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Victor O and Lauren live in Pennsylvania, USA. He was 57 when he was diagnosed in April, 2009. His initial PSA was 3.90 ng/ml, his Gleason Score was 6, and he was staged T1c. His choice of treatment was Surgery (Robotic Laparoscopic Prostatectomy). Here is his story.

As part of my annual physical exam, my doctor included the PSA test once I turned 50. Several years later, he told me that though the PSA was below 4, it showed an upward trend and was higher than he like to see in a man my age. He referred me to a urologist in the same hospital system, who started me on a twice yearly blood test regimen. The PSA score continued on its upward trend, so 18 months after I started seeing the urologist, he performed a biopsy. One sample out of the 12 came back positive with a Gleason of 6. My urologist reviewed my options and recommended surgery.

I reviewed my options and researched the surgeons in my area and sought a second opinion from Dr. David Lee at the University of Pennsylvania/Presbyterian Medical Center. Coincidentally, my accountant's husband as well as a very good friend had been treated by the same doctor within the past 6 months. Compared to most surgeons in my area, who have done about 150 of these surgeries, Dr. Lee is closing in on 2000 cases. I decided to go with the numbers and experience after meeting with him and deciding that in addition to is experience he seemed very personable and had a basic and abiding interest in his patients.

I had my surgery this past Wednesday, Sept 16, 2009 at 8:30 am. I was out of surgery by 11, and in my hospital room by 2. I was urged to walk by 6 in the evening, but the lingering nausea from the anaesthetic prevented me from going much further than the sink outside my room. Dry heaves with surgical incisions was actually the worst part of the entire procedure.

I was discharged the next day by 3 pm, and was encouraged by the surgeon to walk around a lot. I have been alternating between 2 hours of activity and some sort of rest, either on the couch or a nap back in bed. I have walked around the block, walked the dog, who is 14 and not much of a challenge. Last night I prepared a beef stew for dinner. Other than that, I have been bugging my wife to make me pots of tea or get me snacks, as my appetite has actually been quite good.

In any case, tomorrow will be 6 days since the surgery, and I have a 9 am appointment to have my catheter removed. I am rather hopeful, as I had an erection on waking up Sunday morning. It was rather uncomfortable and alarming, with the catheter still in, but I took it as a sign that the nerves are still functioning!

Later: I am now 10 days post op.

Six days after my operation, I returned to Dr. Lee's office to have my catheter removed. I was allowed to go home after I was able to urinate with a strong stream. I did not experience any leaking at that time, and have not since. My wife had bought Depends pads for adults, per the doctor's office's post op instructions, and I did use one on the way home to prevent any possible accidents. She also bought me a new pair of dark colored pants, since most of my wardrobe consists of khakis. In any case, the pad I wore to the doctor's office has been the only one that I have had to use.

I have continued to recover each day and have mostly resumed normal activities. I returned to my office last week, for a couple of hours each day, and I intend to return to at least 6 hours per day starting tomorrow.

UPDATED

October 2009

Five weeks post op with first check up visit with my surgeon under my belt. Not much to discuss with him, which he pointed out was a good thing. I seem to be ahead of schedule in my recovery, and my pathology report was very good. Cancer restricted to less than 2 %, with clear margins. Capsule, seminal vesicles and lymph nodes were all cancer free. Gleason was 3 + 4, so the cancer had advanced from a 3+3 at the initial biopsy. Next step is the 3 month blood test.

I seem to be healing well, with the urination feeling less intense. I have full control and no incidents of leaking since the catheter was removed. I have a pain on the right side of the abdomen that seems to be gas associated. The surgeon checked for a hernia and did not find one. With the bottom of the bladder pulled down to where the prostate used to be, I feel the urge to urinate when I have gas or when my lower intestine fills up. Also, the urine stream starts really fast when I do go. All minor adjustments that remind me that my prostate is gone.

