What is a Prostatectomy Like?

I am exactly two years out from my RALP and do not regret my choices, though sometimes I have doubts I took the correct course. I have several friends who took the radiation route, and all but one had a recurrence of the cancer within ten years. Choosing surgery was based on the advice of every opinion I sought, including the radiation specialist, because I caught the cancer so early, and it was not the slow growth kind. My PSA has since been negligible at every interval that it is checked. Yay. I am alive and prostate cancer seems to be gone. The prostatectomy was followed a year later by a robotic inguinal hernia repair. Coincidental timing? I think not, as many here have agreed, but the repair was successful. At my 18-month PSA checkup, I asked my urologist/surgeon two questions: 1) When will I be 100% continent? He asked how many pads I use and I told him never more than one a day, but I still leak when exercising. "How much leakage?" Just a few ounces but it still required pads when golfing, hiking or playing pickleball. He told me one pad a day fits the definition of "continent" in the eyes of the industry. Question 2) When will I get erections again, since he said the original surgery was nerve sparing. "You are likely as healed as you will ever be", meaning no more natural erections. I fell into the minority group of patient results it would seem, but reading comments on other sites like FrankTalk and NAFC.org makes it seem like there's a lot more men like me out there than the data would imply. In two weeks I am scheduled to get the male urinary sling, but the surgeon has told me flat out the improvement won't be dramatic because I leak so little now. But I am pursuing it because I want to live with as little leakage as possible. I will not tell anyone what choice to make but your life will change because of this cancer. You will come across people who pooh-pooh it saying, "Oh it's only Prostate cancer, they can cure that". And you'll have to nod and smile when you really want to yell back that kidneys never stop producing urine and urine never stops flowing out the body if it doesn't have traffic stops. And you just had your traffic stops cut out of your body. And remember that concept of "self" so big in today's culture? Males grow up thinking an erection is proof they are a masculine being. And now that is gone too. Life is full of changes, and we have to adapt.

I am on Day 80 after surgery, I had very little pain throughout, had the catheter out after 11 days but the incontinence remains a constant challenge. I have to change Depends 6-8 times a day. I get some of the blame for that for not doing enough kegels, especially before surgery. My first follow-up with the doctor and first PSA testing is in late February. Hoping he has some ideas. The odd ting is that my hair has stopped growing. I've had no radiation or chemo, but the last time I had my hair cut almost 3 months ago. It could be age but I was getting haircuts every 4-5 weeks. If that's the worst of it I'm lucky.

I believe I’m in a position to finally provide my own input into this. While I’ve not quite completed the entire process, I’ve experienced enough of it, and it’s fresh enough in my mind, that I can comment.

This is my second robot assisted surgery and, in fact, the exact same surgeon did my prostatectomy and he used almost all the same incision points and, in the end, the recovery from surgery itself is almost identical.

I keep relatively fit, with an emphasis on my core strength (think abs, etc), so having incisions to my abs became very painful to recuperate from both times.

So, what was it like? I just had it out a few days ago. No part of it is fun, but for me the worst part is the ab pain. I take the walking seriously and, like last time, I use a couple of canes to help stabilize me as I walk a bit more each day. Yesterday I pushed probably a bit hard and my abs were absolute murder for about an hour after, I mean more agony than I can remember in a long time. I had the option to take Oxy for this but skipped it because I only use that if the Tylenol doesn’t do the trick.

The second worse part, and it’s far worse this time, is dealing with the gas they pump into you for the surgery. It rises to the high points of your body, shoulders mostly, but if you favor one side while in bed then that entire side gets saturated and the pain is extremely intense. It dissipates over time but takes a few days, it’s already about 1/2 what it was before and that 1/2 is still pretty painful..

Getting used to a catheter for a week is an adjustment. While it generally doesn’t “hurt” (sometimes it does a little), it’s a constant annoyance that varies between you simply always being aware of it there or it actively reminding you that it’s there. I’m counting the days until it comes out - 4 days and change now.

Losing the ability to encourage the relief of your bowels is a huge adjustment. You just can’t do it. For one, you have a surgical zone to worry about breaking open and irritating, a urethra that is just barely stitched on and healing and your muscles are shot. For this reason they give you Gas X and a stool softener to help, but this entire process is pretty not fun. On top of all of this, Oxy constipates you so then you have to deal with that too. Once healed up you can operate in a similar fashion but have to remember that you no longer have independent control of bladder and bowel, so it’s a new “normal” to get used to.

Would I do it again? Probably. It sucks, but that little sucker is gone and so far the doctor is very optimistic that the cancer is taken care of for now. I could have opted for the other primary treatment, radiation, but since the side effects could be the same and then some, I opted out of that (plus every doctor said that at my age it wasn’t recommended, since I’m pretty young for this). There are also the outlier treatments that some have reported success with, maybe those would be better but they just weren’t for my case.

If you get RARP then just know you are NOT going to be back to normal in a few days. You could probably hobble around and try to get back to normal life but you are risking serious injury or even death if you tear something. Even sitting in my recliner doing very little, I thought I would be able to fire up my laptop and work more than I’ve actually been able to. Healing zaps your energy, your whole body is tired and it’s hard to keep up - add to that the bevy of pharmaceuticals and you have a recipe for resting rather than returning to normal.

That’s my $0.02 on my third day post-op.

I am sorry.

Like I said, 12 years in - Normal? Don't remember what normal used to be, it is not the same now.

I understand your point of view "Quality over Quantity". I had RARP. My cancer was confined to my prostate and for me there was one way to remove the cancer. It's been 4 months and all is good now. I didn't want the cancer to spread. I'm 70 now. Doing nothing at all I could live 10 more years, and worrying about my cancer. I wear a pad now, 1 last all day. Not near as uncomfortable as I imagined. There's lots of things you can use for an erection that work.
Just my Thoughts. I wish you nothing but good, It's a tough decision, I wish you nothing but Peace my friend.

is the pain constant or does tylenol help to reduce it. I was told by a doc that it would feel like doing 1000 crunches and I have never done more than 20. So not sure how to relate to that. Are you eating fiber rich food like oatmeal etc to help bowels?

Good to hear your surgery was a cure. So many in here discuss reoccurrence.

Many here would like to hear the result of sling surgery. Please come back and let us know.

Yes, 1,000 crunches is accurate. It was the same the last time I did this too.

Tylenol really does do the trick. The first few days the Oxy helps because the pain can be pretty intense, after that then it’s just a fallback for when things get really painful, like after a long walk, but otherwise it’s good to avoid because pooping really needs to happen and it’s much more challenging when Oxy is backing you up in addition to everything else.

I’ve been eating moderate fiber, not too much, but enough to keep things moving - mostly trying to keep to a mild and more liquid diet (soup, etc) just so I’m not straining.

Made me cry

Hello! Mr. Greybeard,
We are old friends, thank you for your reply, you gave me encouragement.
In fact, my Chinese writing is more touching than the English translated by the translator. When I wrote it that night, I cried many times.
When I was in hospital, it took me 20 minutes to turn over at night, and I tossed and turned in bed all night. It was so uncomfortable.