THERE WAS NO RESPONSE TO AN UPDATE REMINDER IN 2016 SO THERE IS NO UPDATE.

I have been having some increased urgency of urination for a number of years (3-4) maybe, but it was not bothersome enough to think of taking Flomax (not a fan of medication, and have been dealing with it by daily practicing Kegel exercises). Have had regular GP and Uro visits over the years including DRE (Digital Rectal Examination) and PSA tests with no indication of anything out of the ordinary - details follow.

Because of a 1.53 increase to 4.5 in PSA in February 2009 since my last test 3 years before, I was advised to retest and did so on November 9, 2009 which had a count of 4.7, and was advised to have a biopsy which was done this week on December 14, 2009.

I received a diagnosis of prostate cancer found. The biopsy showed 3 of 12 cores, all with a 3+3 Gleason score having "adenocarcinoma" in 10%, 80% and 90% of the tissue in the cores. The above cores were from the left mid, right base, and left apex respectively. The remaining core samples were benign, located as follows: Left base -2, left mid -3, Right mid -4, right apex -1.

I had an ultrasound done at the same time. I have had a CAT scan, with and without contrast on December 18, 2009, and await the results of that and more discussion of the diagnosis and staging when my wife and I have a consult with my urologist on this coming Wednesday December 23, 2009.

All my DREs over the years have been unremarkable, including the latest on November 9, 2009, and the ultrasound on December 14, 2009 immediately before the biopsy also "looked fine" per the urologist during the procedure. The size was measured at 33 gm and the density, calculated as size over latest PSA of 4.7 was 0.14, below (good) the "normal" cut-off of 0.15.

Free PSA was taken on that reading on 11/9/09 of 0.6, or 13% (0.6/4.7), below (bad) the "normal" cut-off of 25%. My urologist said that that free PSA reading, along with the 4.7 level at November 9, 2009, were the reasons for doing the biopsy on December 14, 2009.

I have been doing PSA level checkups since 1997, from age 50, and they are as follows, with the Velocity Increase (VI) calculated following each retest - which I am only calculating now as a result of all this - the "normal" cut-off being .75 per year - anything under that is good, I'm told:

January 15, 1997 - 1.70
June 9, 1999 - 1.80 = VI p/a negligible
July 18, 2001 - 1.70 = VI p/a N/A
June 11, 2002 - 2.80 = VI p/a of .65
December 29 2004 - 2.89 = VI p/a negligible
January 30, 2006 - 2.97 = VI p/a negligible
February 11, 2009 - 4.50 = VI p/a .17
November 9, 2009 - 4.70 = VI p/a .03

So the velocity increase in my PSAs has been very low indeed.

I am very glad that I found this site, with all its resources and links, and especially with all the wonderful men sharing their experiences and thoughts and feelings about treatment options and results. I will continue to update the site with progress.

If anyone has insights to offer after reading this short, possibly premature and partial history, they would be very much appreciated. I am especially interested in any information about the importance of PSA density, volume increase p/a, free PSA%, and actual PSA level, as indicators of how actively growing the cancer cells may be. Of course, that formula could probably make someone a wealthy person! I guess a lot will depend on whether the CAT scan can determine that it is still contained within the walnut!

Thanks for being here, everyone!

Pat B

Update as of January 3, 2010. Happy and healthy New Year everybody!

Subsequent test results:

CT scan of abdomen and pelvis, with and without IV contrast: Overall completely clean. Lungs, liver, spleen, pancreas, kidneys, bladder and bowel (as much as possible for the bowel without oral contrast--otherwise known as a radioactive smoothie!) were all unremarkable, normal, symmetrical, no evidences of masses, lesions, etc! Prostate quote: "Heterogeneous prostate gland--no evidence of metastatic disease". Other quote: "No significant pelvic or retroperitoneal lymphadenopathy" "Evaluation of the osseous structures demonstrates no suspicious appearing lytic or sclerotic lesions". Yeah!

