A family member, "Ben," visited as part of the holiday weekend. His visit gave me a chance to learn how he's been doing recently since his own prostate biopsy and surgery for cancer 3 years ago. This guy is a fit dude, retired from a law enforcement career, sporting a flat belly and looking like he might be wearing 30 inch waist jeans. He doesn't do anythng half way and is pretty straightforward about stuff, even personal stuff. When we had a little time alone together he was willing to talk a bit about his experience with prostate cancer. As usual Ben was straightforward and not remotely self pitying. The guy is a realist.
Three years back, Ben had an elevated PSA, and his urologist recommended a prostate biopsy. His recollection of the procedure: "Unpleasant. Not something you can't deal with, but not something you want to do more than once." The biopsy results came back normal -- no cancer found. But the urologist was not convinced he'd sampled in enough places to be sure there was no cancer. So he recommended, and Ben agreed to a second biopsy session. Again, not a pleasant experience. But this time a diagnosis of early prostate cancer. So early and small, in fact, that the first biopsy had missed it altogether. The recommendations the urologist offered ranged from "wait and watch" to having the gland removed now. A few of Ben's relatives have died of cancer. He has a signficant concern that he could easily become yet another cancer death himself. The wait and watch thing only suggested to him a delay of an inevitable need to remove the gland -- and he wanted to get it taken care of now.
At the time, Ben lived in an area where good medical care was available, but even better care was available a few hours drive away. His urologist suggested he obtain a second opinion to think all this through. One particular option the urologist mentioned was robotic surgery, something available in other medical centers, but not something this urologist, himself, could offer. Ben felt comfortable with his urologist, did not seek a second opinion, and decided to have his urologist go ahead with a standard, open surgery, prostate removal.
The surgery went well, no particular difficulties. Then the healing. Again, no special problem. Recovery was not immediate, however. Ben still faced the two serious complications of total prostate removal, or "radical" prostatectomy, as the kind of surgey you do for prostate cancer is called.
The first major problem is incontinence. The problem here is that the sphinctre that holds urine in the bladder is cut open during the surgery and then reconstructed at the end. Even the best surgeon is not as good as the original architect, so some incontinence during healing is to be expected. Most patients are said to recover normal bladder function in a year. Some sooner. Ben was wearing pads to catch leaks for a year. Now, at three years after surgery, he has only occasional leak events, particularly when working out at the gym. He no longer uses the pads. He did use the bathroom at my place twice in the space of an hour. I suspect he does not allow himself to store up much volume in his bladder so that there is not much pressure trying to get out. He says he still has small leaks when he coughs or strains (like lifing stuff, at home or at the gym). It's not a problem for him. Or not a major problem.
The second major complication of this sort of surgery has to do with natural erections. Or the loss of them. There is a pair of blood vessle and nerve bundles that run along each side the urethra, the tube leading urine out of the bladder and through the penis. These nerves are important for sensation in the penis, and for opening the blood vessles in the penis so that it becomes erect. Losing one of the bundles does not make typical erections impossible. Losing both pretty much does. As others have noted in comments on this blog, there are "nerve sparing" surgical approaches that are supposed to decrease the likelihood of damage to these important structures. Even these procedures, however, will not save the nerves if the cancer has invaded near the area where the nerves pass. It is typical that the trauma of surgery itself will shut these nerves down for weeks to months as the area recovers. Recovery of erectile function in a year is a hoped for goal. There is always a chance that the nerve function will never return.
Ben, along with becoming incontinent, also became impotent. And there's been no improvement in that regard for the past three years. "It is what it is," he says with a wry grin. "You don't want to have that stuff growing inside you, so you have to deal with what you get."
Ben seems to be dealing well. He's enjoying doing the things he does -- recently visiting family (kids and grandkids) several states from his new home, and stopping by to see us as part of the trip. He wouldn't be doing any of that if he had succumbed to cancer.
Inevitably, of course, Ben has a friend who lives near his new home, some distance from where Ben had his surgery. The friend had his prostate removed for cancer a year ago. This person was operated on at a large center where a urologist skilled in robotic surgery was available. Robotic surgery involves using a robot with "hands" capable of very precise movements and a video camera to see with when doing the surgery. The surgeon sits at a complicated console where he picks up and moves instruments, but he views the instruments that the robot "hands" are holding and sees what is going on inside the patient with the video camera. The robot is able to smooth out the actual had motions of the surgeon. The view through the video camera is magnified which helps for dealing with small structures. During the surgery the patient is attended by human assistants as well as the robot. The robot can do nothing on its own. Every motion it makes mimics the motions made by the specially trained surgeon using the device. The surgeon operating the robot may be in the same room as the patient, but may actually be in another room. There are said to be several advantages to this kind of surgery. One is to be able to do very small, delicate things better. Another is to allow this particular procedure to be done through a group of small incisions in the belly wall instead of one, larger one. The surgeon is said to be able to see better than in using a traditional surgical opening and reaching in with his own hands. Recovery time is supposed to be shorter. Finally, using the robots allows the skilled surgeon who manipulates the robots to do more such cases a day, which improves the hospitals revenue and partially supports the cost of the robots themselves.
Ben reports that his friend was back to fully normal function 6 weeks after surgery. Fully normal. So, Ben adds, "If I were to do this again, I'd make sure the surgery was done at a place that offered this robotic option."
