Number 10

Image by Sam Churchill CC BY 2.0

I chose prostate surgery to treat my case of prostate cancer. You and your doctor may choose a different method.

When they wheeled me into the operating room, I had no idea that I would be receiving some “unadvertised” benefits.  Yes, prostate cancer was my diagnosis, and that is not a good thing, but I have to admit that I was more than pleasantly surprised after everything was said and done.

“The 3 goals of successful radical prostatectomy in descending order of importance are cancer control (margins), urinary continence, and potency.”1

 

Urologists sometimes speak of the ” trifecta.”  They’re not talking about horse racing – it’s a term that is sometimes used with prostate removal surgery. What do they mean?  In short, it describes the ideal outcome after radical prostatectomy – the three goals a doctor strives to accomplish if all the stars line up and conditions are right.

The first (and most important) goal of any Radical Prostatectomy or RP is to control your cancer, so that objective is clearly the first leg of the trifecta.  After that come two “quality of life” goals, namely urinary control or continence (no pads) and sufficient sexual or erectile function. If you can attain all three of these goals after Radical Prostatectomy, well then you have done very well.

As I was reading through the medical literature before my surgery, I discovered a new wrinkle in the urological trifecta. In May, 2011, the EAU (European Association of Urology) proposed a new goal or standard for reporting the results of robot-assisted radical prostatectomy. They upped the ante by adding two more goals to the trifecta, making it a pentafecta  – or a 5 goal objective. You can read about the urological pentafecta here.

Their thinking was that in this modern era of PSA testing, prostate cancer is being detected earlier than ever before and therefore bringing in younger patients seeking help for the disease. And these younger patients tend to have higher expectations.  So the European Association of Urology proposed adding two more goals to the trifecta:  4) no post-operative complications from surgery, and  5) negative surgical margins (no cancer cells found on the edges or periphery of the prostate gland after its removal).

I think we can all agree that the urological pentafecta is truly an optimal outcome or result, but I say, why stop there? I’m the patient and patients make all kinds of unreasonable and outrageous demands, so I say let’s pile on more goals for the doctors – let’s “up the bar” even further.

Why don’t we add not one, not two, but – wait for it – five more goals and make this a true 10 goal affair or a decafecta?

Therefore, here are my five additional goals to convert the European Urology proposed pentafecta to my decafecta:

6) Eliminate all symptoms of urinary blockage like weak urine stream, hesitation, incomplete bladder emptying, delay, getting up at night. Bring my urinary function back to when I was 18 years old and “peeing like a racehorse.”

7) No follow up medications – no Flowmax®, no Proscar®, no Avodart®, no hormones

8) No follow up treatments like external radiation or proton beams or chemotherapy.

9) Positively identify the extent, aggressiveness and staging of my disease (can only be done after the entire prostate gland is removed in surgery), so I can get the facts of my disease and help guide my treatment today and in the future.

10) Preserve surrounding healthy tissue – no post operative urinary or bowel symptoms like rectal bleeding, rectal urgency, urinary retention (can’t empty the bladder fully), urgency, burning, etc. Leave the tissue surrounding the prostate un-radiated and in a healthy pre-surgical state.

Is this far-fetched? Is this out of line?  Is this pie in the sky?

In my opinion, no it is not out of line.  In fact, if I could dream this up, it must be possible.  I can say without hesitation that I was, in fact, the fortunate recipient of the urological decafecta.  When you get this kind of outcome, there is no doubt that you have won big, it’s like winning the lottery. It just doesn’t get any better than this.

Did I get lucky? Well let me just say that I was not a passive patient who just let things happen to him.  I researched, I read, I came up with a plan for my specific case with my doctor and then executed that plan. I took active steps to increase my odds for success and put myself in the best possible position for a good outcome – keeping in mind that there are no guarantees. Every case of prostate cancer is different.

All in all, my quality of life – on balance – is better after surgery than before.  Why?  One big reason is that I don’t have any more urinary blockage symptoms. I don’t get up at night and there is no weak stream, no hesitation, and I urinate like I did when I was 18 years old.  Granted I have undergone the mother of all vasectomies, a prostatectomy, and I now have a “dry” ejaculation, but – in my case – I felt I had to do something about my cancer diagnosis.  You and your doctor may not agree, but for me, it was radical prostatectomy performed by an experienced urologist at the top of his game – assisted by the da Vinci® robot.

That said, every case of prostate cancer is different, and yours may be easier or more difficult than mine. Every disease diagnosis is different, location of the disease is different, and outcomes are different. You can only make decisions about your case in consultation with a licensed medical doctor.

However, I believe that I put myself in the best possible position given the facts and circumstances of my individual case by taking certain active steps.

 

The Radical Prostatectomy Decafecta

            1. Control prostate cancer
            2. Preserve urinary continence
            3. Preserve erectile function
            4. No post operative complications
            5. Negative surgical margins
            6. Eliminate all symptoms of urinary blockage
            7. No follow up medications
            8. No follow up treatments
            9. Identify extent, aggressiveness, and staging of tumor
            10. Preserve surrounding healthy tissue

 

  1. http://www.roboticoncology.com/oncology-articles/organ-confined-prostate-cancer/#sthash.mRo6ONyS.dpuf []