Under the knife

Like all men newly diagnosed with prostate cancer my attention turned to treatment options.  For many men the best options is simply waiting.  This is a common path for men with low-risk disease.  For men like me with high-risk disease there are several options but almost all men pick either surgery (prostatectomy) or radiation. There are various pros/cons to the choices.  At the time of my decision the two options had similar outcomes but surgery had an attractive advantage: if necessary (surgery did not get all of the cancer) radiation could be performed after the surgery.  It was also appealing on an emotional level: I wanted this cancer completely out of my body.  My prostate and I were no longer friends!

Having decided on treatment the next step was picking the surgeon.  This was harder than I thought it would be.  All of the data on prostatectomy suggests that successful outcomes are highly correlated with the skill of the surgeon so I was hunting for a prostate ninja.  I talked with a local surgeon who was recommended by my urologist and then paid a visit to a Mayo Clinic surgeon who had helped a friend.  Both doctors were very experienced (> 1,000 procedures) with impressive outcome data but the Mayo mystique won in the end. I chose to have the surgery as soon as possible but it is necessary to wait at least 6 weeks after a biopsy to allow the prostate to recover.  My surgery (a robot-assisted radical prostatectomy) was scheduled for September 2016 in Rochester, MN.

The surgical experience at Mayo was very positive. The doctor was confident and concerned. The nurses were angelic. Yes, the nurses were amazing. I really can't describe how dear they are to me now.  I awoke from my surgery in pain with a catheter (tube running from my bladder to a bag on my leg....through my penis).  I'm confident this was the most vulnerable moment of my life.  The nurses were so sweet, constantly concerned about me, sharing stories of their families.  It was a very difficult evening and my nurse angels got me through it. The next day I was discharged and my wife drove us home.

More details...

• While I loved my Mayo surgical team for their confidence and skill I feel like their attention to my individual situation was less than impressive. For instance, my biopsy showed perineural invasion. Recent studies suggest that "nerve sparing" (attempts to keep the nerves that control erections intact when removing the prostate) surgery is not recommended in that situation but my team did not seem interested in the topic. I had a strong feeling that the surgeon measured himself on the basis of potency outcomes. If my erectile function was good he was successful.  The potential risk to my life seemed less interesting to him.

• Prostate cancer treatment options can be quite contentious.  Unfortunately, many of the parties to the decision lack objectivity.  The surgeon wants to cut.  The radiation oncologist wants to zap you.  The medical oncologist (well...hopefully you won't meet those guys...they come on board when the disease metastasizes) have other plans.  One of the books that helped me see the landscape a little better was this one: Invasion of the Prostate Snatchers.  The book has a very shock-prevoking title which you should ignore.  It's survey of prostate cancer and options is very helpful.