One can never tell, of course, how different the surgical situations were. Maybe Ben's cancer was sitting right on top of those nerve bundles and saving them was not an option. Maybe the other guy's tumor was far off and sparing the nerves was easy. Who knows? Ben does not know.
For now I don't know what recommendations my own urologist is going to be making after the biopsy results come back. While I'm waiting, however, I would value hearing of others' experience.
Three years back, Ben had an elevated PSA, and his urologist recommended a prostate biopsy. His recollection of the procedure: "Unpleasant. Not something you can't deal with, but not something you want to do more than once." The biopsy results came back normal -- no cancer found. But the urologist was not convinced he'd sampled in enough places to be sure there was no cancer. So he recommended, and Ben agreed to a second biopsy session. Again, not a pleasant experience. But this time a diagnosis of early prostate cancer. So early and small, in fact, that the first biopsy had missed it altogether. The recommendations the urologist offered ranged from "wait and watch" to having the gland removed now. A few of Ben's relatives have died of cancer. He has a signficant concern that he could easily become yet another cancer death himself. The wait and watch thing only suggested to him a delay of an inevitable need to remove the gland -- and he wanted to get it taken care of now.
At the time, Ben lived in an area where good medical care was available, but even better care was available a few hours drive away. His urologist suggested he obtain a second opinion to think all this through. One particular option the urologist mentioned was robotic surgery, something available in other medical centers, but not something this urologist, himself, could offer. Ben felt comfortable with his urologist, did not seek a second opinion, and decided to have his urologist go ahead with a standard, open surgery, prostate removal.
The surgery went well, no particular difficulties. Then the healing. Again, no special problem. Recovery was not immediate, however. Ben still faced the two serious complications of total prostate removal, or "radical" prostatectomy, as the kind of surgey you do for prostate cancer is called.
The first major problem is incontinence. The problem here is that the sphinctre that holds urine in the bladder is cut open during the surgery and then reconstructed at the end. Even the best surgeon is not as good as the original architect, so some incontinence during healing is to be expected. Most patients are said to recover normal bladder function in a year. Some sooner. Ben was wearing pads to catch leaks for a year. Now, at three years after surgery, he has only occasional leak events, particularly when working out at the gym. He no longer uses the pads. He did use the bathroom at my place twice in the space of an hour. I suspect he does not allow himself to store up much volume in his bladder so that there is not much pressure trying to get out. He says he still has small leaks when he coughs or strains (like lifing stuff, at home or at the gym). It's not a problem for him. Or not a major problem.
The second major complication of this sort of surgery has to do with natural erections. Or the loss of them. There is a pair of blood vessle and nerve bundles that run along each side the urethra, the tube leading urine out of the bladder and through the penis. These nerves are important for sensation in the penis, and for opening the blood vessles in the penis so that it becomes erect. Losing one of the bundles does not make typical erections impossible. Losing both pretty much does. As others have noted in comments on this blog, there are "nerve sparing" surgical approaches that are supposed to decrease the likelihood of damage to these important structures. Even these procedures, however, will not save the nerves if the cancer has invaded near the area where the nerves pass. It is typical that the trauma of surgery itself will shut these nerves down for weeks to months as the area recovers. Recovery of erectile function in a year is a hoped for goal. There is always a chance that the nerve function will never return.
Ben, along with becoming incontinent, also became impotent. And there's been no improvement in that regard for the past three years. "It is what it is," he says with a wry grin. "You don't want to have that stuff growing inside you, so you have to deal with what you get."
Ben seems to be dealing well. He's enjoying doing the things he does -- recently visiting family (kids and grandkids) several states from his new home, and stopping by to see us as part of the trip. He wouldn't be doing any of that if he had succumbed to cancer.
Inevitably, of course, Ben has a friend who lives near his new home, some distance from where Ben had his surgery. The friend had his prostate removed for cancer a year ago. This person was operated on at a large center where a urologist skilled in robotic surgery was available. Robotic surgery involves using a robot with "hands" capable of very precise movements and a video camera to see with when doing the surgery. The surgeon sits at a complicated console where he picks up and moves instruments, but he views the instruments that the robot "hands" are holding and sees what is going on inside the patient with the video camera. The robot is able to smooth out the actual had motions of the surgeon. The view through the video camera is magnified which helps for dealing with small structures. During the surgery the patient is attended by human assistants as well as the robot. The robot can do nothing on its own. Every motion it makes mimics the motions made by the specially trained surgeon using the device. The surgeon operating the robot may be in the same room as the patient, but may actually be in another room. There are said to be several advantages to this kind of surgery. One is to be able to do very small, delicate things better. Another is to allow this particular procedure to be done through a group of small incisions in the belly wall instead of one, larger one. The surgeon is said to be able to see better than in using a traditional surgical opening and reaching in with his own hands. Recovery time is supposed to be shorter. Finally, using the robots allows the skilled surgeon who manipulates the robots to do more such cases a day, which improves the hospitals revenue and partially supports the cost of the robots themselves.
Ben reports that his friend was back to fully normal function 6 weeks after surgery. Fully normal. So, Ben adds, "If I were to do this again, I'd make sure the surgery was done at a place that offered this robotic option."
One can never tell, of course, how different the surgical situations were. Maybe Ben's cancer was sitting right on top of those nerve bundles and saving them was not an option. Maybe the other guy's tumor was far off and sparing the nerves was easy. Who knows? Ben does not know.
For now I don't know what recommendations my own urologist is going to be making after the biopsy results come back. While I'm waiting, however, I would value hearing of others' experience.