On reading the biopsy report, one of the frustrating things about it is that it leaves to speculation any calculation of the totality of the disease and disease free samples. For example, there were 4 cores taken in the left mid of the prostate, and 1 of those cores had 10% adenocarcinoma. But the shorthand discription of the cores states that there were 4 cores measuring from 0.4cm to 2.2cm in length, so we know that 1 measured 4mm and 1 measured 22mm. But it's anybody's guess as to what the other two measured! And there is no indication which of the cores had 10% diseased tissue, so there is no way to total the diseased or benign tissue or to calculate the % of cancer tissue in the total of the samples. My Uro says just to estimate that each core that wasn't mentioned was about 1cm in length. But in just these 4 samples, the length varied from 0.4 to 2.2cm. And other cores taken were 0.4,0.5,0.7,0.9,1.4 etc. So go figure! I was an accountant in my first career, and I can't!

My Uro, who has treated me for over 10 years, is a robotic surgeon, and we had an hour's consultation with him to discuss the biopsy results, and our options. His recommendation, notwithstanding the gleason of 3+3, very low velocity over 12 years of PSAs varying from 2+ to 4+, unremarkable DREs, clear ultrasound and CT scan was to remove my prostate using robotic surgery that he would perform.

We have scheduled a consultation for Monday the 11th January with the oncologist who is the director of the prostate cancer program at the Abramson Cancer Center at the Hospital of the University of Pennsylvania in Philadelphia, where Louise has many medical contacts through her work in hospital administration.

We are trying to get as unbiased and patient-interested assessment of the risks and benefits of whatever options are open to us, including active surveillance.

I'll keep you posted as we progress.

Patrick.

In January we had a consult with an Oncologist who is the Director of the Prostate Cancer Center at the Hospital of the University of Pennsylvania (HUP), who had her pathologist reread the biopsy slides, and his opinion was that two out of the three cores had a Gleason 3+4=7 score, whereas the original report had all three cores as a 6. Of course they read the density as 40%, 40%, 70%, whereas the first pathologist said they were 10%, 80% and 90%. So we really have to realize that these readings are opinions, not absolute fact. Be that as it may, she recommended strongly that I have surgery, as the disease seemed more aggressive, and was in three different regions of the prostate, ruling out radiation because of adequate targeting limitations (not that I ever would consider any form of radiation therapy, because of the gradually increasing long term effects on neighbouring tissue---sorry RT guys!)

Then I saw two internists that I trust, one in Philly and one in NY who I have been seeing for 30 years and really respect, and both said that I should have surgery. My NY internist said that he really shouldn't be divulging personal info to me as a patient, but as he'd known and treated me for so long, he shared that he had been diagnosed two years earlier, and had robotic surgery. He said he's "pissing like a young man again" and his erectile function is very satisfactory. More on that later.

I asked him if he would mind sharing his diagnosis with me, and he said he had Stage1NoMo, with a Gleason 6 score on cancer tissue that was 5% in one core of twelve from his biopsy! So I said, "And you still had it out?" He said yes, and you should definitely too. By the way, he is 70+, yet still a vibrant, practicing doctor. When I told him that I was seriously considering active surveillance, and continuing the lifestyle changes I had already made, he cautioned that I now had OCD (organ contained, not obsessive compulsive, disease---although sometimes I wonder, with respect to this whole issue!) and if the cancer perforated the prostate wall in between my 3-6 monthly PSA tests, then "the horse is out of the barn" so to speak, and then surgery would involve taking all the nerves as well, and radiation as well, so then all the side effects I was trying to avoid by not having surgery would come back as my permanent, irreversible companions.

My wonderful wife and family, while very supportive, were all concerned about my considering active surveillance, and I was suddenly conscious of a major shift in my gut that surgery was the way to go for me, and robotic because of the better recovery time. Also, we were highly recommended to a Dr. Lee in Philly who does multiple operations two days a week and is third in the country in the amount he does. We met with him and his team, spoke to recent patients, and have decided to have him do the surgery on March 8.

