Retzius-Sparing Laparoscopic Radical Prostatectomy

John

Sounds like an improvement on the conventional DaVinci and a bonus not having a urethral Catheter. 

 “I hope you won’t be using my measuring jugs”. I did point out that urine is sterile and promised to put them through a dishwasher hot wash before putting them back in the kitchen cupboard."

As a member did point out to me a few years ago on the subject of measuring jugs " the Yorkshire puddings never tasted the same afterwards"

Take it easy but not too easy.

Thanks Chris

Edited by member 15 Jun 2018 at 20:34  | Reason: Missing word

Interesting and well written account.  I read your profile.  Good of the surgeon to take you from private to NHS, that once happened to me with a skin cancer but some seem to have problems transferring.   

You were very persistent and tolerant of your condition to wait for the treatment.   I couldn't have done it, if the Barber of Seville had been offered the day after I'd have been in. 

All the best.

Peter

On day 15, I have to report two minor setbacks.

The first is that of the seven keyhole perforations, one has become a problem. When the nurse removed the catheter on day 10, she said all the wounds were healing fine. I enquired about the sutures, and was told: “They’ll dissolve”.

The next day my skin was being pinched where on one keyhole they hadn’t dissolved, and I had to have them removed by the GP nurse two days later. That wound is still sore and slightly weeping. A friend told me “my stitches never dissolve and I always have to have them removed manually”. Perhaps I am the same, due to my dry sense of humour!

The second is that whilst I am completely dry and continent during the day, I have had some leakage at night into the smallest Tena pad, although this morning it was completely dry. Early days I suppose, and apart from the oedema and scabbing on my abdomen, I feel absolutely fine.

P.S. John Thomas is still in hibernation, possibly in mourning for his bosom buddy Tommy the Tumour. Maybe I can tempt him out to play come the summer.

Edited by member 18 Jun 2018 at 16:07  | Reason: Not specified

New technique or not Bollinge, your inners have been through a trauma and will need lots of time to recover

sounds good so far tho

I am going to be a big brave boy and ditch the pads today. I only bought a box of 14 Tena extra light pads and have three left. Keyhole scars very itchy though.

I think I may be party to a miracle, and it will truly be a miracle if the Big C doesn’t come back.

Cheers, John.

Although I only bled for two days after the op into the catheter, over the last week I have been intermittently been peeing red and brown blood with an occasional clot. The nurse says this is normal and is the result of internal stitches dissolving.

I am on my last day of antibiotics for the infected keyhole wound, and I had to go to the nurse again yesterday as two more very fine stitches were poking out of it and they were irritating me. In total, I have had to have nine “dissolvable” stitches removed because they didn’t dissolve!

If the Professor is doing your procedure, rest assured you are in the very capable robotic hands of one of the finest surgeons in Europe.

Four weeks on I am absolutely fine, although I have been signed off for five more weeks.

Best of luck!

Cheers, John

Edited by member 05 Jul 2018 at 10:47  | Reason: Not specified

Exact same hospital and Professor 

I have had to wring the information out of the hospital, as I caught the prostate nurse answering her phone and not on Answerphone (showing my age!). She had been avoiding replying to my emails, as has the Urology department in general. The Professor is still away.

I wonder what the big deal was, I had cancer, thought it had gone, now there’s some left. What’s new? So why the reticence to keep me informed?

Researching salvage treatments right now, but as PSA is undetectable and as I am as well as before the op, it may be some time before I rush into anything else.

Keep calm and carry on!

Cheers, John

Ian

Sorry your news wasn't  better. We still keep thinking about the what  ifs.. Although my husband did have regular PSA Tests because of BPH we still keep wondering whether he should have been referred sooner. No one knows when the cancer first develops. Maybe he would have been 3+3, maybe he would have had his nerves spared, maybe his continence would have been better etc etc.

We've accepted the fact we are where we are and cannot turn the clock back. I expect  lots of men and their partners feel the same.

We are still hopeful for a good outcome  and there seems nothing to indicate you cannot have one albeit perhaps after more treatment.

Best wishes for your forthcoming appointment with the prof and let us know how you get on.

Ann

He told me whilst my PSA is undetectable, they would not entertain an oncology consultation ‘as we don’t want to fill you with chemicals and radiation and make you more ill than you are now. And anyway you may be cured’.

