THERE WAS NO RESPONSE TO AN UPDATE REMINDER IN 2014 SO THERE IS NO UPDATE.

My first indication of trouble came at an annual Urologist check up in mid-October 2006 when the PSA was reported at 5.9 ng/ml which was up from the previous years in the 2.8-3.6 range. I was put on antibiotics (Proloprim) for a month and re-tested. This time in late November the PSA had jumped to 6.6 ng/ml with about 12% free PSA. I was scheduled for a biopsy and scared. The biopsy results were returned December 26, 2006 with a positive on one side 20% of the sample and Gleason 3+4=7. The Urologist gave me a package of literature etc. on available treatments and scheduled a bone scan.

The bone scan was a further shock when they did repeated multiple angle scans of my hip and then referred me to have several X-rays. This really scared me since it was not a good sign. Later that day I remembered falling about 6 weeks earlier right on my butt and tail bone. The Scan results were negative but questioned the hip reaction to the scan. The Urologist agreed that the fall had probably caused the hip to show up. The Urologist advised Surgery and I was inclined in that direction. I was referred to the Surgeon in that practice that did there Robotic Prostatectomy. They had had the da Vinci robot for about a year and had done about 40 operations. I had an appointment for February 1, 2007.

Not being totally satisfied with the treatment choice, I continued intensive research into treatments, outcomes, etc., etc. I finally chose robotic surgery as the best option considering my age, physical condition, level of cancer, etc.---BUT only with a qualified surgeon having experience in at least 100 cases. I read several reports that showed outcomes were greatly improved as the learning curve got to that level. I developed a list of many surgeons nationwide that were experienced experts. The most experienced in the country were Dr. Menon (Henry Ford), Tewari (NY Presbyterian), Patel (OSU) all with well over 1,000 cases. I read a lot of professional journal articles and research reports as well as presentations at various symposiums. I also viewed many operations on this site. A particularly good video is also presented with animation in 6 parts on You Tube. The YANA site was very helpful in comparing experience of a lot of treatments.

Special thanks to those mentors that advised me. Since this robotic assisted operation is rather new the outcome data is very poor and a some institutions enhance the data for their benefit. Be sure to look at the details and beware of the hype. New refinements are being developed all the time but are not universally adopted. The West Coast has different approaches than the East Coast. I would advise anyone to only choose a surgeon that has done no less than a hundred at a minimum. Also a teaching hospital with a highly ranked Urology program is an important consideration. A surgeon and operating team specializing in this procedure is important.

The closest expert experienced surgeons to me were Dr Patel at OSU, Dr. Smith at Vanderbilt, and Dr Albala at Duke. (Dr. David Albala, MD, Professor of Urologic Surgery, Director of Minimally Invasive & Robotic Urologic Surgery). I cancelled my local appointment and called Dr Albala and got an appointment for Feb 13, 2007. I had my records and biopsy slides sent to Duke. At that appointment I talked to the head Fellowship Resident under Albala for about an hour and Dr Albala for about 15 minutes. I asked a LOT of very detailed questions relating to their techniques and outcomes. They commented that I was the best informed patient they had ever had. I was scheduled for surgery on April 24, 2007.

I had a Pre-OP screening a Duke on April 13 with x rays, blood tests, EKG, etc. as well as a brief meeting with Dr Albala. I was checked by many different doctors during that day. I was cleared for surgery with a re-read biopsy report of Gleason 7 and a re-tested PSA of 5.2 , 9.6 % free.

April 24, 2007: The day of surgery I was scheduled as the third case of the day for Dr Albala at 3:00 pm. I arrived at 1:00pm as instructed and waited, and waited. At about 3:50 they called me to get ready for surgery and I was taken to the prep area for IV placement, and meet with the anthologists. My blood pressure showed my anxiety. I waited there until 5:15pm when they brought my wife in to see me. Finally at around 5:30 I headed to the OR. (The case before me had been an overweight person and the operation had taken well over 4 hours.) There were a lot of people in the OR but I remember little of it. The next thing I knew was being asked if I had pain in the recovery room. I did but it was relieved very quickly and I concentrated on breathing deeply as I had been instructed beforehand. I was told that the surgery started around 6:10 pm and lasted a little less that 2 hours. (I am 5'8", 150lb) I was in recovery about an hour before going to my room before 10: 00pm.

I still had pain for a while but not very bad. I was offered a liquid diet meal but just wanted water and ice. I went to sleep at about midnight and woke up at about 2:00am during one of the Doctor visits. I was not very comfortable considering the IV, the catheter and drain in my stomach but had little pain. I did not want to do sit-ups or laugh. The care at Duke was outstanding. The floor was the Urology floor with a Senior Urology resident on duty at all times. They checked on me every hour and answered calls very quickly. The Chief Urology resident checked by at about 8:00am and removed the drain. He said if I wanted, I could go home that day. They brought me a full regular diet breakfast . Dr. Albala's Nurse Clinician came by a little later and said the Doctor had started his rounds but was called to emergency surgery so she was finishing for him. She gave me and my wife instructions on how to care of myself after I left. She and the nurse gave me all the information on the catheter and incision care, diet, rx, activities, etc. I started walking the halls at about 9:30 am. The nurse told me at 10:00 am I was cleared to leave when I wanted to. I stayed and walked off an on for another hour. Overall, I spent 24 hours in Durham. I never did see Dr Albala while at Duke for the surgery. The assistant surgeon talked to my wife to report I was in recovery and all went well. The 2 ½ hour drive home with one stop was not very comfortable but uneventful.