I am on 1/2 tab Levitra that I take before going to bed, preferably 2 or more hours after a meal. Its supposed to help by allowing nocturnal erections to continue as before, though I sleep soundly enough not to be able to report any. I can get an erection, a little tender, but full size, though about 80% firmness, when I watch some porn. There is some really great free porn out there! I can also come, though it takes a little different type of stimulation and the feeling is also different. Just as intense, but missing that ejaculatory part. Anyway, the surgeon said the more I use it, the sooner it will come back. [There is a suggested regimen at Use It Or Lose It ]

UPDATED

January 2010

Four months post surgery, had my PSA tested and I am supposedly cancer free. Have not had any leaking at all since the catheter was removed 6 days post op. Erectile functions has mostly returned, (75%) usually requiring visual stimulation. Initially on 1/2 tablet of Levitra 20 mg. every other day for about a month. Refilled the prescription, and one morning woke up thinking I had the flu, flushed, chill, sweats, nausea, diarrhea, headache behind the eyes. Symptoms passed within a couple of hours. Suspected I had allergic reaction to ED meds. After discussion with PA at urologist office, switched to Cialis. Tested one tab, got much sicker than with Levitra, horizontal for 36 hours, which curiously is the life of the drug in the system. Sucks to be allergic to ED meds. In any case, with my ability to have partial erections at this stage of recovery bodes well for me, according to the surgeon. Sex, however, will never be the same, a lot of adjustments will have to be made.

In October developed a pain in belly on right side, seems to have developed a inguinal hernia [This is a common occurrence after surgery and may be more common with RALP (Robotic Assisted Laparoscopic Prostatectomy) according to some reports]. Had hernia operation a week ago, traditional open, not laparascopic. Evidently just having had the robotic surgery, was not a candidate. Recovery from the surgery is worse than the prostatectomy. Have mobility and can climb stairs, but certain movements are to be avoided due to severe pain at the incision site, such as sitting upright, getting out of bed, bending over to wash face. 4-6 weeks recovery period according to the surgeon.

Glad I selected the robotic surgery for my operation. All I can say is go with the numbers. My original urologist had done about 150 procedures, but according to other doctors I spoke with the learning curve with the DaVinci machine is steep, and 300-400 surgeries are really required to master the procedure. [This view has been borne out by studies confirming it.] The surgeon I eventually chose has done 2,000, and I have to say, I and three other friends who have gone to him have no complaints.

UPDATED

November 2010

Its been a year and a couple of months, and I've had the usual follow up visits with the surgeon, at 3 months, 6 months and a year. Currently continue to be cancer free, with very low PSA levels. Blood tests are now scheduled further apart, and the urologist visits are a year apart.

I had right side inguinal hernia repair surgery in January. It was highly likely that the inflation of the abdomen during the prostatectomy contributed to the occurrence of the hernia. Unfortunately, I did not select my hernia surgeon with the same due diligence that I did with the prostatectomy, and the hernia recurred about a month after the surgery. I was very disappointed, as the recovery from the hernia surgery was much more painful than the prostate surgery.

I put off the repeat of the hernia over the summer, as I was quite busy and active. During the wait, a hernia developed on my left side, so I had them both redone at the same time. Its 3 months post op, and I am not 100 % as far as the abdominal pain.

One year out, my condition as relating to the prostatectomy is good, and according to the surgeon, I am doing very well. I leak a very small amount after I urinate during the period of my hernia surgery recovery, but nothing that my tighty whities can't handle. According to the surgeon, sphincter muscles relax after urination, making control a little more difficult. I continue to do Kegels, my stream is quite strong. I have noticed that the urge to urinate is not as strong as it used to be for having a very full bladder. I am not as uncomfortable holding it is as I was pre-op, but I have not tested, nor intend to, how long I can hold it.

Sexually, the surgeon prescribed Levitra for the immediate post of period, to increase blood flow to the penis, half a tablet before bed time. After about 6 weeks, he gave me some samples of 36 hour Cialis, to which I had an fairly immediate allergic reaction. It felt like I had the flu, as well as digestive issues, that all lasted about 36 hours. Of all the medications to be allergic to...

In addition to the Levitra, the surgeon prescribed a penile erection vacuum pump with a constriction ring, which works really well. Nothing like the brute force of physics to command an instant 100% hard erection. I used this religiously twice per day as prescribed, to keep limber and the blood flowing, for about 6 months. I have tapered off, but still manage to get an erection daily by other means. I can maintain about 85% firmness, sufficient for penetrative intercourse.

I have noticed that sex has to be much more "directed", a combination of direct physical stimulation and mental stimulation. So our sex has been much more about me, if the goal is to get me off. Orgasms have not been as intense or as long lasting, but reasonably satisfactory. I went to the sex shop to get back up constrictor rings for my vacuum pump, and found they don't carry them. I had hoped to avoid paying $20 for a single silicone ring. Instead I came home with some various sized cock rings, and upon trying them out, they do make the orgasms more intense.

