Report of my first trip to the urologist

I sent this post to my family and friends on October 24, 2007.

Well, Mary and I just got back from a 75-minute meeting with the urologist, who is, it turns out, the head of urology in his Mayo-branch hospital. He clearly led us through the explanation of the anatomy involved, the data and how it is analyzed and its implications, and the possible therapies.

I will skip the anatomy except to say that I now have a pretty good idea of where it is in my body.

As for the data, the upshot is that the cancer is in early stages and is at this point mildly aggressive (or low). The significant numbers, should you choose to look into this more deeply, are that the Gleason number is 3+3=6 and the aggressivity is TiC, both of which translate into the conclusions I already gave. The likelihood that the cancer has spread out of the prostate is near zero. The cancer itself occupies less than 5% of the gland, and is located on the back left side.

The therapies, two of which have a 90% cure and one of which has a 0% cure rate, are radiation, surgery, and surveillance. Surveillance, which means ‘do nothing,’ has a ‘nothing happens’ time line of about 10 years, followed by a ‘lots of problems’ time of 5 years and then you die. I believe that the technology they assign to you if you choose this method is a bucket.

The other two have nearly identical recovery times (6-8 weeks), cure rates of 90%, and varying complications. The first, radiation, is easy at the beginning and then hard at the end (10 minutes a day, 5 days a week, in EauClaire for 6 weeks). The second, surgery, is the reverse--a 2-day hospital stay and 6-8 weeks of recovery, hard at first and then easier. With surgery they also check to make sure the cancer has not spread to the surrounding lymph nodes. The incision is just below the belly button. If one has surgery one can have radiation if there is a recurrence (though how that would be prostate cancer is beyond me). If there is radiation, surgery is possible though very difficult, requiring a highly specialized surgeon (we are talking Mayo).

We also discussed ‘male things.’ And since all I knew was vague jokes about it, I will report that detail too. If you want to skip this paragraph, I won’t be offended. After therapy erections are almost always possible (and if not, I will finally be able to take advantage of the daily Viagra ads I receive), however, ejaculations are not because the prostate is what supplies all the fluid that emerges during that pleasant experience (well, or so I remember from the 4 times I ‘did it.’) Orgasms, so he said, are possible.

As with any therapy there are possible complications. The most common seem to be possible (oh goody) lack of bladder ‘constriction control,’ rectal pain, and possible urinary obstruction (though of course this is not possible if the prostate is removed). Whatever version I choose, I would not begin until some time after Christmas (and I do have 10 years to make this decision).

That’s it. I took no notes; Mom took copious ones. I am amazed at how much I can recall. We are fine, but tired from the long, intense concentration. Keep in touch. Love, Dan/d/oc