Why Choose Dr. Gholami
Prostate Cancer Facts
You have been diagnosed with prostate cancer. We want to restore your health so that you can move forward without every having to worry about prostate cancer. Contact Dr. Gholami if he can answer any lingering questions or concerns you may have. Take comfort in the fact that you are not alone. We are dedicated to helping you to ease your concerns and move forward. Some information you should know:
Prostate cancer strikes 1 in 6 men in their lifetime About a quarter million people are diagnosed with prostate cancer each year in the U.S. Survival rates are over 90% for those diagnosed and treated early Early recovery of continence and potency is possible with advanced robotic surgery.
What Treatment Option is Right For You?
The type of treatment that is appropriate for you is based on a number of factors:
- Number of Positive Biopsies
- Stage of prostate cancer
- Current state of health and age
- Personal preferences
- Side effects of the different treatment options
The removal of the prostate (prostatectomy) is the most common prostate cancer treatment for early-stage localized cancer in the United States. Prostatectomy insures the highest rate of cure and removes the entire prostate and cancer from your body. California Prostate Cancer Institute (PCI) offers the most advanced treatment options. At California PCI, Dr. Gholami uses the state of the art da Vinci Robot to cure prostate disease. The da Vinci prostatectomy offers tremendous benefits over open surgical procedures and in the hands of Dr. Gholami, you can be assured you have one of the world’s best surgeons treating you. Since 2000, Dr. Gholami has been performing laparoscopic/robotic surgery offering patients compassionate care and state-of-art techniques to ensure excellent outcomes. You can be assured that your surgery will be done in a private environment with Dr. Gholami doing the entire procedure without the use of residents or fellows.
To see if you are a candidate for robotic prostatectomy, Contact Dr. Gholami.
Prostate Cancer Treatment Options
From Watchful Waiting to Prostatectomy
The treatment of prostate cancer can range from watchful waiting to removal of the prostate. Several factors influence the treatment option that is most appropriate for you. The appropriate treatment option is based on your age, your general health, PSA, grade of cancer (how aggressive the cancer cells are), stage of cancer (how far it has spread), number of positive biopsies, and percentage of each biopsy filled with cancer. The treatment options include:
- Watchful Waiting
- Phytotherapy (Vitamins, Minerals, Diet)
- Hormone Therapy ( Chemical Castration)
- HIFU (High Intensity Focus Ultrasound) Therapy
- Radiation Therapy
- Intensity Modulated Radiation Therapy ( CT Guided, Cyber Knife)
- Proton Therapy
- Cryotherapy (Seeds- permanent and temporary)
- Robotic Prostatectomy ( da Vinci)
- Open Surgery (Old Fashioned)
All options besides surgery leaves the prostate cancer within the body and treats the cancer while the prostate stays in the body. Selecting which option is right for you is a difficult task. Contact Dr. Gholami if you need help or further information to make this process easier. If surgery is right for you, the robotic prostectomy is right for you. Robotic surgery in the expert hands of Dr. Gholami will give you the best chances of resuming your normal life without cancer.
Why Robotic Prostatectomy May Be Right For You?
Robotic assisted laparoscopic surgery using the da Vinci® Surgical System has revolutionized prostate cancer therapy. Robotic prostatectomy has many short and long term benefits for patients through the use of high definition 3-Dimensional optics and enhanced precision.
What are the benefits of da Vinci® Robotic prostatectomy?
- Quicker return to normal activity
- Reduced pain – most patients don’t even need narcotics after surgery
- Shorter hospitalization – most go home the next day
- Reduced risk of urinary or sexual problems
- Virtually no blood loss
- Fewer complications
- Less scarring than traditional open surgery
- Less risk of infection
Why is Robotic prostatectomy preferred over brachytherapy (seeds)?
- No risk of getting future cancers with surgery. Radiation increases one’s risk for future new cancers.
- Fewer complications. Seeds are associated with intestinal problems and bladder bleeding.
- Reduced risk of sexual problems. Radiation can kill the nerves responsible for erections. Advanced robotic surgery can preserve these nerves.
- Less risk of urinary problems. With time, radiation can damage the bladder and sphincter causing increased urinary frequency and difficulty voiding.
A Change in Patient Perception
Screening for prostate cancer has led to increased public awareness and early detection, as well as a decline in mortality rates. Robotic radical prostatectomy (robotic-assisted laparoscopic removal of the prostate gland) is also a contributing factor to these encouraging trends. This state-of-the-art surgical procedure can offer the best chance for complete recovery. Wristed instrumentation, tremor filtration and 3D magnification aid the surgeon in performing one of the most demanding aspects of the procedure – nerve-sparing for preservation of post-operative sexual function and urinary control. Along with cancer control, these are key elements in follow-up for patients undergoing treatment.