In conjunction with telling me that I am doing well, the surgeon told me that I will continue to improve and that it might still be getting better for 2 or 3 years. I guess that is positive news.

UPDATED

April 2012

Stopped seeing the urologist in the office. Get bi-yearly PSA's which continue to be 0, and communicate with the surgeon via e mail. His suggestions, and he has been responsive and communicative.

Continue to have ED in that erections are 80-85% of previously achievable. Enough for intercourse most of the time. I continue to use constriction ring 50% of the time., though over time it has become less effective. Physical and visual stimulus is more important than before. Have started to experiment with reduced doses of Levitra per the urologist's suggestion to find the level at which my allergic reactions do not bother me.

My digestion is not a good as it used to be, but I am unclear if that is the effect of the hernia surgeries or just changes due to advacing age.

UPDATED

May 2012

Victor is clearly feeling a deal better and, as he says, his sense of humour has returned and he has contributed a piece to the TROOP-C page: The Penis Poem

UPDATED

June 2013

I am guessing most guys are interested in the long term report on the two main issues, i.e. incontinence and erection. I am of the age, and the operation is sufficiently in the past, where the distinction between the operation and the normal process of aging is becoming blurrier.

On the urinary control front, I have not had any issues. I continue to practice Kegels when I am on the toilet, seems a good time to do them and easy to remember. Combined with the reading on the toilet, I could say I am triple tasking!

I will drip a little bit about 50% of the time after urinating. Mostly they occur when I first start moving around after standing at the toilet, so I have gotten in the habit of flexing my legs or doing a very shallow squat, that seems to get the last drops out. I don't have any trouble after that.

My bladder will fill up quite a bit without my having as strong an urge to urinate as I used to. In reality, it gives me less of a waiting period, but I have never tested the limit, and have never had an accident. I also sleep through the night without having to make a trip to the bathroom about 95% of the time.

On the erection front, I usually can now achieve a full erection, but generally at the beginning of sex. I go to about 85% after 5-10 min. I'll resort to the silicone ring later in the session, though the sensation if different, and slightly inferior in that you can feel that big ass rubber band around your cock. I've been woken up by morning wood that were as robust as the days of my youth, so I am thinking my waking libido is winding down. I've gotten this far in life without indulging in any fetishing, maybe its time indulge in some as my career winds down.

UPDATED

July 2014

Several years on and physical aftereffects seem minimal. Kegels seem to have conquered any signs of incontinence, though I never had real trouble with that. I stand an extra 30 sec. @ the toilet, change my stance, shift my weight from side to side a little. I used to drip a little when walking away from the toilet, but this tactic has basically stopped that.

Full erections are possible with physical and mental stimulus. Getting old and jaded? Need some little fetish or extra attractive (to me) female images to get erection without physical stimulus. The longer I go, the more stimulus needed to come. Porn + 5 min +done. An hour of foreplay and sex with partner will require a little dirty talk and a vigorous HJ to complete. Mentioned before, but I am allergic to Viagra and its ilk.

Robotic scars never fully went away. Post op double hernia repair holding up, but the one side showing signs that it might need to be redone, but hopefully that's years away. Cross my fingers.

All for now.

UPDATED

August 2015

I have stopped getting the PSA blood tests after several years of 0's. I will get it occasionally, I suppose, like one every 2 years or so. Urinary incontinence has not been a problem. There is occasional leaking, usually soon after I urinate and I do something physical, like bend over or lift something. These episodes I take as a sign that I am not keeping up with Kegels, and get back to doing them. I have found Kegels are good to do while I am sitting on the toilet, I am one of those bathroom readers, and do spend time there!

ED has not been a problem, though a cock ring has been helpful to get a fuller erection. At this point, I am not clear if my 90% erections without the ring are due to age, but the ring gets me to teenage levels! It does seem as if some nerve regeneration has occurred after 3+ years.

UPDATED

September 2016

Pretty much the same status as my previous update, keeping up with the Kegels. Sex life kinda returned to normal, if there is such a thing. Continue to use compression ring, which at this point is probably the only long term effect.

Victor's e-mail address is: mvoei AT verizon.net (replace "AT" with "@")


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