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Decided to go with RALP

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Posted 6/28/2017 11:54 PM (GMT 0)
After speaking with my Urologist a RO and a surgeon who specializes in RALP, I have decided to go with RALP. The surgeon Brian Helfand from Northshore Hospital system, is very highly recommended and has is doing 4 surgeries a week. The surgery is scheduled for mid Aug. I feel this the right path for me at this time
Thanks
Bpc1097

Right base of prostate, needle core biopsy:
- Adenocarcinoma, acinar type.
Gleason score: 6 (3 + 3), (grade group 1)
Number of cores involved: 1 of 2
Total length of tumor: 1 mm
Percentage of tumor: 5% of specimen volume
>50% tumor in any core: No
Perineural/lymphatic invasion: Absent
B) Right mid prostate, needle core biopsy:
- Adenocarcinoma, acinar type.
Gleason score: 6 (3 + 3), (grade group 1)
Number of cores involved: 2 of 2
Total length of tumor: 9 mm
Percentage of tumor: 45% of specimen volume
>50% tumor in any core: Yes
(This is the optimal block for additional testing)
Perineural/lymphatic invasion: Absent
C) Right apex of prostate, needle core biopsy:
- Adenocarcinoma, acinar type.
Gleason score: 6 (3 + 3), (grade group 1)
Number of cores involved: 2 of 2
Total length of tumor: 6 mm
Percentage of tumor: 25% of specimen volume
>50% tumor in any core: No
Perineural/lymphatic invasion: Absent
D) Left base of prostate, needle core biopsy:
- Adenocarcinoma, acinar type.
Gleason score: 7 (4 + 3), (grade group 3)
Number of cores involved: 1 of 2
Total length of tumor: <1 mm
Percentage of tumor: <5% of specimen volume
>50% tumor in any core: No
Perineural/lymphatic invasion: Absent
E) Left mid prostate, needle core biopsy:
- Benign prostate tissue.
F) Left apex of prostate, needle core biopsy:
- Benign prostate tissue.
Posted 6/29/2017 12:10 AM (GMT 0)
bpc, welcome to our club, and congratulations for making it through the first, (and most maddening) part of the process. You've done your research and made the decision that works for you.

Now, some suggestions for the next few weeks as you prepare. First, I'd offer a shopping list, as it were--things I found useful or helpful:

1 A small bucket to set your catheter bag in on the floor next to your chair. When you get up to walk around, just grab the bucket and go.

2. Absorbent pads for your chair and bed...because leaks happen. The "doggie training pads" are cheaper and work just as well.

3. Dulcolax or the generic version of a stool softener. Start taking it the day before surgery.

4. A couple pairs of baggy gym shorts.

Set up your recliner in easy view of the tv. Have a small table next to your chair for your laptop/IPad or whatever, your remote, and your water cup. A good supply of DVD's will be handy as well--daytime TV sucks!

I borrowed a shower bench because I didn't know if I'd be up to standing up in the shower the first few days.

I bought a 'donut cushion', but never needed it.

A tube of bacitracin triple antibiotic ointment...you'll want it for the head of your penis while the catheter is in.

Get your core in shape. Start doing kegals now to get used to how they work. And, have as much sex as possible. It will be different after...and for sure it will be a while post surgery before you can do it at all.

In the mean time..enjoy life!
Posted 6/29/2017 1:06 AM (GMT 0)
Bpc,
Halbert gave you some really good advice above - especially the exercise and sex part.
Those are things you need to work on now.

Pee pads, doggy training pads, TV, videos, etc you can do in the days before surgery. Exercise and sex is something you want to be working on well in advance.

Cue the Rocky theme song and start jogging and bouncing between the sheets now!

Remember, you read it here: An empty prostate is GFMPH. Good for Men's Prostate Health! smilewinkgrin
Good luck.
Jeff
Posted 6/29/2017 2:41 AM (GMT 0)
Hi Bpc,

I'm inn the same boat but am a Gleason 4+3. I am not a doctor, but your numbers seem low, in the range for AS. So why surgery? I assume you got a second opinion? I got 3 from surgeons and one from a RO.