Once the decision was made, I can attest that the worst part of this experience so far felt like it was over.

Now, on to dealing with side effects I can expect after the operation.

As many of you have had, I experienced urinary urgency and frequency, but not pain or reduced or intermittent flow over the past few years, and instead of doing drugs like Flomax, I decided to address it by doing Kegel exercises on a regular basis, 10 each day, contracting for 10 seconds each time. So I was familiar with them, and was advised by Dr. Lee's staff to increase that to 60 per day, 20 at a time, three times a day as follows: Morning - standing, 10 for 10 seconds each with a 10 second rest in between, and afterwards, 10 short contractions of about a second's duration each. Repeat in a sitting position at midday, and in a prone, lying position at bedtime.

So, hopefully, that will go a long way to addressing the incontinence issue. We shall see!

As far as ED is concerned, Dr. Lee, and the literature, stated that it could take from 12 to 24 months to regain erections satisfactory enough for intercourse if there was nerve sparing available at the time of surgery and depending on the use of Viagra and the like, and also, depending on how active sexually one has been prior to surgery. Thankfully, I have been pretty active sexually with my wife, as well as solo in her weekly absences in Philly while I am alone in NY. I had purchased a book at the beginning of this saga, which I had hoped never to need, if I had opted to conduct active surveillance as my therapy, called "Saving Your Sex Life --- a Guide for Men with Prostate Cancer" by Dr. John P. Mulhall, Director of the Sexual and Reproductive Medicine Program of the Division of Urology at Memorial Sloan-Kettering Cancer Center in Manhattan, NY.

It really opened my eyes to what could, and should be done by any man with PCa and surgery or radiation or other treatment. It has a lot to do with preserving the integrity of the penile tissues, penile rehabilitation after treatment, and how to go about that after, and even to some extent before treatment. Apart from nerve sparing, it is all about the "use it or lose it" philosophy. I would urge every man concerned about this, and facing or having had PCa treatment to get and devour this book, as I did, in two days!

After inquiry of my surgeon's staff, while they are excellent at what they do, they did not have the focus or experienced sexually oriented doctors, other than the take Viagra, maybe we'll give you a pump if you want recommendations. There is a lot more to be done, mainly to find ways to get erections as much as possible, not solely for sexual relations, but to oxygenate and preserve penile erectile tissue. I was fortunate enough to get an appointment with Dr. Mulhall at MSKCC prior to my surgery on March 8. So we shall see, but I'm definitely in it to win it back!

God bless you all, and good luck to everyone.

PatB

What Health Professionals Don't Tell Us About PCa Surgery and Recovery
Notes on My Experience:

After a diagnosis of Stage 1 Prostate Cancer (PCa) from a biopsy in December 2009, and after over a month of intensive research, consultation with a number of doctors: internists, urologists and oncologists; and conversations with PCa survivors amid intense family discussions, we decided that I would have surgery, and my wife and I met with a surgeon and his staff in February 2010, and Robotic Prostatectomy (RP) was scheduled for early March 2010.

We felt very comfortable with their expertise, experience and reputation (he does the third largest number of these operations in the nation) and they gave realistic expectations of the time needed for rest after surgery (3-4 weeks), recovery of urinary continence (some men 4-6 weeks, some 6-12 months), recovery of erections "adequate for intercourse" (average 6-18 months, some men even longer). They will prescribe Viagra to aid in the recovery of erectile function, and suggest another possible aid to be the use of a vacuum erection device to fill the penis with blood for 5-10 minutes, once or twice daily, which may also prevent penis shrinkage, sometimes noted after surgery. Their written post operative instructions (from which the above specifics are drawn) also state: "For men interested in more aggressive therapies such as penile injections, we refer you to Dr. X, our erectile dysfunction specialist". A surgery timeline was also given, with how to prepare for and what to do and expect in the weeks prior to, the day of and the day and weeks after surgery. This was heavy on the preparation instructions and light on the immediate consequences of surgery. Their practice also scheduled a "Robot Prostatectomy Pre-Op Class", which I couldn't attend, because of the procedure described in the next paragraph, which was on the same day, but my wife attended, and shared the Power Point slides and what she learned, a somewhat more detailed version of the above.