I thought that rather encouraging. And I am not ill.....except I have cancer. Next PSA in ten days 🤞

Cheers, John

What is so difficult to understand? Someone could only get a 0.001 result if the machine at their lab actually measures down to that level. If the machine only goes to 0.03 or 0.05 posts like your will make people panic that they are detectable.

0.05 is only detectable if it has come from a machine that measures lower so a result of 0.05 does not mean a waiting game of any sort.

(You knew I would respond this way and I did not fail you.)

Bollinge, I think that is a tish response from the nurse specialist. Important to see what the surgeon actually says at your appointment about the pathology but with lymph involvement I think you should insist on an oncology referral if it is not volunteered.

Edited by member 28 Jul 2018 at 11:19  | Reason: Not specified

AC

The retrospective study in the link is already 4 years old and was looking at the PSA scores of men that had the operation between 1993 and 2008. I think science has moved on since 2014 and interestingly, their conclusion seemed to be the opposite of what you are saying? In their report, men with detectable but stable PSA did just as well as those who stayed undetectable. Whether that is <0.1, <0.03 or <0.001 seems irrelevant to their findings. The researchers concluded that it was the unstable PSA with two succesive rises and / or a velocity of 0.05 or more that indicated risk which is not so far from the NICE threshold of 0.2 or three successive rises >0.1 since two successive rises of 0.05 brings the man over the 0.1 point anyway. 

That was what happened in J’s case, as it happens. The post-op PSA was something like 0.04 and dropped to 0.033 before rising to 0.068 and then 0.086 and 0.16 I think. Having the usPSA didn’t make any difference to the timing of the salvage RT; if he had been getting the results to 1dp he still would have been referred at the point when it reached 0.16 :-/

I guess usPSA is useful for men who like the extra worry; but it must be acknowledged that machine noise / tolerance range means that tiny fluctuations are not a cause for panic. It is the trend over a year or more that matters.

Edited by member 29 Jul 2018 at 01:21  | Reason: Not specified

MODERATORS - Something weird is going on. Part of Bollinge’s post has disappeared (his results of <0.1 and the biochemist and GP‘s explanations were there and now they are gone) and the middle section of my most recent post disappeared after posting. Gremlins? 

Where can I get UPSA blood tests done round here (Coventry/Brum)?

Cheers, John

Keep mentioning it - it is an interesting discussion - but it would be better if you could be factual rather than evangelical. The point is that the science is now clearly demonstrating that it is unreliable so some men have been caused undue distress and may have had unnecessary salvage or adjuvant treatment based on flawed results. It isn't the case that some hospitals are behind the times and not providing usPSA; in fact, what we are seeing is cancer centres of excellence withdrawing from usPSA testing. What concerns me more is that people read comments on sites like this, believe that their 0.05 result is a cause for concern rather than celebration and then become angry / frustrated when their urologist / oncologist explains they are undetectable and do not need further intervention. 

It is the same with LRP - there was a ground-swell of opinion that it was somehow going to be the gold standard for prostatectomy. Data has now shown that the outcomes are slightly worse than with open RP but slightly cheaper for the hospitals that already have the machinery in place and have already invested large sums of money in ensuring surgeons are trained to use it. The data is clear enough that hospitals who do not have the Da Vinci will not be investing in it in the future but still we have the evangelists who wish to ignore the facts and continue to tell everyone that LRP is 'best'. It isn't ... it is just more cost effective for the NHS and convenient for men who don't like the idea of being in hospital for a few extra days.

Selecting lab equipment can't be that straightforward.  There are people such as Ulsterman who had early treatment after a sensitive PSA test.  Those hospitals buying equipment that only measures to 0.1 would be less capable of helping him.  Also you don't know what new thinking might emerge so you'd think hospitals would play safe and buy equipment that measures a lot lower, although I'd think it costs a lot more.  I'm happy with the 0.05 at Preston and was initially happy with 0.06 at Blackpool.  I was told by one doctor that testing to lower is better.

I've read things about velocity and time of first rise and to me they're reasons to want a lower PSA reading. Although I guess it would be possible to put up with not knowing as nothing will be done for most cases, and might actually be better not to know.  So I'm not full on with this but haven't been convinced 0.1 is good enough.

On LRP, I was offered Robotic and wanted it but it was at a more distant hospital, Blackburn, and thought the possible difference in outcome was insufficient.   The thought of being in hospital an extra 6 days for an open operation is very unattractive and there is more risk, especially to older men.  I was up and ready to go the day after the op and found it a total nightmare being in hospital for the 24hrs I was feeling alright.