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Robot surgery

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Parting Company with My Prostate - “The Robotic Way”.
by Bruce Ricketts

The purpose:
The purpose of this paper is to share my experience and thoughts with others who suspect they may have a prostate problem or have been diagnosed with prostate cancer, and considering their options.
The important thing to remember is you are not alone. More of us at a younger age are being diagnosed with prostate problems, including prostate cancer, so I guess it is up to men to be more aware of the situation, and act early.
If you are worried about what to do, I hope the following is of help in alleviating concerns and in helping you make your decision.

This month I celebrated my 60th Birthday, minus my prostate and I am pleased to say that unless they knew of my operation, nobody was aware it had gone.
I am a retired IT professional, who keeps fit and loves the outdoor, especially walking, fishing and golf. I have been very lucky to date and enjoyed excellent health all my life. I have a wonderful wife of 38 years, who is my sole mate. We have two wonderful adult children, a daughter aged 33 and son 36. We are a very close family, which has been an enormous help for me, in discussing and dealing with this health “hiccup”.
Two other people have played vital roles - my Melbourne Urologist (Mr. Laurence Harewood), who specializes in Cancer of the Prostate, raised PSA and Robotic Radical Prostatectomy and my GP on the Gold Coast (Dr Graham Exelby).
Whilst we are Melbourne based, we spend many months at the Gold Coast each year, and my GP at Mermaid Beach has provided what I describe as complete “health management” services, rather than just “incident” consultations. For that I thank him. More GP’s should operate that way. Whilst I have been forthcoming in managing my health, you do need a GP who is pro-active, and shows a personal interest.
Most importantly, I have complete confidence and trust in both men, which made any decisions much easier.

Early Detection is important:
Since retiring, six years ago, I decided I had more time to look after my health and that I should have regular medical checkups, including (Prostate Specific Antigen) PSA tests. I went back over my records and found a PSA reading of 0.9 in January 1994 and 2.0 in April 1998. My first retirement reading in January 2002 was 3.8, which did get my attention.
Early Detection is important (Contd):
During the following years, it increased slowly (and there were some decreases) peaking at 4.4 in 2003, remained the same in 2004, and by October 2005 it was 5.3. It peaked at 5.5 in March 2006. My free PSA was low, at a 5%-7% reading.
I had no symptoms of anything being wrong.
After consulting with my urologist, in 2003 I underwent a Trans Rectal Ultrasound & Biopsy. The biopsy results were clear. As a result of the rising PSA, these were repeated in December 2005, (1 biopsy out of 10 was suspect), and March 2006 – the latter results confirmed prostate cancer with a Gleason score of 7, (3+4).
My urologist recommended a chest x-ray and bone scans. Thank goodness, the results of which were both fine.
I have never felt any need to question any advice I have received from either my GP or my urologist, so when my urologist, with my wife (who was with me on all visits to him) and I sat down to discuss the facts and the options, it was more a case of absorbing his recommendations.
I left his rooms feeling informed, aware of all the risks and options, but also fully confident and felt very fortunate that I had met this specialist - urologist, Mr. Laurence Harewood.

The choices:
Given the stage of the cancer, my age, level of fitness, and general health to date, my urologist recommended radical prostatectomy. All other options were discussed to make me aware of solutions, but given my circumstances, in particular we discussed radical prostatectomy - the open and robot assisted laparoscopic procedures. He recommended the robotic radical prostatectomy - because of its advantages over the open method.
I spent time with my urologist’s male nurse who took me through the process of the operation, hospitalisation, after surgery, and discharge. I was also given instructions on going home with the urinary catheter, and “do’s & donot’s” during recovery. All the information was first class. At my request I also made contact with a past patient who had recently undergone the robotic procedure.
I felt ready.
This was March 2006, and my wife and I had booked and planned a 21 day tour of Canada/Alaska for May-June 2006 so we were in two minds over timings etc – should we take the trip or postpone? However, once again after discussing with my urologist we decided to take our overseas trip and lock in the robotic radical prostatectomy for 20th June 2006.

