Side effects after Da Vinci Robotic Surgery!
Please help if you can!
I was floored when I found out 3 weeks ago after a prostate biopsy that I do actually have prostate cancer especially since my PSA was only 0.7. and my urologist said I only had a 1 in 6 chance of the results being positive! It was the digital rectal exam that that brought this about (at least it was good that I did have the DRE done or the biopsy would have never taken place). However, having been on testerone for the past 2yrs. with my bioavailable score being on the real high side, I really expect that had something to do with it though my Dr. didn't necessarily agree.
I am scheduled to have the Davinci robotic surgery performed here in So. Cal by one of the top urology surgeons in the United States in 2 months. I am told with a 0.7 psa, Gleason at 6, and stage T2a-b1 that I am a very good candidate for this "nerve sparring" procedure and in the hands of a world class surgeon my chances for any sexual dysfunction or real incontinence issues are rather small. I sure would like to believe this as I always have been a pretty active guy and still feel and think very young-I am 67 yrs. old but look a lot younger. I'm told that my doctor uses the newest Davinci "S" robot and creates 6 ports in the lower stomach region rather than 5 ports. If anyone has a similar profile and has had this procedure within the last 1 year I would sure appreciate hearing from you re:your results.
Da Vinci Robotic Prostatectomy surgery is gaining popularity as a less traumatic and minimally invasive alternative for treating and removing prostate cancer. The most famous robotic prostatectomy system available today is the da Vinci Robot manufactured by Intuitive Surgical. The da Vinci robotic system enables surgeons to overcome many of the shortcomings of both open prostatectomy and laparoscopic radical prostatectomy.
As with any surgical procedure, the benefits of a da Vinci Prostatectomy cannot be guaranteed as surgery is both patient and procedure specific.
However, patient testimonials and media coverage attest that da Vinci Robotic Prostatectomy patients are discharged within 24- hours of their surgery. Many patients leave the same day, and often walk out of the hospital within hours of their robotic prostatectomy surgery. For most patients use of the da Vinci Prostatectomy provides superior benefits over traditional open or laparoscopic prostatectomy.
I am 61 and my cancer was also discovered by DRE. My PSA was 2.9. My biopsy put me on Gleason 3+3, stage T2a. I had a RRP on Tuesday and left the hospital on Wednesday. I have six incisions on the same horizontal plane as my belly button. The biggest hassle so far is the catheter, but like anything, you learn ways to handle it. I'm very happy with my outcome so far. In a few days the catheter will come out, I'll get my pathology report, and, with luck, this thing will be over.
Best of luck to you.
Re: Side effects after Da Vinci Robotic Surgery!
You need a realistic view about robotic surgery or any type. Doctors are telling too many patients what they want to hear. Especially regarding future sexual function. Their percentages and definitions are way off from what reality seems to indicate.
Originally Posted by markpw2
You want a realistic discussion.
Go to the New York Times
IN the search box, put in prostate and Tara Parker-Pope
When you find the article, read it, then read the 75+ comments.
Its the August 27 article.
"I am told with a 0.7 psa, Gleason at 6, and stage T2a-b1 that I am a very good candidate for this "nerve sparring" procedure and in the hands of a world class surgeon my chances for any sexual dysfunction or real incontinence issues are rather small. "
This is the point at issue. I would say your chances of one of the two of those happening is 50% or greater.. Very few men say that sex is the same after surgery. The definition many doctors use is very loose.
I can assure you, it is not your definition of "normal sexual function" like you have currently been experiencing and are used to.
OK......I've not had the surgery. Read the NY Times article and all of the comments. It offers a more realistic picture. You need a realistic view.
Doesn't mean your choice won't be the same nor that there is a 100% chance you won't be perfect, but......well, just read it.
Also, how many opinions have you gotten?
I do realize that some very low PSA scored prostate cancers can still be dangerous, but normally the lower score the better.
They did the biopsy because of your DRE. Did the tell you the extent of the cancer, in each core they sampled? What were the percentages?
How many cores were positive?
Did you get the biopisies read by a second pathologist? you should.
Many men your age might choose to watch the PCa and not treat it.
In many men it is a valid option, even preferred in the minds of many.
The name used for this can range from Watchful Waiting to Expectant Management. Even famous medical centers have programs for this option.....such as John Hopkins. Certainly not for everyone and much of the criteria depends on the patients situation.
I don't know the details of your testosterone situation. Are you currently being given testosterone?
