Had Radical Prostatectomy last week: What are next steps?

Posted by perrychristopher @perrychristopher, Aug 10, 2022

Hi, I just had a Radical Prostatectomy on 8/4/22 and made the unfortunate decision to look at my Pathology Report before my appointment with surgeon in 2 weeks. Actually, all data looked good except one margin notation. My Gleason was still a 7 as it was during the biopsy in May. No seminal vesicles, bladder neck, or lymphovascular invasion observed. 15 lymph nodes were removed with no sign of tumor and were given a rating of pN0. The tumor itself was diagnosed as a PT2. However, in two slides of the left lateral location of the removed prostate an invasive carcinoma was present at margin. The length of this carcinoma was 1mm. My last PSA taken in March 22 was 3.46. Now I am concerned what is the next step. I was really hoping I would not require Radiation after the surgery, but not so sure now. Any thoughts. Thank You. Perry Christopher

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Following. Just has my RALP 8/23 and am looking forward to hearing about the lab reports about the gland and a pair of lymph nodes. But the surgeon was very enthusiastic yesterday.

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@whytee

Just had my prostate removed after diagnosed with Gleeson 9 aggressive cancer. Get staples and catheter out tomorrow. After more recuperation have to do PSA to see if any residual cancer. Will probably also have radiation to capture any micro-spread.
Anyone else out there going through this?

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Welcome @whytee. Yes, there are many members who, like you, are going through prostate cancer and treatment. To help you connect with others, I moved your message to this existing discussion:
- Had Radical Prostatectomy last week: What are next steps? https://connect.mayoclinic.org/discussion/had-radical-prostatectomy-last-week/

I encourage you to browse the discussions and follow the Prostate Cancer group here: https://connect.mayoclinic.org/group/prostate-cancer/

Many members have talked about their radiation experiences and choices they made. Do you know what type of radiation you may be offered?

I bet you're looking forward to getting that catheter removed!

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@maxvt

Following. Just has my RALP 8/23 and am looking forward to hearing about the lab reports about the gland and a pair of lymph nodes. But the surgeon was very enthusiastic yesterday.

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Wow, Max. Looks like you, @perrychristopher and @whytee are all on a similar timeline with having just had a prostatetectomy, and in your case a robot-assisted laparoscopic prostatectomy (RALP) only 2 days ago. How are you feeling? What helps to be comfortable post surgery?

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@colleenyoung

Wow, Max. Looks like you, @perrychristopher and @whytee are all on a similar timeline with having just had a prostatetectomy, and in your case a robot-assisted laparoscopic prostatectomy (RALP) only 2 days ago. How are you feeling? What helps to be comfortable post surgery?

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I was taking 3000mg per day of OTC Tylenol for the 1st week. Also took the prescribed med to ease the catheter irritation. I think it was called Peridium? I also took OTC Colace stool softener 2 times/day. I was careful with food intake. Oatmeal in morning. Tuna for lunch. Some sort of veggie dish for dinner. Even with this I didn't have a bowel movement for 4 days after surgery. On day 8 they removed catheter. No big deal there. I kept taking the Peridium until I ran out. I had a 10 day supply. Also cut Tylenol dose in half on day 8. Stopped all Tylenol on day 12. Feel fine now. A little urine leakage but not much. I am going every 3 hours. I asked my surgeon about this yesterday on my Post Surgery meeting and he said I will get back to normal. He wrote a script for Physical Therapy to strengthen Pelvic muscles. They will teach me to do Kegels correctly I hope. My pathology report was good. No Lymph nodes had PCa nor did anything else. Both nerve bundles spared. I had a 1 mm area of PCa near the edge of prostrate removed but all was contained in prostate. He did not cut across any PCa. I have a PSA test scheduled in 5 weeks. He said no radiation required. Hopefully it stays that way. Hope this helps.

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@colleenyoung

Wow, Max. Looks like you, @perrychristopher and @whytee are all on a similar timeline with having just had a prostatetectomy, and in your case a robot-assisted laparoscopic prostatectomy (RALP) only 2 days ago. How are you feeling? What helps to be comfortable post surgery?