Are You Right for Robotic Prostatectomy?
Are you interested in the best chances for cure while maintaining normal sexual and urinary functions. The da Vinci robotic prostatectomy gives patients the best chances of cure while minimizing any urinary or sexual issues. In our expert hands, you can be assured that you have the best chances for complete recovery.
You Can Resume Your Normal Life As Soon as 2 Weeks After Robotic Prostatectomy
Sex Beyond Prostate Cancer Therapy
Although the first goal of prostate cancer therapy is to rid the body of all cancer, the ability to resume a normal life after prostate surgery is another equally important issue. The possibility of sexual problems, or impotence, after prostate surgery is a real concern, as the nerves that control urinary and sexual function and are intimately associated with and attached to the prostate. With conventional surgery and prostate radiation, these nerves are often damaged as they are fragile and difficult to protect. Using the da Vinci® robotic system in the expert and experienced hands, allows Dr. Gholami to more accurately identify and preserve the vital nerve structures needed for normal sexual and urinary function. The 3-dimensional, high definintion optics of the DaVinci system allows Dr. Gholami to distinguish the cancerous tissues surrounding the prostate from non-cancerous vital tissues around the prostate to ensure cure for the patient. This advanced west coast technique has allowed for a dramatic decrease in postoperative problems. After surgery, patients are placed on an extensive rehabilitation program to minimize the time to return to a normal life.
After robotic prostate surgery:
You will start on Cialis or Levitra or Viagra 1 week after surgery when your catheter is removed. You can resume sexual activity starting one week after surgery. We recommend having sexual intercourse at least 2 times a week to encourage good penile muscle function and performance. If your erections are not perfect by 6 weeks after surgery, Dr. Gholami will start treatment with stronger medications to ensure normal strong erections. Sexual activity and strong erections are encouraged immediately after surgery to ensure the quickest return to normal function. Although there is no ejaculation, the sensation of climax or orgasm is unchanged. Normal sexual function returns as quickly as a few days after surgery and can improve up to years after the procedure. If you have questions about sexual problems or the da Vinci Robotic Prostatectomy, contact Dr. Gholami.
Urinary Control After Prostate Surgery
Accidental urinary loss or incontinence after prostate surgery is a common concern of patients facing prostate cancer surgery. Robotic prostatectomy, fortunately, minimizes the risk of incontinence. Patients who have robotic prostate surgery regain total bladder control more quickly and completely when compared to open prostatectomy. Review of our data dating back to 2001 has demonstrated an incontinence rate of less than 1%. This is due to the expertise of Dr. Gholami in addition to the excellent optics and dexterity of the DaVinci Robotic system. Recovery of urinary control after prostate surgery varies from a few days after surgery to 3 months after surgery. This recovery is unique to each patient and is dependent on each individuals ability to heal. Long-term urinary control problems are extremely rare after robotic surgery.
After Robotic Surgery Urine Function, Control and Incontinence
A catheter will be inserted during surgery. Four to ten days after prostate surgery you will return to Dr. Gholami’s office to have the catheter removed. Bring a protective pad with you. (This is compared to an average of 14-21 days with a catheter after traditional radical prostatectomy.) Upon removal of the catheter, you will need to retrain the muscles that control the flow of urine. Be sure to urinate every three hours when you’re awake to retrain your bladder and as soon as you feel the urge. Walking and Kegel exercises will help strengthen the pelvic floor muscles. Approximately, 300 Kegel exercises a day are recommended until total bladder control is achieved. Kegel muscle exercises are done by stopping your urinary stream/flow or trying to lift your penis up and down. Many patients are dry and do not need pads one week following surgery. However, you may want to wear a bladder control pad in the initial post-operative period to deal with temporary incontinence after prostate surgery. When you begin to regain continence, you will typically remain dry throughout the night at first. The second phase encompasses night and early morning control. Finally, you will remain dry night and day. Drink plenty of water as adequate fluid intake will assist in optimum bladder health. Urinary function also improves for up to two years after prostate surgery. Please remember that overcoming incontinence after prostate surgery will vary from one man to the next. Do your exercises, be patient, and be sure to contact us if you have any questions or concerns about radical prostatectomy incontinence and your progress. At the Northern California Prostate Center, post-operative care and patient satisfaction are critical components of the treatment process.
Recovery Time after Prostate Surgery
What to Expect?
Recovery time is much shorter after robotic prostate surgery as compared to that of traditional open prostatectomy or non-robotic laparoscopic prostatectomy. The overall recovery time from a prostate surgery varies from one man to the next; however, here are some typical recovery times of patients who have elected to have a DaVinci Prostatectomy. Time in hospital: Nearly all patients go home within 24-hours of surgery compared to a typical three day stay for traditional open prostatectomy Catherization: All patients are able to have their catheter removed within 4-10 days after surgery Return to work: The majority of our patients are back to normal daily activities within 1-2 weeks. Men with jobs that require heavy lifting will need to be on light duties for 4-6 weeks Urine control: Nearly all patients regain full bladder control within 1-3 months. Activities: Walking and Kegel exercises are recommended to help speed up the recovery process. This regular but gentle form of exercise will strengthen the pelvic floor and also help improve continence, weight control and cardiovascular health.