My surgeon wanted a "closer and clearer look at the prostate" before the operation, so he scheduled me for an endo-rectal MRI, which is just what it sounds like, an in-de-rectum MRI! No details were given as to what this would be like. I was somewhat forewarned, as a colleague of my wife, who had had recent RP, felt that this was the worst part of the whole process. Well, it was no picnic, and I was given no indication of how uncomfortable a procedure it would be! It entailed having an MRI sensor of some sort, which was quite large and felt like a latex fist thrust into and embedded in my rectum for 35 minutes while I lay on the table in the MRI cocoon with the machine emitting its ear-shattering vibrations and noises, with instructions to remain perfectly still! [There is simply no excuse for patients not to be given earmuffs or even music to deaden this sound.] I called over a week later just before the operation was scheduled, to get the results (no one called to report them to me), and was finally grateful to have endured it, as it showed quite convincingly that the PCa was most certainly organ contained, with no evidence (from the MRI anyway), that there had been any spread outside the prostate, and it seemed sure that the surgeon could perform the operation to include bilateral nerve sparing. It was well worth the discomfort to get that news!

In preparation for surgery I took a laxative the night before and didn't eat solids after 3PM the day before or clear liquids after midnight. I arrived at the SPU (short for Short Procedure Unit!) at 8AM and was taken into pre-op, and though was scheduled to be the second surgery, as it turned out I was third in line after two other patients who had very large prostates and longer time in the OR, so did not actually get wheeled into the OR until about noon. By then I had been interviewed by my anesthesiologist, and gotten my belly shaved. I remember being introduced to the OR nurse and scrub nurse, and marveled at the octopus-like DaVinci apparatus with multiple arms hanging from the ceiling, which contained all the instruments, microscope and searchlight that would soon be probing and assaulting my CO2 gas inflated abdomen.

I was asleep before my surgeon came into the OR, and did not see him until the following morning, although I trust and am sure he and his skilled hands manipulating the toggle controls at the DaVinci control console across the room were there throughout the Short Procedure in the Unit! Although my memory is a little foggy for some of the hours after surgery, my recollections combined with my wife's indicate that I was in recovery for about an hour, and she was waiting in my room for my arrival for the same time, until they could find someone to wheel me up to that floor and that room. She says when I finally arrived on the gurney which was rolled into position beside the bed, the orderly asked if I could move over on my own. By that time, I was feeling quite a bit of pain, and extreme exhaustion, so I requested a little help! Then my wife told me that the surgeon had come out of the operating room immediately after surgery, while his resident assistants were "sewing me up", to say that the operation was "routine" and was very successful, the PCa was all contained in the prostate with no involvement of the seminal vessels or any other membranes or organs, and both nerves were spared. Yeah!

The following hours were uncomfortable for me and extremely frustrating for my wife, as there was very little attention from the nurse and nursing assistants (NAs), other than the requisite periodic check of my vital signs. I was supposed to constantly be drinking fluids, and I would go through the small pitcher of ice and water in no time, with no response from pushes of the call button. So my wife (who stayed with me way past visiting hours until about 10PM), would go to the nurse's station and ask for more water, and they would advise her to go back to the room and push the call button and an NA would be along to get some. After explaining that we had already tried that, they reluctantly opened the locked kitchen door, so she could replenish the pitcher with ice and water. This whole process was repeated over and over. I was required by the doctor to be helped out of bed and taken for an accompanied walk (pushing my IV stand) of about 15 minutes around the ward. Finally, at about 11AM at one of my vital signs checks, after repeated requests and promises that someone would take me for a walk, the NA grudgingly took me for one five minute spin around the corridor, and promised to come back later to take me for another walk to complete the requirement. I never saw her again. Also she put me back in bed, and left before I realized that she had pushed the bedside table to the side of the room, way out of my reach, on which rested not only the book I was reading, but my water, AND the control for the TV, which also contains the call button for the nurse. The only thing I was left to read was the large sign on the wall opposite my bed which said, in effect: "Under no circumstances must you even think about getting out of your bed on your own, for any reason whatsoever. Press the call button for the nurse if you need to." After waiting for about half an hour, now about midnight, when my exhausted body was aching for water and sleep, and no one had turned up, I started to shout for help. I could actually hear the nurses at the nurse's station down the corridor talking to themselves in between my shouts. About 15 minutes later a nurse turns up to check my vital signs, and asked if I was "the one who was shouting".

