Robotic Surgery tomorrow morning, emergency question!

JustJB · Posted: Sun Nov 01, 2009 3:56 pm Post subject: Hi,

Thanks so much for your posts. Its very reassuring to have an idea of what to expect. Chris, I love your comment about sleeping through the night!! I actually had that though last week, thanks for confirming it. I was at a Halloween party last night and shared that anecdote with some guys who truly appreciated it also!
Our ducks are in a row here, pretty much ready for Thursday. I have to drink some Magnesium Citrate on Wednesday morning, and the clear diet of course, but surprisingly the enema was crossed off my list by the surgeon. How about you guys pre-op?
I have a bad tooth and need to see the dentist tomorrow. I'm hoping the fis is straight forward somewhat non-invasive so it doesn't have to wait for recovery.
Today I'm cutting the lawn and cleaning up, etc, preparing for when I have to rely on others to do it for me for a bit. I'm actually looking forward to Thursday and getting this done already
_________________
Age 52
Gleason 3+3 = 6
Stage T1C
1 out of 12 cores involved
Left side, median lobe

Travelingman

It's Monday morning, exactly 7 days ago at this time I was being wheeled into the operating room. Except for the catheter, I cannot believe how far back to normal I feel. We went to church yesterday & I could not kneel due to the placement of the leg bag, but otherwise it was a normal experience. The incicions are slightly sore & I wonder how long the glue on them will be there. I contine to take the stool softner & tylenol but the tylenol is more for my back (had that bad back for a while) than anything else. Tomorrow is the big day for catheter removal. Did any of you guys need to have the catheter put back in due to complications? Do you just keep leaking from the time the catheter is removed or do you stay dry for a while & then leak when you move or something?
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

PositiveGuy

Dear Justjb

I had to take Citro-Mag on Sunday and Monday prior to my Da Vinci surgery on Tuesday morning. As well, on Monday night, I had to administer a fleet enema. It was almost worse than the surgery what with all the cramps and toilet time.

Good luck with your preparation on Wednesday and the surgery on Tuesday. See you on the other dise.

Keep well.
Regards,
Bill
_________________
Age 64. Diag. 01/09 PSA 5.6, Gleason 3+3=6, T1c TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear. RALP - 09/29/09, back home 10/02/09. Pathology - 10/14/09 Gleason Score 3+3 = 6 No positive margins. No Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and bladder neck cancer free.
10/16/09 - 3-4 pads a day, 10/31 2/day, 11/09 one pad/day
ED 10/16/09 - Zip, nada

PositiveGuy

Hi Travelingman,

At the moment the catheter was removed, I sat up and immediately peed on the floor of the examination room. A bit embarrasing to say the least. I leaked every time I sat up or moved that first day. It got better as the day went by, but I did use four pads the frist day. It is now 3 weeks post-catheter and I am down to one pad per day and am dry through the entire night. See my post on the Landry Protocol for Incontinence exercises on this forum as to what I am doing in the way of pelvic floor exercises.

http://cancerforums.net/viewtopic.php?t=14761

Keep well and good luck on catheter removal,

Regards,
Bill
_________________
Age 64. Diag. 01/09 PSA 5.6, Gleason 3+3=6, T1c TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear. RALP - 09/29/09, back home 10/02/09. Pathology - 10/14/09 Gleason Score 3+3 = 6 No positive margins. No Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and bladder neck cancer free.
10/16/09 - 3-4 pads a day, 10/31 2/day, 11/09 one pad/day
ED 10/16/09 - Zip, nada

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

My catheter removal wasn't as bad as I had feared. First, the nurse did something with a syringe, putting sterile water through the catheter into my bladder. When it felt like my bladder was full, she removed the catheter. I just took a big breath and exhaled while she did that. Took a few seconds. Not painful, just uncomfortable. It was followed by a stream of liquid. She had placed a container below me (I was standing) for that purpose. I got dressed, putting in some pads I had brought with me.
Seems like I was pretty leaky for the first day or two, then it got better. I wore pads for a couple of weeks, but for the last couple of days it was more psychological. I regained continence without doing much in the way of exercise. But I was also younger than average for prostatectomy (43).

