Prostates, modesty, and other things-part one

A few of you readers know that I had an operation this summer. In the Spring, I found an elevated blood level of something known as prostate specific antigen (PSA). I have measured this for some years, and this time it was above normal by about twice the level of last year. So, it was time to investigate. I went from my family doc to a nice German Urologist in a nearby city. The upshot of that was that a biopsy was done at eight points in my prostate. By that time, I had been investigated with a repeat PSA that was still elevated and a DRE (digital rectal exam) commonly known as a "finger wave". The biopsy showed that I had PC (prostatic cancer). I should say that way back in my training years I had spent three nice months on the urology service in Memphis. I enjoyed urology because I had some mighty good staff men who let me do a lot. Prostatic cancer (PC) is a common thing in older men, so I never really felt the shock that people feel with the word "cancer". There are various ways to treat PC. Surgery, radiation, hormone therapy, what is called active surveillance, and sometimes a combination of these and other modalities. It has been said that all men will get PC if they live long enough but few will die from it.

It so happened that an old partner of mine has a son who is an urologist in the USA. We had been together earlier in the year when I was in the USA, and he had related that the son was doing a new procedure on the prostate using robotics. Now my experience doing open prostatectomies in past years had led me to believe that open prostatectomies were brutal and bloody. The fact that robotics had taken all that away was interesting, and it became even more interesting when I found out that I had PC. The doctors all went over my treatment options with me, but I knew that the robotic way was going to be what I wanted. The mentality of a surgeon is to cut it out, if it is cancer. Enter here the Internet. An unbelievable amount of information is available about PC there, and I began to research robotic assisted laproscopic prostatectomies (RALP). I also decided that I would feel more at home in a Swiss hospital than back in the USA, so I went on the hunt for one close to me. A little less than a year before I got the diagnosis, the Luzernerkantonsspital in Luzern had added a new man to their urology staff who was trained in RALP. I checked him and his credentials out on the Internet and even read some of his papers which he had published. He looked like the guy for me, so the local urologist called and set me up with an appointment with this doctor. Dr. Mattei turned out to be a super nice guy who answered most of my questions before I could ask them. He didn't mind telling me the straight scoop about his training, number of procedures done, good and not so good points about the operation, etc.

I signed on to meet the robot with him as soon as it could be done. That turned out to be a good 5 weeks later. The interval is needed because after biopsies are done, the prostate must return to normal before the robotic surgery can be done safely. The month of June and first week of July went slowly, but the time gave me a chance to study more on what was going to happen. I found some well done podcasts on the Internet to watch the operation, and I read about patients that had had this done. The RALP is truly a fascinating method of removing a prostate and its associated structures. The patient is under anesthesia on an operating table. The robotic machine is fixed in position over him, five or six arms of the robot are inserted into the abdomen through small openings (band aid size), and the surgeon sits across the room at a computer console. The surgeon uses movements with two fingers of each hand to manipulate the arms of the robot. The computer dampens down his movements so they are far more precise that with a human hand. The whole thing is seen through a 3-D camera with a great light source and 10x magnification. Watch a podcast if you want to see more. After the surgery, a catheter remains in the bladder for 3-4 days, but the patient often leaves the hospital the next day. Two or three ounces of blood loss is the average opposed to 8-10 times that with open prostatectomies.

When the big day on 8 July arrived, I was more than ready. The Luzern hospital is less than 30 minutes drive from home, so we were there in plenty of time on the day of admission. More will follow.