Prostate Transplant?

TO MJLUKE

I had a similar situation as yours, same Gleason, biopsy showed only one side involved. My PSA was 6.5 but I had a big prostate (89 grams) and BPH, so I was entitled to that PSA number. What drove my biopsy was the free PSA number -and a desire to be 100% sure. I was diagnosed just before my 64th birthday (June 2008).

After my Da Vinci robotic RP (November 2008) they found cancer in both sides, but still a Gleason 6, and most importantly, completely contained within the prostate capsule. What a relief!

The problem I have with the Brachy is, you just don't know what you have. The biopsy is notoriously inaccurate (described as stabbing knitting needles into a pillow and possibly hitting a golf ball, the golf ball being the cancer). Can you live with that uncertainty?

Even if the Brachy does kill the cancer, and your Gleason and PSA number does indicate that it PROBABLY hasn't spread beyond the capsule, you will undoubtedly be talked into ADT (Lupron or something similar). The thing here is, you won't know for sure for a couple of years at best, and if they missed, or if the cancer was indeed outside of the capsule, then start counting the days.

I got as far as the volume study for the Brachy (where they map the prostate for the seeding), and the oncologist who worked with my first urologist, said NO WAY! At least one of them had some integrity. I had already received a Lupron shot (unnecessary at that point, but a big profit driver for the urologists who push Brachy). I suffered numerous side effects from the Lupron shot (actually from the resulting low testosterone). Google low testosterone to see what I am talking about. Google: Takeda pharmaceutical Lupron to see the abuse associated with Lupron. Takeda was fined $875 million for their abusive sales practices, the largest healthcare fraud case ever.

http://www.wiggin.com/pubs/alerts_template.asp?id=15315210162001

The part about the urologist who had a yacht named Lupron is my favorite part of the story.

Brachy WAS a good option until 2-3 years ago. It took a highly skilled and experienced surgeon to perform the nerve sparing and bladder re-attachment during an open RP. Results were inconsistent.
Continence and erectile problems were more common than not. The surgery was very invasive, debilitating, BIG incision, a lot of blood loss. Nerve sparing techniques were primitive.

The Da Vinci surgical robot changed all that.

My point here is, the Da Vinci robotic RP if done by a competent surgeon is no more invasive than the Brachy, probably less so when you factor in the Lupron. Although you won't see the erectile issue immediately like you will with the RP, the radiation from the Brachy will permanently damage the erectile nerves over a period of a couple of years. Your natural testosterone production may never come back after a couple of Lupron shots, and Lupron is ALWAYS part of the Brachy protocol. These are things the Brachy people conveniently neglect to mention, and for good reason: The word about robotic RP is spreading fast.

The key if you do go robotic RP is a competent, experienced surgeon. The Da Vinci robot provides the means for a successful outcome, but it's still up to the surgeon. Any artist can buy the same paints as Picasso, but his results are not the same. With a competent, experienced surgeon you should see my results and the results from the other robotic RP posters here. Competent, experienced surgeon. This can't be repeated often enough.

The REALLY big advantage of the robotic RP is you know immediately what your prognosis is. Your abdominal cavity can be carefullly inspected with the illumination and magnification of the robot's camera. Your prostate is out, to the pathology lab, and the results are back in a week or less. If you're clean, that's it, you get back to your life. Done. Finished. No more cancer. It's a great feeling.

That's NOT how it is with the Brachy - you'll never know for sure until the cancer recurs. You spend the rest of your life looking over your shoulder.

With the Brachy you will live with serious uncertainty for at least a couple of years. If the "Shot In The Dark" misses the cancer and it gets outside of the prostate capsule, you will eventually die from the cancer.

The robotic RP is so minimally invasive that you can travel to a well-known robotic center. The Da Vinci robot is VERY expensive, and if you live in a rural area you will have to travel. Many smaller hospitals simply can't afford one.

You're expected to be up and walking shortly after the surgery, one overnight, and on your way home the next morning. I used 2 mg of morphine that evening (I was a little anxious and the nurse suggested it to put me to sleep). That was it for pain medication. I reallly didn't have any pain at all. They sent me home with a few painkillers, but I didn't need them. At the one week post op when he pulled the catheter, the surgeon cut my "no sex - no lifting" time from six weeks to 3 weeks. I had a semi-usable erection at the 3 week point. Semi-usable means OK for me, wife wasn't that impressed.

The only evidence I have of the surgery at 5 months is a well-healed 2" vertical scar. Sure, I had a young, motivated, experienced surgeon, but he's not the only one out there.

Good luck -whatever you decide! It's a journey you won't forget. I wish you the best.

I was up until 4AM this morning reviewing the responses from other posters and working on my reply. 

 My uncertainty and my fear of making the wrong decision was strong.  Had I had a smaller prostate I would have taken advantage of one of the many HIFU trials going last year.  Would that have been the right decision?   Is there ANY right decision? 

My wife thinks I'm nuts, with early onset of some form of dementia.  As she points out, "You're cancer free, you pee when you want to, our sex life is better than we thought it would be.  What do you want?  (I want that mechanical prostate with the hot fudge ejaculation).

