My Prostate Cancer Journey - David Cook

Prologue

Every man’s journey with prostate cancer is different. Some men may encounter major challenges while others encounter only minor problems. This is my personal prostate cancer journey.

This documented journey was originally presented in three separate Parts. I am now incorporating them into five chapters and documenting my journey into one paper and have written additional chapters to bring the reader up to date 5 ½ years later.

The purpose for writing this chronicle was to provide men who have been diagnosed with prostate cancer a glimpse of what they may encounter along their cancer journey in plain simple language from my own personal experience. You too may travel the same journey as I or have the same questions as I did. I would have liked to have had similar information to read before I started my journey. A lot of good reliable medical information is available in the public domain but little was available in writing from the perspective of a man that actually went through Robotic Radical Prostatectomy Surgery. I am pleased to share my journey with you.

The content in this document is merely for educational and information purposes about my personal prostate cancer experience and how I remember events and details unfolding. This is my personal journey and these observations and reflections are solely my own and do not reflect the views of those of PCNO. It is not nor should it be interpreted or construed as professional or medical advice. Any information contained herein should always be validated and confirmed by your family doctor or urologist.

Furthermore, I would also like to caution readers that some information contained herein is explicit, and of a sexual and personal nature. I would trust that it will not be perceived as being offensive, profane, nor vulgar realizing that such graphic information may be upsetting for some readers who are dealing with extra stress and trepidation due to their personal circumstances. Some humour has been exercised to embolden the notion that ‘laughter is the best medicine”. Reader discretion is advised due to the mature nature of the content.

You may have heard about the wonderful outcomes and the not so good outcomes of men dealing with prostate cancer. The less successful outcomes are becoming more rare thanks to medical advancements. I kid you not when I say medical advancements in dealing with prostate cancer are happening every day and we are blessed to have right here in Ottawa one of the most renowned cancer clinics in North America.

My family doctor told me from the onset, “you may die with prostate cancer but you will not die of prostate cancer”. I say, remain hopeful, positive and cheerful, no matter what challenges that may lie ahead. You will get through this.

Your journey usually is never alone and typically impacts others as well. Your spouse, partner, family and friends are all part of your journey. If you are alone seek out and confide in a friend or one of the many support groups in the community such as Prostate Cancer Network Ottawa (PCNO). We are all in this together.

I am happy with my outcome and I am leading a healthy life today.

It all started in the summer of 2014 at age 64 when my family doctor sent me to the General Campus of The Ottawa Hospital’s Cancer Assessment Clinic to see an urologist. So let’s begin my journey.

The Dreaded “C” Word Is Not To Be Dreaded

Chapter I

After a number of routine DRE’s (digital rectal exam) during my annual checkups and increasing PSA levels (prostate-specific antigen blood test), my family doctor felt it best to refer me to an urologist for a second opinion to determine the cause of my enlarged prostate and rising PSA levels. (Oh, yes, you do have to bend over for one more DRE!!) This took place at the General Campus of The Ottawa Hospital’s Cancer Assessment Clinic -- not because my doctor thought I had cancer, but because this is where the experts hang out!

Based on the findings from the urologist’s physical examination in May 2014 when I met with him for the first time and results of previous family doctor instigated PSA testing (July 2013 - PSA 5.41; March 2014 - PSA 5.44; May 2014 - PSA 7.20) , the urologist felt it best to recommend a prostate biopsy for early June 2014. A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate which will confirm if cancer is present or not.

Following a biopsy, tissue samples from the prostate biopsy are sent to a pathology laboratory to be examined under a microscope for cell abnormalities that are a sign of prostate cancer. If cancer is present, it is evaluated to determine how quickly it's likely to grow and spread, and to identify your best treatment options.

In many men, prostate cancer can be slow growing and never go beyond the prostate gland or spread to other sites, thus the risk may be considered low. One strategy to deal with low risk prostate cancer is called “active surveillance,” where your urologist closely monitors you and considers treatment only if and when the disease appears to be growing or spreading. On the other hand, if the cancer is very aggressive, it will require immediate treatment. Your prostate cancer may fall anywhere in between these two extremes.

If you undergo a prostate biopsy, it may be a few weeks before you meet with the urologist again to receive the results. You will be presented with the Pathology & Laboratory Biopsy Report and explained its contents. I met with my urologist to discuss the findings of the biopsy on July 4, 2014.

I was hoping not to hear the dreaded “C” word, but with the odds that one in 7 men will be diagnosed with prostate cancer my odds were obviously better than winning the Lotto 6/49! As of January 2020, I have been hearing that the odds are getting better to one in 8 or 9 men will be diagnosed with prostate cancer. This is encouraging.

“Yes, you have prostate cancer” was all that I heard as it echoed around in my head. Translated into medical terminology, I had a PSA of 7.2; Gleason Score of 7 (4+3); and a Clinical Stage of T1C. (N.B. At the end of this Chapter is reference material on Understanding the Gleason Score results.)

I was immediately sent to have additional blood tests and a chest x-ray before I left my urologist’s office/hospital. I was also told to go home and research the type of treatment I would like to pursue to deal with my cancer and report back with my decision. “Great,” I thought to myself and “You are the expert, doctor but I am supposed to determine my treatment”. Darn, I should have gone to medical school!

But don’t panic, this quandary is resolved further down in this article.

Also, I had a bone scan mid-July which required drinking some awful tasting liquid over a 1½ hour period while waiting for the scan to commence which took approximately 45 minutes to complete. Apparently, you can purchase at the hospital flavouring to add to the liquid to kill the awful taste. But of course did I heed the recommendation? No, so I had to endure it! Really it was doable. But then again, I’m just being a wimp!

Let me digress for a moment.

First, don’t make the same mistake as I made. In the past when I heard that someone had been recently diagnosed with cancer, for some reason “six months to live” keeps popping into my head. Silly me, that’s what I thought when I was told that I had prostate cancer and I panicked thinking how am I to get all the things I need to get done in such a short period of time before the grim reaper gets me! I worried unnecessarily for a week, until I found out, “like that is not going to happen any time soon.” Moral of the story, ask your urologist what is your timeframe so that you can still get out of doing all those things you kept putting off and you will see that you will still have plenty of time left ahead of you to do them if so wish and to reach a good old ripe age.

Secondly, as I stated earlier, “You’re the expert doc, you tell me what type of treatment I should opt for?” The doctor wants you to make the final decision because it is really your decision to make. The exercise in coming to such a decision is that you will educate yourself about prostate cancer and choose a treatment that you are most comfortable with based on your cancer diagnosis and your quality of life priorities. The medical team is there to support you in any way they can and I am sure your urologist will not let you make an ill-informed decision.

