Re: ROBOTIC PROSTECTOMY AND REATTACHED NERVE BUNDLES

[Guest guest]

Dr. Mark,

That sounds like me. Gleason 7, 7 out of 12 cores positive. No cancer outside the gland. Enlarged prostate made removal difficult, complicating nerve sparing. 20 months after the surgery the PSA remains undetectable. My bladder control is completely normal, but ED remains. I handle it with tri-mix injections. The discomfort from the injection is relatively minor, and with some stimulation, a firm erection occurs that lasts up to 90-plus minutes so intercourse can be relatively normal. I do slowly seem to be recovering normal functioning as I can get fairly firm erections with viagra, but not as good as with tri mix, and a weak erection without viagra, both improvements over, say, 9 months ago. Tell your friend to get onto viagra or cialis as soon as his urologist will allow. Also tri mix. See the Dr. Mulhall video on sexual recovery after prostate cancer surgery on the Memorial Sloan kettering website. He says getting started on these ASAP

makes recovery more likely. I started a bit late.

Mike

Subject: ROBOTIC PROSTECTOMY AND REATTACHED NERVE BUNDLESTo: ProstateCancerSupport Date: Monday, October 3, 2011, 3:13 PM

Hey Everyone,My close friend just got out of surgery and the surgeon said that thecancer (Gleason 7)(10 out of 12cores were positive) had not gone beyond the prostate. He said that the nerve bundles were reattached which I assume means that total nerve sparing was not possible.Anyone with post-op experience with nerves "reattached" and expected recovery results......continence and impotence?Thanks for whatever you can share.Mark------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other

members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it

[Guest guest]

Mark,Despite what the doctor said about the cancer not being out of the gland, the surgeon can not tell. If I had a dollar for everytime i hear this type of report I would be a rich man, I am not a rich man. All the surgeon can say is that there were no visible tumors or cells in the immediate vicinity of the gland. It is impossible for the surgeon to know that there are not cells that had already escaped and are either in the general area of the gland or even circulating through the body. This type of response from doctors Is irritating, dishonest and unhelpful. A man who is told this cam stop monitoring their PSA and get themselves into serious trouble. Always remember that no matter what primary treatment is chosen about 30% of men will experience a recurrence at some later date.Your friend must understand this and remember to continue monitoring his PSA until he dies from someother cause. This is not to say that your friend is in fact cured, but not knowing the truth, although comforting can cause serious consequences. T Nowak, M.A., M.S.W.Survivor of metastatic prostate, Melanoma, Thyroid & Renal CancersDirector of Advocacy & Advanced Prostate Cancer ProgramsMalecarewww.malecare.comwww.advancedprostatecancer.net

Hey Everyone,

My close friend just got out of surgery and the surgeon said that the

cancer (Gleason 7)(10 out of 12cores were positive) had not gone beyond the prostate. He said that the nerve bundles were reattached which I assume means that total nerve sparing was not possible.

Anyone with post-op experience with nerves "reattached" and expected recovery results......continence and impotence?

Thanks for whatever you can share.

Mark

[Guest guest]

Good point , and this is true even if the pathology report comes back indicating the lymph nodes appear clear. Micrometastesies (micromets) may have escaped through the system to come back and bite us at a later date.Mike

Hey Everyone,My close friend just got out of surgery and the surgeon said that thecancer (Gleason 7)(10 out of 12cores were positive) had not gone beyond the prostate. He said that the nerve bundles were reattached which I assume means that total nerve sparing was not possible.Anyone with post-op experience with nerves "reattached" and expected recovery results......continence and impotence?Thanks for whatever you can share.Mark

[Guest guest]

> Despite what the doctor said about the cancer not being out of

> the gland, the surgeon can not tell. If I had a dollar for

> everytime i hear this type of report I would be a rich man, I

> am not a rich man.

> All the surgeon can say is that there were no visible tumors or

> cells in the immediate vicinity of the gland. It is impossible

> for the surgeon to know that there are not cells that had

> already escaped and are either in the general area of the gland

> or even circulating through the body.

> This type of response from doctors Is irritating, dishonest and

> unhelpful. A man who is told this cam stop monitoring their

> PSA and get themselves into serious trouble. Always remember

> that no matter what primary treatment is chosen about 30% of

> men will experience a recurrence at some later date.