Before surgery, when my doctors told me I would be going home the next day, I contemplated asking my insurance company if they would allow an extra day in the hospital, as it may help with my recuperation, but I decided against it. Good decision.

The next morning my surgeon visited me, and gave me the same good news he gave my wife, and I told him how grateful I was, and thanked him profusely. I asked about a plan for dealing with the after effects of the surgery, the ED and incontinence, and he said he would give me a prescription for Viagra when I visited his office in a week's time to remove the catheter, and I would get discharge instructions then. My wife came over very early and brought breakfast, my first solid food for a while, so I didn't have to eat what the hospital offered. After passing some gas, with great discomfort, I was discharged.

At home, over the next few days, I experienced stinging pain from the six incisions in my abdomen, and was still bloated with gas, the continual movement and expulsion of which through my bowels was excruciatingly painful. That was the bad news. The good news was that I knew each occasion of pain would only last a few seconds, but the further bad news was that it would be repeated in waves, and then the reoccurrence of those episodes of waves of pain would continue for the rest of the week. The pain medication I was given just made me drowsy and didn't help with the incision pain, but Tylenol did somewhat. Neither helped with the gas pains, or the bad back pains I had from tensing against the other pain, I guess. I walked at least a mile each day, sometimes a slow stroll into town, sometimes a shuffle back and forth across my bedroom for half an hour on a rainy day, and I believe that was helpful. I also drank a lot of fluids, and was constantly emptying my catheter bags, which seemed to have twice as much urine in them than the amount of fluids I drank!

The first night home I emptied the 2000ml. night bag three times before I awoke the next morning. The smaller daytime leg bag also had to be frequently emptied. Having the catheter in was not as bothersome as I had imagined, but had to be positioned and supported against my leg with an extra strap, in addition to the ones supplied with the bags, in order to be less irritating. However, I was extremely grateful to have it out after only a week's time, which was not a big deal at all, and very professionally and quickly done by one of my surgeon's very capable assistants in his office.

I am so fortunate to have a devoted wife, who is my partner and my best friend and my lover, who fetched and carried and changed and bathed and cooked and cared for me so much during those recuperative days and since!

At the time of my catheter removal, I was also given the pathology report on the resected prostate, left pelvic lymph node, left and right seminal vessels and other proximate adipose tissue. The conclusions of the report were that the prostate had a 2-10% involvement of PCa, graded a Gleason 3+4=7, and staged pT2c N0Mx, located in the peripheral zone on both sides. The PCa had not extended through the capsule (organ contained), and there was no seminal vessel invasion, no tumor seen in the adipose tissue or lymph node, and no positive margins. There was also an indication in the report that some of the cancer was in the nerves within the prostate (not the nerves outside the prostate that were spared), called perineural invasion, and I was told when the report was explained to me that sometimes the cancer can spread more rapidly to other areas if it is present in these nerves. So it was a good thing to have addressed it when I did. Altogether a very optimistic and reassuring report and prognosis that all the PCa had been removed. Yeah! I am very grateful and thankful, and feel that we made the right decision to have surgery, as opposed to all the other options available, including active surveillance which I had seriously considered.