Thirdly, the dreaded “C” word by the way has other meanings which you will come to embraced, such as: there is no question cancer is a Challenge but you are Capable and it Can be Conquered with Choices that are supported with Courage, Confidence, Character, and a willingness to Change which in the end will Comfort you with a Contented feeling that you made the right Choice which will be Celebrated in the Company of your Caring Community of family, your medical team and many supporters, like the PCCNO during your journey.

Wow, if that wasn’t alliteration, I don’t know what is!

Now, back to the biopsy conducted on June 5, 2014. I found it to be a lot less intrusive than a colonoscopy and a bit more intrusive than a DRE. By the way, the Nike commercial, “no pain, no gain” does not apply here. Prior to the procedure, you are met by a nurse that explains what will take place and shows you the instrument that will be used. It takes the medical doctor about 15 minutes to complete the procedure.

Approximately 10 to 12 core samples of prostate tissue are taken under ultrasound guidance using a specially designed device known as a prostate biopsy gun. However, prior to taking any specimen samples the prostate area is frozen, so “no pain” but maybe some mild discomfort at most, usually.

It is required that you are accompanied to your biopsy by a person to ensure your wellbeing until you get home. Don’t even think of driving yourself home as this is prohibited. Once home, over the course of a week or more, you will be discharging blood from the biopsy site when you urinate. This is normal and the speed to which the blood will disappeared over time will depend on each individual. Also, and this is important, you will be passing blood and/or small blood clots when you ejaculate following the biopsy procedure until all that blood leaves your system. Once again, this is normal. I found it a good idea to masturbate as soon as you are comfortable to do so, (standing over the toilet preferably), as this will help get rid of the blood being passed through your urine as well. You might become alarmed at the sight and amount of bloody discharge upon ejaculating, but this is normal. I waited over a week before I masturbated and my recommendation would be to do it as soon as you are comfortable to do so and at least several times over the first couple of weeks. The more blood you get rid of, the better. And the good part, yes you can have sex whenever you are ready to do so.

By now you are getting overwhelmed with information you have assimilated from various sources and somehow you need to make a decision as to the type of treatment that would be best for you and one that you would be comfortable in committing to. I read a lot and availed myself to as much information as I felt I could absorb. I was able and I am sure you will be too, to access medical professionals, including doctors, to explore and pose questions about surgery, radiation and other prostate cancer treatments before making your decision as to how you would like to proceed.

To help me make my decision, I created a spreadsheet that listed the pros and cons of each issue/concern associated with surgery versus radiation, as these were my two choices for potential treatment. You may make a similar spreadsheet and of course add other treatments related to your specific case which you may wish to consider/evaluate. I ranked them on a scale of 1-5 of importance to me and I also assigned a risk scale to each in regards to the probability of that issue or risk ever happening according to the research I found. I did not mathematically tally up the results but used the table to explore the pros and cons of each treatment. In the end, I think one comes to a decision by their own instinctive intuition.

Here is an example of only two of the 20 issues that I identified that were important to me in considering which treatment I wanted to undertake:

pros and cons of each issue/concern associated with surgery versus radiation
ISSUE Related To Surgery Comments Radiation Comments Risk (H-M-L) Importance to me (1 – 5)
Erectile Dysfunction
2 yrs After
Surgery & Radiation 64% Immediate effects 66% Slower effects H 4
Urinary Leakage (Incontinence)
2 yrs After
Surgery & Radiation 8% 5% L 3

The next step was a return visit in August 2014 to meet with my urologist and support medical team to announce my decision and obtain reassurance that this was the right choice for me. In my case, I chose Robotic Radical Prostatectomy Surgery (see Chapter II of My Personal Journey).

The final step is your medical team preparing and informing you about your choice of treatment and getting a date set for the big day, surgery in my case. Or the first day of your radiation regime or any other treatment option you may have decided to undertake.

I would encourage all men to take their wives, partners or best friend with them along this journey. I don’t think I could have reached this point in my journey without the kindness, understanding and encouraging words of my wife who accompanied me throughout the whole process and during follow-up appointments. It’s a team challenge.

Some of the resources I availed myself to while learning about prostate cancer and making my decision were, (in no order of importance):

My medical team (including the nurses, doctors and social worker)

The information provided to me by my medical team, e.g. “Prostate Cancer – Information Guide and Personal Record” book

Prostate Cancer (Understanding the Disease and its Treatment) Third edition. Fred Saad, MD & Michael McCormack, MD. (The best book I read to date in simple understandable language)

Assume the Position: One Guy’s Journey Through Prostate Cancer. Richard K. Bercuson, 2008. Available through PCNO and Amazon.ca or Book.Google.ca.

The information pamphlets within the hospital and hospital library/resource centre

Surgery and Radiation information sessions offered by the hospital & in speaking with the medical doctors

Monthly Calendars obtained at the reception desk of the Ottawa Hospital Cancer Centre:

  1. The Ottawa Hospital Cancer Centre Education & Support Calendar (Blue calendar)
  2. The Ottawa Area Education & Support Group Calendar for People Diagnosed with Cancer and their Loved Ones (Green calendar)

Prostate Cancer Network Ottawa Branch, http://www.pccnottawa.ca/ (I cannot stress to you how important contacting this organization is prior to or immediately after your diagnosis. I would even contact them prior to your biopsy. An excellent support network convening monthly meetings and which produces a very informative monthly newsletter called “The Walnut,” a must read.)

Maplesoft Centre for Cancer Survivorship Care, Ottawa (you can contact them before or after being diagnosed. A great support network with cancer coaches available to you.)

Recent advances in the treatment of prostate cancer have significantly decreased the risk of death. The quality of life of men living with prostate cancer continues to improve dramatically each day with new research and clinical trials. That is why the citizens of greater Ottawa are so fortunate to be serviced by The Ottawa Hospital Cancer Centre. The service is outstanding but more importantly it is a world leader in cancer research. In 2014, The Ottawa Hospital was selected to host a $60M national research network for innovative cancer treatments. According to their news release:

  • “The Government of Canada announced $25 million today (15/12/2014), with an additional $35M from partners, to create the first Network of Centres of Excellence (NCE) devoted to cancer research. The NCE, called Biotherapeutics for Cancer Treatment (BioCanRX), will be led by Dr. John Bell, a senior scientist at the Ottawa Hospital Research Institute and professor at the University of Ottawa.
  • ‘But what is really unique about this funding is it allows a fantastic team of Canadian scientists to work together to develop several therapeutic strategies in parallel, and then test these both alone and in combination, with the goal of finding the most effective way to help our bodies’ own defences fight cancer. In this case, the whole really is greater than sum of its parts,’ added Dr. Bell”.

In concluding Chapter I, remember you are not alone on this ride. Remain hopeful, positive and cheerful, no matter what challenges may lie ahead. All the best.

