Hello all:

I am now in my fifth day of recovery following a laproscopic prostatechtomy.
All is going well, but first some info about how I got here.

My internist noted that my PSA was up to 5.0 from about 2 a few years
earlier while doing a routine health exam. This was in December, 2005. He
referred me to a urologist at the Kaiser Permanente Harbor City facility in
greater LA. This turned out to be a great choice.

My (and I now consider him My) urologist did a DRE and found the prostate
normal. So he prescribed a weeks medication of ciprofloxacin and a follow up
PSA to rule out prostate infection. The PSA was still about 5.0 so he
performed a biopsy. The biopsy was mildly uncomfortable but the feeling went
away a few hours latter.

He took 12 samples and a few days later, the pathology report showed 3
samples with cancer cells. I was at stage T1c and Gleason 6. I am 59 years
old. We discussed treatment options: prostatectomy and two forms of
radiation therapy- external beam radiation and brachytherapy (seeding). He
made an appointment for me to see a radiation oncologist to discuss these
options. For surgery he recommended the laproscopic variety. He does this
almost exclusively and does 3-4 per week. He has been in private practise
(or whatever a major HMO doctor is) for two years and I would guess has
performed 500 or more prostatectomies. He said that the only difficulty
could be my previous abdominal surgery which could cause him to abort the
laproscopic method and revert to open. More on this later.

I saw a radiation oncologist and she was not very helpful. She did not
recommend radiation treatment in my case, but had limited experience with
prostates (mostly ovarian and breast!!!). So I asked to be referred to
someone who routinely does brachytherapy for the prostate and ended up
seeing another radiation oncologist. Up until that point I was leaning to
brachytherapy. The second guy was a real pro. He does 4-5 prostate
brachytherapies a week. This is a significant point. If you are not getting
the info you need, keep asking. One benefit here is that I was working with
the biggest HMO in California and in the biggest population center and
someone on their staff had to be a pro in the field, you just have to keep
asking.

The second radiation oncologist generally did not recommend it, for all of
the reasons discussed here and in the literature: with surgery you get a
second chance at radiation therapy if the pathology report so indicates. And
it has the longest history and about equal side effects as other treatments.

So, I called my urologist back and scheduled surgery. The procedure was
performed last Friday and lasted 9 hours. I was the first patient in the OR
that day and the last one out. The problem was all of the scarring and
adhesions from my previous surgery. My urologist probably worked 2/3 of the
time just to open up his field of view/operation. But it was well worth it.

That night I slept in between BP taking, blood drawing and whatever else and
awoke fully at 8:00 AM then next morning. I only had one morphine injection
for pain and that was due to a gas bubble or something. Later that day, the
main souce of pain was the damn catheter. My urologist came by about noon
and I had already gotten out of bed and could walk as far as the damn
catheter would allow. So he discharged me with appropriate antibiotics and
pain medicine.

When I got home about 5:00 that day I felt reasonably well and slept pretty
well that night. I took one or two vicodan tablets for gas pain. The next
day I ran a little bit of fever (100 deg) and had a lot of trouble with gas.
Later that day after a world class bout of flatulence I felt much better. I
didn't sleep very well though- that damn catheter.

Today my urologist called with the pathology report- clear margins, so he
got it all!!!!! He also told me that he was able to preserve the erectile
nerves on both sides. So, that is as good as it gets at this stage. I will
go in again in about another week to have that damn catheter removed and
start the longer term recovery process- dealing with whatever incontinence
and impotence.

I feel fine and could go to work today if it weren't for that damn catheter
and the risk of tearing apart the uretheral sutures. That is the main
benefit if laparoscopy. I am at least 5 days better shape than when I had
conventional abdominal surgery 20 years ago.

I will post another report in about 3 months on the long term recovery
process. But it seems that I have licked the disease!!!!

David