Prostate Surgery
 

I will be undergoing robotic prostate surgery next week, but would like to get back to racing by the end of June. I would appreciate hearing about the experiences of those who have gone through this procedure and gotten back to riding. I am told that it is important to stay off the bike for up to 8 weeks, but other forms of training will be ok.

Thanks,

Please let us know how it goes. Stuart Forbes is a true believer in the Da Vinci system:

"In August, Dr. Ashutosh Tewari, director of robotic prostatectomy at NewYork-Presbyterian Hospital/Weill Cornell, removed Forbes's walnut-size prostate and lymph nodes and reattached his bladder to his urethra without once putting his hands inside the patient. Using Intuitive Surgical's da Vinci robotic system and operating through five tiny incisions, Tewari conducted the entire procedure from across the room. He sat at a console and turned two knobs to remotely manipulate tiny surgical instruments attached to adjustable robotic arms. Forbes was walking within hours of his surgery and was discharged the next day. He compares the discomfort from the largest incision (about two inches long, and the only one to require stitches) to a bad pimple. By midweek he was walking three miles daily. In 10 days he was back at work. After three weeks he was playing golf again; by late October he'd regained normal urinary, and most sexual, function. "I'm about as excited as anyone can be about this procedure," he says."

Had a prostatectomy in June 2001 and 6 weeks later I sat on the saddle. I got off it very quickly. Had to buy a new saddle with the cutaway for the pelvic bone and at 8 weeks went for a 30 mile offroad ride. Next week sat on the bike and it was a new saddle again. I went through about a saddle a fortnight after that and finished up with my original saddle but a new and updated version.

If you can keep the body fit by other exercise you should be OK but watch out for the "Pain" when you do decide to sit on a saddle. 5 years on and the surgery has no effect on me but I am afraid that pelvic bone ache still comes on after about 4 hours on the bike. No more 2 day rides for me but I never liked them anyway. My view is that is a normal person can do it in 2 days- then a cyclist can do it in one.

Stapfam's experience is similar to mine except that my doctor wouldn't let me near an upright bicycle for 12 weeks. Like Stapfam, I could only ride 0.4 mile the first time that i got back on a bike. The second time was 0.8 mile. I worked up to 13 miles at about week 14 or so and then after that it wasn't too bad.

FWIW, I had a radical perineal prostatectomy and a cancer that required a large margin removal. Perhaps the robotic surgery is less damaging.

Good luck and best wishes.

I recently had robotic surgery. I was back on the bike at 3 weeks riding about 10 miles on the flats. Now at 5 weeks, I increased my distance but still do not have the strength I had before the surgery. Riding distance at the end of June may be ok but racing may be tough.

I had the traditional open surgery. Out of the hospital in 3 days. 3 weeks incontinence. Back riding in a couple of months. Still have 1-year follow-ups - Meanwhile OK.
Saddle issue - still haven't found a great saddle (4 years later). What was comfortable before the surgery became a pain post op.
Good luck and wishes for a full and fast recovery

Another finding the saddle a problem. Seems funny that the pain that arrives is definitely Bone pain and and yet it is tissue that is operated on. So Sallison- be warned. Start borrowing saddles now and I do suggest a slightly more upright position and a well cushioned saddle. Funny thing is that pre-op I had a Flite Titanium and post-op I eventually finished up with a Flite Gel flow that is an updated version of my original saddle.
Just to give heart- Psa Rating of "0" and I was signed off from hospital appointments last year as being clear.

Back to that saddle- Move around on it a lot and stand as much as possible. Most of my Rides take in steep hills and I finish at the top with a couple of gears left and out of the saddle pushing. Still Don't like sitting for 4 hours at a time. As to strength on the bike- could not push myself on the bike for 18 months- That magic "C" word gave me a reason to hold back. Then I set myself a target with only 6 months to get fit in. It was kill or cure. I am cured and back to full riding including the 12 hour rides offroad. Mind you after 8 hours in the saddle- everything went numb so could not feel any pain- In the legs- shoulders- back or the Butt.

I had robotic surgery on October 2, 2006. The projected hospital stay was 1-3 days. Due to some complications ( internal bleeding, infection at drain site, low O2 sat) I was there for 6 days. Catheter was removed after two weeks and I was told I could exercise but to stop if I felt pain. I tried to go to the gym 2-3 days a week but the abdominal incisions (there are 7) were slow to heal and I was limited by the pain and, to a lesser extent, by incontinence.

I took my first ride on a real bike on December 2, 2006. It was a very easy and flat 6 miles. I stopped often to rest. Due to the bad weather and abdominal soreness from overdoing some of the gym workouts, I didn't ride again until Jan 22, 2007. I went 12 miles on a single speed MTB with big soft tires. I felt good, stopped every 3 miles to rest and stood often.

