First, thanks to ALL of you for making this site so informative and productive. I've learned a lot since I found it several months ago. HealingWell is heads and shoulders above the other sites I visit.
Second, I posed a question to my urologist that I know is of interest to the newly dx'd: Can you visually see evidence of prostate cancer extension or invasion while you are in there (with the idea that this could influence what is taken out, i.e., nerves during the procedure)?
His answer was "Generally not, unless the tumor itself is visible, or there is significant PCa (more tumors) in the abdominal area or the lymph nodes are noticeably swollen".
What is significant about his answer is, and he concurred with the conclusion I immediately drew, the judgement as to what they are going to take (or more importantly leave) is made pre-op, based on a complex equation that includes age and patient preference, but mostly based on Gleason and PSA numbers and the biopsy.
We all know that the Gleason score varies, and we also know that the biopsy is somewhat hit or miss (literally). While we want ALL the cancer out, we also want to preserve the erectile nerves.
What's the solution? A biopsy with more cores as someone has suggested? The discomfort associated with a longer biopsy (which could easily be addressed with pain medication) might be a fair trade-off. A second pathologist's opinion might produce a more exact staging. In hindsight, we can all look back and describe what we could have done better. Our insights provide guidance to the newly Dx'd.
Not only is choosing your treatment provider very carefully of utmost importance, it's obvious that you need to communicate very clearly with him.
We're all Monday morning quarterbacks here, this is not as easy as it initially seems . . . there is a reason for med schools. That said, you are still responsible for charting your own course and the consequences of your decisions (or lack thereof).
FINALLY, I had another undetectable PSA test, 8 months post op. Am I out of the woods? Maybe, but I immediately scheduled another PSA in 3 months. Enquiring minds want to KNOW.
My testosterone is 680 with no supplementation. I've recovered about 80% of my pre-op erectile function (I no longer worry about it, that seems to help most of all), and I was dry the day after the catheter was pulled. I'm at a good place in my life -moving on.
I'm thinking of changing my name to IdahoPosterBoy -does it get any better than this??? I fervently hope that all our new visitors have my great results.
But, you New Guys, YOU HAVE TO WORK AT IT!
Dx'd June2008, Gleason 6, PSA 6.5, Prostate 89 grams, PSA number 6-7 for years due to BPH, free PSA number drove biopsy
DaVinci RP Nov 23, 2008 by Dr Todd Waldmann, Boise Dr Waldmann was my second urologist, I'd be sitting here with a limp dick, in diapers, if I'd stuck with the first urologist.
Nerves spared, erectile rehabilitation program w/ viagra first, then cialis w/ 3 x weekly VED started immediately post-op (began pumping at 3 weeks)
Up and walking immediately post-op (Walk a mile before you go home-big incentive) Pain free, some tenderness, released at 3 wks to normal activity including intercourse.
Dry the day after catheter was pulled, some erectile ability at 3 wks, steady improvement, used ED med and pump until recently. Still use daily ED med.