Reference Material: Understanding the Gleason Score Results

The following information was gleaned from various sources. I believe it to be still relevant but once again if you have questions verify the information below with medical professionals.

Following your biopsy the 10-12 biopsy samples are send to the lab for a pathologist to examine. The pathologist looks at the biopsied tissue samples through a microscope to determine where the cancer is the most prominent (the primary grade) and then where it's next most prominent (the secondary grade). If cancer tissue is detected, the pathologist then grades the tumor.

Pathologists grade prostate cancers according to the Gleason system, named after the inventor. This system assigns a Gleason grade based on how much the cells in the cancerous tissue look like normal prostate tissue.

Next, the pathologist assigns a score from 1 to 5 to each area or core sample: one score for the primary grade and one score for the secondary grade. Since prostate cancers often have areas with different grades, a grade is assigned to the two areas that make up most of the cancer. The Gleason score is the sum of the primary and secondary grades. These 2 grades are added together to yield the final Gleason score (also called the Gleason sum). The Gleason score can be between 2 and 10, but most biopsies are at least a 6. The higher the Gleason score, the more likely it is that the cancer will grow and spread quickly.

As a result, the total score can be anything from a 2 (primary grade 1 + secondary grade 1) to a 10 (primary grade 5 + secondary grade 5).

  • If the cancerous tissue looks much like normal prostate tissue, a grade of 1 is assigned.
  • If the cancer cells and their growth patterns look very abnormal, it is called a grade 5 tumor.
  • Grades 2 through 4 have features in between these extremes.

If cancer is present, most biopsies are grade 3 or higher, and grades 1 and 2 are not often used. The lower the score, the better. A combined Gleason score of 10 is very bad (although there are still many treatments that doctors can offer men with high Gleason scores). Here's how the final Gleason scores break down:

   Scores from 2 to 4 are very low on the cancer aggression scale.
   Scores from 5 to 6 are mildly aggressive.
   A score of 7 indicates that the cancer is moderately aggressive.
   Scores from 8 to 10 indicates that the cancer is highly aggressive.

Along with the grade of the cancer (if it is present), the pathologist’s report also often contains other pieces of information that can give a better idea of the scope of the cancer. These can include:

  • The number of biopsy core samples that contain cancer (for example, “7 out of 12”)
  • The percentage of cancer in each of the cores
  • Whether the cancer is on one side (left or right) of the prostate or both sides (bilateral)

For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and the lessor of the tumor is grade 4 and they are added for a Gleason score of 7. The highest a Gleason score can be is 10.

Now, to confuse you a little more, a Gleason score of 7 can have two meanings. As an example, if the predominant grade is 3 and the secondary grade is 4, the resulting Gleason score is 7; however, if the predominant grade is 4 and the secondary grade is 3, the Gleason score is also 7.

Which man is happier with his score?
Answer: The lower predominant score of 3 has a less aggressive cancer than the higher predominant score of 4.

This may be a good understanding of the Gleason Score but really how important is the Gleason score?

The Gleason score is very important in predicting the behavior of a prostate cancer. Still, other factors are also important, such as:

  • The PSA level,
  • Findings on rectal exam (DRE),
  • How much of each core is made up of cancer,
  • The number of cores that contain cancer,
  • Whether cancer was found in both sides of the prostate, and
  • Whether the cancer has spread outside the prostate.

Robotic Radical Prostatectomy Surgery

Chapter II

This Chapter is my personal experience of undergoing Robotic Radical Prostatectomy Surgery at The Ottawa General Hospital. Remember, while every man’s experience with prostate cancer is different, this is my personal journey. (N.B. At the end of Chapter II is reference material on Radical Prostatectomy.)

As an aside, if you have a waiting period before you are scheduled for surgery my urologist said losing weight is a good thing before surgery. The caveat here is that it all depends on your current size and weight. If you are overweight losing weight lowers your risk for serious surgery-related complications such as infection, blood clots and heart attack. So even making small changes to your eating and exercise habits can make a difference to avoid complications during and after surgery.

I was admitted to hospital on September 2, 2014 and was very fortunate that the operating room unexpectedly became available due to a cancellation. My robotic surgery started at 8:00am and finished at 12:00 noon. (I understand that since my surgery, the operation can be much shorter.)

At 6:30am I reported to the “Same Day Admission/Surgical Day Care Unit Reception Desk” where I was assigned a temporary bed and prepped for surgery. I changed into a surgery gown, given some medication, asked a series of questions, had a PIV (Peripheral Intravenous) device attached to my hand which was used by the anesthesiologist to inject the anesthesia. Then the best part, thanks to the nurse, I got hot! No, it’s not what you’re thinking. The nurse places an air mattress underneath your bed covers which is being continually filled with warm air to circulate over your body. This is to warm your body up before surgery.

About 15 minutes to a half hour before surgery, you are taken away and wheeled into a corridor just outside the operating room. Prior to being wheeled into the operating room you are met by the anesthesiologist who reconfirms some of your medical information and explains what will soon take place. At this time you can pose any further questions you may have.

You are then wheeled into the operating room. Your surgeon introduces you to the medical team who will remain in the operating room until you surgery is completed. The surgeon will then brief the medical team as to the type of surgery that is to take place. At this time, you will have another opportunity to pose any further questions.

Then the anesthesiologist will ask you to try breathing into an oxygen mask to make sure that it fits properly over your nose and mouth. His/her final words to you are “I am going to start the anesthetic drip now” and the next thing you know you are waking up in the recovery room wondering when the heck are they going to start the surgery? OMG, it’s over! I’m alive! No pain, some discomfort, it was a piece of cake I think to myself! A small incision above my navel and 5 one half inch incisions across my belly, all below my navel. These incisions heal very well and disappear over time. You may want to speak to your urologist about apply a cream like vitamin E which helps in the healing of cuts/incisions.

I awoke from the anesthesia at 1:30pm. Once fully awake, I was without pain and quite comfortable. I remained in the recovery room for some time being monitored constantly and being offered sips of water. When a hospital bed becomes available, you are wheeled to your room for the night. Your diet increases from sips of water to clear fluids and then to a regular diet.

However, the next morning in my hospital room it was quite a different experience. I was not in pain, as much as, I was feeling great discomfort. Aching stomach, probably from the surgery, upset stomach and a migraine. I am susceptible to migraines when I do not eat my meals on a regular basis and it was 8:00am the day after surgery, and I had not eaten for 36 hours. I vomited a bit and that helped settled my stomach and of course I felt much better after eating my breakfast. Also, the day after surgery is when, the J/P drain (Jackson-Pratt drain) which is used as a post-operative drain for collecting bodily fluids from your surgical site is removed. (N.B. this is not your catheter.) By the end of the day, around 5:00pm, I felt reasonably comfortable enough, along with my medical team’s assessment to be discharged and welcomed sleeping in my own bed.

