Please add in the comment section something you did not know and now you do, maybe something you wished you’d known at the beginning of your “decision” process.
For me in this category would be this….. the robotic removal of the prostate is usually done intraperitoneal and the open method is extraperitoneal. This means that the anastomosis is done differently and many times means that the robotic method takes longer for the continence to return. This is purely anecdotal, but the patients in whom I have removed the prostate open seem to return to continence much sooner. I personally did alright but was surpised and a bit worried that it took three months for me to become dry. I am very grateful to be dry, very but it was dicey there for a while.
Excerpt from ” The Decision”
Did you know?
- · You have a higher incidence of bladder or rectal cancer after having received radiation.
- · Frank Zappa, Bill Bixby, and Dan Fogelberg died in their fifties from prostate cancer, all within three years of diagnosis.
- · One in six men will be diagnosed with prostate cancer at some point in his lifetime.
- · Prostate cancer is the most common cancer in men.
- · The reason the urologist will monitor the PSA after treatment with either form of therapy is that a PSA elevation over time is an indicator of recurrence of disease.
- · The PSA is sometimes unreliable in the diagnosis of prostate cancer, but it is an excellent marker in determining the recurrence of prostate cancer after treatment.
- · Prostate cancer is hereditary, so if your father has it, you need to be checked earlier and more often.
- · Annually, 40,000 women die of breast cancer; 25,000 men die of prostate cancer. Government funding for breast cancer is twice that for prostate cancer.
- · Prostate cancer is more common in African Americans and has a higher incidence of being more aggressive.
- · The ribbon for breast cancer is pink; the ribbon for prostate cancer is blue.
- · September is prostate cancer awareness month and designated as such in 2003 by President George Bush.
- · October is breast cancer awareness month and designated as such in 1985.
- · After the child bearing years the prostate has no other function than contributing to the fluid expressed at ejaculation.
- · When a man has a vasectomy or a prostatectomy his sex drive or libido, which is dependent on the male hormone testosterone, does not change. Testosterone is produced by the testicles and released into the blood stream and subsequently not affected, or its blood level diminished, by either procedure.
One of the oldest Urology jokes around involves a man coming to the Urology clinic for a vasectomy all dressed up in a tuxedo. When asked,” Why the formal attire?” he responds,” If I am going to be impotent, I’m going to look impotent.” The problem with this joke, as explained in the bullet above, is that a vasectomy makes you sterile (no sperm), it has no affect on potency. Potency refers to erectile function which is independent of fertility (which is what a vasectomy affects). I mention this because it is misconceptions like these which abound within the male population, and contribute to the “perfect storm” of delayed diagnosis alluded to earlier in this book. It is still a cute joke however.
- · The external sphincter, which is anatomically below the prostate, is not disturbed by the prostate’s removal. The contraction of this muscle contributes to the feeling of climax and is usually not affected by a prostatectomy.
At a three month follow up visit, with a patient in whom I had removed his prostate, I asked if he had had sexual activity. He indicated that everything was working well but that his wife would no longer have sex with him. “When I climax now doc, I start to shuttering all over so bad that it scares my wife. She won’t have sex with me now, she’s afraid I’m going to hurt something.”
- · After a prostatectomy the male and female anatomy, from a urinary standpoint, becomes very similar, except for the length of the urethra.
- · The normal prostate is the size of a walnut, but can increase with age to the size of a lemon or sometimes larger.
- · Men are often told they have an “enlarged prostate” after a rectal exam by their primary care physician. What is felt on exam does not give an indication of the prostate’s anatomy as it pertains to the prostatic urethra. This is why a small prostate can produce significant obstructive voiding symptoms and a palpably enlarged prostate can cause no voiding symptoms.
- · You can have prostate cancer without any voiding symptoms. You can have significant voiding symptoms and not have prostate cancer.
- · You can have a very small prostate and have cancer or a very large one without prostate cancer.
- You can have an elevated PSA and not have prostate cancer. You can have a normal PSA and have prostate cancer.
- · You can have a normal rectal exam and have prostate cancer. You can have an abnormal rectal exam and not have cancer.
- You can have the free portion of the PSA be very high, indicating a less than 5 percent chance of having prostate cancer, and a biopsy report subsequently showing every one of the twelve cores containing cancer.
- I perform several hundred biopsies a year and in approximately 15 percent of the men tested the biopsy reveals prostate cancer. Nationally the positive biopsy rate is probably somewhere between 15 and 20 percent.
- The most common reason for a prostate biopsy being done is for an elevated PSA.
- · There are no hard and fast rules short of a prostate biopsy in determining if a man has prostate cancer. The pre-diagnosis variables are all over the board. (As residents) we used the term “mental masturbation” to describe when the options regarding a diagnosis or treatment were overly “cogititated” to the point of inaction (similar to a general who is indecisive to a fault). When there are any concerns that a man might have prostate cancer, in my opinion it is best to do the biopsy and put the issue to rest; it takes about 10 minutes to do, can be done in the office, and has a low risk profile.
- · A rectal exam does not cause the PSA to be elevated.
- · Having sexual intercourse the night before the PSA is drawn does raise the PSA.
In completing a medical questionnaire, a doctor asks an elderly lady,” Do you and your husband have intercourse?” The lady goes to the waiting room door and yells in front of all the waiting patients and asks, “Honey do we have intercourse?” The husband, obviously perturbed by the question, says, “How many times do I have to tell you? We have Blue Cross Blue Shield!”
- · If you have voiding symptoms because of prostate cancer, it is most likely in an advanced stage.
- · The prostate, on rectal exam, feels like the thenar eminence, the muscular area on the palm of the hand below the thumb, when the fist is clinched.
- · Prostate cancer is the single most common form of solid tumor in humans.
- · Prostate cancer is second only to lung cancer in annual cancer deaths of U.S. men.
- · I would rather have my prostate removed by a skilled open surgeon than an unskilled robotic surgeon, and vice versa.
- It is not uncommon for men whose prostate has been removed to have the loss of urine at the time of climax. This usually occurs if the bladder is relatively full and improves as the external sphincter matures in its new and heightened role in preventing incontinence.
- Urine is sterile.
- Surgeons are more afraid of veins than arteries. The anatomic variation of the veins surrounding the prostate can be a major cause of blood loss during a radical prostatectomy. Arteries are seldom an issue.
It invariably happens that after performing a rectal exam, a patient will ask, “So, tell me doc, what made you decide to go into this field?” What they are really asking is, “Why in the world would someone voluntarily choose to do this type of work everyday? All those years of study just to be a prostate doctor doing rectal exams on men all day?” The reason I went into urology is because it is one of the few surgical specialties that has limited exposure to emergencies after hours. Around the time that I had to declare what type of doctor I wanted to be, we had our first son Clay, and I hated spending nights away at the hospital. Someone told me that the urology program’s residents took call from home, something none of the other surgical programs allowed. When I learned this, I immediately inquired, “Where do I sign up?”
When I called my mother to tell her I had decided to be a urologist, she exclaimed incredulously,” Ye Gods John! Do you know what they do?”