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As a surgeon I have to often times dissuade patients from choosing surgery. You think I’m kidding don’t you? Surgeons do it all the time. Radiation therapists also tell some patients that radiation may not be the best option for them. That I know is even harder to believe….just kidding. (It’s a surgeon-radiation therapist thing.)

Many patients and their family think that if you take the prostate out you are cured. When I speak of needing to follow the PSA every three months after a radical prostatectomy, I am often asked why that is necessary. PSA is variable in the diagnosis of prostate cancer, but very reliable in terms of determining if the cancer has returned after treatment.

A PSA should go to negligible, usually something like .02 and stay there. If a PSA rises then that might indicate recurrence.

How does this happen?

• For surgery it happens because there was…

This is a shadow box I made for a charity auction a couple of years ago. A clock made with Viagra stuff that drug reps had given me over the years. The guy that bought it, brought by for me to autograph it.  I called it …”Hard Times.” The plaque near the hammer says, “In hard times…break glass.” Ps…should have never sold it …it was too clever and valuable to sell.

• Does a prostatectomy change a man’s libido? No. Libido is in a male is a function of the hormone testosterone and that is produced by the testicles and hence not affected.
• My free PSA is low. Should I have a biopsy? Well, do put some credence to what your doctor recommended. Remember him or her? The lower the free PSA the higher the likelihood of a positive biopsy. When you get  the report back there will be a percentage beside…

When the prostate is removed the surgeon has to put the bladder back together with the urethra. A catheter is placed to “stent” this area of the anastomosis. The reason a catheter is used and left in from 6-14 days is to allow time for this area to heal. In doing so keeping urine from leaking out into the area where the prostate was removed.

So…you have the bladder sewed to the urethra and going through this is a catheter. The catheter, a foley catheter, has a balloon on it that keeps it from falling out. The balloon is just inside the bladder on the proximal side of the anastomosis.

There is a space around the catheter that allows both blood and urine to leak around the catheter, through the anastomosis, and then out the tip of the penis, not through the catheter, but around it.

In the case of…

Podbean thoughts on “sapping up” all you can from everyone before you make your “decision.”

and we named our children after towns we’d never been to….so proud of ourselves for using so many verbs and nouns….

2012-09-20 to Today

Recent comment/question on this blog

I recently had a PSA of 17 and so saw a urologist and he ordered antibiotics for a month and another test. Tested the same and so he performed a biopsy with the 12 small cores you mentioned. Biopsy came back negative for cancer. I should mention there have been no symptoms, no urination problems, nothing at all which I have read is very common.

My urologist has recommended another biopsy in 6 months. My thought is to have another PSA check in 6 months and if PSA is the same avoid the second biopsy until and if I ever see an increase from 17. What do you think? From What I have read the biopsy should be avoided unless necessary.

T.M.

This question comes up often and is troublesome for both the patient and the urologist. Here are some salient points to consider. Also…

Guitar Capo-Or as my mother used to say, ” Necessity is the mother of invention.”

When I was a urology resident I had to do a research paper on Fournier’s gangrene. I got somehow the original article on the subject by Mr. Fournier himself. It was in French and much to the chagrin of the chairman of the Dept. of Urology, it cost something like 500 dollars to translate it. Fournier’s is an interesting and devastating disease process. Two things are remarkable about it: one it can start as a small scratch on the scrotum and in hours infection can devour tissue from the scrotum and then up onto the abdominal tissue and skin (an infection that gallops) and despite all the destruction, the testicles themselves are spared. Why? The skin of the scrotum and that of the testicles are different so the testicles are unaffected. Think of a forest…