Living Well

February 3, 2010

Prostate Cancer: My Experience with a Prostatectomy

A prostatectomy was my decision for curing my prostate cancer.  At 53 when diagnosed, this was the best option for me.  I went into this surgery well informed concerning all the positives and negatives of this radical surgical procedure.  My goal for it was the cure of my cancer and the opportunity to live well in the aftermath of this diagnosis.

During the consultation with my urologist, he explained the procedure very well and in detail, which included many drawings.  Right at the top of the page was a list of risk factors which he wrote in doctor-prescription type penmanship.  The risk factors of this surgery are: bleeding during surgery, infection following surgery, incontinence, impotence, anesthesia related risks (including death), damage to adjacent nerves and structures, a pathology report during the surgery that shows the cancer has spread to the bladder or other tissue surrounding the prostate.  While most of these are rare, it is important to know that these things still happen in the best of situations.

At this point, we began discussing the surgical procedure, whether it would be done by the surgeon actually cutting me open or through a mechanical process called Di Vinci.  The Di Vinci is very successful and is widely used.  There are pros and cons to it.  Since I did not choose this method, it is important to have a detailed conversation with your doctor about it.  I chose being cut open by my surgeon for one reason:  he had trained to do this procedure in this manner and had performed over 600 surgeries like this.  I had confidence in him to actually use the scalpel as trained as well as having honed this skill over many years.  Additionally, this visual procedure allows the surgeon to see all of me at once, not only areas of me through a monitor, as with the Di Vinci process. 

As a side there is one item to ask your surgeon.  How many of these procedures have they performed?  This is very important because of the male anatomy in the groin area.  This surgical procedure, whether Di Vinci or manually, has potential to cut a number of nerves.  Nerves will be cut related to the prostate which effect the eventual potency issues faced in the future.  The surgeon is really trying to perform “nerve sparing” procedures, that is cutting as few of these nerves as possible.  Also, nerves that operate your bladder and also operate your legs run through this area of your groin.  One of the first orders of business is for the surgeon to locate and protect the nerves that go into your legs.  If this is not done properly, any disturbance or nick of them will cause you problems in walking.  I share all of this so that you see why you should ask the surgeon or listen for how many of these surgeries they have performed.  If your urologist has not performed at least 100 of these surgeries, ask for a second opinion or locate a surgeon who has a successful record with this procedure.  Remember YOU are responsible for your own health care and YOU have the right to get the best care, particularly with a procedure that will affect you for the rest of your life.  

Your surgeon will be removing your prostate and seminal vesicles during this procedure.  These two glands attach to your urethra (the tube that takes urine from your bladder down your penis to be expelled).  This “component” will be removed in one piece.  It is attached by nerves that come into play during sexual activity and give you the ability to have an erection.  This is where the surgeon will use nerve sparing procedures—attempting not to damage the nerves that will give you the ability to have an erection in the future.  This prostate/ seminal vesicle component is also attached to the vas deferens, which is how sperm get from your testicles.  These tubes will also be detached.  Finally, because this component is connected to your urethra, this tube going to your bladder will be cut on each side where the semen enters your urethra during sexual activity, the component removed, and your urethra sown back together again.  This part of the process will require that you have a catheter during the first 12 days or so after surgery.  This is because this internal stitching and section must heal.  The catheter will help keep the urethra open during the healing process.  You will wear this catheter home; it will likely be removed by your surgeon at your first follow up visit (but your surgeon will explain all of this as well as the maintenance of this catheter).

Following the surgery is the time of healing.  The healing process for me went like this: surgery was about 2 or so hours, I spent 3 days in the hospital, 12 days at home recovering with the catheter, office visit to remove the catheter (I used men’s urine pads after this for a while because there may still be some leaking as the bladder heals and becomes stronger), 2 weeks without driving (in that same period as the catheter), 2 weeks of lifting nothing more than a milk jug, 2 weeks more of nothing over 20 pounds, after 4 weeks as advised by your surgeon.

The first 10 or so days at home were difficult.  Because of the incision running from just under my navel to about the middle of my pubic bone, I could not get around very well.  I spent a good deal of time lying in bed.  The catheter also kept me from getting around much.  But, after the first week, I did find that just walking around in my house began giving me the stamina I needed to get stronger.  After the catheter was out (as well as the staples holding the incision together), I began walking outside (it was April of the year).  I walked a little every day and increased it over the weeks of my recovery until I was finally walking five miles every day.  I would highly recommend walking as a way to increase your stamina and energy during this time of recovery.

It was during this point that the waiting begins.  The honest surgeon will tell you that it will take roughly one year to 18 months to heal fully from this surgery.  It is during this time that one has to be patient with the issues of incontinence and impotency.   Here is where your confidence and communication with your surgeon are critical.  Constantly talk about each; be honest with how your body is responding during this time of healing.  It is no time to be macho in this healing process.  Playing that form of pride may hinder your complete recovery or not allow you to take appropriate steps if other medical measures are needed.

For me, this time of recovery was filled with prayer, reading, reflection on life, listening to music that gave me strength, being with family, relying on family, and considering the good that could come out of this moment in my life.  Prostate cancer IS a life long journey.  This time of recovery can give you the opportunity to consider it, plan for it, and focus on living well in the midst of your journey.

Blessings, grace and peace.

David Neidert

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