The discharge instructions I was given at the catheter removal and pathology report appointment a week after surgery, included a request to make an appointment for a PSA test and post op appointment in 3 months. It included instructions about things to watch for as warning signs such as blood clots in the urine, difficulty urinating, pelvic pain, etc. With respect to the major side effects of prostate surgery, incontinence and erectile dysfunction, the following is the sum total of the instructions given:

Begin doing 60 Kegel exercises a day on an empty bladder, 20 each morning, afternoon and evening, 10 of them held for one second, and 10 of them held for ten seconds. Please begin the Viagra tomorrow night if indicated. Take half of a tablet every other night at bedtime at least two hours after your last meal.

I guess that implied that if you were dissatisfied with your urinary continence after 6-12 months or level of erectile dysfunction after 6-18 months or longer, you could call for a referral to their Kegel/urinary incontinence instructor or erectile dysfunction specialist. Fortunately, when I was first diagnosed in December '09 and researching the internet and buying books to try to learn everything I could about PCa and decide what I was going to do about it, I bought a book that I put on my bookshelf and hoped that I would never have to read. I was hoping that I would be able to practice active surveillance, along with positive lifestyle changes in exercise and eating habits and vitamin supplementation, to slow the growth of cancer cells in my prostate and keep them contained therein. I would be treating my diagnosis not as a death sentence, but as a wake-up call to lead a healthier lifestyle, unencumbered with the dreaded side effects of urinary incontinence and erectile dysfunction, and be destined to die of something else after a long life. As soon as I decided to have surgery, which I then scheduled for a month later, I pulled it off the bookshelf and devoured it cover to cover in one reading. It was written in 2008 by Dr. John P Mulhall, MD, the Director, Sexual and Reproductive Medicine Program, at the Division of Urology at Memorial Sloan-Kettering Cancer Center in Manhattan, New York, and is titled: "Saving Your Sex Life - A Guide for Men with Prostate Cancer"

Reading that book changed everything about the fear of, and uncertainty I felt about being able to endure and conquer this greatest threat to my manhood, sense of self, and sexual wellbeing. Had I read it first, it would have made the decision to have surgery so much simpler and obvious to me as the best course of action, for me, to combat the threat of PCa. I would highly recommend that any man who gets a PCa diagnosis, and any PCa cancer survivor dealing with erectile dysfunction, get and read this book.

I was fortunate enough to get an appointment with Dr. Mulhall the week prior to my surgery, and he reiterated the main point of his book ("use it or lose it"), which was that the key to conquering erectile dysfunction was to have healthy erections! And as soon as three weeks after surgery! He explained that the nourishment of erectile tissues in the penis with infusions of healthy oxygenated blood on a regular, sustained basis was essential to regaining erections of a size and firmness necessary for penetration in sexual relations.

He started me on 25mg. of Viagra (1/4 of a 100mg. pill) immediately, stopped the night before and the night of surgery, and restarted the next day, even with the catheter still in. "Don't worry" he said, "you can't get an erection with a 1/4 pill at this time". Three weeks after surgery I was to take a full 100mg pill and try to get an erection. I was to repeat this each week for the next three weeks, and make an appointment to see him six weeks post surgery to report the results. He said that if I was unable to get an erection hardness of more than 60% of what I was able to achieve prior to surgery, he would start me on penile injections, which would not fail to produce an erection. The first would be at that appointment, the second at an appointment a week later, and I would be trained at both of those on how to self administer them thereafter. He explained that the goal was to cease the injections once satisfactory erections were attained only with Viagra, and in time, if possible, to cease the Viagra if natural erections became attainable without medication. I asked him whether he would suggest using a vacuum pump device to attain erections prior to starting on injections, as had been suggested by my surgeon's office, and as I understood are being used by many men to combat erectile dysfunction. He explained that while vacuum pumps were useful in helping with penile stretching and penetration when combined with a ring around the base of the penis, the pumps drew venous blood, de-oxygenated "old, used" blood from the veins into the penis, and so did not contribute to the healthy oxygenation of the cells and cavernous musculature of the penile shaft. The use of Viagra and penile injections did, and that is why he does not use or recommend vacuum pumps for forestalling or reversing erectile dysfunction. So I'm with him, and healthy, whopping erections are in my future, by hook or by crook, or shall we say, by drug or by needle!

