Post Surgery Lab Results

Wow, what a blow. I visited the surgeon yesterday to get the catheter removed and the results from the lab tests on the removed prostate. After the positive feedback directly after surgery and how well I was recovering my wife and I were expecting only good news. The tube came out without a hitch, but unfortunately the lab results were not so cheery. The cancer was worst than expected. It was on both sides of the prostate, had (just) penetrated the capsule, and there was tumor in both seminal vesicles. Also the Gleason grade is slightly worst (4+3) from (3+4), with a small area of 5 but not enough to go into the score. On the bright side the lymph nodes were clear and the removed prostate did not have positive margins. I am now staged T3b.

It seems that the seminal vesicle involvement is the really bad news. These are glands attached to the prostate which are removed as part of the radical prostatectomy. Prognosis-wise it means that there is now a high chance that the cancer will (or maybe has already) spread elsewhere. I guess maybe the fact that it is established in this non-prostate tissue means that it has the ability to spread? According to one prostate calculator,  http://www.prostatecalculator.org/, I now have a 39% chance of remaining cancer free (according to PSA tests) for the next seven years. So the odds are now dipping below even that I am cured.

My doctor is recommending that we do nothing now and test PSA in a month's time. If it is undetectable then just keep watching, but if the PSA is there then to consider enrolling in an experimental treatment where hormone therapy (testosterone suppression) is combined with chemotherapy. I will have to do some more research about this. I know that radiation and/or hormone therapy might be an option at this point also. Time to check the second opinions again I think.

Post Surgery

My surgery was one week ago today.  After only one night in hospital they sent me home with a few sticking plasters, a box of codeine fortified tylenol, and a tube coming out of my penis with which to pee into a plastic bag. Tomorrow I implement my triumphant return to the upper reaches of this island home (Manhattan) to see Shaman Badani at the temple of Columbia Medical Center, and receive the crucial next metric in the ongoing statistical prognosis calculations that my life has been reduced to. Fingers crossed that the margins were not positive, no lymph node involvement was discovered, and no worsening of the Gleason grade has occurred. All that being ship shape then my trusty Sloan Kettering cancer calculator rates me about a 96% chance of being cured. At least to the ten year extent of its output anyway. Hopefully I don't kick the bucket the day after my life insurance expires, although actuarially speaking no doubt it is all worked out that way. Someone remind me to dust of my paraglider if that looks imminent. Also tomorrow they will yank out my catheter tube, which I am told is not as unpleasant as it sounds. It will surely be a big plus to have it out in any case as it is a great inconvenience to have a plastic tube coming out of your penis.

Which brings up the next worry. How is my wee control going to be after this tube comes out? They tell me the chances of permanent incontinence are small (maybe one percent). And I have a high regard for my sexual muscle control due to many years of sporadic yoga classes. So keggling came as second nature to me. Still, diapers would really suck. And speaking of sexual control, will I ever again have an erection? More kids via the natural method are out for sure I am told, the connections are lost, but Dr Badani has written papers about his advanced nerve sparing techniques that seem to almost guarantee some kind of partial return of erections if all the follow up months of viagra enhanced pumping exercises are followed to the letter. Well I am ready. Never say I am not eager for the next challenge on this odyssey of discovery. Tomorrow I shall reveal what happened at the doctor's office.

Diagnosis and background

I am 45 years old, caucasian, grew up in Australia and live in New York City. First tested PSA in August 2006 as part of a routine blood test. It was 2.48. In January 2008 it tested at 4.5, above the test range of 4.0, and I was referred to a Urologist. The Urologist prescribed antibiotics to rule out infection and retested. It came out at 3.5 which he considered still suspiciously high and performed a biopsy on June 30th 2008. The biopsy came back positive for cancer, with gleason score 7 (3+4), 70-80% in 3 of 8 cores. The follow up CT scan and bone scan showed no evidence of spread beyond the prostate. The Urologist recommended radical prostatectomy (prostate removal) by robotic, laparoscopic surgery, his speciality, and surgery was scheduled for September 30th.