Four Years Later

I have been having my PSA tested every six months and am pleased to say it is completely negative, meaning I have no signs of recurrence of the cancer. Since prostate cancer is slow-growing, it will be another six years before I can officially be pronounced “cured”.

Update

It’s now the day after Christmas.  I would say most of my post-operative pain is gone.

Next week they said I could resume exercising.  Because the weather’s cold it might be a weekend before I try riding my bike, but I’ll probably resume strength training anyway.

So I’d say most of my short-term post-operative problems have cleared up.

My incontinence is mostly limited to small leaks which mostly happen when I’m standing with either an almost empty or overfull bladder.  Anything in between I seem to be able to hold without conciseness effort.  If my bladder gets too full then I leak in any position.  “Too full” doesn’t really mean much.  Starting next week I may try holding more in to try to increase the capacity.

The other long-term problem I face is even more delicate a subject than incontinence and that is impotence.  Right now I am unable to get an erection, although my libido is returning to normal.  That’s kind of frustrating.  They say that will come back over a period of 3 months to a year.

 

The Pathology Report

After my prostate was surgically removed, they sent it off to the pathology lab for a biopsy.

The news was generally good:  the “margins were negative” meaning that the edge of the tissue removed did not contain any cancer cells.  That means they didn’t leave part of the tumor behind.

They also analyzed one of the seminal vessicles–it too was free of cancer cells.

They did not remove any lymph nodes, but the report says, “Areas suspicious for, but not diagnostic for lymphatic space invasion are seen.”   This worries me.  But, I guess, for now, there’s nothing to do but to monitor my PSA (more on that later).

 

Continence – Part 1

WARNING:  explicit content.

 

 

 

One of the problems with prostate removal is that is, at least at first, makes you incontinent.  The day I came home from the hospital I basically dripped all day.  I have to wear pads (the same material combination as disposable diapers).

But somehow when I went to bed, my bladder filled and I had to get up to use the bathroom — twice during the night.

Now, day by day, it seems to be getting better.  It is worst when I stand, better when I sit and better still when I sort of slouch, e.g. while watching TV.

I’m still at home recovering.  Next week I return to the office.  It’s going to be a nuisance but I guess I’ll be able to handle it.  We will see.

(Note:  I call this part 1 because I expect to have more to say–and presumably progress to report–as time goes by.)

Awakening

I slowly became conscious.  But I was so tired that I immediately drifted off again.  I must have done this two or three times before I became fully awake.

I immediately thought, where am I?  And then I remembered:  I was coming out of surgery.  I carefully and gently felt my belly.  Yes, there were the six round holes, each covered in a small neat bandage.  The holes through which the robot had entered my body.  The holes through which the malignancy had been removed.

I had several fears when I had walked into the hospital that morning.  One was that I would die in surgery.  The chances were remote, but still I worried.  Other people have told me they have had that same fear.  Why?  To me anesthesia is a little like death.  You feel nothing; you experience nothing.  But unlike death, you wake up (usually).  Of course anesthesia is a little like sleep too.   The difference is you don’t dream.  Most of us don’t worry about whether we’ll wake up when we go to bed at night.  I think it is because that happens frequently and we do survive;  anasthesia is much less frequent so we have less (or maybe no) previous experience to call upon.

I was also afraid they would have to convert from robotic surgery to conventional surgery.  But the holes I felt for assured me that had not happened.

I also worried about the pain I would feel, but as I lay there in the recovery room, I felt very little pain or discomfort.  I realized I was still in the lingering fog of the anesthesia.

I don’t think I fell asleep again, but I was in a kind of twilight.  I don’t really remember much of what happened there.  (I guess nothing much did.)  Eventually I was wheeled from the recovery room to an ordinary hospital room, and transferred from the gurney I had been on to an ordinary hospital bed.  There I was joined by my family.  I’m sure I have looked better.  I had an oxygen tube in my nose and an IV in my arm.  The doctor’s had warned my family that my face might be puffy because I had been in a position with my head lower than my body during the surgery.  But my wife said there was no puffiness.

My mouth and throat were incredibly dry and my throat was sore from the tube that had been there during the surgery.  I drank lots of water (which the nurses encouraged.)