The first two days at home went well with only Tylenol needed for pain. I was having gas pains but didn't pass any until 24hrs after the surgery. The bloated feeling and gas pains were more uncomfortable than the surgical pain. The catheter is a real bitch to get used to. I took Tylenol for 4 days after surgery and a dose of Milk of magnesia got the bowels moving. Dr. Albala's office called on Day 7 (today) with the Pathology report. Cancer was confirmed on one side only and fully contained, negative margins and negative lymph nodes. A very good report!! I am very happy with my choice of an experienced surgeon and hospital with a top rated Urology department. I had never had surgery before nor been in a hospital. I hope I won't have to go back.

I was told to schedule catheter removal in 10 days locally rather than travel to Duke for it's removal. I have that scheduled for later this week with my local GP Doctor. I am definitely looking forward to that appointment. A follow-up at Duke is scheduled for late June. I will update my recovery as I can. Contact me if you have questions.

UPDATE July 10, 2007 The catheter was thankfully removed on May 3 by my local GP. I leaked most all the time while I was up and around doing things. No leaking while in bed or while sitting, but when I got up I would start leaking. 3-4 pads per day. I worked on Kegels and used the "hold the cup" method to help identify and stop leaking. I made little progress for almost a month and then it seemed to suddenly start getting better. At first I didn't leak the first half of the day and later it extended into the afternoon. Stooping or getting up still caused a squirt. One Depends pad a day. By week 8, I was mostly dry all day and graduated from Depends pads to a female maxipad. I am now using one of those for security and it hardly gets wet. On June 18 I was also given Ditropan 10mg per day. The Ditropan was maybe what was the final help in improving continence. Patience is the key in regaining continence. (Overall I used about 150 Depends pads)

I went to Duke for a followup check on June 18. The PSA was checked at < 0.1 or undetectable. They scheduled the next checkup for 6 months. I was given Cialis taken 10mg three times a week, and a VRD pump. I have not had any natural or Cialis induced erections yet. The VRD works but it takes some time to get used to it. While I am showing little ED progress I think it is too early to expect much. I have noticed some firming of the penis some mornings lately so maybe that is a good sign.

The surgical outcome and recovery was uneventful with little or no pain. Only some discomfort when sitting on flat hard surfaces for about 6 weeks. The scars are fading. Overall I am satisfied with my surgery, recovery, and ontological outcome.

June 20, 2008: I just had my year-after-surgery appointment at Duke this week and was released to my local Doctor. My current PSA remains at < 0.1 or undetectable. I was told to get PSA checked every 6 months for two years and then annually, and let them know if I needed them again.

I did have an check-up appointment at Duke in December '07 with a PSA of < 0.1. At that visit I did talk for the first time with the Resident who did part of my surgery. He took the time to discuss the case very well and addressed any questions.

Since my last update in July of last year the continence issue has vanished with no noticeable leakage at about 10 weeks post-op. I will say that I do leak some after about 4 or 5 beers but I have learned to expect it and a female mini-pad will easily take care of it. On the ED issue I have been on Cialis for a year along with the VED pump. I noticed little improvement for 9 or 10 months. In the past few months I have noticed definite improved fullness and reaction to stimulation. Not yet ready for action but at least something is happening and maybe I am half way there. I was told at Duke that my age did delay the reinnervation process and I could probably expect some further improvement for the next 6 to 12 months. I did not opt for injection therapy at this time as the next stage in ED treatment. Everything considered, I am back to normal (except ED) in all aspects and without the cancer. I can also pee much better than before surgery. (I can write my name in the snow--which I couldn't do for years.)

Overall, my 18 month involvement with Duke and Dr Albala has provided the outcomes that are within my expectations. While not completely perfect, so far I remain optimistic for a full and complete recovery. I do not regret my choice of Duke.

I have had several PSA tests since my last update. All have been < 0.1. I will note that my General Practice doctor's lab reported 0.04 6 months ago but the latest was undetectable. The Urologist's lab has reported < 0.07, their lowest level. Both doctors tell me the PSA is 0 and have to be quizzed to get the actual lab report number. PSA is stable at undetectable. I have PSA checked at least every 6 months.

Continence issues have resolved. No pads, everything normal.

ED finally started to respond to Viagra, but only after a full two years from surgery. While not a really hard erection it is usable. This recovery has taken a lot of time but is slowly improving. I was advised to use injections or implants about a year ago but decided to give it more time. Time seems to have worked out for me.

No treatments currently.

Still have ED but Viagra is mostly effective. Not the best but good enough.

Currently having no treatments. PSA is checked twice a year at my request by my GP doctor. It has been between 0.00 and 0.02 for several years. It has been 6 years since surgery any my only side effect is ED. Viagra usually works to obtain an adequate erection. No other health issues at this time.

I still feel that I choose the best treatment for me. It was removed and I have not had to deal with any significant problems since.

Jim's e-mail address is: jferguson AT bellsouth.net (replace "AT" with "@")

NOTE: Jim has not updated his story for more than 15 months, so you may not receive any response from him.