All in all, sound like you've not had much time to learn about all this.
You seem to be on a "fast track" for making the decision. Gosh, you said you just learned about this 3 weeks ago and you are already set for surgery. Is there something we don't know that indicates the urgency?
Seems like a very fast time frame to make all these decisions when you haven't had that much time to learn.
I'd give you some other links here but I think there is some rule about that.
I had my prostate out August 6 with a Da Vinci machine operated by Dr. Ash Tewari at New York Presbyterian Hospital in New York City. I'm 59 years old, had a PSA of 4.9 and a gleason score of 3+3, with two of twelve core samples having cancer cells . The post-op pathology report on the prostate confirmed the cancer hadn't spread out of the prostate.
I don't know how many arms the machine had. I had six holes in my belly, and one of them was used for a fluid drain post-op.
I was in significant pain after the surgery in the recovery room, but extra doses of drugs stopped that. I was up and walking about 7 hours after the surgery. I walked out of the hospital about 35 hours after the surgery. I've been walking for about a hour a day every day since the surgery.
Doctor Tewari has performed over 2000 prostate removals and uses a somewhat unique procedure to reconnect the urethra to the bladder that reduces the incontinence problems. You can read about it on the doctor's website. http://www.theehealth.com/2005art/ I had small urine leaks for the first 5 days but after that I haven't had to use any pads during the day. At night I've had 3 cases of leaking in 25 days. It happens when I'm sleeping very deeply, I've drunk lots of liquid, and the bladder pressure doesn't wake me up. So now I'm trying to make sure I don't drink much before bedtime, and I'm using a pad and sleeping on a couple of small towels at night. I'm doing the kegal exercises everyday and I'm hoping this night time problem goes away.
I'm able to get an erection, but it is slower and takes much more stimulation, as well as 20 mg Cialis. I was able to get an erection and masturbate to orgasm on day 8, the day they took out the catheter. I just had to find out if everything still worked. I felt I was healed up enough to try intercourse on day 24. Again it took lots of stimulation to achieve a firm enough erection for penetration but we did accomplish full satisfaction for both partners. After making penetration when the arousal was high the erection was as firm as ever.
I've talked to 3 other patients of Dr Tewari and they reported similar results to mine. All of them were 65 to 70 years old. They all encourage me to go to Dr Tewari. They really liked the doctor and his staff.
It is strange having an orgasm and not ejaculating. It is a satisfying orgasm, but possibly not as earth shaking as prior to the surgery.
From what I've read and what doctors have told me the experience and expertise of the doctor is all important in the out come of your surgery. Research the doctors extensively and get specific data form them on how many surgeries they've performed, and the percentages of patients and over what period of time it took them to regain continence, and obtain erections sufficient for intercourse. My doctor has all this data posted on his website. Check it out. I traveled from Arizona to New York because I wanted the best surgeon possible. I highly recommend him and his staff.
A good book to read about prostate cancer is "Surviving Prostate Cancer, by Dr. Patrick Walsh. Although Dr. Walsh isn't a proponent of the robotic procedures I got the impression he and his staff were somewhat behind the times on robotics. But the book is still a great book to read to know all about this type of cancer.
Best of luck with the cancer. Don't settle for just any doctor. Find the best. My neighbor settled for a well meaning local surgeon and a year and a half later he still struggles to get an erection and has more incontinence problems than I do. He's upset with his results.
I wouldn't put too much stock in the New York Times article. It is possible that outcomes are being over-promised, which would explain the disappointment. However, what really matters is what is your outcome relative to the alternatives. You can never know, but if you listen to the person making the 4th comment on the NYT article, he says, "When in doubt, do nothing." This, in my opinion, is not a good strategy for dealing with PC. In May of this year, my younger brother died of PC. I was diagnosed with PC on August 11. On August 26 I had my prostate removed by RP by someone who has done hundreds of these surgeries. I was very comfortable with his advice and that of my primary urologist. If you are in good health and have T2 PC, surgery appears to give the best outcome. I will also say that I do not care if I ever have another erection and that I would rather live with some incontinence that allow cancer to continue to grow in my body after what I saw my brother go through. Dying of PC is much worse than not having sex or wearing a diaper.
I have not had Da vinci surgery but i did have laparoscopic RP by the Frenchman that perfected the surgery and was recruited by Memorial Sloan-Kettering Cancer Center in Manhattan. He does nothing else and does several hundred a year. My outcome was not what I had hoped for and 4 years later I am facing a likely PSA rise.
