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Prostate cancer redux
Old 08-11-2009, 11:20 AM   #1
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Prostate cancer redux

Ironically, after all of the discussion we’ve had on the advisability of PSA testing for prostate cancer, I myself was diagnosed a couple of months ago. My PSA had been bouncing up and down for the last couple of years, as high as 4.1 and as low as 2.9. My digital exams were negative, and I had a mixed set of recommendations from doctors on what to do about it, so I decided to wait and retest every three to six months.
Three months ago my PSA rose to 5.7, and my urologist felt a spot on my prostate for the first time. Even then, he said he doubted it was cancer, because of the way my PSA behaved. He thought it was an infection, but recommended a biopsy to make sure. I had the biopsy, and was diagnosed with intermediate grade PC of high volume (many places in the prostate), but still early enough to allow a good chance for a cure.
I went through extensive reading about options, and I won’t bore you with details, but last Friday I chose to have a robotic prostatectomy by one of our most experienced local urologists. The surgery went fine, I was home in 24 hours with only six bandaids on my midsection, and little or no pain. Been recovering at home, and will have the pathology report early next week, along with removal of my catherer and staples. I won’t know for sure how everything went until the pathology report comes back, but my doctor is hopeful, and the numbers for cases like mine show about a 90% chance this not coming back in the next 10-15 years. He also saved both of my nerve bundles, so I have a very good chance of regaining potency.
I appreciate the support I’ve received through private emails, and the information shared on this board concerning prostate and other cancers. I’ll be glad to answer specific questions here or in private, but thought it more appropriate to give you my thoughts and observations from a medical and retirement perspective.
Medical
1. In spite of all that has been written and studied about PSA it’s still a pretty good tool, in the hands of an experienced urologist, to find PC at an early enough stage to cure it. I saw 4 or 5 urologists, and not one jumped right on the PSA, they only used it as an indication that something might be going on. They don’’t look only at the absolute PSA number, there is also something called free PSA, as well as PSA velocity, PSA density, etc etc. So, my advice, don’t be afraid of PSA testing, use it as a valuable tool – one of the few we have – and consult with experienced urologists if anything looks funny.
2. In spite of anything you may hear, a prostate biopsy is no big deal. I went and played 9 holes right after the biopsy. Again, it helps to have a good urologist.
3. Catherers are #&%$& but they do the job.
4. Every nurse definitely looks gorgeous under versed, but it’s hard to reach them in a drugged state before they move away from you.
Retirement
1. I retired fully last February and, since my PSA had been bouncing around, I made sure my medical insurance was set up the way I wanted it before retirement. It’s a lot harder to change insurance after retirement, and especially with a medical issue.
2. Same with life insurance, if anyone uses it, make sure it’s set up before retirement and before health issues arise. I would not be insurable at this time, but I arranged for a 10 year term policy a couple of years ago when I was still clear of health issues.
3. Some lifestyle hobbies and activities are harder to do once health issues arise, and they will. So, when planning for retirement, plan activities that you will be able to pursue regardless of health. In my case, I’m a big sailor, but realized that I can’t pursue that hobby the way I once did. So I’ve scaled back over the years and have added a small pontoon boat that I can ride around in even while recovering from surgery. I plan to return to golf in a few weeks, but that may also have limits as I get older and encounter other health issues. So I have my fallback hobbies, such as guitar playing and reading, that I can always pursue.
4. With the uncertainties in health insurance, it’s best to take care of issues at the earliest opportunity, before costs increase out of reach or they become unavailable.

And the most important thing, it would be pretty difficult for me to get through this without my faith and the support and love of my DW. It's hard to appreciate. I't's easy to take a loving partner for granted until something like this happens.
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Old 08-11-2009, 11:56 AM   #2
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Sharing your story is so helpful for us--our lives are about a lot more than finances and it helps to hear how to deal with health issues. Thank you.

Sending best wishes to you that you will now have a full recovery, and my admiration to your DW.
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Old 08-11-2009, 12:15 PM   #3
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FR.....your post is amazing; with everything you're having to deal with, you want to help others. You make this world a better place.

Flowers from TX to help speed your recovery....
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Old 08-11-2009, 12:40 PM   #4
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Been a rough patch for the board, health-wise, including a couple I have had PM correspondence with.

Great attitude from beginning to end, FR. Stay well, everyone.
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Old 08-11-2009, 01:17 PM   #5
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FR, thanks for that post. Excellent information and I appreciate you sharing with us. All the best to you.
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Old 08-11-2009, 06:09 PM   #6
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Glad you caught it when you did! I wish you the best of luck in the future!!!
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Old 08-11-2009, 06:26 PM   #7
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FR, thanks for that great post of information. I have the test every year, both PSA and the digital exam. This December I'll ask my doctor about the other test just to see if he is familiar with them. So far all my numbers have been low. Best wishes for a complete recovery.
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Old 08-11-2009, 06:45 PM   #8
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FR,

Let me add my thanks to everyone else's. With all that information you've provided up front, I guess we can count on an update or two...here's hoping they are all good news.
So, did even the male nurses look good?
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Old 08-11-2009, 07:35 PM   #9
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FR - glad you caught it early, and that you had a good doc who was able to save the nerves. Dad had it 14 years ago and is cancer free, but the procedure for saving the nerves was not as well established, and the doc was probably not as good. Even though he has no cancer now, he does have issues. Anyway, with a 24 hour stay (dad's was 10 days, 3 of them in the ICU) and with only band-aids, I'm sure things will turn out great for you. Thanks for posting, and do keep us updated. I'm keenly interested, as if this cancer is as related to genetics as I have heard, my number will be up in about 10-12 years. Thanks

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Old 08-11-2009, 08:27 PM   #10
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Glad things have gone well for you. Hope you get a good pathology report. I get a PSA test every year and the old manual test too. One of those things my doc shames me into letting him do.
