For the rest of Jan. and Feb., I rode 12 miles 5 times and 18 miles once. I would have liked to have ridden more but the weather was very wet.

In March, I rode 20 miles on the 4th and all was well... just a little soreness. I stopped to rest every 3 miles. On March 6th, I rode the same 20 mile route and felt as though I didn't have the energy for the ride. I had some soreness in the saddle but continued on anyway. I stopped every 3 miles to rest. Because of some slight incontinence, I was wearing absorbent pads at this time and when I changed out of my riding clothes, there was some bleeding. I drank a lot of water to flush it out but there was a urinary blockage. I spent the evening in the emergency room having a catheter installed. My Urologist says that the blockage is probably due to scar tissue and NOT caused by the bike ride... just coincidental. This is also the opinion of all of the Doctors in the ER (been back several times). Needless to say, I am not riding now. When I can get back to it will be up th the Docs.

This has been my experience and you may have a different outcome. I just thought you might like to know what it was like for me. FWIW, I am 61 years old.

If I would offer any advice, it would be to ask questions about the type and intensity of exercise you want to engage in, and do what your Doctors say would be appropriate for you.

It looks like a lot depends on the complications encountered in the surgery. I'm 55. I had 5 small incisions that healed up pretty quickly. I was in the hospital for only 18 hours and had the catheter in for 2 weeks. That was the worst part of the whole thing. Didn't have any incontinence.

Right after it was removed I did a couple of long walks. I just got back from my 8th ride after surgery (5 weeks yesterday). The rides have been from 10-20 miles all fairly flat.

I bought a Planet Bike ARS saddle but never used it. It looked too cushy. So, I'm riding on my usual Terry Fly saddles.

Good luck and stay positive!

Had brachytheraphy (radioactive seed impants), no chemo, no external radiation, no cutting. Outpatient surgery. Three days after the procedure, drove 1,000 miles in 2 days. Off the bike for a full three weeks (tried it after 1 and then 2 weeks, but no go . . . even put a wadded up wool sock in shorts . . . Ouch!) then back to normal riding. No other saddle needed.
Lots of options out there! Back to riding 100+ miles a week.

So, excuse the thread bump, but I just had the needle biopsy today and (literally) will have to be on pins and needles for a week when I get the results. The urologist that I went to does the robotic surgery, but I hope it won't come to that.

I'm curious what PSA's and symptoms you folks had. My PSA is 1.9 and the prostate is firmer on one side than the other, with a tiny bump that my doctor noticed.

Good luck, stevesurf. Be sure to inquire about CyberKnife, DaVinci, and brachytherapy and try to get unbiased opinions from different doctors. (Understandably, a surgeon will not recommend radiation any more than a radiation oncologist will recommend surgery.)

My understanding of PSA readings is that velocity, or rate of change over time, is a more reliable marker than the absolute value.

Thanks so much; in that case, I increased about 1 percentage point per year (1.6 in 2006, 1.7 in 2007 and 1.9 in 2009) and I'm 50.

I also just found a very useful guide that contains a scoring method:

http://www.prostatecancerfoundation....-RTN-GUIDE.PDF

Sallison,
I have not had to go trhough any prostate issues, but do wish you the best of luck with both the surgery and the recovery.
Best regards

Barry, 62
New Jersey

uhhhh
 

uhhhh, ever hear of a bike with a lawn chair on it? They are called recumbents. They can go faster because of less wind resistance.
It will take 3 months to one year to develop the muscles for a recumbent. They are not all the same muscles used on a diamond frame, aka DF or wedgie.
The white beard is optional.

For whatever it may be worth, one of our local cutters has been training on a brand-new DaVinci and thinks it is a huge step forward. "Not quite night and day," he says, "but pretty (darn) close."

I had robotic surgery here in France a year ago. I have no idea what the process is called but it sounds rather like the DaVinci. They've been doing robotic prostrate surgery here for a very long time now. I was home 3 days after the surgery. On my bike less 3 weeks later but only for short rides but mostly because my legs were tired. Same saddle as before, a Selle Anatomica, zero problems at all with the saddle and riding.
Regarding the nuclear seeds and surgery, the explanation between the two that my surgeon gave me was that with surgery, if some cancer cells had already escaped the prostrate membrane and weren't removed during the surgery, they then follow-up with radiation therapy or something like that. The problem with the seeds is that they do not necessarily work on all the cancer cells yet there is no way of telling if that is the case or not. If for whatever reason the radiation didn't kill all the cancer, they are not able to then attack the remaining cells with surgery. I don't know why. Hence for me the choice was pretty clear, surgery first and then if needed, radiation, which hasn't been necessary. Also with the robotic surgery that I had, the prostrate is removed intact and then examined to see exactly how much cancer there was, where it was located, and what are the chances that some cells escaped.