Coming to terms with the issue and decision:
This is not easy and everybody deals with it, in their own way I suppose.
In my case, given my IT background, and my desire to understand things in detail, I had done lots of reading up to this stage to gain an understanding of prostate cancer, at least to satisfy my mind. Now, having found out that I really do have prostate cancer, my reading and research had new meaning and focus.
Men’s health magazines, research papers, the internet web-sites, and reference books all played helpful roles in satisfying my questions. I know I drove my wife mad with research, and she often suggested I was in “data overload”, but I needed to do it to get clarity of what I was about to undertake.
However, you do need to be careful, as whilst the internet search engines are wonderful in providing feedback, some of the data is questionable and a bit scary. Once again, my urologist gave me a list of quality web-sites to reference, which were extremely helpful.
Having satisfied myself that I understand what I had, and what the surgery would do, one still has those questions of success or otherwise, incontinence and impotence, and how will it affect me?
I must admit, that whilst I thought of all the consequences, I have always had a positive attitude, so I did not dwell on any negatives. It was a matter that my wife and I had discussed and we agreed that getting rid of the cancer was the number one objective, then, if we need, we would deal with any side effects.

The date of the operation soon arrived:
Our trip to Canada/Alaska was tremendous and I did not let my impending surgery affect our trip. I had made my decision and I had no need to change it. In fact, as we made more new friends on our trip we heard of more men affected by prostate problems, so it actually made more sense to “get on with it”.
My robotic radical prostatectomy was carried out in Melbourne’s new Epworth Eastern Hospital in Box Hill.
I have only praise for the hospital and its staff, they were fantastic.
The operation took something like 5 hours, and went extremely well, thanks to my urologist again, and his support team of professionals. After being wheeled to the surgical ward at lunchtime and I have never been so happy to see a digital clock that read “17.57.00”. I knew I had come through the operation…step one achieved.

The immediate visible outcome of the robotic radical prostatectomy from my perspective were six small incisions in my abdomen, and that dreadful catheter. I felt well, and spent several hours in the intensive care unit overnight, as part of normal procedures.
When my urologist visited, he was happy with how the surgery had gone, and a day and a half later I was on my way home, (after the obligatory bowel movement in hospital). Not long afterwards I received a call from my urologist with the pathology results – which were “best possible outcome”. The results were that the tumour was organ confined with no extra capsular extension and the margins were negative.
Laurence Harewood did a marvelous job and I am forever grateful.

Recovery at home:
It’s not fun having a catheter inserted, but its only for a few days so stop complaining…that was my approach. Bowel movements were also difficult at first. Recovery went extremely well, the catheter came out on day nine and the plumbing then started to reposition itself. Considering just days earlier I had undergone major surgery, the body was healing well.
I listened to what my urologist and urology nurse had said about recovery - what to do and what not to do, and decided I would conform. I walked whenever I could, drank litres of water and got things moving whenever possible. I did not drive the car for 3 weeks.

Two months after the operation:
The first month is the “tender” stage, and I was very conscious of not doing too much, not straining or lifting anything.
Two months later I am pleased to say I feel great, both physically and mentally. It’s good to have the operation behind me.
My small scars have healed, I am walking 6 klms each day with my wife, and am back playing 18 holes of golf weekly.
From an incontinence perspective I am affected by stress incontinence – coughing, sneezing, twisting, walking distances etc, and it is improving daily. “Tena for men” works wonders and nobody knows. I have twice sought the services of a expect continence physiotherapist and have been fairly regimented in doing my pelvic floor exercises. Based on daily improvements, I am hopeful all gets back to normal in the coming months.
My erections have not returned yet, and they are eagerly awaited. A bottle of Penfolds Grange is ready.

In conclusion:
I have just had my PSA rechecked, and the result was fantastic (undetectable - less than 0.1). I have a re-check in four months.
So looking back on this experience, would I make the same decisions, and the answer is -

I have no hesitation in recommending robotic radical prostatectomy if you are faced with a similar challenge as I was. It gives you the peace of mind that at least you have removed the cancer, and with the aid of the new robotic techniques, with little stress on the body and the benefit of a rapid recovery.
An excellent reference site for robotic radical prostatectomy is www.davinciprostatectomy.com.

For the readers of this article, what are the lessons:
• Manage your health, have regular checkups, and don’t ignore your PSA and DRE tests,
• Persist with tests if things don’t look right ( I was told by one medical GP not to worry about my PSA until it was over 10, then we would know I have a problem),
• Find a GP and Urologist you are confident in and trust,
• If you are so inclined, read until it hurts, but don’t believe every web site article,
• In consultation with your Urologist, make your decision and stick with it,
• Don’t waste time, the sooner you act, the sooner you part company with your diseased prostate, and hopefully gain peace of mind.

Good luck with your health.

Bruce Ricketts
Glen Waverley
30th August 2006