Got home and settled in for the night. Around 9:30pm I was experiencing some bladder discomfort and realized that my urine was not empting into the catheter bag. I had a blockage and the urine was being forced out of the head of my penis (the meatus) circumventing the catheter tube. Apparently, this can occur on occasion. Things were getting messy and I became anxious. I grabbed some paper towelling and bed pads, placed them over my groin area, threw on a house coat and off to the nearest emergency outpatient department which happened to be The Ottawa General Hospital.

Emergency hospital staff realized the urgency and dealt with me immediately. The nurse confirmed blockage and as required consulted first with an urologist prior to embarking on any medical intervention. The nurse used a flushing technique to dislodge a large blood clot and immediately thereafter my urine was flowing normally again into the catheter bag. There was no discomfort at all undergoing the flushing technique which lasted about one minute and the catheter tube did not have to be removed from my penis to perform this procedure. I remained at emergency for an additional half hour to ensure all was working well prior to returning home. (N.B. At the end of Chapter II is reference material on Flushing.)

All was well until a few hours later, again I experienced the same problem but less dramatic and it was back to emergency, but this time I emptied my large catheter night bag before departing the house. However, from the time I left my home to being seen by emergency staff, the blockage somehow became unblocked on its own and required no intervention. I remained once again at emergency for a half hour prior to returning home to make sure all was working well.

Since the above incidents, my ongoing recovery was uneventful. I am most appreciative for the excellence and professionalism of the emergency outpatient department staff.

Finally, now for “La piece de la Resistance,” having survived 10 days of wearing a catheter, I was meeting the surgeon for the first time after surgery on September 12, 2014 and was dreading having the catheter tube pulled out of my penis. My doctor released air from the catheter balloon which holds the catheter in place so it does not slip out of your penis. The catheter is held on to your leg by a Statlock Foley Stabilization Device (the device used to secure the catheter to your leg, see My Personal Journey, Chapter III, #11). After the doctor released the air from the balloon, he asked me to cough and before I could even finish my cough it was all over in a nanosecond. He had pulled it out. Again, I worried for nothing! This appointment with the surgeon was also an opportunity to get his take on the outcome of the operation.

Wearing a catheter for eight to ten days can be tiresome but certain not painful. My greatest worry was the concern that it might fall out when showering, emptying or changing the bags. If you are careful, there is no need to worry as a Foley catheter is held in place by an inflatable balloon which keeps the catheter securely in the bladder as I mentioned above. (There are many websites that explain everything you ever wanted to know about catheters, one such site is http://urology.ucla.edu/body.cfm?id=525 but remember your best resource for medical information is your medical team.)

As for dealing with incontinence, I have been very fortunate, after removal of the catheter I wore Depends for 3 days and incontinence pads/guards for men for about 3-4 days. Then after that, I had a bit of leakage when forcing gas (farting) or forcing a bowel movement. But this leakage decreased quickly overtime and has not caused me any significant problems since. I also do not have to get up in the middle of the night to urinate.

As for penile rehabilitation, (getting an erection after having surgery) I was prescribe 5mg of Cialis on a daily basis with a couple of 20mg Cialis pills for special date nights! To be honest, it is still a work in progress. Time will tell the tale. Maybe that could be good fodder for a separate article! However I do cover this subject in Chapter IV.

Approximately three months following my surgery, I visited my surgeon/urologist to receive the results of my first PSA score and the good news was that it came back “cancer undetectable,” a far cry from the words that first echoed through my head “Yes, you have prostate cancer.” I received the results of my second post-surgery PSA test and again similar results indicated “zero cancer.” Much to be thankful for.

In concluding my journey story up to this point, I cannot over emphasise the excellent and caring attention I received from my urologist/surgeon, medical team and staff at The Ottawa General Hospital. They were with me all the way and readily accessible when I needed their advice and assistance and will continue to be with me as I journey along.

In concluding Chapter II, remember you are not alone on this ride. Remain hopeful, positive and cheerful, no matter what challenges may lie ahead. All the best.

Reference Material: Radical Prostatectomy

This is the most common surgery for removal of localized prostate cancer. It completely removes the prostate cancer. At The Ottawa Hospital, robotic assisted surgery, such as the da Vinci Surgical System, is living up to this challenge. With this leading-edge medical technology, the surgeon uses computer-assisted cameras to guide tiny robotic arms to access hard-to-reach areas of the body with greater precision. This minimally invasive surgery allows for smaller incisions, which means less blood loss, less pain, and fewer complications – all resulting in faster recoveries.

Reference Material: Flushing

Basically, the procedure as I recall it consists of the nurse using a bladder syringe filled with a solution like Sodium chloride 0.9%. The syringe plunger is inserted into the catheter and is depressed slowly until the fluid is instilled, after which the syringe is removed and the catheter begins to drain. If no drainage occurs, gentle suction is applied via the catheter syringe. This must be performed gently, as it is possible to suck part of the bladder wall (urothelium) into the eye of the catheter, causing pain for the patient and trauma to the bladder, which in turn may cause infection (Macaulay, 1997). The washout can then be repeated if necessary until the fluid from the catheter becomes clear.

If this procedure does not produce the expected results, I understand that the catheter may be removed from your penis and similar or alternate procedures are used to dislodge the blockage. Once it is determined that the urine is flowing properly, the catheter is replaced in your penis.

Helpful Tips to Assist in the Recovery and Comfort of Your Rehabilitation Immediately Following Robotic Radical Prostatectomy Surgery

Chapter III

The material, literature and instruction you have received from your medical team to date provides excellent and through information on how best to provide rehabilitative after-care following your surgery.

This chapter is my personal experience in wanting to share with others additional practical tips to facilitate after-care and rehabilitation that I discovered useful during my own recovery following my Robotic Radical Prostatectomy Surgery at The Ottawa General Hospital. What may be a better technique or method that works well for one man may not be practical or work so effectively for another man. These tips are only suggestions that made my recovery easier and may be of help to you, knowing that each man’s recovery experience from surgery differs as to the level of discomfort he experiences and can tolerate.