> Your friend must understand this and remember to continue

> monitoring his PSA until he dies from someother cause. This is

> not to say that your friend is in fact cured, but not knowing

> the truth, although comforting can cause serious consequences.

>

In the marvellous article posted on Terry Herbert's Yananow site:

http://www.yananow.org/MyersManagement.htm

Dr. " Snuffy " Myers, a leading expert on prostate cancer

wrote the following:

" ... we know that approximately 90% of men eligible for

radical prostatectomy have prostate cancer cells in their

bone marrow at the time of surgery! While the number of

cancer cells in the marrow decline in the year after surgery

and become undetectable in many, there is no assurance that

small nests of cancer cells do not remain in a dormant state

waiting to be activated at some future date. "

I don't want to alarm your friend. The odds are in his favor,

and if a pathologist did not detect cancer cells " on the margin "

of the excised prostate, that's definitely a good sign (better

than its opposite.) But as and Dr. Myers both say, it's not

any kind of guarantee that the surgeon " got it all " , as so many

surgeons like to say.

In fact, the pathologist's report isn't even a guarantee that

there is no cancer " on the margin " . The pathologists don't

examine every millimeter of the surface of the excised tissue and

couldn't do so without spending days at the microscope looking

over a single specimen. They give a rough and ready estimate

based on looking at samples of the tissue.

Doctors don't like to give patients bad news. They don't want to

alarm them when there may not be anything to be alarmed about.

But, like , I wish that some doctors were more circumspect

about the good news and would caution their patients to keep

getting PSA tests on some regular schedule, at least until they

are no longer in danger from a recurrence. They should also

continue to adhere to a healthy lifestyle with good diet and

exercise.

So I agree 100% with 's advice.

Alan

[Guest guest]

I accept that when a surgeon says he "got it all" he means that he removed all that could be seen, detected, felt, in the surgical area. He was as successful as a surgeon could be. I also accept that no surgeon will cover himself by reporting the information Dr. Myers offers in the post below. I also accept that those men who are "cured" have some small number of circulating tumor cells which are less aggressive, and a small enough mass to avoid growth in the less fertile area in which they find themselves. Thus, undetectable PSA.These comments from surgeons and oncologists are not conflicting. They represent differing circles, if you will, of knowledge and experience; the surgeon with his sensing and three dimensional experience inside the small area in the body of the patient, and the pathologist and oncologist with the intensive microscopic experience with tiny samples from anywhere in the body. > Despite what the doctor said about the cancer not being out of > the gland, the surgeon can not tell. If I had a dollar for > everytime i hear this type of report I would be a rich man, I > am not a rich man. > All the surgeon can say is that there were no visible tumors or > cells in the immediate vicinity of the gland. It is impossible > for the surgeon to know that there are not cells that had > already escaped and are either in the general area of the gland > or even circulating through the body. > This type of response from doctors Is irritating, dishonest and > unhelpful. A man who is told this cam stop monitoring their > PSA and get themselves into serious trouble. Always remember > that no matter what primary treatment is chosen about 30% of > men will experience a recurrence at some later date. > Your friend must understand this and remember to continue > monitoring his PSA until he dies from someother cause. This is > not to say that your friend is in fact cured, but not knowing > the truth, although comforting can cause serious consequences. > In the marvellous article posted on Terry Herbert's Yananow site: http://www.yananow.org/MyersManagement.htm Dr. "Snuffy" Myers, a leading expert on prostate cancer wrote the following: "... we know that approximately 90% of men eligible for radical prostatectomy have prostate cancer cells in their bone marrow at the time of surgery! While the number of cancer cells in the marrow decline in the year after surgery and become undetectable in many, there is no assurance that small nests of cancer cells do not remain in a dormant state waiting to be activated at some future date." I don't want to alarm your friend. The odds are in his favor, and if a pathologist did not detect cancer cells "on the margin" of the excised prostate, that's definitely a good sign (better than its opposite.) But as and Dr. Myers both say, it's not any kind of guarantee that the surgeon "got it all", as so many surgeons like to say. In fact, the pathologist's report isn't even a guarantee that there is no cancer "on the margin". The pathologists don't examine every millimeter of the surface of the excised tissue and couldn't do so without spending days at the microscope looking over a single specimen. They give a rough and ready estimate based on looking at samples of the tissue. Doctors don't like to give patients bad news. They don't want to alarm them when there may not be anything to be alarmed about. But, like , I wish that some doctors were more circumspect about the good news and would caution their patients to keep getting PSA tests on some regular schedule, at least until they are no longer in danger from a recurrence. They should also continue to adhere to a healthy lifestyle with good diet and exercise. So I agree 100% with 's advice. Alan

