Biochemical Recurrence

[cajun1949]

So the biochemical recurrence has me worried. I'm 14 years since my initial radical prostatectomy. PSA levels have been rising for 3 years. My question is at what point should my Urologist suggest for me to see oncologist? I'm not putting numbers, I've read so many conflicting suggestions online. I will say my initial diagnosis was made at age 53 ( now 67, going to be 68 May 27th) Gleason score of 7, and PSA 5.2, and Cancer stage T2c. So being curious as I am would like some input on this.

Also I've had leakage since after surgery. Started with one pad, sometimes two a day. I could live with that. Started leaking more 2 to 3 pads a day everyday. Had cysto on 4/7/15 and found scar tissue, had surgery to remove on 4/22/15. wore catheter for 2 weeks and leakage was worse, 6 to 7 pads a day. another cysto on 11/10/15 reviled more scar tissue. Back to surgery on 11/17/15, which they found a staple left from initial surgery, it was removed.

More about that staple.... I went to the hospital and ask for the OR report to find out exactly what had transpired. Actual dictation.

" Upon entrance in the bladder neck area he was noted to have a foreign body present. I was able to grab it and remove it without difficulty. It was apparently a clip from his surgery that eroded into the bladder neck region probably due to his prior laser of his bladder neck. The patient tolerated the procedure well, had to compilations. Again, his bladder neck was open. This may have why I was unable to scope him in the office."

I'm using 3 to 4 pads a day fully soaked, sometimes leaks through and I have wet jeans. I've learned years ago that if I wear really tight undies putting the extra pressure it lessons the leaking. I walk a lot and watch what I drink and still it leaks. I went to a festival yesterday (live in Louisiana and we have festivals all the time) and have to bring a back pack with extra pads. My Uro wants to implant the AMS 800 Urinary Control System. My worries are that I'll still have to wear pads and have this foreign object implanted and still have recurrent urine leakage. Anyone had this done? and how did it work for you?

And don't even get me started on my sexual problems!

Any advice would be appreciated!

[JoelT]

You have thrown a lot on the table. You have asked about recurrence, incontinence and you have mentioned sexual issues.

As far as a recurrence, you have not supplied any numbers for the PSA rises. Please give us your numbers from the first PSA test you had post surgery to the most recent. Without knowing these numbers it is hard to be specific, however usually three years of rises indicates there might be reason for concern. Please share your numbers. Also, has your urologist had any other tests performed including a DRE? Let us know.

Did you discuss with the urologist anything about this clip? Is your current Urologist the doctor who did the surgery? Have you had a second opinion?

There is never a guarantee that any of the implants will totally resolve the incontinence. Often, it does, but it can also just help somewhat to nor at all. If the problem you are having significantly interferes with your life you should seriously consider doing something about it.

There are a number of things you might consider doing:

Doing Kegel exercises cam help strengthen your bladder muscles. These exercises involve tensing and relaxing certain pelvic muscles.

Using a catheter to collect urine may help. One option sometimes used is using a rubber sheath called a condom catheter that can be put over the penis to collect urine in a bag. Sometimes it is worth considering learning to use self-catheterization yourself to drain and empty the bladder at regular times. Most men can learn this safe and usually painless technique.

Compression (pressure) devices can be placed on the penis for short periods of time to help keep urine from coming out.

There are medicines to help the muscles of the bladder and the muscles that control urine flow. Most of these medicines affect either the muscles or the nerves that control them. These medicines work best for urge incontinence.

Surgical implants of a sling or an artificial sphincter may be used to correct incontinence.

Material such as collagen may be injected to tighten the muscle that controls urine flow.

Neuro-muscular electrical stimulation can help. This treatment is used to retrain and strengthen weak urinary muscles and improve bladder control. FIY – To perform this treatment there is a probe inserted into the anus and then a current is passed through the probe at a level below the pain threshold, causing a contraction. The patient is instructed to squeeze the muscles along with the current. After the contraction, the current is switched off.

However, none of these can guarantee a perfect solution.

You do need to talk to a few different urologists and surgeons to learn about the pros and cons of each option before you do make a decision. Take your time and learn as much as you can.

Joel

[Johnstonearch]

Fire your Urologist and find a new one along with a medical oncologist. Never just rely on a surgeon when dealing with Pca. You MUST have the information that oncology can bring to the table.

[JohnVonhof]

I may be uneducated on some of these things, but I have always said that if my PSA rises and indicates a recurrence of cancer, I have a cancer problem, not a urology problem - and I would want to talk to an oncologist.

[rhbishop2]

I had a similar problem. Initially after surgery and radiation I had a stricture. Sorting that out led to the opposite, requiring me to use a receptacle and a bag. Finally I had an AUS fitted and although I still need a pad, usually one a day, life is almost back to normal. Unfortunately the cancer is still there, held in check by ADT.

[bdbarrett]

My husband had both urge incontinence and stress incontinence and got an AUS 3 years ago + Botox shots in bladder every 5-6 months. It has been wonderful for him. Life changing. No leaking.