Please consult your surgeon or medical team if you have any questions regarding these tips. PRACTICAL TIPS (in random order)
  1. For the first few days at home, you may find it more convenient to be parading around in the privacy of your bedroom naked with the catheter hanging from your penis for your caregiver(s) to most likely see. So, if you are a shy person when it comes to bearing it all (Doing the Full Monty), you’ll soon get over it!
  2. Prepare your bedroom in advance for your return from the hospital. Rearrange or remove excess furniture. Your ability to lean forward, move from side to side, raise yourself up and down may not be as easy as before your surgery, so placing the nightstand clock in a different location to be seen from a laying down vantage point may prove more practical. You will want to monitor the time quite frequently initially.
  3. Ensure that you have a night table next to your bed to be close at hand for your medications and water, juices, etc.
  4. Clear off the vanity in the bathroom and just keep the things you need there to clean your catheter bags and clean yourself. Stock your bathroom with the toiletries you will be needing so they are close at hand.
  5. You will be showering and may not be as agile as before your surgery, so you may want to purchase an anti-slip shower or bath mat to be placed inside the tub or shower for better secure footing.
  6. You may want to purchase at the dollar store a shower caddy which can hold a bar of soap and shampoo and usually has one or two hooks to hang a face cloth. These items are then easier to reach and hence you avoid having to bend down to retrieve them. I also used the shower caddy to hang up my catheter tubing and bags to drain and dry.
  7. I preferred to shower when I was wearing the night time catheter bag because of its long tubing which allowed me to place the bag on the bathroom floor and run the tubing under the shower curtain which prevented me from stepping on it during my shower. It also facilitated easier drying off as the bag was not wet as well. Another suggestion which I did not try but may well be preferred was to remove/disconnect the catheter bag before showering, but make sure that the catheter tubing is still attached to the Statlock Foley Stabilization Device, to avoid any unnecessary movement.
  8. I found it very useful to purchase a box of Heavy Duty Paper Clean Up towels. This product can be purchased at either an automotive or hardware store. They absorb both water and oil efficiently and have a high wet strength. These small throw away towels (10 x13in) are very handy to dry your groin area after washing and also rubbing off the red surgical dye which may stain a white bath towel. Also, they are great for general cleaning up purposes.
  9. I am suggesting to hook the larger night time catheter bag to your bedframe, however, another option I found useful was to hook it to the inside of a rectangular or round plastic water bucket placed on the floor. I placed the bag inside the bucket and then once in bed pushed the bucket away from the bed so that the tubing had no kinks in it, nor was there any looping of the tubing which makes for easier flowing of the urine into the bag.
  10. To secure the leg catheter bag (the smaller bag) to your leg, it come with two cloth elastic straps with a plastic button on each strap that fits into a slit (similar to buttoning your shirt) allowing you choose the slit that best tightens around your leg. I was told that the plastic button is prone to breaking and so another easier way to secure the straps is to just tie them as if you were tying a shoe lace. It was much easier to tie and easier to undo and worked very effectively. Since my operation it may be the case that a newer more efficient version of securing the leg bag has been developed.
  11. During surgery the catheter is inserted in your penis while you are under anesthesia, hence, no discomfort. Also, a Statlock Foley Stabilization Device is attached (self-adhesive) to your leg to hold the catheter tubing in place and reduce any unnecessary movement that would cause the catheter tubing to be dislodged from your penis. Something you definitely do not want to happen!
    (N.B. I will now describe the Foley Catheter and the Statlock Foley Stabilization Device which was placed on my leg but it is possible that a similar device by another manufacturer could be placed on your leg which may not be identical).
    The Foley Catheter has two (exit) openings at one end of the catheter (similar to the letter Y). The other end, of course, is the portion that is inserted in your penis which has a balloon attached to it. The larger exit opening is where you insert or attach the tubing from your catheter bag to the catheter itself and the second exit opening which is closed (has a cap over it) is for the use of the urologist/surgeon/nurse to pump in air or liquid into the balloon to secure the catheter so it does not fall out of your penis.

    Do not open this this cap!

    There is a plastic clip on the Statlock Foley Stabilization Device that secures the catheter tubing exit openings in place. When changing catheter bags it is recommended that you open the clip. Then wash with alcohol around the two plastic catheter openings, and also the plastic tapered end of the catheter bag that will be inserted into the larger exit opening of the Foley catheter.

    Once the alcohol washing is over, you place the catheter plastic openings back inside the clip and snap it closed. It is important that you place the small exit opening and the larger exit opening in their respective correct places in the clip, otherwise you will pinch the tubing and restrict or cut off the flow of urine to the catheter bag. N.B. The arrow on the white plastic clip points towards your penis.



    The Statlock company has a video explaining how their products works at: https://www.youtube.com/watch?v=AsyA4Ijdalk
  12. You may want to advise your urologist/surgeon prior to surgery as to which leg you would prefer having the Statlock Foley Stabilization Device attached. It was placed on my left leg but I would have preferred to have it placed on the top portion of my right leg. Why, because I sleep on the right hand side of my bed and also I usually find it more comfortable sleeping on my right side at night. With the Statlock Foley Stabilization Device placed on my left leg, the tubing had to the cross over from my left leg to the right leg and then over the right hand side of the bed. Having the Statlock Foley Stabilization Device on my right leg would have avoided the unnecessary cross over. If you usually sleep on the left hand side of the bed, ask to have the Statlock Foley Stabilization Device secured to your left leg.

    To better understand what I am trying to explain, prior to your surgery take a 3-4 foot length of string and imagine it coming from your penis and tape it to the preferred location on which ever leg you prefer. Lie on your preferred side and place the string over the bedside. This will help you visualize and determine what leg would be more preferable to have the Statlock Foley Stabilization Device placed on. In the end it is no big deal if the device is placed on either leg.

