I chose surgery as the treatment method to deal with my cancer. Specifically, my surgery was Radical Laparoscopic Prostatectomy performed robotically at Strong Memorial Hospital in Rochester, NY.
Therefore, most of the following questions and answers are based on my personal experience. If anyone has other questions/answers that might help other men, please feel free to email me and I'll include them as well.
What does the prostate gland do?
The prostate gland is located at the base or outlet of the bladder. One function of the prostate gland is to help control urination by pressing directly against the part of the urethra that it surrounds. Another function of the prostate gland is to produce some of the substances that are found in normal semen, such as minerals and sugar.
What is staging?
There are two types of staging, clinical and pathological. Both provide indicators of how far the cancer might have spread. Clinical staging is based on clinical information such as a DRE, PSA levels, ultrsound, biopsy, etc and is never 100% accurate. The most accurate way to ascertain the spread of the cancer is with pathological staging, which actually means looking at samples of all of the tissue in question. Unfortunately, the only way this can be done is to remove the prostate. So, only men who have had a radical prostatectomy would be candidates for pathological staging.
What is a nerve bundle?
The neurovascular bundles or nerve bundles, one on the left side of the prostate and one on the right side carry nerves and blood to assist in achieving an erection. If surgery is chosen as the treatment of the cancer, these bundles may or may not be spared.
What are margins?
Following radical prostatectomy, the tissue removed is pathologically examined randomly around the surface. If no cancer cells are found on these "margins", then your margins are negative and the chances are pretty good that all of the cancer cells have been confined within that tissue and thus have all been removed. If cancer cells are found on the "margins", then your margins are positive, and the chances are pretty high that cancer cells remain in your body.
What is localized prostate cancer?
When the cancer is confined to the prostate it is said to be localized. Men who have localized cancer have the best chance of long-term survival.
Where can I talk to other men about Prostate Cancer?
This website offers you that opportunity. Just go to Talk to Survivors link. To insure the privacy of those men who have volunteered to discuss their experiences, you need to obtain the password from your urologist.
Will a special diet cure my cancer?
Alternative medicine includes such non-traditional treatments as herbs, dietary supplements, and acupuncture. The way herbal treatments work and their long-term side effects usually are not known.
Which is better, surgery or seed implants?
Seed implants (Brachytherapy) is a relatively noninvasive radiation treatment relative to surgery. One of the disadvantages with seed implants is that if the cancer is not destroyed (the seeds didn't work), then surgery is no longer an option. For me personally, I did not want to take that risk so I elected for surgery.
If I have surgery, will I be using a catheter?
Yes, usually for one to two weeks. For me, this was a very inconvenient nine days. On my way home from the hospital, which was a 6 hour drive, I discovered that the upper leg strap on the catheter bag was not as tight as it should have been and when I stepped out of the car, the weight of the urine in the bag quickly pulled it down around my ankles. When I saw what had happened, I thought I had pulled the catheter out of the bladder--needless to say I was frantic. A call to my doctor's office reassured me that the catheter was still in place. On the second day home, I also had some urinary leakage around the catheter. When I called my doctor, he explained that this is not that uncommon. Finally, the catheter, even on the shortest of walks was, physically, very irritating. Here is a good series of pages about the Foley Catheter
Does surgery require a blood transfusion?
It might, but I did not need it.
How long must I remain inactive following surgery?
Depending on what you read or on your physician, you probably will refrain from any strenuous activity for anywhere from three to eight weeks. I started back to work (desk job) a day or two after I got home from the hospital. I also began walking daily, following the advice of the nurse at the hospital. If not for the catheter, I would have been walking 2-3 miles per day within one week of surgery. Once the catheter was removed, I was back at work full time and was walking at least 3 miles each day. My doctor dictated I refrain from strenuous physical activity, including lifting more than 20 pounds, for four weeks after the catheter was removed. After that, I resumed my daily hikes up a nearby mountain with no problems.
Will I be incontinent after surgery?
You might be to a certain extent. After my catheter was removed, I felt about 90% continent within one week and I was totally continent within one month.
Can I have surgery if seeds don't work?
No. That is why I chose surgery (Radical Prostatectomy).
Isn't radiation a better choice than surgery?
That depends on your age, physical condition, and staging. My cancer was localized, I was only in my late fifties, and I was in excellent physical condition so I chose surgery, which I felt gave me the best chance for a long-term survival.
How do I know if all the cancer cells have been surgically removed?
If your margins are negative and your follow up PSA level is 0 or very close to 0 (<.01 ng/ml), then there is an excellent chance you are free of prostate cancer. However, if your PSA level is .1 ng/ml or higher it means prostate cells are still present somewhere because only prostate cells make PSA. Therefore, for all intents and purposes, it means that a few cells escaped the prostate before it was removed, and now have grown to the point somewhere in your body where they're producing enough PSA to be detected.
When will I be able to go to work?
Depending on the treatment and your profession, anytime from 2 days to 8 weeks. Obviously, if you elected surgery it will take much longer than choosing seed implants. However, as your doctor will tell you, recovery time will depend on many factors, including your overall health and fitness.
When can I drive again?
Depending on the treatment, anytime from 2-10 days. I was driving the same day the catheter was removed (9 days after surgery).
How expensive is the treatment?
Most treatments are expensive costing on average anywhere from $15,000 to $25,000.
How do I know if the cancer is cured?
You'll probably never know for sure, but if your PSA levels are 0 if you've had surgery or are under 1.0-2.0 if you have elected treatments other than surgery, then most men would consider themselves lucky.
What happens if I just "watch and wait"?
My urologist told me "You'll be fine for 2-3 years, you'll begin having problems within 5 years, and you'll probably be dead within 10 years". So, if you're 85 years old, then the "watch and wait" approach is probably not a bad choice, but if you normally would expect to live at least another 10 years following your diagnosis, then some other treatment is best.
Where should I go for treatment?
Find the urologist and hospital as close to home which provides the treatment of your choice and gives the best chance of success. The success of any treatment is directly related to the expertise of the urologist performing it. So, someone who performs the procedure 10 times each week is probably going to do a better job than someone who does it twice a month. My surgery was performed in Rochester, NY, nearly 6 hours away from home. Personally, I decided that the inconvenience of such a long drive was more than balanced by the type of treatment provided as well as the outstanding reputation of the surgeon and of the hospital. Another concern I had about the distance was what would I have done if an "emergency" situation had developed at home during the first nine days following surgery. As it turned out, any problems I did have were adequately handled by the prompt return of my phone calls by the very professional staff in Rochester.
Following surgery, what follow-up is required and what is my prognosis?
Approximately 3 months following surgery you will have a PSA level test done. Because PSA is produced by prostate cells, and your prostate has been removed, your PSA level should become undetectable within 3-6 weeks of radical prostatectomy surgery (as the half-life of PSA is 3.2 days). If this PSA report is < .01 ng/ml or undetectable, then for the moment you are in pretty good shape, and you will be monitored every three months for the next two years. Any detectable PSA level after radical prostatectomy or when a rising PSA level is detected on the serial 3-month measurements, it may either indicate local recurrence or distant disease. Your chances of developing a rising PSA level, and your subsequent chances of long-term survival, appear to be related to your pre-surgery PSA level and Gleason score.