Q&A session with Doc Baker

Anne and I met the doctor yesterday (9/29/2008) for a Q&A session.

What does the prostate do?

Your prostate has two important functions: one is to help control urination and the other is to help sexual activity.

The prostate has a so-called passive role in the process of urination. It helps to control the rate at which urine flows out of the bladder and into the urethra. It does this by the effect of muscle fibers in the prostate that surround the urethra.

The prostate also has an active role in sexual activity. The prostate gland makes a whitish glandular secretion which collects within the prostate and is fed into the urethra during ejaculation. This glandular secretion helps the motility of the sperm in the urethra and makes up about a third of the seminal fluid, thus giving seminal fluid its whitish appearance.


What causes prostate cancer?

Don't know.


If the prostate is cancerous, does my ejaculate contain cancerous cells that can be passed to my partner?

No. The doc tried to explain to me why this was so, but honestly, I got lost. Bottom line - I'm not putting cancer into my wife.


What stage is my cancer?

T1c. We call a prostate cancer stage T1c when it is found as a consequence only of the patient having a positive result to a prostate specific antigen (PSA) test but no other clinical sign of the disease. This stage compares precisely to the so-called stage B0 disease in the Jewett-Whitmore staging system. Because of the rapid increase in the number of patients having PSA tests in the past few years, stage T1c has become a relatively common stage of prostate cancer to be diagnosed.


How long have I had this cancer?

Hard to say with certainty - about two years is his best guess.


How fast does prostate cancer grow?

The doc told me it takes (on average) about 10 years for prostate cancer to be detectable via a digital rectal exam (DRE). This is one reason the PSA test has been so helpful - it can detect prostate cancer far sooner than a DRE.


How will I know I am cancer free?

Continuing PSA tests.


Do I have additional risks for rectal/bladder cancer?

No additional risks in my case.


Since I have some form of cancer, does that make me more susceptible to other forms of cancer (e.g. lung cancer)?

There is no evidence that having prostate cancer increases the risk factors for other forms of cancer. At least that's what he said, but I still wonder...


Survival rate for my age group

Due to early detection and my overall health, I am in the 99% cure rate category.


My treatment options

Hormone therapy. Not a viable option for men in my age group.

Radiation. There are numerous radiation therapies out there: Brachytherapy (seed therapy), External Radiation therapy, Proton External Beam Radiation, HDR, etc. Doc said that these treatment options are not advised for younger patients due to the "collateral" damage than can occur. Further, radiation leaves the prostate in the patient and turns it into scar tissue, which can lead to long term problems.

Surgery. The "gold" standard in prostate cancer treatment. You have three basic types: open, laparoscopic and robotic laparoscopic ("da Vinci"). The latter represents the current "state of the art" in surgery and offers the highest rate of success . This is the treatment method that I have (currently) selected. Here is a YouTube video of this gizmo: click


Incontinence

After the operation, I will have to wear a catheter for the first week. I will also be incontinent for at least a month, probably closer to three months. Due to my age and health, I have a better than 90% chance of having urinary control after three months. As I understand it, I may have life long "issues" with some leakage under certain situations (squatting, lift heavy objects, etc).


Impotence

I will be impotent for some amount of time after the operation. It's no surprise, but every patient is different in this respect. Some patients have erections within a few days of the procedure, some can take up to a year and others never have an erection (unassisted that is).

It seems the bottom line is this: the sooner you catch the cancer, and the better your health and "functions" are prior to the operation, the better your chances for a recovery to full function after the operation. Makes sense when you think about it.

Lastly, as I understand it I'll almost certainly be a Viagra (Cialis, Levitra, etc) customer for life. I suppose there are worse things in life to deal with. Maybe I'll get lucky and won't need them, selling my tabs to neighbors for beer money. :)


Recovery/Rehab

I should be back on my feet within a few days of the operation. Urinary control rehab involves Kegel exercises. Long pause... It's amazing how fast you lose almost all modesty when you have prostate cancer, but there are limits. There is one more "rehab" I have to do daily: use a vacuum erection device. There, I said it. The doc says it helps keep a fresh supply of oxygenated blood to the penis while the nerve structures and surrounding tissues are healing. There was another reason, but I was so weirded out by what he was saying that I forget it. Good Lord. Are there no limits to how embarrassing this process is going to get???


Schedule

I currently have Dr. Baker scheduled for the da Vinci procedure. Back to his office on 10/30 for instructions, scripts, etc. Pre-op at Brandon Hospital on 11/13, surgery on 11/17.