People have different experiences, but I think you should be prepared for at least a few very leaky days, and hopefully it will diminish to a low level of stress incontinence later. You may need to perform Kegel exercises, as you probably know.

It's highly unusual, thankfully, to have to be re-catheterized. It does happen once in a while.

I continued to pass blood clots off and on for a couple of weeks after catheter removal. Startling to see something like that shoot out, but harmless unless they block urine flow (again, not very common) or if there is active bleeding.

You should be free of the ball and chain for good, very shortly.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Travelingman · Posted: Mon Nov 02, 2009 4:13 pm Post subject: Re: my experience

[quote="Replicant"]My catheter removal wasn't as bad as I had feared. First, the nurse did something with a syringe, putting sterile water through the catheter into my bladder. When it felt like my bladder was full, she removed the catheter. I just took a big breath and exhaled while she did that. Took a few seconds. Not painful, just uncomfortable. It was followed by a stream of liquid. She had placed a container below me (I was standing) for that purpose. I got dressed, putting in some pads I had brought with me.
Seems like I was pretty leaky for the first day or two, then it got better. I wore pads for a couple of weeks, but for the last couple of days it was more psychological. I regained continence without doing much in the way of exercise. But I was also younger than average for prostatectomy (43).

People have different experiences, but I think you should be prepared for at least a few very leaky days, and hopefully it will diminish to a low level of stress incontinence later. You may need to perform Kegel exercises, as you probably know.

It's highly unusual, thankfully, to have to be re-catheterized. It does happen once in a while.

I continued to pass blood clots off and on for a couple of weeks after catheter removal. Startling to see something like that shoot out, but harmless unless they block urine flow (again, not very common) or if there is active bleeding.

You should be free of the ball and chain for good, very shortly.[/quote]

Replicant & Positive Guy, that is good news. Did you have any burning when you urinated the first few days after removal of the catheter?
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

Travelingman,
Yes, I had a little burning for a day or two after the catheter was removed, as I remember. Nothing too memorable, though. I was drinking plenty of water to clear out the plumbing.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

PositiveGuy

There has been no burning with my urination since the catheter was removed. I did, however, pass some blood and clots in the second week and it cleared up almost immediately. A bit scary when you see it, but it is most usual and to be expected from time to time. It seems odd to be able to pee like a twleve year old again. No starting and stopping now, it is full flow ahead every time.

Keep well,
Regards,
Bill
_________________
Age 64. Diag. 01/09 PSA 5.6, Gleason 3+3=6, T1c TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear. RALP - 09/29/09, back home 10/02/09. Pathology - 10/14/09 Gleason Score 3+3 = 6 No positive margins. No Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and bladder neck cancer free.
10/16/09 - 3-4 pads a day, 10/31 2/day, 11/09 one pad/day
ED 10/16/09 - Zip, nada

Travelingman

Hi everyone, I got the catheter removed this morning & got my pathology report. Boy I am glad to be free of the catheter. Surgeon had me lie down on the table & he removed the catheter. No pain on removal & no burning afterwards. Plus, I didn't pee on myself! Now I get to learn how to control my bladder again! Some of the guys told me they went through about 4 pads a day at first. I'm on my 3rd pad 2 hours after the catheter was removed. We went directly from Dr. to vote in our elections. When I got out of the car, one pad bit the dust! It is truly amazing how much that pad holds! Now on to the pathology. If you read my signature you'll see I had 4 biopsies over 4 years & that only the 4th showed anything. 4th biposy showed 5% of one core & a Gleason of 3+3=6. Surgeon greeted me with "you made a wise decision to have the surgery!". The good news is that the cancer appears to be contained in my prostate. My final Gleason was 3+4=7 & approximately 30% of the tissue shows tumor. If I had gone WW as some thought might be prudent who knows how long it would be before the cancer spread beyond my prostate. Just as important, I think, is that I chose to have surgery when I am young & healthy. I believe my surgical recovery was easier due to this & I hope that incontence issues & ED will be easier to also conquer. I am also very happy I chose surgery over radiation. I feel that most of the pain is past me & that ED is something I would have faced later with radiation. As far as incontinence goes, I would rather face this than potential damage from radiation. I will update my signature with the details from the patholgy report. I will also post another reply with the pahology stuff & my questions for you guys who might know what a couple of things mean. One of the things I found very interesting when I met the surgeon today was that he didn't seem the least concerned with the details of the report but said he felt confident that I would be ok. I am very thankful to God, my wife, the prayers of you guys & others & for the info I received on this forum, that lead me to make the decisions I did.
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

