August 29, 2017
I’ll pursue these after I’m better, but these are initial thoughts:
- While it would increase red tape, there should be ongoing regular monitoring of the progress of continence and erectile function for each such surgery. “The NHS – who make surgeons report their success rates these days – regard success after RP as using 1 pad or less per day by 12 months post-op.” – Source]
2. Patients should get a copy of the robotic prostate surgery video.
Doctors do get a copy of their surgery video record:
“I asked my doctor if he understands why some people have more severe incontinence problems and he said there is some correlation with age and fitness but that he’s reviewed the videos and records from his past surgeries and tried to correlate them with the outcomes but he still doesn’t understand the variations in outcome.” [Source].
This does imply, though, that the video might not do any good to an untrained patient. If even experts can’t use videos to predict continence outcomes then giving the videos to the patients may not help.
A full-fledged cost-benefit test should be applied in each case before any change is made to existing policy.
August 29, 2017
This is a list to provide me with some sense of context:
Mayor Rudy Giuliani
Robert De Niro
August 28, 2017
MY PSA RESULT POST-SURGERY
Some notes here. The following video is useful:
August 28, 2017
The pre-surgery biopsy is available here. Post surgery biopsy below.
MAIN POINT TO NOTE: I have a small positive surgical margin [“To the naked eye, it can look as if all of the cancer has been removed, but when a pathologist examines tissue samples, cancer cells may be lurking right along the edge of the cut tissue. This means that some cancer cells may have been left behind, in what doctors and pathologists term a positive surgical margin.” –Source]
HOWEVER, it is in the para-apical area, which seems to suggest it is less like to cause a problem. [“Positive margins are more common at the apex, where there’s much less surrounding tissue, but they can occur in other areas, such as the bladder neck. A positive margin at the bladder neck probably has the highest likelihood of leading to biochemical recurrence…. The researchers found that patients with a positive margin at the bladder neck were three times more likely to have biochemical recurrence than patients with negative margins. Positive margins at the apex or laterally were equivalent in terms of recurrence, with patients twice as likely to experience biochemical recurrence as those with negative margins.” [Source] But also see this blog post.
FURTHER, it is the lowest category, i.e. Gleasen pattern 3. Obviously, if that area had Gleasen 4 pattern, the risk would be higher.
INITIAL VIEW: Regular PSA testing is essential in my case.
CLINICAL NOTES: HISTOPATHOLOGY
G1 3+4=7 PCA. Radical prostate.
1) “Prostate gland” – A prostate gland with attached seminal vesicles and vasa deferentia, 35mm apex to base, 45mm right to left lateral and 43mm anterior to posterior. Prostate weight without attached seminal vesicles and vasa deferentia is 39.7g. The attached right seminal vesicle is 25mm and the right attached vas deferens is up to 10mm. A possible detached left vas deferens is 25mm in length and a short stump of seminal vesicle is 5mm in maximum dimension. Specimen serially sliced from base to apex into 9 slices, with slice 1 being the base and slice 9 the apex. Within all slices are multilobulated circumscribed creamy nodules, predominantly in the anterior right and left lateral quadrants which appear to be closely abutting the anterior margin. Inking: anterior yellow, posterior black, left lateral green and false resection margin post seminal vesicle and vasa deferentia resection orange. RS, part processed. 36 blocks.
1A-1G – LS base slice 1:
1A-4, 1B-2, 1C-2, 1D-1, 1E-1, 1F-2, 1G-3LS
1H-1K – composite slice 2:
1H-1 left posterior slice, 1I-1 left anterior slice, 1J-1 right anterior slice, 1K-1 right posterior slice.
1L-1Q – composite slice 4:
1L-1 left posterior slice, 1M-1 left middle slice, 1N-1 left anterior slice, 10-1 right anterior slice, 1P-1 right middle slice, 1Q-1 right posterior slice.
1R-1W – composite slice 5:
1R-1 left posterior slice, 1S-1 left middle slice, 1T-1 left anterior slice, 1U-1 right anterior slice, 1V-1 right middle slice, 1W-1 right posterior slice.
1X-1AA – composite slice 6:
1X-1 left posterior slice, 1Y-1 left anterior slice, 1Z-1 right anterior slice, lAA-1 right posterior slice.
1AB-1AE – composite slice 7:
1AB-1 left posterior slice, lAC-1 left anterior slice, 1AD-1 right anterior slice, 1AE-1 right posterior slice.
1AF-1AG – composite slice 8:
1AF-1 left lateral half, 1AG-1 right lateral half, 1AH-1AJ-LS slice 9 apex.
lAH-3, lAI-2, lAJ-4LS.
1AK-1 – shave of right seminal vesicle and vas deferens
1AL-1 – shave of left seminal vesicle and vas deferens.
2) “Anterior prostate fat” – Multiple pieces of fatty tissue in aggregate 30 x 25 x 5mm. All in. 2 blocks. kp
1-2) The sections from this extensively sampled radical prostatectomy confirm acinar adenocarcinoma, predominantly characterised by separate well-formed infiltrative glands, with a minute component (<5%) represented by poorly-formed glands with ill-defined lumina, evoking modified Gleason score 3+4=7. Tumour is centred in the right anterior quadrant, and extends into both sides of the organ from apex to base in a patchy infiltrative pattern (estimated span 30mm). Tumour reveals no extraprostatic extension and there is no invasion of sampled seminal vesicles. The bladder neck shows unremarkable smooth muscle, and lymphovascular invasion is not identified. The tumour involves one anterior surgical margin over 1 mm span (Gleason pattern 3 disease, block 1AD), and 2 separately sampled lymph nodes within the preprostatic fat are free of tumour (specimen 2, 0/2). Background prostatic parenchyma exhibits nodular hyperplasia.
SYNOPTIC REPORT FOR PROSTATE CANCER
1-2) RADICAL PROSTATECTOMY (39.7g) AND PRE-PROSTATIC FAT
– ACINAR ADENOCARCINOMA,
– GLEASON SCORE 3+4=7 (ISUP GRADE GROUP 2),
– TUMOUR LOCATION: CENTRED IN RIGHT ANTERIOR QUADRANT,
– MAXIMUM SIZE OF DOMINANT NODULE: 30mm,
– OTHER TUMOUR NODULES >10MM: ABSENT,
– EXTRA-PROSTATIC EXTENSION: ABSENT,
– MARGIN STATUS: INVOLVED,
-> LOCATION: ANTERIOR, PARA-APICAL,
-> EXTENT OF INVOLVED MARGIN: 1mm,
-> TYPE OF INVOLVED MARGIN: SURGICAL,
-> GLEASON PATTERN AT MARGIN: PATTERN 3,
– SEMINAL VESICLES: NOT INVOLVED,
– BLADDER NECK: NOT INVOLVED,
– LYMPH NODE STATUS: IDENTIFIED IN ANTERIOR PROSTATIC FAT, NOT INVOLVED (0/2),
– AJCC TUMOUR STAGE (8TH EDITION, 2017): pT2 NO.
August 28, 2017
Most men wear diapers and just wait for several months until their bladder control returns, but current medical research tells us that an exercise program targeting the pelvic floor muscle below the bladder can help these men regain their control earlier,” said Daniel Kirages. [Source]
Kirages is an associate professor at USC.