    I was informed that the Statlock Foley Stabilization Device is placed on your leg by a nurse in the recovery room but as you will still be under anesthetic, ask your surgeon to inform the recovery room nurse as to the leg you would prefer it be attached to.
  13. When sleeping on my side, I found placing a small pillow between my legs prevented the opposite leg from rubbing against the catheter and it also ensured a better sleep. Using a pillow or cushion between my legs also helped with the problem of comfortability having had the Statlock Foley Stabilization Device placed on my left leg as opposed to my preferred right leg (refer to tip #12 above).
  14. Speaking of pillows, if you anticipate a long drive home from the hospital after your surgery, you may want to insert a small pillow between your stomach and the seatbelt for greater comfort, as your stomach may be a little sensitive following the surgery.
  15. You will be emptying your catheter bags quite frequently, the leg bag more frequently than the larger night bag. One evening I emptied my night bag at 10:00pm before going to sleep and awoke at 6:00am to great stomach and bladder discomfort. I soon realized that my bag was filled to capacity and was preventing additional urine from exiting my bladder into the bag. My bladder was uncomfortably over filled. I immediately emptied the bag and about a half hour later things settled down and were back to normal. The tip here is to set your alarm clock for a 4 to 6 hour wakeup call from the time you last emptied your night bag allowing you sufficient time to re-empty it avoiding the little difficult I experienced. The time period obviously depends on how much liquid you have drunk or will be drinking and how fast your bladder normally empties itself.
  16. When wearing your leg bag, you may want to lie down for a while. Your leg bag must be below your bladder for the urine to flow properly. When lying in bed I placed a chair on the side of the bed which was lower than my bladder and rested my foot on it. While on the couch I used a small box placed next to the couch to rest my foot. If you own a lazy boy chair, lucky for you, but make sure your bag is lower than your penis to allow for good urine flow into the bag.
  17. I placed an absorbed bed mat underneath me at all times to help keep my bedding clean. You can have some unexpected urine dribble, excessive sweat build up, and on occasion when passing gas (farting) you can expel some wet gas. Also, when wearing the larger catheter bag, I did not wear underwear as it was too cumbersome to put them on and take them off so I slept naked. Not wearing underwear increased the chances that even though you may wipe well after a bowel movement some remaining feces could get transferred to the bed linen, so using a bed mat was wise. Bed mats also proved invaluable after I had my catheter removed. (I first used some remaining doggie bed mats I bought when I was training my puppy, (glad I did not throw them out!) and then bought proper bed mats available for adults.
  18. I also purchased a box of unscented Baby Wet Wipes to wash myself, particularly in the groin area. They also came in handy after wiping your rectum with toilet paper to give your rectum a good final wipe with the Baby Wipes.
  19. For my second incident of catheter blockage and rushing back to the hospital (refer to Part II for that story) and urine spillage, my wife cut a pair of Men’s Depends pants on both sides turning them into a super large like female Maxi Pad which I then placed between my legs, covering from my rectum to above my penis area and held it in place with my hand during the ride to emergency outpatients. The ability to pull a pair of Depends pants on over the catheter bag, along with the tubing would have been next to impossible due to the urgency of leaving the house and getting to the hospital. The best solution was to slit the pants on both sides and hold them in place with one hand.
  20. Let’s get dirty and talk about bowel movements and passing gas (farting). During surgery, a tiny camera is inserted through a very small incision (about an inch long), usually in or just above your navel. A gas such as carbon dioxide or nitrous oxide is pumped into your abdomen to help lift your abdominal wall off of your pelvic and abdominal organs so that the camera can view them clearly. After surgery the gas is removed but not all of it ends up being fully expelled and until done so, it can add to your discomfort.
    Our regular gas (farts) comes from when you eat; you just don’t swallow your food, you also swallow air. The gas that makes up a fart comes from two sources: more originates from the breakdown of food by the digestive system, and some is from swallowed air, e.g. chewing gum and even from being stressed. Small amounts of these gases travel through your digestive system as you digest your food. All of these gases in the digestive system have to escape somehow, so they come out as farts!

    Hence, the sooner you can fart the gas out, the better! Some patients start farting the day after surgery while others a little longer. It was not till I got home the next day that I started farting. Oh, what a relief it was!

    You can feel your stomach growling and experiencing some discomfort while waiting to have your first fart. It’s starting to come and you want to try to exert some abdominal pressure to make it happen, but you must be careful not to create more stress on your surgery area and increase any pain. I found that getting up and walking around helped the process. I also found that by raising my backside (bum) off the bed mattress or leaning to one side, reduced the physical pressure on my rectum and allowed my rectum to open up more, easily relieving the gas. Once you start farting, other farts come more easily.

    The greatest discomfort I endured following my surgery was the inability to have a bowel movement due to constipation, I believe from the medication. I can truly say, that you will never experience a more welcomed bowel movement than after surgery!

    Unfortunately, no drugs are made without having their associated side effects. Pain killers are no exception. One of the most common side effect among pain medications is constipation. More so, as pain killers are taken, the body tends to consume greater amounts of fluid to practically facilitate absorption of the medication. Thus, there is less absorption of fluid in the digestive system, causing some delay in the propulsive movement of the digestive tract, hence leading to constipation.

    My first bowel movement was 3 days after surgery. I was experiencing great discomfort (I would not call it pain per se.) Just like the inability to fart, your stomach is upset, in discomfort and grumbling. You feel like a bowel movement is about to happen but the stool is not moving fast enough for your liking down the colon towards your rectum and out. You want to try to exert some abdominal pressure to make it happen, but you must be careful not to create more stress on your surgery area and increase any pain.

    Finally, you think the moment has arrived and you go sit on the toilet seat. The key to all of this is to be patient, you can’t rush a good thing! I sat on the toilet for about a half hour. I found that by sitting upright as possible and rocking gently back and forth helped to relax the muscles inside my rectum to begin the process of elimination. You may also try raising your feet 4 - 6 inches off the floor by placing your feet on a couple of large books. (I always wanted to know what I could do with my two copies of War and Peace!) Also, at the same time you can grunt and exert some mild pressure to facilitate the elimination of the stool. Another tip, don’t be in a hurry to get off the toilet seat after your first bowel movement as with any Beethoven Symphony, there is a good chance for a second great movement to play out!

    I did take a stool softener as suggested by my urologist, however, I did not take a laxative and perhaps that would have been more helpful to facilitate a bowel movement sooner than later. It was brought to my attention sometime after my recuperation that prune juice is a man’s best friend. Why didn’t I think of that before!
  21. Exerting pressure to eliminate stool can cause urinary leakage around the head of your penis, this is normal. I put some Kleenex or toilet paper under my penis to catch the spill over. This enables clean up and also allows you to see how much spillage there is due to the wetness on the Kleenex, otherwise, if you don’t do this the spillage runs onto the toilet seat and down into the toilet bowel and you can’t tell if the spillage is decreasing over time. Oh, by the way, the spillage does decrease significantly over time, even if you are not checking.
  22. It was suggested to purchase a plastic squeeze bottle with a tapered tip nozzle to facilitate the squirting of water and solution (vinegar or bleach) into the catheter bags to clean them. This certainly was advantageous. (I used a new mustard or ketchup plastic dispenser bottle but the nozzle was a bit too big to be inserted into the catheter tubing, but nevertheless it worked after a little jigging around.)
  23. Because it is necessary to wash your hands quite frequently, I preferred to use a liquid soap dispenser. Easier and less mess around the sink.
  24. You will need alcohol to clean your catheter and I purchased a bottle of alcohol with a spray pump attachment that worked very well.
  25. After cleaning a catheter bag I hung it up on my shower caddy to dry with the exit end opened pointing downwards to allow the solution to continue to drip out and dry more thoroughly. My only caution is to ensure you close the exit opening of the catheter bag before attaching the bag to your leg. You will only make this mistake once, as I did!
  26. Keeping a daily diary may prove invaluable if you need to inform your medical team of your progress for any reason. It also allowed me to keep track of when I had taken my pills, experienced any pain or discomfort, had bowel movements, ate and consumed water, etc.
  27. Doing Kegel exercises is very important. I kept track of how many I did in several intervals during the course of a day by using a counter that can be reset to zero.
  28. You are upstairs in bed and need immediate assistance, your wife, partner, caregiver is downstairs in the basement with the laundry machine going, they cannot hear you, or they could be hearing impaired, what to do? You call out loudly, you yell, you use your cell phone to call your residence telephone, no luck. A small whistle with a high pitch may be the solution. Having said that, I would not recommend continuing to use this solution after you have recovered or you might end up sleeping in the basement for a while!

