Patient History

The patient is a 55-year old white male with a history of diabetes, primary biliary cirrhosis, and prostate cancer. (1) He has a history of vasectomy and is taking glipizide, methotrexate, colchicine, and ursodiol. The patient runs his own computer data management company and is married. (2)

The patient had a biopsy one year earlier that was negative. When his PSA rose to 6.6 ng/m, he was re-biopsied and found to have two cores with Gleason 6 adenocarcinoma on the right. The physical exam had been benign, i.e. clinical stage T1c.

After numerous discussions, including a thorough review of the situation with his hepatologist about primary biliary cirrhosis and anesthesia and surgical risk, the patient chose a laparoscopic radical prostatectomy. (3,4)

The pre-operative labs were fine with the exception of mildly elevated liver function tests. He had received a mechanical bowel prep the day before surgery and was premedicated with antibiotics and LMW heparin.

The patient was perfectly stable through anesthesia, the blood loss was 200 cc., and his post-operative hematocrit was 38. The specimen came out anatomically correct and I was able to spare the neurovascular bundle on his left.

The pathologic examination showed a 42-gram specimen with a Gleason 6 adenocarcinoma that did not involve the seminal vesicles, bladder neck, or urethral margin; the surgical margins and capsule were free of tumor. Given this pathology report and based primarily on one of our studies, I would estimate the patient's 10-year disease-specific survival probability at more than 97%. (5)

The patient left the operating room with Band-Aid dots for dressings. He began to drink clear liquids within 2 hours of anesthesia and was sitting in a chair eating crackers and drinking juice within 5 hours of anesthesia. On being asked about pain, he replied that he felt like he had pulled a muscle in his abdomen. He got no analgesia after surgery and was discharged home with a Foley catheter 16 hours after surgery ended.

The patient resumed contact with his clients and was doing some computer work at home one day after discharge. I had placed no physical restrictions on him and, in less than 4 days after his radical prostatectomy, he was out shopping for a car.

The Foley catheter was removed 10 days post-op and he received Septra DS for 3 days and some Urimax to reduce urethral irritation. According to our phone conversations since then, he has been having erections and is continent. It sounds like he is actively pursuing his usual business. A serum PSA drawn at your office May 24, 2000 was <0.1 ng/mL.

References

1. Krongrad A, Lai H, Lai S: Competing risks of mortality in prostate cancer. J Urol 158:865-868, 1997.
2. Krongrad A, Lai H, Burke MA, Goodkin K, Lai S: Marriage and mortality in prostate cancer. J Urol 156:1696-1700, 1996.
3. Krongrad A: Laparoscopic radical prostatectomy. Curr Urol Rep 1:37-41, 2000.
4. Guillonneau B, Krongrad A, Vallancien G: Laparoscopic radical prostatectomy: a technical manual. Private publication. 2000.
5. Guillonneau B, Krongrad A, Vallancien G: Laparoscopic radical prostatectomy: a technical manual. Private publication. 2000.