I was diagnosed at NorthShore but decided to go with either the top doc at NW or U of C. Both have done over 3000 robot ops each. So, Helfand does 4 a week. He looked young to me. How many has he done in TOTAL? From all I have read, and I have done a lot of research in the last six weeks, it's the total number that counts.

Best,

Nick
Posted 6/29/2017 3:03 AM (GMT 0)
I got it that you made your decision...I support you...I do not support the decision...there is a difference...Its classic over treatment...imo...and If I did not support you...I would not tell you this...
PS...be still boys and girls...ladies and gentlemen...
Posted 6/29/2017 3:21 AM (GMT 0)
honestly, there will be naysayers, but don't listen to them... it's such a personal decision & one that you ALONE will have to live with... we too chose surgery & our numbers were very similar to yours (on our first biopsy)... but after johns hopkins reviewed them, they upgraded us to more 3+4s... and then after surgery, we were actually upgraded yet again to 4+3 with tertiary 5 PLUS a rare cancer called intraductal carcinoma! so yes some people will say it's overtreatment, but then again WHO KNOWS. it could go the other way like it did for us. YOU do YOU.

just make sure you go w/the very best surgeon you can find! one that has done thousands and thousands of surgeries. it makes all the difference in the world.
Posted 6/29/2017 5:19 AM (GMT 0)
naysayers...if you are referring to me...you may want to take a course on reading 101...if you were not... er nope you were referring to me and any one else who puts a spin on it dfifferent from your own....read my post again and see if you can see any light there...I hope for a cogent response or none...
Im just mad now that your troll got me...and Ive been trying real hard...real hard to be good...then your negative post...your reap what you sow madam...oh and as far as thousands of surgery... the captain of the Titanic had 30years of experience...working against him {there is a lesson there}...life is not black and white madam...hopefully the OP's spouse saw the light in my post...you managed to see the dark... tit for tat mods...but do your thing...remember her naysaying...seems like a lack of decorum...on an other wise...wise and helpful thread...she should not get a pass...but if so...Ill take the heat...its a bit chilly ...
Posted 6/29/2017 7:57 AM (GMT 0)
I was G3+4 and would have gone brachytherapy except I had an enlarged prostate (BPH).
It's worth reading some of the post surgery experiences (diaries) recorded here. If you are employed there will be some impacts in the first 6 weeks or more.
Posted 6/29/2017 8:06 AM (GMT 0)
A very warm welcome to you BPC, and congratulations on making a well considered decision. Hubby too, is G4+3, so I guess you could say you are both in the same 'club'!
You have come to the right place for support, advice and encouragement.
All the very best with your surgery and don't hesitate to ask the folks here as much as you like.
Kind regards Jaybee
Posted 6/29/2017 9:52 AM (GMT 0)
Nick2017, Dr. Helfand is in his middle 40s. He has been doing the RALP for a number of years, he has done over 2000. Everyone at Northshore has told me if they were having the surgery, he was the person they would want. In talking to him, both I and the wife were impressed by his attitude, knowledge and his staff. I decide on surgery due to the Gleason score: 7 (4 + 3) and my age 56 years young.
Good luck
Bpc1097
Posted 6/29/2017 11:00 AM (GMT 0)
BPC, the 4+3 jumped out at me as well. Best of luck to you. Get in shape, get prepared, and keep us posted. See you on the other side.
Posted 6/29/2017 11:37 AM (GMT 0)
BPS - Congratulations on finishing the most difficult part of your PCa journey. You have made the choice of which treatment (of several) is best for you. I'm sure you don't realize it yet, but for most of us the decision is one of our toughest.

I'm also in the Chicago area, but chose radiation treatment at Lutheran General Hospital in Park Ridge. My cancer. . . my choice. Same goes for you -- your cancer. . . your choice.

I did not consult with any docs at Northshore, but they are quite popular in the area. They also sponsor/host an UsToo Prostate Cancer support group. I have attended some of their meetings, but I chose to continue attending the UsToo chapter up in Lincolnshire. The NorthShore group seemed, to me, to be primarily guys who were treated years ago and are now dealing with recurrence. I felt out of place, being of similar age to them but far earlier in my PCa journey. The group at Lincolnshire is actually split into two group meetings on the same evening. They have one group for the advanced disease/recurring disease patients and for everyone else. Check it out on the web - it may be for you, it may not.

