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searching for the right procedure for me.

8 years 1 month ago #39033 by RBH
I had a similarly diagnosed bladder cancer, same stage. I had the bladder, prostate, seminal vesicles, and a bunch of lymph nodes removed, the surgery following 8 rounds of 4-drug chemo. The surgeon installed an ileal conduit to a stoma in my belly. My robotic surgery was at the James Cancer Center at the Ohio State University.

To directly address the prostate question, in the post-surgery pathology exam it turned out I also had prostate cancer, while the lymph stuff was cancer-free. So taking my prostate was a good move for me. My experience may not directly transfer to your situation, since I didn't know about the prostate cancer until later.

I chose the ileal conduit and pouch system because from what I was able to find out in reading, acquiring control of a neo-bladder is not infrequently problematic, and at age 70 I'm not planning on going down to the beach in a Speedo to show off my abs any more. :)

Cosmetically my pouch is virtually unnoticeable. In the summer I normally wear t-shirts and still one has to look pretty close to see the top part of the pouch above my belt line.

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8 years 2 months ago #38725 by mmc
You may find this link useful. This is the discussion thread from a couple of years ago when I was asking a similar question about which diversion to get: To neo or not to neo--that is my question

On the prostate, they are going to take it. Too high risk of spread to prostate so it just goes. Get a surgeon with high volume on surgeries for your choice of diversions and also with a high success rate on nerve sparing surgery for the prostate removal part. That way, even without the prostate, erection and orgasm are still possible, although it can take some time for the erection functions to return.

Mike

Age 54
10/31/06 dx CIS (TisG3) non-invasive (at 47)
9/19/08 TURB/TUIP dx Invasive T2G3
10/8/08 RC neobladder(at 49)
2/15/13 T4G3N3M1 distant metastases(at 53)
9/2013 finished chemo -cancer free again
1/2014 ct scan results....distant mets
2/2014 ct result...spread to liver, kidneys, and lymph...

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8 years 2 months ago #38711 by BillM
efoster,

I had the same question about the prostate. I was told grade 3 tumors like to keep releasing cells or micro mets for survival. Between age and mets, G3 statistically comes back in the prostate sooner as you get older. My doctor told me that sometimes if you’re 30ish and pushy enough, the prostate avoids the knife, but very rarely. For men they should call the surgery what it really is, radical cystoprostatectomy.

I’m guessing 2/3 is T2G3? After you have a surgeon picked out, ask about diversions. The neo was my choice and things have worked out pretty well. Because of where the tumor was, there was a chance the urethra could have been too damaged and the Indiana pouch was the second choice followed by the bag.

Bill

5.24.10 Final staging T2G3 7.28.10 Started Gemcitabine, Cisplatin neoadjunctive chemotherapy
11.2.10 RC with NEO 11.18.11 First year CT shows possible liver tumor
12.8.11 Confirmation of TCC BC mets to the liver 6.27.12 Final round of Dose Dense MVAC
7.26.12 Final scans showed no tumor or no...

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8 years 2 months ago #38638 by Patricia
Hi efoster...i believe we conversed last night in the chat room. I'm glad you're going to MD Anderson and i think we gave you the names of Grossman, Dinney, and Kamat.....all excellent. And they also have the ability to do all 3 of the diversions. If your local uro can only do an ileal he probably doesn't get the volume of cancer patients that MD Anderson does and you really want someone with lots of experience with bladder cancer and nerve sparing. They do seem to take a lot out don't they? The prostate is removed as it is close enough for those pesky little cells to invade there also. With a female we get a hysterectomy, ovaries, fallopian tubes, part of the vagina, the urethra in thos e with an Indiana Pouch and for an extra bonus some take the appendix since they're in there! You want a team that also removes all the correct nodes...some quantity but mostly quality!!
As for the diversion that will suit you as long as the tumor is not near the urethra you will have a choice. Here's a paper from Cleveland Clinic with a pretty good explanation of the 3 types of diversions.
http://my.clevelandclinic.org/services/urinary_reconstruction_and_diversion/hic_urinary_reconstruction_and_diversion.aspx
where are you located?
pat

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8 years 2 months ago #38637 by efoster4242
Hello everyone. I have stage 2/3 bladder cancer and they tell me I have to have my bladder removed along with the prostate. The tumor is located in the bladder only at this point so one question I have is why take the prostate. They can remove the prostate without taking the bladder so why not the other way around? I was wondering if any of you that have had this surgery can tell me what the problems I will face with each type of diversion. The most common seems to be the pouch on the outside. I would prefer the neo-bladder for cosmetic reasons of course, but don't know if I am inviting more problems than it is worth. I am going to MD Anderson on Aug 2 and will be looking for the best doctor to do my procedure. I also have an appt. with what appears to be a good doctor here that does only the pouch on the outside. Any help would be appreciated.

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