I was considering either radiation or surgery and for reasons I posted
earlier decided on surgery.

I met with my urologist today to go over the details and here are my
notes on the meeting --

Viv and I met with my urologist (Dr. DiCostanzo) today and he
confirmed that I am a good candidate for surgery.

Quals:
He does these operations 2-3 times per week and has been doing so for
10 years. He appears up-to-date on the latest surgical techniques and
issues.

Last week's meeting with the radiation oncologist:
He said that the pathologist that the radiation oncologist uses
confirmed that the Gleason score is 6.  That makes 3 pathologists who
agree on the score.

The procedure:

The operation will be done through an opening 4" long from my belly
button to the pubic bone.  They will start with an epidural anesthetic
followed by a non-narcotic general anesthetic.  The bladder sphincter
will be spared as the urethra is cut below the neck of the bladder –
so I have a better chance at urinary continence.

The first step is to check the lymph nodes for cancer.  If they are
soft and fatty the operation will proceed.  If there are any nodules,
they will immediately send a sample to a pathologist and proceed only
they are free of cancer.

The size of my prostate (60 grams) is not a problem to the procedure.
I asked what was the largest prostate he has seen – 110 grams!

The catheter remains in for 15 days.  There is also a drainage tube
with a rubber bladder that is used to remove fluid accumulation from
the site.  This stays in place for 4 days.

His primary goal is to cure the cancer.  He will spare the nerves
unless there is evidence of cancerous involvement.  He mentioned that
the nerves are microscopic in size and cannot be seen.  But surgeons
know where they are located.

I asked if he did the laprascopic technique and he mentioned that, in
his opinion, no-one does it well in Canada.  He said that if I were
interested in that approach the best places are a doctor in Detroit
and in France where the technique was developed.

Outcomes:
He mentioned at an earlier meeting that his cure rate was in the high
ninety percentages at 10 years for a man with my stats (Age 63; PSA
6.7; Gleason 6; Free PSA 19%; 3 positive biopsy cores out of 17 with
10%/10%/5% cancer cells).
He reports that the incontinence rate of his patients is 2-5% at 1
month.
Potency rate is 50-70% at one year.  At 18 months a person has reached
the "final" potency state.

Bleeding during the procedure:
I will donate 2 units of my own blood before the operation. Only 40%
of the Dr.'s patients require blood and less than 1% require more than
1 unit.
He said that normally there is not a lot of blood during the
procedure.  However, if there are a lot of large blood vessels
surrounding the gland (which is more likely if the prostate is large)
then it may be a bloody operation.

The schedule:
The surgery is scheduled for Markham-Stouffville Hospital on Monday,
October 27. I will be out of bed on Tuesday, walking on Wednesday and
discharged Friday A.M.
October 14 - Pre-op session at the Surgical Assessment Clinic.
Oct 16 and 23 - Donate blood.

Pre-op preparation:
He advised to eat fish rich in iron.

I should start iron supplements (900 mg/day) one month prior to the
operation.

It would be helpful to a good recovery for me to loose a few inches
around the waist – be a "lean" patient.

He suggested not worrying about Kegel exercises now – concentrate on
strengthening the stomach muscles.

Summary:

He answered all our questions satisfactorily.  We have met with him
twice altogether and I have met him an additional two times.  Both Viv
and I feel good about his skills and motivation to do a good job.