Patients speak about prostate cancer and laparoscopic radical prostatectomy
Fred Hermann, MD, Cornelia, Georgia
October, 2003: my PSA prostate specific antigen increased from the previous year's 2.5 to 6.4 ng/ml. One of the diagnostic possibilities was acute or chronic prostatitis. But not necessarily.
Urologist Thomas Rickner, a friend and colleague, suggested a trial of antibiotic and a repeat study after 2 weeks. Levaquin 500 mg. was used and the repeat PSA was 9.9 with a free fraction of 7%. So much for acute or chronic prostatitis.
Exam by Thomas Fassuliottis MD, my personal urologist, revealed a 30-gm prostate with a 1.5 cm nodule on the right side. Three years earlier, his exam showed a 20 gm gland with that same nodule and biopsies x 6 had shown no tumor or PIN. Results of this year's biopsy were entirely different. On November 26, 2003 biopsy shows a Gleason score 7 tumor in 70% of the tissue from the right and 30% of the tissue from the left. A bone scan and CT scan with contrast showed no obvious extension or metastasis.
Dr. Fassuliottis recommended radical prostatectomy. He has done hundreds of these and his incidence of incontinence and impotence seem to reflect the national average. Other alternatives were discussed: cryotherapy, brachytherapy, but he was less sanguine toward brachytherapy, having seen several failures resulting in aggressive, radiation resistant tumors.
I called Les Yanamoto MD at Loma Linda and discussed proton treatment for prostate cancer but, while he assured me freedom from the typical radiation cystitis and proctitis, the long term success with proton beam therapy is not superior to prostate brachytherapy and requires almost 10 weeks for treatment completion.
I discussed radical prostatectomy with Dr. De Lani of Springfield, MA who my sister-in-law feels is an absolute wizard with very low complications at the prostate cancer treatment center there where she works as a physician assistant. Dr. De Lani agreed to do my prostate cancer surgery. Almost as an aside, he stated that the future surgical care of prostate cancer will be laparoscopic radical prostatectomy (LRP) but that few urologists in this country have the necessary skill to perform the procedure. My daughter, Lori, called on that same day saying that she had stumbled on a website extolling the virtues of LRP. She had emailed Dr. Krongrad and he had answered in less than 4 hours, offering to call me to discuss LRP and my particular situation.
Dr. Krongrad called me and a long discussion followed. He answered my questions about LRP and referred me to his website. After thoroughly exploring that site, I asked to be considered for LRP. My medical records were forwarded to him and an appointment for an exam in his office was scheduled for Dec 22. On that same day, I preregistered for surgery for Dec. 29 at Aventura Hospital and met with anesthesiology.
I arrived at Aventura Hospital and Medical Center at 6:00 AM Monday, Dec. 29. Mine was the first case and required about 3 hours to finish (I am morbidly obese, which increases the difficulty of prostate surgery procedures).
I was able to take clear liquids that afternoon in recovery and was transferred to 7th floor Med-Surg under the capable and cheerful care of Loris, Natalie, and Michelle. They saw to all my nursing needs. Dr. Krongrad saw me the following morning. He had reviewed the slides with the pathologist. The tumor was a Gleason score 7 and extended through the thickness of the capsule but did not involve the surrounding fat or the seminal vesicles. He had been able to preserve the left neurovascular bundle but had sacrificed the right to give a wide surgical margin around the nodule on that side as we had discussed prior to surgery. Dr. Krongrad thought it most likely that my PSA in 3 month's time would be zero.
I was discharged that same morning to my hotel on Miami Beach, the Casablanca.
At the Casablanca I had everything necessary: a great view of the ocean, a kitchenette, a tub for hot soaks, and great Cuban food at the hotel restaurant, Playa Toledo.
Our first day out of the hospital was a day of rest and clear liquids, waiting for a return of bowel activity. The blessed moment came at 12:31 AM on the second post op day and we celebrated with a full breakfast later that morning, followed by a walk on the beach and a wade in the surf. Aside from some fatigue and the constant irritation of the Foley catheter, I could not believe I was 2 days out from a radical prostatectomy.
The following day I enjoyed a swim in the surf and some laps in the hotel pool which was kept heated. I combed the beaches for shells and watched the great cruise liners come and go. My wife and I enjoyed sunrise over the Atlantic and the leisure to read the first 4 books of the Patrick O'Brian Aubrey/Maturin seagoing novels. I had my cell phone with me and took the opportunity to catch up with old friends.
Our departure date of Jan. 4 arrived all too quickly. Dr. Krongrad had called almost daily asking lots of questions to insure that all was well and there was really no medical need to remain in Miami. We began a slow drive up to our home in Georgia at the base of the Blue Ridge Mountains almost 1000 miles from Miami.
Of course, it's great to be home. But my experience with LRP in Miami seemed more like a vacation than a surgery. I had never enjoyed the post-op period with any of my previous surgeries. I have Dr. Krongrad to thank for that. Dr. Krongrad's skill in LRP may be unmatched in this country. I am truly grateful for the services received.
Many surgeons seeking an enviable complication statistic would hesitate to render care in my case. As I previously mentioned, I am morbidly obese with a BMI of 41 and am 61 years old. As a physician in family practice, I have suffered embarrassment advising patients to do as I say and not as I do. Every urologist I spoke to prior to my decision for LRP cautioned that my weight could easily compromise the recovery.
Certainly, the more tissue damage done in surgery, the more pain and immobility likely post-op. LRP helped to minimize the tissue damage, bleeding, and immobility, and thus reduced the post-op risks. Dr. Krongrad did insist that a stress echo and cardiologic clearance be given prior to LRP in my case as well as a complete blood and chemistry profile be done. But I can clearly understand that Dr. Krongrad is a physician whose motivation is the health and welfare of those people fortunate enough to be his patients. With this in mind, his statistics equal or better those of his cherry-picking colleagues.
I am now 8 weeks out from surgery. Urinary incontinence is minimal. Erectile function has yet to return but I remain hopeful for full function because the left bundle was preserved. I was able to return to work two weeks out from surgery part time, and full time work began upon removal of the Foley catheter, which was truly the worst part of the entire experience.
I have no reservations recommending Dr. Krongrad to my patients for whom radical prostatectomy is appropriate and have already done so. He and Ruth Krongrad, who manages the office, epitomize surgical care for those of us unfortunate enough to have prostate cancer.
Gratefully,
David F. Hermann, MD