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I don’t have pain, but serious discomfort in the abdomen from the incisions. I am wearing a corset that is supposed to help, and walking, indoors. (It’s Texas and it’s hot!) I’m eating oatmeal and salads, and did 4-5 weeks of PT, kegels, before the surgery and am looking forward to going back. I’m taking an occasional Tylenol but no other medication.

I see my Surgeon again on 9/1 for cath removal, and hopefully, the lab results on the prostate and two lymph nodes. The surgeon was very enthusiastic the day following the surgery, so I am optimistic.

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@perrychristopher

I was taking 3000mg per day of OTC Tylenol for the 1st week. Also took the prescribed med to ease the catheter irritation. I think it was called Peridium? I also took OTC Colace stool softener 2 times/day. I was careful with food intake. Oatmeal in morning. Tuna for lunch. Some sort of veggie dish for dinner. Even with this I didn't have a bowel movement for 4 days after surgery. On day 8 they removed catheter. No big deal there. I kept taking the Peridium until I ran out. I had a 10 day supply. Also cut Tylenol dose in half on day 8. Stopped all Tylenol on day 12. Feel fine now. A little urine leakage but not much. I am going every 3 hours. I asked my surgeon about this yesterday on my Post Surgery meeting and he said I will get back to normal. He wrote a script for Physical Therapy to strengthen Pelvic muscles. They will teach me to do Kegels correctly I hope. My pathology report was good. No Lymph nodes had PCa nor did anything else. Both nerve bundles spared. I had a 1 mm area of PCa near the edge of prostrate removed but all was contained in prostate. He did not cut across any PCa. I have a PSA test scheduled in 5 weeks. He said no radiation required. Hopefully it stays that way. Hope this helps.

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The prescribed drug for catheter irritation was Phenazopyridine not Perodium. Just wanted to clear that up. Thanks.

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@maxvt

I don’t have pain, but serious discomfort in the abdomen from the incisions. I am wearing a corset that is supposed to help, and walking, indoors. (It’s Texas and it’s hot!) I’m eating oatmeal and salads, and did 4-5 weeks of PT, kegels, before the surgery and am looking forward to going back. I’m taking an occasional Tylenol but no other medication.

I see my Surgeon again on 9/1 for cath removal, and hopefully, the lab results on the prostate and two lymph nodes. The surgeon was very enthusiastic the day following the surgery, so I am optimistic.

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Everyday you will feel better Max and have less discomfort when moving around. I had 6 incisions which seems to be the "going rate" for this surgery with one being slightly more sore than the others. You could try upping the Tylenol if it doesn't bother your stomach. Good luck with everything and good job on the pre surgery Kegels. By the way my procedure was also the robot assisted one. My surgeon used the DaVinci system.

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@whytee

Just had my prostate removed after diagnosed with Gleeson 9 aggressive cancer. Get staples and catheter out tomorrow. After more recuperation have to do PSA to see if any residual cancer. Will probably also have radiation to capture any micro-spread.
Anyone else out there going through this?

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I was also a Gleason 9 (4+5). Had my RP in March 2022. First PSA post-surgery was undetectable, will do my second in a couple of weeks. For you at this time, the most important information will be your final pathology report. Once you have that you will have a better idea of what the future may hold. For now, I would suggest concentrating on your recovery and getting stronger.

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As far as follow-up treatments go, I would follow your urologist's recommendations and, if you are uncomfortable with his/her recommendations, then get a second or even third opinion from someone practicing at a medical center of excellence like Mayo, Hopkins, etc. But that aside, my best advice is to do lots of Kegel exercises and keep doing them. It's the best way to prevent incontinence.

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@perrychristopher

Everyday you will feel better Max and have less discomfort when moving around. I had 6 incisions which seems to be the "going rate" for this surgery with one being slightly more sore than the others. You could try upping the Tylenol if it doesn't bother your stomach. Good luck with everything and good job on the pre surgery Kegels. By the way my procedure was also the robot assisted one. My surgeon used the DaVinci system.

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Incisions, I had five. My surgeon also used DaVinci. I had my cataracts removed early July, also with DaVinci system. And my incision discomfort lessens with each day.

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