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Old 08-11-2009, 08:52 PM   #11
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Thanks for a great informative post !
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Old 08-11-2009, 09:02 PM   #12
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Sorry to hear about your problems FR, but it looks like they caught it early and you have an excellent prognosis.

Thank you so much for sharing - it's an excellent post.

All the very best to you (and your DW)
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Old 08-12-2009, 08:06 AM   #13
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So, did even the male nurses look good?
No, thank goodness. If they had I would have told the doc to rewire my nerves, he got them backwards

Seriously, the first thing I remember when I came out of anesthesia was a beautiful nurse with a slightly panicked look as she pushed away from me. They tell me I was trying to grab and hug all the nurses as they walked past.

So far so good, going on day 5 of the recovery, getting cabin fever.

Thanks to all for your good wishes, and thanks to Rich for some PMs answering some of my dumb questions about medical terms and such.

Rambler, congrats on your dad being cancer free after 14 years. I'd say he's beaten it, even if he has other issues. And you're right about this surgery not being as advanced 14 years ago, we're fortunate that so many advances have been made not just in surgery but on other methods. If my cancer grade had been just slightly lower I would probably have gone for radiation seeds, which is even easier. And I've heard of some other methods on the horizon that are still being tested, like high intensity ultrasound. One urologist said that prostate cancer is on thin ice. However, it's still the second leading killer in males, after lunch cancer, so early detection is definitely the key. By the time your numbers rise, if they rise, you can have a variety of minimally invasive treatments.

Johnnie36 if your numbers are low I'd put this out of my mind. But if they start increasing, even if they are relatively low, then I would go to a good urologist just to rule things out.
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Old 08-12-2009, 08:13 AM   #14
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Sorry for your diagnosis but glad it was caught now and the prognosis is good. Yours is the first thread I open since my own diagnosis of tongue cancer. Your insurance point is well taken and a miscaculation that I made. I had planned to self insure never dreaming I would get cancer at 50. Anyone who has similar plans may want to re -evaluate their life insurance needs . Pontoon boats sure can be a lot of fun, go enjoy.
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Old 08-12-2009, 08:17 AM   #15
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I have two friends who had the new robotic surgery. and they are both doing great. Short recovery times, and all the plumbing returned to full functionality.
Best of luck to you.
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Old 08-12-2009, 08:22 AM   #16
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Hope your recovery is speedy.

I'm going to show dh2b this post. He is a little reluctant and says his age (49) doesn't warrant it yet, but with some proper motivation , I will get him lined up for an exam/test. His doc is also my doc, so he is cornered.
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Old 08-12-2009, 08:44 AM   #17
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FR, thanks for that tip on "if the numbers increase". I'll be sure to watch for that trend. When I get my blood work this year I'll chart the year to year figures.
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Old 08-12-2009, 01:11 PM   #18
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Sorry for your diagnosis but glad it was caught now and the prognosis is good. Yours is the first thread I open since my own diagnosis of tongue cancer. Your insurance point is well taken and a miscaculation that I made. I had planned to self insure never dreaming I would get cancer at 50. Anyone who has similar plans may want to re -evaluate their life insurance needs . Pontoon boats sure can be a lot of fun, go enjoy.
ratface, what I went through is nothing compared to what you've gone through. Well, maybe it was, but I was knocked out Hang in there, buddy, every day that passes is one day closer to your being over this thing.

Not sure what I would do if I didn't have insurance, or was self-insured. These robotic procedures are extremely expensive. I don't think the doctors and hospitals get any more reimbursement for using the robot, so right now they are taking the cost a little out of hide until the machine begins paying for itself. But if I had been self-insured, they would probably have charged me the entire amount, which I doubt if I could afford.

If anyone is interested, this is a clip from an Irish TV show that demonstrated the da vinci robot being used to peel a grape. There's no blood and guts, just a grape being peeled, but goes to show the extreme precision of these machines.

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Old 08-18-2009, 01:16 PM   #19
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Update, if anyone's interested. Just saw the doc for the biopsy report. Looks like he got all the cancer out! The surgical margins were clear, and so were the seminal vessicles (sp?). They did upgrade the stage of my cancer slightly, and found that 25% of my prostate was cancerous. So looks like I'm one of the fortunate ones to have caught this just in time. I only have to return in three months for another PSA test, which should be 0.

I chose an extremely gifted surgeon. The pathology report said there was cancer less than 1mm away from the margin, inside the prostate, yet he was able to surgically separate it out and remove it cleanly. I did a lot of homework before picking this doctor, he's done over 400 of these and is one of the top on the east coast.

For those of you who worry about prostate cancer, please keep in mind that I'm one of the very few in which it was found and had to be treated surgically. As we've discussed on this board, an argument can be made that this type of cancer is overtreated, so have your PSA taken, but don't be too hasty to act until you have all the facts.

P.S. Almost forgot. Incontinence is a big issue with prostate surgery, at least for a few months. So far looks like I'm completely continent. As I said, this surgeon is awesome. The other issue is impotence, but the doc is hopeful there too, and I should know in 2-3 months. Even there, he says there's things they can do to fix the little guy. Maybe TMI.
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Old 08-18-2009, 01:28 PM   #20
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Finally, that's excellent news! Hope things continue to look up for you.
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