It’s been four days since my radical prostatectomy. It’s the step I chose to become cancer-free. There is definitely a choice to be made and the route I took may not be one others would make. But I”ll share my thought process, as well what the procedure is like, and my recovery thus far.
Surgery vs. Radiation
If you are faced with prostate cancer, the kind that must be acted on, your choices aren’t the same as breast cancer, or lung cancer, or colon cancer. There is no chemotherapy regimen. Your choices are to surgically remove the prostate or have radiation therapy. As part of my decision making process I met with a radiation oncologist. In the interest of full disclosure, my urologist, a surgeon, was admittedly biased in favor of surgery, and when I walked in the door of the Multi-Care Cancer Center in Puyallup I was too. It would be disingenuous to suggest I had an open mind.
However, I did listen carefully to the options presented to me by the doctor. I was offered two radiological options. The first was a daily treatment program radiating the affected areas. It would require about an hour at the Center each day including preparation and “clean up,” and the course of treatment would last 7-10 weeks. A second radiological procedure open to me was a more intense set of applications over a shorter period of time. However, describing it would be a little like explaining recreational activities from the Spanish Inquisition. Whoa.
I can tell you my internal compare/contrast mechanism, which often works a little too fast at the best of times, was done calculating within thirty seconds or so. Many of the concerns I have regarding post-surgery side effects-impotence and incontinence and various forms of collateral damage, are also present in radiological treatment. There is also the whole business of spending every single day of summer break at the Cancer Center. In addition to creating an incredibly inflexible schedule, there was something unsettling about going to the Cancer Center every single day. If you are coping with simply being told you have cancer, as I did, it was an incredible downer. After this trip I freely imbibed a great deal of good local gin. I couldn’t imagine going to see others suffering much worse from cancer than I every single day. This was not going to contribute to my positive state of mind. It was surgery for me.
You’d think that with the central location of the prostate in the lower abdomen we’d be talking about a big incision, with doc rummaging around in there until he found what he was looking for, a quick snip, snip and out the nasty little fellow would come. If you thought that, you’d be right, say 15 years ago. But like lots of other surgeries, such as gall bladder, it’s done sort of laparoscopically. In the old days it was a vertical belly gut rip, or a posterior entry (which I’ll simply leave to your imagination,) with big ol’ incisions and a 5-7 day hospital stay. Increasingly the surgery is done robotically with five small incisions and the stay is overnight.
Robotic surgery takes a lot of the guesswork out of the procedure. Under the old “open” procedure the doctor had to proceed mostly by touch and feel to complete the operation. With robotics he can use fiber optics to see better what he is doing. The doctor essentially sits in a control room manipulating a many armed robotic device, while assisted at bedside by additional doctors and staff. In the Puget Sound area, robotic prostate surgery is practiced almost exclusively. That doesn’t seem to be the case everywhere. My urologist, Dr. Robin Lee was a Fellow working with Dr. James Porter in Seattle a few years ago. Dr. Porter is a world renowned artiste with robotic surgery and Dr. Lee was able to slide me under Porter’s door for surgery. I felt I was in great hands. Porter is direct and competent, and has performed thousands of these procedures. That Porter went through this same procedure last year adds to my confidence.
The procedure lasted a little over three hours. It takes place in a congested area-the bladder, urethra, and some critical nerve bundles are nearby. The entire prostate is removed, not just the affected bits, as well as a sphincter muscle along the urethra. The nerve bundles operate the reproductive system. If they are cancerous, or near the cancer they can be removed as well. The procedure, as you may be imagining, can have some serious side effects. Removal of the sphincter muscle can result in some incontinence, though that is often regained over time. The nerve bundles are quite a different story. Removal of some or all the nerves will likely result in a level of sexual impotence. There are a variety of treatments for this, including the use of drugs such as Cialis or Viagra, or more aggressive therapies. Complete removal of the nerve bundles would require an implant to restore sexual function.
At this point my prostate is out, I am catheterized, and the doctor removed part of one of nerve bundles. What does this mean? I have no freakin’ idea; it’s just too soon to know. I can tell you I’ve been taking Cialis for about two weeks, and this weekend I’ll be shopping for adult diapers. In both cases I have no idea to what degree I’ll be suffering the side effects. The most important thing is the prostate is removed, it’s been sent to the pathology lab, and I’ll have an idea next week whether or not I’m cancer free.
This will be brief, because I’m so short into the recovery period. This is my first surgery, so I have little to compare it to. As with many surgeries, I was well supplied with pain-killers. I’ve tried to take them judiciously. I am a great believer that sleep is the greatest aid to healing, so I’ve mostly used the Oxycodone they supplied to aid my rest. I do a lot of sitting and watching television. But I also get up and move around a lot to prevent clots in my legs. I haven’t left the house yet, but may in the next day or so. One big deterrent to that is the catheter that keeps my bladder free of urine. Yes, it really has a purpose beyond merely forcing me to manage my urine production in a humiliating fashion. I have a mini-bag that attaches to my leg that allows me some discrete mobility. I haven’t used it yet, but may try today.
I’m not in a lot of pain. The only area of sensitivity I have is at the site of the five incisions. Even that is not bad if I can keep my forty-pound Rusty dog from insisting on being in my lap. One challenge is to deal with all the oxygen they pump into the belly for the surgery. They literally fill your abdominal cavity with gas to give them room to see and work. Eventually that gas has to leave. One way is through walking which leads to some gas escaping through belches. There is one other way for the gas to escape-yes, you know how and where. It took two days for that to begin happening, and the bloating was painful. Until it did, there were no bowel movements for me. Everything began moving in rapid order yesterday; I was never so happy to cheer number two in my life.
I’ll share the outcome of my visit with Dr. Porter next week. He’ll remove the catheter, and hopefully will share the pathology report with me. I expect phase two of my recovery will also begin then.