Prostate Surgery (prostatectomy report)

(I can't imagine that this will be of much interest unless you are planning to have prostate cancer surgery and you are wondering what to expect) Your experience may be different.

Eight years ago, at age 50, I had my first test for the Prostate Specific Antigen as is recommended. The score was within the standard range at 1.36. Four years later, the score had gone out of the standard range and my primary care physician suggested more investigation. They did a biopsy, which is a little more discomfort than they’d like you to think putting a tube up your anus and shooting needles into your prostate for core samples. It confirmed that there was some cancer and I was given some options: I could have surgery to remove the prostate, they could plant some radioactive seeds in there to effectively kill it in place, or I could “watchfully wait”. Nothing was urgent. Prostate cancer grows so slowly that for some older men it isn’t even treated, because it’s likely that they’ll die of something else before the prostate cancer becomes an issue. But, it does grow faster in younger men.

I scheduled surgery because a younger person handles it better, but then I cancelled it and decided to wait; I started eating a plant-based diet and upped my running.  I was kind of impressed that the next two test four months apart were back down into the standard range. They told me that dips could occur but that the trajectory would continue upward. I became less particular about what I ate and the numbers did start to go up, but I continued to “watchfully wait”.

I went about living my life and never really thought about it much, but I would sometimes wake up in the night in a panic, or mildly worried other times. Either way, you could say I was losing sleep over it, even though I believed that I wasn’t truly worried. The website for my healthcare provider allows me to graph test results over time. The PSA graph was starting to get steeper. There were occasional minor plunges, but by the summer of 2016 the general upward trend had continued and it was up to 8.73. One doctor had mentioned that some people test in the 100’s. I didn’t ask if they were living their last days, but the graph was looking steep on the right end. I opted for another biopsy and they took even more core samples and more of them were positive for cancer, so I decided to schedule for January, 2017. That was three weeks ago.

On the morning of surgery, I was out from 7:30 am until 10:30 am, but felt ok when I came to. I remember the surgeon saying people feel like they’ve been run over by a truck, a friend told me of a friend who needed lots of care the first few days of recovery, and a coworker who said her usually tough father cursed in pain at every bump in the road on the way home. This was not my experience. The surgeon was happy to note that as surgeries go, mine was boring, and that was a good thing. I expected pain, but didn’t even feel much, although my abdomen felt like I had done a few too many sit ups. I thought I’d be groggy from the anesthesia, but I did a couple of reasonable challenging crossword puzzles a few hours out of surgery, pointed out the multiple errors in Spanish language signage in my room, chatted with family, and ate a big turkey and gravy dinner. My daughter hung out that evening and we had a lengthy discussion about all kinds of unusual topics.

I’d never had a catheter before. It would be in place for ten days to allow for the urethra to heal around it where it was sewn back together. I thought it would be a huge annoyance, but I rather appreciated being able stay very hydrated and not think about having to head off to the bathroom. I walked just shy of 20 miles over those ten days. There were some occasional issues with what I would call back pressure and urine would not flow into the tube, but rather seep out around it. By the tenth morning I was ready to pull it out. I had the option of having a nurse remove it or do it myself. I’m a DIY kind of person and since I’d been dealing with it for ten days, I felt I should do the honors.

The remaining challenge is continence. I had done some Kegel exercised before the operation, but mostly just to be sure I knew what I was doing. I’ve been doing them more regularly now and I think I am making improvement, but there are times I wonder. I seem to do well lying down. I can maintain control for the most part and make it to the bathroom to pee like I haven’t since I can remember. It is a challenge to hold anything in walking around, and I realized rather early on that I was going to need something to absorb leaks because even just standing I continued to leak. I’m a runner and I decided to give it a try two weeks after surgery. I jogged 2 miles. I didn’t bother with any kind of pad; most of the leakage seemed to be absorbed by the lining of my sweats. The next day I jogged three miles and felt quite good. A cold that had been working its way through the family hit me the next day. Fortunately, it was mild and I took it easy for the next four days. Yesterday I ran jogged a couple more miles and today I added a little over three. I have not been able to hold it while running and running with a big soggy pad between my legs with all the other standard equipment is just too much, so I just let it flow. I've done a lot of laundry these past three weeks.

Tomorrow, I start back to work. The most I’ve been on my feet is about an hour at a time. I feel like I’ve been busy, but I admit I have been content to rest and relax for long stretches. I teach high school and I go non-stop for about six and a half hours. I hope a can get out to the restroom when I need to, to swap out some soggy gear before it works its way through to my clothes. I usually drink lots of water while working, but I think I’ll keep hydration to a minimum and assess at the end of the day if adjustments are necessary. Supposedly, 95% of men with this surgery gain their control back within 18 months. I am optimistic that it will be weeks, and very few, at that.

After two days of work, I can report that my energy level has been fine. I seem to still just leak throughout the day and have to make sure to get to the restroom every couple of hours. I've grown accustomed to swapping out Depend pads and I'm optimistic that this will not be necessary soon.