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Old 07-18-2007, 02:36 AM   #1
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Three month post op visit with surgeon

Yesterday we did a three month visit with my surgeon by phone. He'd said earlier that if all was well a phonecall would be sufficient. We talked about how often to have PSA tests -- he said annually is sufficient. I was surprised at this but I'm okay with it. He also said no further followup was requirired but we'd talk again 13 months after surgery.

He inquired about urinary control; I replied that I'm pretty much 100% there. He asked about ED. I'm all D, no E. He said that at six months, if there's no improvement, I should get back in touch and inquire about drug therapy. I am participating in a double blind Viagra study.

We talked about bicycle riding and he said again that activity of any kind was not a problem. [I've been riding a recumbent for six weeks.] I've no soreness or discomfort of any kind.

All in all, the call was rather anticlimactic. [sp?] And, reassuring. Very nice.

I'd no idea what to expect. Is this similar to what you guys saw at a three month doctor visit?

 
Old 07-18-2007, 05:24 AM   #2
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Re: Three month post op visit with surgeon

Consult someone else.

This might be similar to what many found at a three month visit, but it's far from ideal.

Without knowing any details, some general observations are:

After surgery, PSA should be checked every 3 months.

Great that you have good urinary control, however you should have been working on ED well before now in various ways: (eg: exercises, Viagra, pump).

Forget about the double blind Viagra study, you should have been using Viagra before now to increase blood flow and help the healing process (if not specifically for sexual activity).

Sorry if this is not "reassuring and Very nice", however this is as I see it.

John

 
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Old 07-18-2007, 07:09 AM   #3
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Re: Three month post op visit with surgeon

As far as the PSA goes, my urologist recommended that after the 6 weeks post-op psa(assuming it is 0) he wanted it repeated every 6 months for 5 years...then go to once a year. I don't know if there is any specific standard for follow-up PSAs. Maybe once a year is sufficient. It would certainly decrease the anxiety (waiting for the result) to only once a year instead of every 3 or 6 months! Concerning the ED...I believe that most urologists are now starting some sort of "penile rehabilitation" (i.e. pills, shots, pumps, etc.) within the first few weeks after surgery. Apparently, the faster you get the blood flowing, the faster the return of function...at least that is the current theory.

 
Old 07-18-2007, 08:17 AM   #4
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Re: Three month post op visit with surgeon

Sounds a bit 'free-spirited' in approach to me too. following my 6 week post-op PSA, i go on a PSA every 3 months schedule for 2 years, then 6 months for x years.

my 3 mo. check up was face to face with the surgeon and primary RN. we covered, in this order, PSA at zero, continence (which was 98% at the time), and potency status (which was zero at the time and still is zero).

i am on Levitra 20mg 2x per week. they where not hesitant to suggest penile injections to 'kick start' the system now if i chose to do so. i am currently at the 4 mo. mark. i decided to give it 'til month 6.
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Last edited by jj1963; 07-18-2007 at 08:20 AM.

 
Old 07-18-2007, 10:49 AM   #5
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Re: Three month post op visit with surgeon

Another person here who is on the three month PSA schedule, though only the six weeks one has been performed, which was undetectable. Folks may vary, but I would feel more reassured with three month PSAs, at least at first, with that compensating for the anxiety accompanying the testing at such frequent intervals.

 
Old 07-18-2007, 11:40 AM   #6
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Re: Three month post op visit with surgeon

I'm 2 years post-RRP (as of next week) and I've been on a 6 month PSA schedule. Of course my PSA was only 4.6 before surgery with clear margins, no lymph node removal, both nerves spared and post-op confirmed Gleason 3+3.

Uro gave me a prescription for Cialis 'as needed' and I took it a little but didn't like the nasal congestion which made my snoring much worse. My E is now greater than my D; it takes a little longer for full arousal but fantasy and soft-core porn fiction (stories, not movies) does the trick just fine. I'm now 4 months away from turning 51, BTW.
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Old 07-22-2007, 03:18 PM   #7
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Re: Three month post op visit with surgeon

Hi CRS
You and I posted together about bike riding and I was impressed with your recumbent suggestions.

I am at six months post DaVinci surgery.

I am "shocked" by the lack of attention your urologist has shown. You have been given some very good advice by the people on this forum. I suspect your doctor was happy to hear your report of few urinary difficulties and your ability to get out on your bicycle that he minimized your erectile problems.

I have been on intense therapy with vacuum pumps, Viagra and all the rest, with no good results. I am beginning injection therapy next week. I hope that it will work.

If you have a good urologist, he will be working with you to get everything working right, and not wait to see what happens. I suggest that you talk face to face and discuss the ED problems. If he doesen't give you good answers you might try to find a more proactive doctor.

Even doctors can be lazy, we need to make sure they do their job.

Let us know if things are "looking up"...so to speak.

 
Old 07-22-2007, 04:21 PM   #8
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Re: Three month post op visit with surgeon

leftcoaster,

my doc has said all along that erectile function should return for me beginning at around 6 months. i am showing some signs of life quicker, just no real erections. the doc said he'd prescribe now if i wanted. [they told me this before at JH -- get in touch if i wanted to go that route.] but because i'm seeing some signs of life down there and because i'd like to minimize my drug intake, i've decided to see what happens in the coming weeks. if the slow return of action doesn't progress as fast i expect, i'll likey see my urodoc again and perhaps get a prescription for something, as he suggested. but since i'm making noticeable progress, i want to minimize my drug intake for now.

i'm quite pleased with my doc and with the care i received at johns hopkins. often in this forum i have perhaps oversimplified my description of the care and advice i've gotten there. i think the docs and staff there have been quite rigorous.

regarding PSA -- i'm of course continuing my regular physicals which include a PSA test. i also discuss all this with my GP -- who has been a great source of help and info for me on this.

 
Old 07-22-2007, 04:30 PM   #9
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Re: Three month post op visit with surgeon

left coaster -- i forgot to ask: are you back on regular upright bikes now, without discomfort? i've not even tried my uprights since i got the recumbent, but i feel i could likely ride without discomfort. but i like the recumbent.

 
Old 07-22-2007, 07:18 PM   #10
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Re: Three month post op visit with surgeon

from what I have read. PSA at 6 wks and then every 3 months the frst year (minimum) is not uncommon and generally a good idea.

I suppose depending on what any PSA test you have had to date, that could be relaxed a bit but I would still prefer at least 6 month intervals after initial 6 weeks test.

I did know a guy that had an initial lowering for a few months that did climb to greater than pre-op levels after that. He then had radiotherapy and has since had low PSA (at least a year post radiotherepy at this time).

Better too often than not often enough, expecially right after surgery. That is when you wnat to toss in the adjunct radiotherapy if indicated. Not wait until things have progressed at all.
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Old 07-23-2007, 06:14 AM   #11
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Re: Three month post op visit with surgeon

One thing that may be of significance is whether the follow-up is with the surgeon or with a urologist who may do surgery but who does not specialize. Surgeons operate and may have less interest in the follow-up. For example, a surgeon I initially considered fired me when I decided to have the surgery with another doctor (I had planned to follow-up with him since the surgery was not in my city).
If my surgeon said annual checks on PSA were sufficient, I would not accept that though others may be comfortable with that. Also, it would be possible to schedule additional PSA tests with your regular doctor if you wanted to remain in contact with your surgeon. Either way, one of the important things to consider is that there are two things being treated in the follow-up. One is the cancer, the other is our own anxiety. If annual PSA testing meets the urologist's reasoned opinion for the former, but does not meet our need to deal with the latter, we just have to be assertive and get it done!

 
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