Remaining positive and cheerful, no matter what the challenges, is the best tip I can offer for your speedy and successful recovery. All the best.

Incontinence, Penial Dysfunction and Nutrition

Chapter IV

I will broach these subjects not necessarily to provide advice but more to let you know how I coped and dealt with these issues.

Urinary Incontinence, or the loss of the ability to control urination, is common in men who have had surgery or radiation for prostate cancer. You should prepare for this possibility and understand that, for a while, at least, urinary incontinence may complicate your life.

There are different types of urinary incontinence and differing degrees of severity. Some men dribble urine, whereas others will experience a total leakage. Loss of urine with a cough, sneeze or laugh is called stress incontinence and is the most common type of urine leakage men experience after prostate surgery. On the other hand, the need to frequently urinate with episodes of leakage, called urge incontinence, is the type seen most often after radiation treatment. Doctors continue to improve treatments for prostate cancer to reduce post-surgery and post-radiation incontinence. https://www.webmd.com/urinary-incontinence-oab/mens-guide/urinary-incontinence

In my case I experienced mild incontinence following surgery but after my recovery and up to 5 ½ years out, while the strength of my urine flow may have weakened a bit, I have not encounter any further issues. But one never knows what tomorrow will bring!

Penile Dysfunction more commonly referred to as Erectile Dysfunction. Yes this will happen with surgery and radiation. My urologist warned me about this issue while discussing which prostate cancer treatment I was going to choose. I was cautioned that in most likelihood I would not be getting an erection similar to before surgery and maybe none at all. At this juncture in my decision making, I thought, “die of prostate cancer or live without getting an erection”? Well, if I am dead I certainly won’t be getting an erection! This decision was a no brainer for me.

While my urologist made a passing statement that he knew a local urologist who specializes in erectile dysfunction and could get me erect to enjoy good sex, we did not discuss in any great length how this loss would affect me down the road both physically and/or mentally. I would have liked to been made aware that, yes this is a big deal. For some men, even more than the issue of incontinence. Indeed you are grateful to be able to halt the cancer but as time goes by knowing that you cannot get an erection like you did before surgery can play on your sense of “manhood.” But then again, “time heals all wounds” as they say and you cope accordingly.

One thing we did discuss was nerve-sparing techniques. Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. It is important to define the right and key anatomic (anatomy) landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative (during the operation) anatomic variations may affect the use of nerve-sparing technique, nerve-sparing degree and the approach.

So let me now give you some of my personal thoughts on how I viewed nerve-sparing in my situation.

Each man’s anatomy may vary to some degree from another man. Also, within an individual there can be slight variations of the anatomy of the prostate that were not noticeable or detected until the surgeon is actually inside your body checking around. As well, and most importantly, is the amount of cancer that the surgeon detects once inside which would undoubtedly play the biggest role as to how much sparing can be done without comprising the need to insure that all the cancer is removed. So the degree to how much nerve sparing is going to take place and how the surgeon is going to tackle that may only be decided once inside your body. Having said that, nerve-sparing success (if one can really measure that) will depend on each man’s recovery and how well he gets an erection like the good old days before surgery. In my case I think the jury is still out because I believe it is still a work in progress. I am hopeful that my nerve-sparing procedure did help to some degree.

For men that have the opportunity to pursue “active surveillance” to deal with their prostate cancer, I am sure the knowledge of knowing that a different treatment plan in all likelihood will cause erectile dysfunction is certainly a factor that plays a big part in their treatment decision to pursue active surveillance. I say, keep the ability to get an erection for as long as you can, if active surveillance is the right decision for you.

But for myself this was obviously not an option. So what was I to do? Following your surgery your urologist may prescribe taking 5mg of Cialis to kick start the mechanics that help you get an erection. In my case I was also given 20mg of Cialis to use on date night with my wife, hurrah! Well, I chose to come off Cialis as it did not appear to be working for me and because in a very few percentage of men Cialis can cause unpleasant mood swings which certainly does not help your relationship. So once again, what was I to do?

As mentioned above, there is an urologist in Ottawa that has a Urology and Men’s Health Clinic that specializes among other issues in erectile dysfunction. The successful treatment that you may have heard about is sticking your penis with a syringe, ouch! No, there is no pain associated with this procedure. Let me explain.

Upon consultation with this urologist you are met by a male nurse who will instruct you on how to inject yourself. The urologist will determine the amount of dosage which will be required for you to obtain an erection. You will be guided at that time while in the doctor’s office to inject yourself. To simplify explaining this to you I will do it in steps.

  • You are instructed how to use the syringe and load it up with the serum called TriMix. My initial dosage was 0.05cc but later I dropped it to 0.03cc as my erection was lasting several hours and became uncomfortable for so long. Gee, if only I had a harem!
  • You are shown where the optimal location is on your penis to inject yourself and you wiped that area with an alcohol pad/serviette.
  • You will experience some trepidation prior to injecting yourself for the first time for fear that this is definitely going to hurt and “what the heck am I doing”! I guarantee you it does not hurt one bit if done properly in the right spot.
  • Following the injection you apply pressure on the injection site with an alcohol pad for 5 minutes.
  • Next, OMG I am getting hard, Wow! The serum becomes effective within 5 to 15 minutes after injection.
  • The nurse will return after 15 minutes to feel your penis to determine the stiffness of your erection which will indicate if the procedure was successful, how well the serum is working and if the dosage amount was adequate enough or should the dosage be increase a bit.
  • You will then be given a prescription for the serum but only certain pharmaceutical outlets dispense this serum because it has to be prepared in a sterile laboratory. The serum also has a best before date.
  • You are instructed to allow 48 hours to pass before your next injection.
  • Most importantly you are instructed that if your erection lasts more than 4 hours you are required to go immediately to a hospital emergency where a doctor will put a small needle into the penis and drain the blood or inject a small amount of countering medication. If you ignore this, you could sustain permanent erectile dysfunction and you definitely don’t want that to happen. When I felt the need to shrink my erection, I have place a cold compress or a bag of frozen peas on my penis and that quickly reduced all swelling. Just make sure to wrap the bag of peas with a cloth as direct skin contact with the frozen bag is somewhat unpleasant.
  • Lastly, you may leave the doctor’s office a little embarrassed because you have an erection and have to go pass the other patients in the office who might comment “Wow, what a nice erection’! But don’t worry, they will be experiencing the same situation later. Ok, so I am joking about the comments!

I have been using this serum for the past four years and find it most rewarding. The more you inject yourself the greater are the chances that overtime you can develop an erection hard enough for penetration without injecting yourself because you have been aiding the rehabilitation of the mechanics that help you get an erection. This success without injecting yourself can also be intensified with additional medication such as Cialis or Viagra. Ask your urologist about this. N.B. Remember, you cannot use Cialis or Viagra with 48 hours of using TriMix.