Travelingman

As promised, here are my pathology results. I view this info as very good news & am interested in any thoughts you guys might have.
No tumor on bladder neck margin. Two small lymph nodes no tumor seen. Prostate & vas deferens--Adenocarcinoma of prostate, Gleason score 3+4=7. Approx. 30% of tissue shows tumor. Both right & left lobes show tumor. The urethral resection margins and the entire resection surface are free of tumor. The seminal vesicles are also free of tumor.30% of the tumor shows Gleason pattern 4. Tumor size dominant module 1.2 cm. Extraprostatic extension not seen. Seminal vesicle invasion not seen. Perineural invasion not seen. Lymphatic (small vessel invasion) not seen. Venous (large vessel invasion) not seen.

Pathologic staging primary tumor T2B. Regional lymph nodes, 2 examined none with metastasis. Distant metasis: MX. Margins free, closest distance from margin: Approx. 3 mm.

Now, I have a couple of questions for you guys. What does "MX" for distant metasis mean? The seond question is about my stage of tumor. I assume that T2B is pretty good, am I right?
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

MX: The "M" refers to metastasis.
X: not determined.

This is standard pathology reporting. Just means that from the prostatectomy pathology, it was not determined whether there was distant spread.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

Travelingman · Posted: Tue Nov 03, 2009 5:05 pm Post subject: Re: MX

[quote="Replicant"]MX: The "M" refers to metastasis.
X: not determined.

This is standard pathology reporting. Just means that from the prostatectomy pathology, it was not determined whether there was distant spread.[/quote]

Thanks for the quick response Replicant, &does the NO refer to lymph nodes?
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

N0 (N zero) means "no regional lymph node metastasis".

In my case, the surgeon did not remove any lymph nodes, so my pathology was T2c NX MX.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

srtimmons · Posted: Tue Nov 03, 2009 7:48 pm Post subject: good news

Travelingman - sounds like good news to me. Very similar to my situation. Hopefully we are cured. Only comment I have is the staging.
T2B means only one lobe is involved. If both lobes were involved, then it would be T2C.

Good luck on the incontinence and ED fronts.

Steve
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative. Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

Post-RRP PSA: 9/09: .006

Travelingman · Posted: Tue Nov 03, 2009 7:52 pm Post subject: Re: right

[quote="Replicant"]N0 (N zero) means "no regional lymph node metastasis".

In my case, the surgeon did not remove any lymph nodes, so my pathology was T2c NX MX.[/quote]

Thank you Replicant for another rapid response. It seems that in your case many investigative steps were missed. Do you attribute that to a lack of experience on the part of your Doctor? This disease seems to have many vague issues. As an example, I had a biopsy with 5% of only 1 core, yet the surical pathology report showed 30% of my prostate contained cancer. It just seems to make everything even more difficult to evaluate when trying to make a decision. Some made a strong case for me to WW but I decided to treat the problem now. I chose surgery so that I would at least avoid some of the unknowns by having a pathology report. At this point, I'm glad I made the decision I did. Time will give me further indicators to see if it was a wise decision. Is your disease stable at this point? From what I read on your posts you're a strong believer on early aggressive treatment when PSA returns. I think this is wise as we all have a window of opportunity. BTW, thanks for the excellent job as moderator!
_________________
PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09 T2B Tumor 30% of prostate involving left & right lobes NOMX Gleason 3+4=7 Urethral Resection margins & resection surface clean Seminal vessicles clean

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