Eventually Dr. Carroll had come to visit me.  The great Peter Carroll.  I had been told to find the best surgeon I could.  When I told people I had chosen Dr. Carroll,  “he’s the best” was the response I had generally gotten.  I was happily surprised at how well known he was to other doctors as well as other cancer patients.  (Even my ear doctor had heard of him.)   Of the three surgeons I consulted he was the only one who said he could spare the nerves that run along the sides of the prostate gland.

Now Dr. Carroll was telling me that he had indeed been able to “spare the nerves”.  He also told me that he believed he had removed all the cancer–there were no signs of it in surrounding tissue, and none on the edges of what was removed.

By evening I had progressed to eating jello.  In the middle of the night they brought me some yogurt at my request.

Also by evening they had me up and walking around the ward.

Laproscopic  surgery is one of the great advances in surgery in the 20th century.  It produces less blood loss, less pain, and allows patients to get out of bed sooner.  With lacroscopic surgery, small round holes are used rather than a large incision.  The surgeon uses fiber-optics to see what is being done.

Now at the beginning of the 21st century, robotic surgery is enhancing laproscopic surgery.  This technique allows the surgeon to remotely manipulate paddles that translate to finer movements of the robotic components.  Thus, the surgeon can make very fine movements.

It is impossible to sleep at night in a hospital.  Nurses are coming in every few hours to check your vital signs, and there are constant noises in the hallways.

The next morning I was given a meal of solid food.  I ate small portions of each dish:  scrambled eggs, sausage,  toast.

By noon I was pronounced well enough to go home.  I was transported in a wheelchair down to the front entrance where my older daughter was waiting with the car.

I had probably taken too little pain killer prior to leaving the hospital because the ride across San Francisco was probably the worst of the pain I had experienced from the surgery.  We dropped my daughter off at her apartment and then my wife drove me the rest of the way home.

From that time until now I have been recovering at home.  I returned to San Francisco once (a week after the surgery) to have a catheter removed.  Now I can drive again.  I walk around the neighborhood and probably eat too much.

In January I will have a blood test that I hope and expect will further confirm that all of the cancer was removed.

(For more on this subject, see my Prostate Cancer Blog. 

The Story So Far

So first of all, “PC” doesn’t mean “personal computer.”  I’m not trying to keep this a secret.  But neither am I trying to broadcast it to the world.

In April I had my annual physical examination.  One of the tests I always have is a PSA (prostate specific antigen) test.  The results were not high, but they were higher than the previous years.  This is considered a warning sign for prostate cancer, although this (and the use of PSA tests in general) is controversial–too many false positives.

To make a long story short, I ended up getting a biopsy and prostate cancer was found.  My doctor then ordered additional tests — a bone scan and a CT (computerized tomography) scan to determine if the cancer has spread.

Luckily those tests came back negative.  This means there is no sign of the cancer spreading to other parts of my body.  That is very good news, because if it has spread, it would be incurable.

So now I need to get the cancer treated so that it won’t spread.

I’m in the process of interviewing doctors, each of whom has their treatment to tout.

There are four standard treatments for prostate cancer:

  1. “Active surveillance”, previously known as “watchful waiting”.  The theory behind this technique is that prostate cancer is often slow growing and no treatment is necessary, especially in older men (in their 70s).  However I am not that old, and my cancer is not expected to be slow growing and so it needs a more active treatment.
  2. Surgery.  Remove the prostrate removes the primary tumor.  If it hasn’t spread then you’re done.
  3. Beam Radiation.  This is a traditional treatment for cancer;  in this case the beam is focused on the immediate area so the usual side effects are largely absent.
  4. “Seeds.”  This is another form of radiation therapy.  In this form, small pellets (“seeds”) of radioactive cesium are implanted directly into the prostate.
All of these latter three treatments are available to me.  They all have approximately equal cure rates, but they all have (different) nasty side effects.  

So, as I said, I’ve consulted with three doctors, each of whom advocates one of the three latter treatments above.  None of them advocate active surveillance for the reasons already mentioned.

“My” doctor–the one who is assigned to treat me at present–is a surgeon and not surprisingly recommends surgery.

I have a friend who is going through the same process and he has lots of doctor friends.  They recommend against “my” doctor because he is young and inexperienced.  So I have an appointment with another surgeon who is very well known (and very thorough).  The only problem is that he is booked until September 15.

So I’m thinking, reading, and waiting.