In any case, you have come to what I feel is the best online support group for PCa. The folks here have a wealth of knowledge and are very good at caring and sharing.

P.S. With your pathology at your age, I probably would have made a similar choice of treatment.
Posted 6/29/2017 1:07 PM (GMT 0)
Welcome and like the other guys said, this is a big step out of the way on your journey. RALP was my choice and I have no regrets about my decision.
Posted 6/29/2017 1:47 PM (GMT 0)
Great that you made your choice. Often that is the most difficult part.

Now, just get it done.

Andrew
Posted 6/29/2017 1:57 PM (GMT 0)
Welcome, and may it all go perfectly with you on your choice, a choice that many others make. Hopefully, you have explored all of the options and the expected- or at least common- side effects(SE) and cure rates of each treatment. Once the cancer has been dealt with, it is those SEs that you will be living with, not uncommonly for life. Of course, none of the treatments are free of potential seious SEs, it's just the relative rates and maybe different SEs. The other thing I have not seen mentioned yet: I know you have made your decision, but please don't feel rushed to get 'er done. That is the one glory of PC compared to most other cancers: there really is time to consider the various options.

But I am assuming you have already considered and researched all of the above, so may your treatment go as smoothly as possible with the best possible outcome!
Posted 6/29/2017 2:23 PM (GMT 0)
Welcome to the club no one wants to join. I have been down a similar road. I am a patient in the North Shore system. I wasn't aware of your doctor. I ended up with a well known surgeon at the U of C. I was pleased with my choice overall. My continence is excellent, my PSA is undetectable, but I still suffer from ED. I expected that, as everything I read says it may take between 1-2 years for the nerves to heal.

You can copy and paste the URL in my signature if you want to read my story of surgery. Just know that most patients have few, if any complications. However, it is major surgery.

Good luck.
Posted 6/29/2017 2:38 PM (GMT 0)
Good luck, keep posting, I am in the looking mode.
My numbers are better than most, but this is my 3rd cancer, I have to treat it differently , I feel.
I am interested in your success,

See my 3 + 3 stream
Posted 6/29/2017 2:43 PM (GMT 0)

Paxton said...
BPS - Congratulations on finishing the most difficult part of your PCa journey. You have made the choice of which treatment (of several) is best for you. I'm sure you don't realize it yet, but for most of us the decision is one of our toughest.

I'm also in the Chicago area, but chose radiation treatment at Lutheran General Hospital in Park Ridge. My cancer. . . my choice. Same goes for you -- your cancer. . . your choice.

I did not consult with any docs at Northshore, but they are quite popular in the area. They also sponsor/host an UsToo Prostate Cancer support group. I have attended some of their meetings, but I chose to continue attending the UsToo chapter up in Lincolnshire. The NorthShore group seemed, to me, to be primarily guys who were treated years ago and are now dealing with recurrence. I felt out of place, being of similar age to them but far earlier in my PCa journey. The group at Lincolnshire is actually split into two group meetings on the same evening. They have one group for the advanced disease/recurring disease patients and for everyone else. Check it out on the web - it may be for you, it may not.

In any case, you have come to what I feel is the best online support group for PCa. The folks here have a wealth of knowledge and are very good at caring and sharing.

P.S. With your pathology at your age, I probably would have made a similar choice of treatment.

