection with stimulation and the Viagra, not quite enough for penetration, but it is constantly, if slowly, improving. And while I once got no response at all to stimulation without tri-mix or Viagra, I now get a weak erection, perhaps a 3 on a scale of zero to 10.

Perhaps in another year I'll be able to dispense with tri-mix and/or Viagra. The tri-mix injections, by the way, aren't an issue as long as I get them in the correct area of the penis -- easier said than done.

Mike's e-mail address is: michaelc628@hotmail.com