I want to learn more about side effects of robotic prostatectomy

@mikerbn

I faced the decision in January 2014. There were really two options then, surgery or brachytherapy.

I chose the former as it was "curative...!"

The surgeon was skilled and experienced, nerve sparing...

The pathology report was T2CNoMx

SV, ECE and margins negative...

GS 4+4, only 10% prostate involvement.

Side effects:

The catheter came out after a week, no incontinence.

Yes, initially erectile dysfunction but resolved itself over 6-12 months with daily 5 mg Cialis and "exercise...! Orgasms were dry and it took greater physical and mental stimulation to achieve erection and orgasms. Initially there was some urine leakage when orgasmining but they went away. Was there some length and girth reductions, yeah, I never "measured" before or after so that's a qualitative judgement.

After the first two weeks I was able to travel again and go back to the gym, albeit starting at lower weights when going resistance training. By a month I was pretty much back to "normal..." playing basketball, riding my bike...

What will your experience be? You don't know going in. In part the skill dnd experience of your surgeon may play a role, your health and physical conditioning may also factor in.

Will it be curative? Again, you don't know. There are monograms such as the ones MSKCC has that can "predict" the probability based on your clinical data. Mine was 30% probability of BCR, unfortunately, the nomogram was correct, BCR after 18 months.

Still, it's been 12 years since diagnosis, SRT, doublet and triplet therapy, here I am!

Three of those 12 years have been on treatment.

It's been a good 13 years.

Kevin

I've actually done both...2-1/2 years of active surveillance and now three weeks post Robotic DaVinci Surgery. in the past 2-1/2 years I've watched my PSA rise, two biopsies with advancing 3+4's to 9 of the 12 samples and one 4+3, created the talk with my Oncologist to go with the surgery. On top of that , my prostate was the size of an orange instead of the normal size of a walnut! It was attached to my rectum, and was pushing hard on my bladder.
The surgery took 4-1/2 hours! God bless my Oncologist, who hung in there and didn't penetrate the rectum. He said this surgery was one for the record books! I've always been an over-achiever! Ha!

I'm 75 years old and my father died of cancer 25 years ago, starting with his prostate and spread to his spine and elsewhere. He didn't have the sophisticated surgery tools that we now have. He suffered for a long time before he passed. That helped me make the decision to go for surgery over active surveillance.

Now I'm going through the physical and emotional challenges of recovery and it's not easy. Incontinence is the major issue, along with the aches and pains of post surgery. I'm now off all pain medications, and slowly getting by, one day at a time. Each day I notice improvements in baby steps. I had a meeting with my Oncologist last week and he showed me the Pathology reports of the prostate and 25 surrounding lymph nodes. The prostate was, as expected, loaded with cancer, but the nodes had no signs of cancer at all. To me this is a big win! I am now a cancer survivor!

I start physical therapy in two weeks, to learn how to improve my incontinence. From these pages in this web site, I have learned from other guys how to tackle all of these challenges.

I hope this helps you while you go through the mental gymnastics of this disease. My only advice is to keep up on your PSA tests!

@jeffmarc thanks for the response. No I have not done any test post RP surgery other than the PSA blood test. The only recommendation from both my surgeon and urologist is to Monitor (their caps). I understand that based on the post operative prostate biopsy that I had significant cancer with higher risk for reoccurrence. So I am not sure if I should pursue further testing other than the quarterly PSA blood test. Is ignorance bliss or do you think there are tests I should pursue. I am in very good health and fitness with no other medical issues. Thanks. Rick

@rkenitz
You are correct with all of the issues you’ve had further testing like the decipher score is not really relevant. You’re very likely to have a reoccurrence sooner rather than later. You never know some people go for many years even though they seem to have a very serious cases.

If your PSA does start to rise, try to get switched over to monthly tests, You don’t wanna let it get too much out of control before you get on one of the drugs. The drugs these days work very well and can keep people alive for a long time.

@jeffmarc perfect, I will do that.

I too was a Gleason 3+4=7, with 9 of 12 cores positive. I have written this many times, but the Gleason score is just the "tip of the iceberg" of prostate cancer. It is a cytology procedure using very few cells compared to the entirety of the surgically-removed prostate. The Gleason only tells you that you "do" or "don't" have cancer. It tells you nothing of the anatomical features and disease prostate as a whole.
I opted for the DaVinci Robotic Assisted RP, and I was glad I did, because my prostate pathology was much worse than the low/medium risk Gleason 3+4=7 wanted to suggest. You have no idea how bad your cancer really is, until the entire prostate is removed, and the Pathologist examines the entirety of it, with MANY microscope slides that may reveal Extraprostatic Extension (EPE), Surgical Margins", Cribriform Glands, seminal vesicle invasion (one or both), and other things. I had ALL of that, and the biopsy could not and did not reveal any of that...a biopsy can't tell you that information. But...
Yes...there is no denying the inconveniences and frustrations of having the surgery. Your best bet is to find THE BEST and MOST EXPERIENCED urologist that you can find at a major urban medical center to do the surgery...someone who has done 3,000 - 4,000 RP's or more. If you live in a smaller city with one or two hospitals where the local urologist has done 100-300 or so RP's...DON'T GO TO THEM. You need maximal expertise.
Yes...you will have a catheter for 10-14 days, after which you will be incontinent and wearing diapers for months. If you are lucky your continence will return within 4-6 months, but most gents like me, don't see a full return of control and continence for 6-12 months. Even with the surgical sparing of the neurovascular bundles that are necessary to achieve erections, you will have ED for 9 months to two years...maybe permanently. I am at 10.5 months post op and I have yet to have an erection, and I still dribble little leaks of urine (I wear a thin "Shield" in my new boxer shorts (I was a boxers guy before surgery).
When I discussed options of Active Surveillance, Radiation, and surgery, my urologist flat-out said: "You have cancer...it is NOT going to go away, so why give it two years to get worse doing Active Surveillance?" After two years of Active Surveillance, no one is ever told that they are cancer free...they are only told how much the cancer has spread. My urologist said that he NEVER does Active Surveillance, and he never does radiation first ("It turns your prostate into a walnut sized chunk of scarred concrete, that is nearly impossible to remove surgically thereafter if the radiation did not work"). You stand a better chance at longevity and fewer problems if you have the surgery, despite the moderately long post-op inconveniences and frustrations. Good luck to you.