As for urinary continence, as I write this, 72 hours post pulling-of-the-plug de-catheterization, I am still using Depends diaper-like underwear briefs. The first 24 hours I used 8, the second 24 hours 5, and yesterday, 3. Last night I was woken by the urge to urinate 3 times and made it to the bathroom without significant dribbling, and woke up with a mostly dry Depends brief. I am continuing with my 60 Kegels a day routine that I started the month prior to surgery, and am taking it one day at a time. I believe I was fortunate, maybe wise enough, to start doing Kegels on a daily basis (only 10 a day however), to try to combat the Lower Urinary Tract Symptoms (LUTS) that I have experienced (frequency and urgency of urination) for a few years, instead of turning to drugs (Flomax and the like).

So that's the story to date, mid March 2010. I will continue to document my experiences and share them, in the hope that they can inform and maybe help others. Ciao for now!

I have had successive three month PSA tests since my robotic surgery in March 2010 that have returned undetectable levels, the last being in early March this year.

In response to a reminder, Pat wrote:

Have been traveling abroad and will due update when I return in a month.

I apologise for not updating my story for a long time, but a lot has happaned since I last posted in Spring of 2010.

In May of 2010, my wife of 30 years was diagnosed with lung cancer, which was inoperable. After a long 10 month battle, with chemo and radiation, she succumbed to the disease and passed away in March of 2011.

In May of that year, I met a woman who is a native of my country on a trip back there, who is 4 years younger, but has many of the same friends I do. We had never met, as she had moved away 30 years ago, as I had. We fell in love and were married in December of 2011. We currently live here in the US, but plan to return home to live in a few years.

As far as my health and side effects are concerned, I am pleased to report that I am in excellent health, and the side effects from the removal of my prostate have mostly been eliminated entirely.

I have no incontinence, save for sometimes slight involuntary leaking late in the evening, if I am especially tired. I attribute that to not keeping up with regular kegel exercises, and is always corrected when I do some regularly. I never require any pads or wear anything other than briefs, not boxers.

The remarkable recovery I have had is with erectile disfunction, which is virtually gone. I get very serviceable erections with stimulation from my wife, and wake up with nocturnal erections virtually every night. I use Viagra on occasion, and with that, have erections that last for as long as I want them to, prior to orgasm. I attribute this success to the preparations I took prior to surgery, and since, when I used Viagra prophilactically on a regular basis, and used injections to create erections when I couldn't in the early months of my recovery. I also attribute it to the very active and regular sexual activity I engage in with my wife, who is very caring, loving and sexy! The adage to "use it or lose it" is very true. The truth is that I have a more active, varied, and satisfying sex life after the surgery than I had before.

I hope this has been helpful and encouraging.

Thankfully, I have remained very healthy, and have PSA tests only once per year, along with my annual physical, and so far the PSA has been undetectable.

I am in a very happy, sexually active marriage with my wife, and we enjoy each other and doing things with each other, and our combined family of 6 children and 7 grandchildren.

My only medication to alleviate side effects is a 20mg pill of Cialis every two or three days (three per week). With that assistance I have no erectile problems. This works better for me than the Viagra I was taking, as that depended on episodic intervention when sex was planned. Also, it requires not eating for three hours before or three hours after taking the pill to be most effective for me, and wears off in a few hours. With regular Cialis medication as I described above, I get erections anytime with stimulation, so as the ad says, "when the time is right, I am ready"! Incontinence, as I mentioned before is not an issue other than slight dribbling when tired late in the evening, which would probably go away if I kept up my kegle exercises.

Hopefully I will remain cancer free, but am conscious of how lucky I have been, and focus on enjoying every day that I am granted.

Best wishes to all.

Pat B

Pat's e-mail address is: mbjapb AT gmail.com (replace "AT" with "@")

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