HOWEVER, no one can give you anything but odds on your outcome. Problem is that odds are useless or nearly so for an individual. They work great for groups. I was once told (after 2 negative biopsies) that the odds were 80% that I did not have cancer. You were given only a 1 in 6 chance of having PCa Those odds were worth nothing to me or you. You cannot be certain about the future. You have to educate yourself, make your best judgment, and not waste time second guessing the decisions that are behind you.
I was 54 with Gleason 8 and a PSA of 8.7 and higher so my decision was easier. Even in your shoes, I would need some very expert convincing before I decided on watchful waiting however.
Good luck and keep us posted.
History: Biopsy showing 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests beginning 2008: Feb .06, May .09, Jun .10, Aug .10, Nov .15 - SRT Dec 2008 ---Post SRT PSA 2009 Feb .10, May .09, Aug .06, Dec .04, 2010 Mar .04, 2011 .02, 2012 .02, ---- STARTED UP Feb 2014 .06, Jul 2015 .10, Oct 2015 .10, Feb 2015 .15, Jun 2015 .17, Dec 2015 .25
Well, if one can say anything was easy about it, at least the decision, in your particular situation, was more clear cut.. I'd certainly agree with your choice.
Originally Posted by Hawk
However, in a person who was 67, with a psa of .7, unless there are other details that seriously increase risk ( and I know there can be), then I'd say "active surveillance" is a option to consider.
If you look at the following study you might find it interesting for the select group to whom it applies.
Of course one is always making a bet. On the other hand, if you take 100 men age 67 just walking down the street.........and you grab them and perform biopsies randomly, you will find a substantial number have prostate cancer unknown to them. Repeat it 3 to 6 times and you may find 1 in 3 with previously undiagnosed PCa.
Now we wouldn't want to operate on all of them EVEN if we knew they had cancer because we know most of them aren't going to die of it even if untreated.
So there certainly is a place for "active surveillance" as John Hopkins calls it. I think watchful waiting......has gotten a bad name, as though its nothing more than "hopeful waiting".
My husband had same surgery Dec. 13th, 2007. I will say the recovery is much slower than he expected and when listening to the urologist you hear that some recover fast and you want to be one of those, but it does not always work that way. He just turned 56 in August. He can have an orgasm but a lot of times the erection just gets barely hard enough for penetration. The Cialis & Viagra cause terrible headaches for him, but they seemed to help the erection some. You can always use a VED device. It has been 8 1/2 months since surgery, and finally things are starting to work some on their own. Now his erection is getting harder sometimes. He also feels that maybe he can try to go without a pad for incontinence as long as he is not doing any heavy lifting that day.
If you have any questions I will try to answer if you want to privately email me. So far his PSA levels have remained undetectible.
I had my surgery exactly one year ago at the University of Rochester, NY with Doc Jean Joseph with 1200+ surgeries. My final gleason was 6 and no positive margins.
I was getting a full erection within two weeks of catheter removal, but I needed a lot of manual y visual stimulation to maintain it. It has been a year and I can still get a full erection without drugs, but I still need a lot of manual stimulation to keep it. Once penetration is achieved, I can go for hours without a problem, but once the stimulation stops, I loose the erection very fast.
With repsect to orgasms, well, they are as itense as before my surgery, but then again, they are very different also. The one major problem I have now is that I ejeculate urine. Even if I empty my bladder before sex, I will still ejeculate urine. The funny thing is that when I ejeculate urine, it is with more force and intensity than when I ejeculated semen when I had my prostate. When I had my prostate, my ejeculation amounted to nothing more than a drible of semen, but now without my prostate, I can ejeculate urine like a fire hose with such force I can almost hit the cieling. Having the urine ejeculating through the tipe of my penis also gives my orgasm somewhat of the same feeling and sensation that I remember when I use to ejeculate semen, but maybe a little more intenes since the force of the urine leaving the penis seems to be greater then what I had with semen.
The only problem with this is..... women don't like be ejeculated with urine. So I have to be real careful and pull out before orgasm and then throw a towel over my penis so I don't wet the bed. That does not do much fo the romance of the moment. Too bad I couldn't find a pill that would turn my urine milky white , then it would be just like old times. Isn't prostate surgery fun!!!!
Biospy 4/2007 - 2/12 <%5 Cancer Gleason 6
RP 9/25/2007 Uni Rochester, NY
Gleason 6, Negative Margins