Friday, March 08, 2019

Tom’s Great Big Prostatectomy Adventure

When we last visited Tom’s prostate cancer experience, we were deep in the process of researching treatment options. 

For the past four years, Tom had been a participant in the University of Washington's Active Surveillance program, in which he had PSA tests every three months and biopsies every 12 to 18 months. Although his PSA had remained under the normal 4 ng/mL, the past two biopsies had shown a few Gleason 7 (3 + 4) segments, which was disconcerting after two years of only Gleason 6 readings. Although there was no rush since his cancer was obviously slow-growing, it was time to act.

Tom's urologist, Dr. William Ellis, suggested that he explore the variety of treatment options available, among them brachytherapy (radioactive seed implants) and surgery. I knew a bit about brachytherapy, as my father, who also had prostate cancer, had been part of a clinical trial in 1998 when the method was just beginning to gain favor. In fact - as I recently discovered in going through my father's documents after he died in 2017 (NOT of prostate cancer) - Dr. Ellis had been one of my father's doctors!

After briefly considering radiation, Tom decided against it for a number of reasons. Most importantly, Tom wanted to know definitively what he was dealing with. Radiation destroys the prostate but doesn't remove it. This bothered Tom for a few reasons. One, he just didn't like the idea of "carrying around dead tissue." And two, without testing the organ itself, one can only guess at the pathology of the disease.

Surgery, on the other hand, provides the benefit of a definitive pathology report, as the organ is removed and tested. In addition, the major side effects of ANY treatment of prostate cancer - incontinence and erectile dysfunction - only get better over time after surgery, whereas with radiation, one is "waiting for the other shoe to drop," since these side effects tend to come on slowly after treatment.

So surgery it was. Back in December we made an appointment for Dr. Ellis to surgically remove Tom's prostate (a prostatectomy) on February 12th at the University of Washington, about an hour drive from our home in Gig Harbor. Our plan was to drive to Seattle the day before surgery and stay with Elisabeth and Danny, who live just a 4-minute LightRail ride from the University. In fact, this is Elisabeth's daily commute, as she works as a nurse anesthetist at the University, even occasionally working directly with Dr. Ellis in exactly this surgery!

It didn't occur to us for a second that the Seattle weather might hinder our plans. But when February 12th drew near, THIS is what we were dealing with.

Weather reports called for a very small window in which we could try to make our way to Seattle. We decided to drive to Bremerton and take the ferry to downtown Seattle rather than brave the freeways.

This photo was snapped during a very short window of decent weather - even a glimpse of blue sky!

We arrived safely at Elisabeth and Danny's house on Capitol Hill, but snow fell all night long - and then the rain came, making our short walk to LightRail treacherous, as we waded through slushy puddles.

Finally! What an adventure - and surgery hadn't even begun!

Elisabeth is a nurse anesthetist on the University of Washington surgical staff, so this was very familiar territory for her, which helped Tom tremendously, as he was given (or at least made to feel that he was given) VIP treatment by Elisabeth's co-workers.

Dr. Ellis came to talk to Tom, reminding him that his full expectation was that the cancer is contained to the prostate and that he would be able to spare those very important nerves. We knew, though, that this is only a "best guess" until the prostate is actually removed and tested, so our fingers remained crossed that everything would go well and that the outcome would be positive.

After Dr. Ellis left, the wonderful anesthetist, Chris gave Tom a dose of Versed, which...

...well, look at his face!

My guess is that Tom wasn't very nervous when he was wheeled back to surgery.

Tom's surgery lasted about four and a half hours, during which time Elisabeth gave me a glimpse of her work at UW. She was able to get a few updates from Chris, who said that Tom's status was "railroad tracks" - that is, completely stable and doing really well.

It's hard to kill almost five hours on a dreary snowy day in Seattle, but we did our best.

Once we heard that Tom was in recovery we made our way to see him. First Elisabeth because, she said, he "might not be ready..."

She was right. He looked... well, not himself.

The surgery finished at 5:30, but Tom was quite slow to wake up. He was still very sleep shortly before 8:00 PM!

I was provided a chair/bed in Tom's hospital room so I could stay with him overnight.

At about midnight, Tom's nurse mentioned that she'd be getting him up to walk soon, but said that it could wait until morning if he preferred. He suggested getting up to walk right then - and then had to walk five full laps around the floor. Such a show-off! I just wanted to go back to bed, but wasn't about to be the one to cut things short!

The next morning, he did it again. He was doing better than either of us had expected! And look at the fashion statement!

In order to facilitate healing, all men who undergo a prostatectomy are sent home with a catheter in place. Once we were instructed on how to care for the catheter for the next eight days, Tom was ready to head home! Or rather, to Elisabeth and Danny's, as our long, winding, snow-covered driveway at home would be impossible for him to navigate for at least another day or two.

Two days later, when we headed home, Tom navigated the driveway beautifully, helped by Elisabeth and our friend Courtney, and carrying his catheter bag in a bucket. I didn't get a photo of this, as I was reaching out to neighbors to try to find a place to park for a few days. Quite a few trees had come down while we were gone, including one across the pond!

Elisabeth stayed with us for the next four days, providing nursing expertise as needed. But Tom hardly needed her, as he was healing beautifully! He never touched the opioids that were prescribed for him, choosing instead a regimen of Ibuprofin and Tylenol. Within two days, he wasn't even taking those!

Tom said the most annoying part of his recovery was carrying his catheter around in a bucket - which we named "Uri"!

Eight days after his surgery, we headed back to UW for catheter removal and to hear the results of the definitive pathology report. We were absolutely thrilled at the results - all cancer confined to the prostate, no other tissue or organs involved. ALL GOOD!

It has now been a bit over three weeks since Tom's surgery and he is doing GREAT. I joked that I've needed to lock up the power tools, so ready is he to get to the many awaiting projects around the house. But he did get to one easier project that included no heavy lifting (which is forbidden for four to six weeks) - he refinished the two large butcher blocks in our kitchen.

It is often said that the goal of a prostatectomy is, in essence, three-fold: first, and most importantly, to remove all cancer. Second, to spare the patient from ongoing incontinence. And third, to spare him from resulting ED. The cancer is gone! And the other two side effects are already showing to be not much of an issue at all... and they will only get better over time.

There is no one gold standard for the treatment of prostate cancer. Each man needs to make the choice that is best for his circumstance. Tom and I are both thrilled with how this prostate cancer adventure has ended (though I should say that we aren't fully guaranteed that it is over forever; sometimes, many years later, it reappears), with the cancer eradicated and side effects not much of an issue at all. We consider ourselves (as it is a couples' disease) very fortunate!

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