She's an OR nurse and sees patients regularly who are MUCH worse off than I ever was.  As she puts it, "I see patients with hemmorroids that are worse than your PC "

Did you review the posts in  the topic:   Head's Swimming, How Do You Decide?    under the Prostate Cancer topic?  A lot of careful thought went into the posters' responses.

You have the luxury of taking your time to make the decision that is right for you.  The other posters are right.  It's a decision that is different for each, and so many factors enter in.  I will say this, you are walking the walk, and there is no such thing as too much knowledge.  If you keep working at it, you will come to a point of confidence, as I did, that your treatment decision is the right one for you.

I freely admit that I am biased in favor of the robotic RP, and my bias is probably driven by my stellar outcome.  I'm not the only one:  Check out which treatment option most of the posters chose.  One of the posters pointed out in rebuttal to my advocacy of robotic RP that only 60% of the RP's done at Sloan-Kettering are considered "successful"   One of the unspoken issues here is surgeon competence.  Is it possible that only 60% of the surgeons at SK are really great surgeons?  If you DO decide on RP, then you have only made half of your decision.  You still have to find that crackerjack surgeon who is consistently producing the outstanding results you want.  Luckily, you have the time.  Not only do your have the good cancer, you have early stage good cancer!

 There is a lot going on re: PCa  This post from John T is just one example:

https://www.healingwell.com/community/default.aspx?f=35&m=1384654

One of the difficulties in making the best decision is not really knowing what is going on in your prostate.  PSA and Gleason are statistically predictive for a large population, but each individual is different and biopsies are routinely proven inaccurate by the subsequent pathology report.  An accurate imaging diagnostic would be a godsend to everyone.  One wonders why this test (and HIFU) isn't available in the US ???  An accurate imaging diagnostic would drive a lot of decision making.

Johns Hopkins has an "expectant management" program for early stage PCa, perhaps that would be a good intermediate decision while you continue to process the huge volume of information?  I admire your persistence in seeking out the best option.

HI Guys,
Just found your site today when looking up Prostate Transplants. Diagnosed in May '09, Gleason 6, PSA 5, TC1, 6 out of 12 samples are positive with <5%. Trying to decide what type of treatment to take Radiation or Surgery. Spoke to Radiologist and my DR who does open. He referred me to a Robotic surgeon with whom I will speak to in a couple of weeks. I did active surveillance for 3 months and almost forgot I had PC. A visit to my Dr a month ago and he suggested HT. Now I think about it everyday and think of either stopping the HT or pulling the trigger earlier than later. This is why I googled Prostate Transplants and came to your site. I will also go to a local support group in a couple of weeks as well.
BTW, I enjoyed your site and your good humor. Thanks

Not so fast Worried Guy, you may not ever ejaculate again (the main point of your DNA thinking) But some of us, perhaps many, can still produce pre-semen from the Cowpens Gland. Some men's are removed, some aren't according to my surgeon. In the old days, that would happen first, its suppose to clear the urethra of any impurities and urine and prelubricate it for the regular ejaculate to follow upon climax. With me, be interesting what other guys here say, I am fluid dry through the whole sex process, and then at the moment of climax, I can often feel this pre-semen come to the front of my penis and exit. Wouldn't say it comes out with great force or spurts (excuse the graphics), but it happens after a climax, not prior to one. So in a way, its like an small scale, mini ejaculation. All I know, it feels good. Post surgery orgasms for me are so much more intense and last 2x or 3x longer. So, there would be ample DNA to convict you from the pre-semen if you reach that point in time. And I hope you do, brother.

David in SC

Jeff, I think i spelled it right. I flunked biology in school, not my thing. If I understand rightly, the testicles produce the sperm, the prostate (our dearly departed) produced most of the ejaculate fluid, and this cowpen or is it cowpers gland, produces the pre-semen. Anyone please correct me if I don't have this right. My dr. told me outright that he didn't remove mine, so thus it works.

Jeff, your time will come, from all I have read here, the pumping is good for your system. If you are going to get something from it, at least strike oil, worth more than a barrel of pee, lol.

On the DNA front, they can convict you on a single strand of hair.

Keep healing brother

David in SC

Sonny, that was an excellent spin on your situation, so it is very much something to look forward. The shooting dry is easier to get use to then men think ahead of time, and the sooner one can disconnect the old way from the new way, the more they can look forward to a new and different phase in their love life, once they overcome any ED after treatment.

And yes, the lack of fluids does indeed open up avenues of possibilities that might not have been so practical in the "old days". Know what you mean first hand.

Best to you, brother.


David in SC

BTW,  I've gotten a lot of laughs with the Jarvik prostate transplant  (with the choice of hot fudge, butterscotch or strawberry ejaculate).

Here's another one:

Doc:  "How's it going"?

Me:   "Well,  OK . . ."

Doc:  "What's wrong?"

Me:   " Well, Doc, I just realized that I won't be able to work in the Adult Film Business in the future . . .  (PAUSE   -we're both thinking of those elaborate ejaculation scenes...) 

 . . .but, I was never able to get any work in the Adult Film Business in the past  anyway"

Post Edited (KeyWestPirate) : 9/6/2009 12:35:29 PM (GMT-6)