[Guest guest]

Well, I see it a little differently but maybe it is the same thing.

The 90% of prostatectomy patients having prostate cells in their bone marrow

statement is interesting, but is it born out by science. Dr. Meyers seems to be

quick on his pronouncements but is there any science behind them. Maybe, we just

don't know. Or do we?

And if the statement is true, isn't it also very likely that our immune system

will destroy those cells in short order. And since there is no longer a gland

pumping new out ones, then most of us will be free of prostate cancer cells.

I just have a hard time believing that 90% of prostatectomy patients survive for

decades with cancer cells hanging out in their body, waiting for the right

conditions to go viral.

[Guest guest]

Actually, Judah Foldman and Boston's childrens hospital did that exact same experiment on rodents with PCa and came up with the same results. He determined that the primary tumor exerted a chemical signal that told micorometastisis not to grow. But when the primay tumor was removed (the rat's prostate), those metastasis began growing. Unfortunately Folkman died a few years after conducting this research and I don't know who has taken his place. He did have a partner by the name of O'Neil eil I believe who is a pretty sharp guy himself. I think he's the same researcher who determined that there is a segment of the population that is immune from the HIV virus and that immunity had to do with their ancestors survival of the Black

Death back in the 1300's. He did extensive research in England going over ancient Church records in determining who survived and traced their decendents to those whom he discovered who although exposed to the HIV virus many times , never aquired the virus or it's antibodies.

I know I saved that article and another like it but the problem is trying to locate it in my files. BOB

----- Forwarded Message -----To: prostatecancersupport <prostatecancersupport >Sent: Thursday, October 6, 2011 5:08 PMSubject: RE: Re: ROBOTIC PROSTECTOMY AND REATTACHED NERVE BUNDLES

If we only knew ?? Many years ago on a documentary on breast cancer: the question was, If a doctor removed the breast and the cancer returned in about 10 years was it because he missed some of it. In a study it was determined that the cells away from the main tumor were held in check by an Anti-Angiogenesis chemical put out by the primary tumor, and when the primary tumor was removed they were no longer held in check(multiple metastasis) It has been my understanding that the same holds true for prostate cancer. But the mind set on tumors is complete removal. Halfway through my radiation treatment I wanted to stop with the idea that I didn't want to kill the tumor just kick it's ass enough to slow down it's growth while holding all the other cells in check. Of course the Radiation Doctor became unglued which upset my wife and me being in a castrate mode from Lupron just said Moooo an they did what they wanted. So I'll never know.Henry There is some work done on this approach :

About tumor-starving therapya tumor-starving (anti-angiogenic) therapy. It is not chemotherapy and works differently.The purpose is to block a protein called vascular endothelial growth factor, or VEGF. Normal cells produce VEGF, but cancer cells overproduce VEGF. Blocking VEGF may prevent the growth of new blood vessels that feed tumors.

To: ProstateCancerSupport From: djmarchand@...Date: Thu, 6 Oct 2011 17:41:28 +0000Subject: Re: ROBOTIC PROSTECTOMY AND REATTACHED NERVE BUNDLES

Well, I see it a little differently but maybe it is the same thing.The 90% of prostatectomy patients having prostate cells in their bone marrow statement is interesting, but is it born out by science. Dr. Meyers seems to be quick on his pronouncements but is there any science behind them. Maybe, we just don't know. Or do we?And if the statement is true, isn't it also very likely that our immune system will destroy those cells in short order. And since there is no longer a gland pumping new out ones, then most of us will be free of prostate cancer cells.I just have a hard time believing that 90% of prostatectomy patients survive for decades with cancer cells hanging out in their body, waiting for the right conditions to go viral.