Had a PSA of 16- and over here they get worried if it goes over 10. Biopsy showed Ca in all 6 tests That biopsy hurt as the prostate was very firm all over. Radical prostatectomy with a 12" incision- Think the surgeon must have had big hands.

Now 7 years later and Psa still at "0" but Good sign is that other than a bit of sorenesss after 4 hour rides- I have no problems.

Steve,
Good luck on the results. I have the same procedure set up for next week.

I'm surprised that this newer operation requires 3-days in the hospital. I had the older, more invasive surgery and I was out in about 30 hours. At the time ('98) I was not into biking, but I did have to lay off weight training for something like a month. However, in three months I was canoe tripping in Canada and portaging 120 lb loads for up to a mile and had paddling days covering up to 27 miles in zero current.

I probably started regular cycling about 2 years later and have never noticed any after-affects from the operation.

Interestingly, this new operation has the lowest rate of post-operation satisfaction. Here is an excerpt of an article.

Al

Regrets After Prostate Surgery

One in five men who undergoes prostate surgery to treat cancer later regrets the decision, a new study shows. And surprisingly, regret is highest among men who opt for robotic prostatectomy, a minimally invasive surgery that is growing in popularity as a treatment.

The research, published in the medical journal European Urology, is the latest to suggest that technological advances in prostate surgery haven’t necessarily translated to better results for the men on which it is performed. It also adds to growing concerns that men are being misled about the real risks and benefits of robotic surgical procedures used to treat prostate cancer.

Duke University researchers surveyed 400 men with early prostate cancer who had undergone either a traditional “open” surgical procedure or newer robotic surgery to remove the prostate. Overall, the vast majority of men were satisfied. However, 19 percent regretted their treatment choice. Notably, men who had undergone robotic surgery were four times more likely to regret their choice than men who had undergone the open procedure.

Researchers say the higher level of regret among robotic patients suggests that they had higher expectations for their recovery, possibly because the robotic procedure is widely touted as a more innovative surgery than traditional prostatectomy. Even among men who had the same scores on erectile function and other measures of post-surgery recovery, the robotic patients still reported a higher level of dissatisfaction and regret than other men.

Part of the problem may be that doctors who perform robotic prostatectomies commonly cite potency rates as high as 95 percent and above among their patients, giving patients an unrealistic view of life after surgery.

Biopsy
 

I had a prostate biopsy a couple of weeks ago because of a PSA reading of 5. My results were 11 samples clean and the 12th sample was "atypical." Doc says I'm okay for now but need another biopsy in 6 months.

By the way, as I sat waiting to go in for my biopsy I could hear the guy ahead of me having all sorts of trouble. He was grunting like a stuck pig. When my turn came I told the Doc that I was now very nervous. He said the guy ahead of me was unusual I should have no problems. Of course he was right but I was sweating it.

I've been reading Dr. Pat Walsh's book on Prostate Cancer and highly recommend it. You can get from Amazon.com

Good luck!

Great to hear you're doing well.

Many thanks; so here's what to expect on the needle biopsy:

Three days prior you're on an antibiotic like Levaquin; stay away from Aleve or Motrin; Tylenol is fine
Three hours prior you take an enema
The test goes really quick
Slight pinch when the anesthetic goes in, and then you don't feel anything
Ten samples are taken (it sounds like a staple gun but you don't feel anything)
There can be blood in stool, urine and ejaculate (ejaculate can have blood for even three weeks after)
Slight soreness for a few hours after; plan on getting a nice three to four hour nap after you eat something
Drink pleanty of water afterwards

Sounds like a big advance over 10 years ago. I don't think they used anesthetic then. Mine was painless until an hour after I got home. Then I got hit with the most severe pain I've ever felt. It put me on the floor.

I had a prescription pain killer left over from a shoulder operation the year previous. It took care of it, but it was tough going until it did. From what I've read recently and doctor claims aside, my experience is not unusual.

Al

How interesting this thread appears just before I go back to the doctor to review the latest PSA results. Last year I underwent a needle biopsy due to a 6. All samples came up negative and the doctor said he checked them carefully. So now I am on an annual testing schedule, this being the first after the biopsy.

I searched for the best thread, and I bumped it after my biopsy this week, which, thank God, I just got the results - negative.

The doctor still has to go over what he wants to do with the enlarged prostate, but I know the first thing to go is the Fizik Arione seat on the Bianchi. Next, I'm going to one of those Specialized Body Geometry Shops and try to figure this seating position stuff out. It makes sense that the seat could have contributed to it as most of the riding I've been doing for the past 1.5 years has been on that Fizik saddle.