Paxton- I'm interested in the UsToo support groups. Their site doesn't mention the groups you talk about. Can you give me more information. My email is in my profile if you'd rather do that. Thanks.

bpc- didn't mean to highjack your topic.
Posted 6/29/2017 3:49 PM (GMT 0)
Just 5 weeks off surgery - I can suggest the following
- start doing Kaegals now , 3-4 times a day - you have probably read about how to do it - what stuck to me is it's like imagine you are walking naked into cold water and trying to lift your balls to avoid freezing smile . Do 10 sec holds and also the 25 quickies!!!
- if they will put a drain hole - you will need to get gauze to clean and bandage - make sure you test the tape - I got rashes from the first tape I got so had to switch to a another brand
- switching the catheter to both legs is better than just always letting it hang from the same one - less chance of developing rashes
- get prune juice to drink 2nd day after surgery - helps in addition to stool softners
All the best and see you on the other side !!!
Posted 6/29/2017 4:03 PM (GMT 0)
BPC,

My apologies! I did not see the 4+3 figure, I remembered the 3+3, so I guess you made the right decision as to choosing surgery over AS. Sorry about that.

I have had quite a few "issues" with NS's Uro dept, although I like my urologist. So we decided with something so important to "Go downtown". Presently choosing between the best uro surgeon at NW vs Univ of Chicago. This is after a lot of research. Dr Helfand may be great but NS is second tier. OK for appendectomies and child birth, but not the future of my sex life and continence. Before you pull the trigger as to where to go we could talk.

If you join any Chicago area support groups please PM me, we can meet up. My surgery will be late July/early August. I can also explain my problems with their uro dept, although I have many positive experiences with the other NS departments, including knee surgery last week.

Best,

Nick
Posted 6/29/2017 4:07 PM (GMT 0)
bpc1097,

You've been getting pretty good advice here and I only have a few things to add.

First, I think some commenters may have read past the Gleason 7(4+3) core in your biopsy pathology. Without that core you would be a very good candidate for AS. With that higher-risk core not so much.

Second, I'd avoid the antibiotics in the ointment you use to lube the tube. Bacitracin, etc., can be irritating and catheters seldom become infected if you keep things clean. Aquaphor might be a good choice, its a lighter, less occlusive, ointment that is mostly petroleum jelly but not as goopy as Vaseline.

Another item of clothing you might consider buying before your surgery is a pair of loose-fitting hiking pants that have zippers at the knee to convert to shorts. I found them very handy for getting out and about with a leg bag strapped to my thigh. The knee zipper gives easy access to the drain on the bag.

Good luck.
Posted 6/29/2017 4:10 PM (GMT 0)
Welcome and Good luck. My only advice is to take the Kegels exercises seriously. I did and I was among the lucky ones who was dry immediately when the catheter was removed.
Posted 6/29/2017 4:26 PM (GMT 0)

Nick2017 said...
BPC,

My apologies! I did not see the 4+3 figure, I remembered the 3+3, so I guess you made the right decision as to choosing surgery over AS. Sorry about that.

I have had quite a few "issues" with NS's Uro dept, although I like my urologist. So we decided with something so important to "Go downtown". Presently choosing between the best uro surgeon at NW vs Univ of Chicago. This is after a lot of research. Dr Helfand may be great but NS is second tier. OK for appendectomies and child birth, but not the future of my sex life and continence. Before you pull the trigger as to where to go we could talk.

If you join any Chicago area support groups please PM me, we can meet up. My surgery will be late July/early August. I can also explain my problems with their uro dept, although I have many positive experiences with the other NS departments, including knee surgery last week.

Best,

Nick

Nick- Feel free to contact me if you have any questions about the U of C. My story is recounted at the URL in my signature. Good luck.
Posted 6/29/2017 5:03 PM (GMT 0)
BPC,

I'm on you're exact time track. I'm scheduled for RRP surgery on August 16.

Question to group on kegels -- I've been doing sets of 10-15 four x a day. I can squeeze easily enough, but can't seem to hold. When I go to "release" after 2 seconds, I don't feel anything because its already released. Anybody else have this issue or a tip to offer?

Thanks
Posted 6/29/2017 9:01 PM (GMT 0)
It is important to to contract the right muscle - the pubococcygeus muscle or PC muscle. You can see if you found it, if it also lifts the testicles up when you squeeze. You can do 50 squeeze per set and 10 sets per day. As a bonus your erections will be better and the penis larger (anecdotal?).
Try to remember to resume the Kegels when catheter has been removed. It will help with recovery of the erectile ability and will reduce the risk that your penis getting shorter from the surgery.
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