Men often ask, “what about orgasms”? The first thing you should know is that there is no ejaculation because your prostate has been removed which produces sperm. And yes, you do experience an orgasm. However, you may encounter a very small amount of urine leakage when reaching orgasm. The strength of your orgasm again depends on each individual’s prior performance and although the orgasm may not be as long or as strong as previously in some cases, it is normally very rewarding.

Well, now that I have bared my soul on that topic, let’s move on to nutrition.

Nutrition, is very important prior to and after surgery. As mentioned earlier if you are overweight losing weight prior to surgery lowers your risk for serious surgery-related complications such as infection, blood clots and heart attack.

Everyone should be trying to maintain a healthy diet and engage in some type of exercise during the course of our lifetime. You will no doubt have heard about certain vegetables, plants, juices and liquids that are championed as ideal products to consume to evade cancer and/or to delay existing cancer from spreading or getting worse. Little or no scientific clinical research has really come forward with evidence that any of these food products actually do help evade cancer. The full relationship between the foods we eat and prostate cancer is not yet known. But having said that, changing your eating habits and eating products in moderation that are healthy for you is always a good thing to do.

I heard that people who mainly ate fish had a lower risk of prostate cancer. So let’s get on that bandwagon immediately, I thought. Nay, nay, too late! If a seafood diet was to be of any help at this stage in the game I should have started this as a child and carried it throughout the course of my lifetime. Ok, let’s try something else. Well the fact is that there is no quick fix. However, starting to maintain a good diet at any time in your life is a good thing to do. The better your overall health is the better are your chances of staying that way and it will obviously help in your recovery of prostate cancer.

The Ottawa Maple Soft Cancer Support Centre among other counselling support services offers has an excellent program on nutrition if you wish to investigate foods that are beneficial to you to deal with cancer by eating healthy and also foods that you may wish to avoid.

And what about naturopathy such as nutrition, exercise, acupuncture, massage and herbal remedies and also homeopathy remedies?

Both modalities share the tradition of searching for the root cause of illness to treat patients at a fundamental level, and are considered to be "holistic." Although the path to a diagnosis and the treatments rendered may differ between the two, homeopaths and naturopaths share the belief that, if given the proper attention and care, our bodies are capable of healing themselves.

The main difference between the two as I understand it, is that naturopathy is a health system that utilizes many different treatments and modalities (which may even include homeopathy) and homeopathy is solely focused upon the use of remedies.

It has been my impression over recent years that medical doctors are not as pessimistic as they once were about their patients exploring alternative cancer treatment options as long as they do not discard their conventional medical treatments and prescription medicines. It is comforting to see that cancer doctors are recognizing the benefits of complementary therapies alongside of conventional medicine that offer an integrated approach to fighting cancer and other illnesses.

Am I Cured of Cancer 5 ½ Years After My Surgery?

Chapter V

Well, not exactly but maybe? There has been some PSA activity raising its ugly head after two years of non-detectable PSA testing. So, what’s up with that, let me tell you?

You may have heard about the “5 year benchmark” after a radical prostatectomy. What this is referring to is that research is supporting the credence that if a man who has undergone a radical prostatectomy and maintains undetectable PSA levels for 5 years, while one cannot say 100% that he is cured of prostate cancer, the chances of prostate cancer not reoccurring is good to excellent.

Let me begin by first quoting some text from an article to give you a rudimentary crash course on why PSA testing is so important after radical prostatectomy.

“A prostatectomy is a type of surgery during which a surgeon will remove the prostate gland, often due to cancer. Following the operation, doctors use prostate-specific antigen testing to check for signs of cancer recurrence.

Only prostate glands make PSA. They produce low levels of a protein called prostate-specific antigen (PSA). Cancerous prostate cells also produce PSA. Doctors use PSA tests to check levels of PSA in a person's blood. Higher levels of this protein can indicate a problem with prostate health, including prostate cancer.

One treatment option for prostate cancer is a prostatectomy. During a radical prostatectomy, a surgeon will remove the prostate as well as some of the tissue around the gland. After a prostatectomy, it is normal for a person to continue having regular PSA tests. This helps doctors check that the surgical team removed the cancer successfully, and that it has not returned.”

After treatment, men expect their PSA levels to be very low. In many cases levels of PSA in the blood will be undetectable. Although surgeons remove the prostate gland during a prostatectomy, some cancer cells may have escaped the prostate before it was removed and now have grown to the point where they’re producing enough PSA to be detected. If these cancer cells multiply, they can cause prostate cancer to return. Therefore, PSA testing can help doctors find and treat recurring prostate cancer early. This is why they offer PSA testing, along with other tests, to men after they have had a radical prostatectomy.

If you recall, my first sentence in this chapter of my paper was “Well, not exactly but maybe?” That is because if testing does detect PSA after a prostatectomy, this does not mean that cancer has returned. Noncancerous cells can also make PSA. Seeing a rise in PSA level does not always mean that prostate cancer is returning or spreading. The test is very sensitive and can pick up small changes in the PSA levels. Doctors will usually want to know how quickly levels of PSA are rising. If levels of PSA remain stable or rise slowly or by a small amount, further treatment may not be necessary.

A doctor usually considers the following factors when looking at post-operative test results to see if PSA levels are high enough to cause concern and prior to giving advice on treatment:

  • A man’s overall health
  • Medical history
  • Age and life expectancy
  • Cancer grade and aggressiveness
  • If cancer has spread and where
  • Previous treatments
  • Medication

Also the doctor will likely ask the individual about any possible symptoms that could suggest that prostate cancer has returned.

Therefore, I am being followed closely by my urologist/surgeon and having regular PSA tests which thankfully are currently very low (PSA 0.16 – October 2019) and show no evidence of rapid rising or doubling occurring to date. The use of active surveillance is the order of the day for me now. However, if my PSA starts to rise dramatically then it will be time to explore the need for radiation or some other treatment.

Until I update this paper in the future, remember “remain positive and cheerful, no matter what the challenges, is the best tip I can offer for your speedy and successful recovery as you journey along. All the best.

NB. Most of the text above in Chapter V has been gleaned from an article which I found to be extremely informative: https://www.medicalnewstoday.com/articles/323899.php

Another article that I fond informative entitled “What You Should Know about PSA Levels after Prostatectomy”: https://www.healthline.com/health/prostate-cancer/psa-after-prostatectomy

*Remember that one has to be very cautious about the authenticity of any article, particularly ones found on the Internet (including the ones cited in my paper) and what is the medical source that has published the article or piece of research. It may sound reliable but is it? Always confer with your doctor. Thank you.

David Cook,
Updated February 11, 2020


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