Ok, I had been diagnosed with prostate cancer and had scheduled da Vinci robotic surgery at the local hospital with my urologist. What am I thinking now?
I’m thinking about how – in a few short weeks – I am going to be in an operating room, knocked out, and my doctor is going to be snipping away down there in my groin area. How much is he going to take out? Is he going to preserve my nerve bundles, or isn’t he?
So I called him up to “lobby” for my case. “… Doctor, I just want to remind you that of the 12 needle samples you took in my biopsy, only one showed any sign of prostate cancer. And of that one sample, only 5% contained cancer. So that’s pretty good, right?”
That means the prostate cancer is at a pretty early stage, right? That means you can perform a double “nerve-sparing” procedure on me, right?
I was trying to “remind” the doctor of my specific case, so he wouldn’t go cutting all over the place.
I was also sure to mention that my Gleason score, a measure of prostate cancer’s aggressiveness, was a very middle-of-the-road 6. (This can go all the way to 10, which is the most aggressive score).
SIDEBAR: Well, as it turns out, this was all pretty unnecessary, because any surgeon who is preparing to do a radical prostatectomy on someone is going to go over their clinical test results and know them backward and forward BEFORE a single cut is made. THEY KNOW.
So how far did this lobbying get me? All I can tell you is that in my case, my doctor listened to me (seeming like he had heard this discussion many times before), and agreed with me that my test results were what they were, BUT DID NOT PROMISE TO DO ANYTHING ONE WAY OR THE OTHER.
You know what? How could he? Every case of prostate cancer is different. You don’t know what you’re going to find until you get in there.
The number one goal is to eliminate the prostate cancer. There is no going back on that. That’s your number one problem, and that’s the highest priority goal of a radical prostatectomy.
The very best-trained surgeons know the techniques involved with removing the maximum amount of diseased tissue to give you the best chance of curing your disease while, at the same time, preserving as much of your continence and potency as your specific case will allow. You can’t ask for more than that. If your disease has progressed to a point where the surgeon has to take out more of your plumbing down there, then no amount of training is going to be able to help you out.
Controlling your cancer, preserving urinary continence & erectile function are the three goals that make up the Trifecta – what every urologist strives to achieve given the facts and circumstances of each particular case.
As it turns out, I was a good candidate for the nerve-sparing procedure, and my doctor was able to spare both of my neurovascular bundles and still achieve negative margins (meaning no cancer was found on the outer edges or periphery of my prostate gland).