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Thread: Recurrent prostate cancer after prostate removal

  1. #1
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    Exclamation Recurrent prostate cancer after prostate removal

    Underwent robotic prostate removal in 2003. The surgeon "had to harvest a nerve during the surgery" which left me impotent. Cancer returned in bed tissue and was treated by radiation (35 sessions) in 2008. My PSA readings since have been next to nothing and have not increased. I am experiencing increasing problems with incontinence 1) going many times 2) dribbling before I can get to a toilet 3) leaking if I bend over at the waist. My question is: Does cancer returning to the bed tissue ever reach a far removed point where it no longer registers on the PSA scale? My previous doctors were in the USA but I now live in Thailand. Should I be worried or is the increasing incontinence a natural process of getting old? I am now 74 years old.

  2. #2
    Moderator Top User HighlanderCFH's Avatar
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    Hi,

    Sorry to hear about your situation. I think that if there should be a recurrence of PC you would definitely have a detectable PSA reading. If I'm wrong about this, others will correct me.

    Sure, it could be an age factor regarding the incontinence. However, my question would be if you were incontinent in the years after the surgery? Also, have the doctors suggested that you begin doing Kegal exercises? If you have not done them before, we can tell you how they are performed. Very simple & easy and they help strengthen the muscles that control urination.

    Also, perhaps a surgical procedure might be possible for you (if necessary) in which an artificial sphincter is installed to block the flow of urine from the bladder. A PC friend of mine had this done. He is completely dry and, when needing to urinate, he presses a button hidden in his scrotum which opens the artificial sphincter and he has an easy urination. Then it closes again & keeps him dry.

    Good luck to you!
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  3. #3
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    PSA typically goes up with prostate cancer recurrence but not always.
    The suggestion of kegel exercises is good. there is only one sphincter controlling urine now after surgery and it might get weak with age. good luck.
    DOB Sept. 1947. Prostate cancer Gleason 7 (3+4), PSA 5 in Oct 2010. Cryoablation Jan. 2011. Had some complications.
    Experienced nocturia, irritable bladder summer 2011. "Agent Orange"compensation from VA Oct 2011.
    PSA: .05 01/26/2012, .06 6/26/2012, .04 12/24/2012, .04 6/26/13, .05 1/27/14, .05 10/21/14
    I am eating vegan mostly plus a little fish. Take some supplements.
    (Any advice given is the personal opinion of a layman and is not intended to replace the advice of a health professional.)

  4. #4
    Moderator Top User HighlanderCFH's Avatar
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    Hi lancepeace,

    I know there is the one sphincter that, I think, is at the bladder before the urethra enters (or used to enter) the prostate. I might be wrong, but isn't there also a sphincter at the bottom of the prostate where the urethra enters the penis? I seem to recall reading about how there is, in a normal situation, THREE controlling factors regarding urine flow -- with the prostate being the 3rd?

    I seem to recall reading about how the "main" part of holding in the urine is lost when the prostate is removed and that the Kegal exercises help strengthen the remaining two controllers (meaning the two sphincters).

    I could be wrong about this, but I'm not sure. I once thought I was wrong about something, but I was mistaken. LOL

    Thanks,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13, 9/29/14 PSA <0.1
    Semi-firm erections from time to time.

  5. #5
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    Hey Chuck.
    I'm at the library now and don't remember the details. I read in some book that 2 sphincters are lost in the surgery. But I'm vague on the details. Will try to look it up later. Best
    Lance (not my real name)
    DOB Sept. 1947. Prostate cancer Gleason 7 (3+4), PSA 5 in Oct 2010. Cryoablation Jan. 2011. Had some complications.
    Experienced nocturia, irritable bladder summer 2011. "Agent Orange"compensation from VA Oct 2011.
    PSA: .05 01/26/2012, .06 6/26/2012, .04 12/24/2012, .04 6/26/13, .05 1/27/14, .05 10/21/14
    I am eating vegan mostly plus a little fish. Take some supplements.
    (Any advice given is the personal opinion of a layman and is not intended to replace the advice of a health professional.)

  6. #6
    Moderator Top User HighlanderCFH's Avatar
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    Thanks Lance,

    If you find any more info, please let us know.

    In the meantime,
    Happy New Year,
    Chuck

  7. #7
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    We lose the sphincter at the bladder neck and of course the prostate from a radical prostatectomy. That leaves only the external sphincter, also called the striated sphincter. This is from Walsh's book (just looked it up again) and my surgeon told me the same. Apparently the external sphincter does not do much "work" when our plumbing is intact and has to take over when we lose the other two so we have to strengthen it which can take some time.
    Age 58 at diagnosis, 10/12
    PSA 8/10 2.3
    PSA 6/11 2.2
    Positive DRE during exam, PSA 3.3, 9/12
    Biopsy 10/10/12, one core of 12 positive, 30%, Gleason 3 + 3=6.
    DaVinci RRP 11/30/12.
    Pathology- 20% involvement, all Gleason 3+3=6
    Negative seminal vesicles and lymph nodes, organ confined
    Some positive margins at urethra and posterior surgical resection margins
    Doc not concerned, he is confident my first PSA in 3 months will be undetectable hope he is right!!
    Staged as pT2, N0, MX

  8. #8
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    Happy New Year
    Ron, thanks for saving me the trouble of looking it up.

  9. #9
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    Your welcome, had the Walsh book back in the bedroom and needed to refresh my memory also.

    Happy New year to all!!
    Age 58 at diagnosis, 10/12
    PSA 8/10 2.3
    PSA 6/11 2.2
    Positive DRE during exam, PSA 3.3, 9/12
    Biopsy 10/10/12, one core of 12 positive, 30%, Gleason 3 + 3=6.
    DaVinci RRP 11/30/12.
    Pathology- 20% involvement, all Gleason 3+3=6
    Negative seminal vesicles and lymph nodes, organ confined
    Some positive margins at urethra and posterior surgical resection margins
    Doc not concerned, he is confident my first PSA in 3 months will be undetectable hope he is right!!
    Staged as pT2, N0, MX

  10. #10
    Moderator Top User HighlanderCFH's Avatar
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    Thanks Ron!

  11. #11
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    Hi Anthony, i'am 64 and had mine out in 2003. Recurrent in 2008 had radiation. Again had radiation 2010 with hormone treatments and all the while my psa was up and down and all over the bloody place. My doctor and me decided not to to much weight in pas reading. If your not in any discomfort I would say do nothing. As far as in continence I try not to bend over or get to excited . But if it's really funny I say the hell with it laugh like crazy. A little pee is a small price to pay for a hearty laugh. God Bless.... Gimmy

  12. #12
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    Thanks for all the great advice. I will check out the Kegal exercises. My problem stems from my dissatisfaction with the Urologist who performed the robotic surgery. He was too much of an "artist" to be bothered with post-op questions and my regular urologist retired. Had the first biopsy at the VA by a PA - it was her first. She advised me that the sample taking would feel like a shotgun going off in my ass. That's when I knew I was in trouble. My heart problems probably preclude any other surgeries. Grin and bear it and try to drink less than 12 beers a day. Again thanks and good luck to you guys.

 
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