Prostate Cancer Recovery
Complete prostate cancer care and recovery can be a realistic expectation. Contact Dr. Gholami to discuss your eligibility for these advanced state of the art procedures.
About Dr. S. Shawn Gholami
If you are researching prostate cancer treatment options, you may already know that robotic prostatectomy is a minimally invasive surgery approach that offers significant benefits over other treatment options. What you may not know is that Dr. Gholami is the surgeon you want performing your prostatectomy.
Why Dr. Gholami?
Dr. Gholami has performed thousands of laparoscopic and/or robotic procedures since 2000. He has been performing laparoscopic prostatectomies longer than >98 % of practicing urologists. Additionally, Dr. Gholami is an expert in laparoscopy so that he can perform highly complex laparoscopic procedures done by very few surgeons worldwide. Why Dr. Gholami? Dr. Gholami is an internationally recognized expert in the field of minimally invasive laparoscopic and robotic surgery. He has been training novice urologists and sharing his expertise worldwide since 2000. His passion for innovation and leadership is demonstrated in his work. Most importantly, Dr. Gholami will ensure that your entire procedure is performed personally by Dr. Gholami himself, starting with the first incision and ending with the last suture. Unlike many teaching centers, academic institutions, or other teaching factors, Dr. Gholami does not allow residents or other surgeons to perform any portion of your operation. He has one surgery room operating at a time in order to allow his full focus on you the patient. You will not be in a teaching and learning environment, where Dr. Gholami teaches, a resident learns, and the patient gets learned upon. Your surgery will be done in a private, first-class setting with all the attention and care you deserve.
What To Expect
Have peace of mind. After robotic prostatectomy you should expect o return to normal. It is expected for you to have excellent cancer control, normal urinary control, and the ability to have sex. Robotic prostatectomy generally has less complications and allows for a quicker return to normal activities when compared to open surgery or radiation therapy. If you have any questions, contact Dr. Gholami.
What to Expect Before Your Surgery
Preparation for Prostate Cancer Treatment
Your primary care physician and/or urologist will assist you with the required preoperative tests. These tests should be done approximately three weeks before surgery. If you have any questions regarding pre-operative tests please contact Dr. Gholami or call 408-358-2030. You will need an EKG, complete blood count, urine analysis, prostate ultrasound report, prostate pathology report, and chest x-ray.
Specific Pre-operative Instructions
1 month prior to surgery
- Schedule pre-operative testing. This testing should be completed no sooner than four weeks prior to the date of surgery to ensure the results are current. This testing will help to ensure that we have not overlooked any serious medical complications with surgery. Pre-operative testing generally consists of a chest X-ray, routine blood testing, and an ECG (electrocardio gram, an electrical map of your heart that can reveal and diagnose electrophysiological problems with your heart). These tests can be done by your primary care physician or we can help arrange them for you.
- Initiate a regular routine of male kegel exercises. These exercises strengthen the pelvic floor muscle group which are involved in stopping the flow of urine. By building them up now, you will speed up your return to continence after surgery. Also, strengthing the pelvic floor muscles improves orgasmic function, and thus will help you preserve and regain potency. In the interest of continence and potency, it is essential you begin a consistent regiment as soon as possible and continue to maintain it faithfully after surgery.
- STOP taking most herbal supplements believed to be detrimental to your pre-surgery health. This includes: St. John’s Wort, Ma Huang, kava kava, ephedra, licorice, pennyroyal, germander, chaparral, borage, coltsfoot, comfrey, life root, sassafras, aristolochia fangchi.
- STOP taking supplements that act as blood thinners and increase the chance of excessive bleeding during surgery including: ginko biloba, garlic, gensing, dong quai, willow, red clover.
- STOP taking Vitamin E before surgery because it too can increase the risk of excess bleeding during surgery.
10 days prior to surgery
- STOP taking any aspirin products, they increase your chance of excess bleeding during surgery.
- STOP taking any Motrin (ibuprofen) or related non-steroidal anti-inflammatory drugs.
- STOP blood thinners like Coumadin or Warfarin 72 hours prior to surgery. You should ask the doctor who prescribed this medication, if it is okay to STOP taking this medication in light of your impending surgery. While it is generally beneficial to stop taking these 7 days prior surgery, in certain cases it is not advisable. If your doctor does NOT allow you to discontinue taking these medications, please contact us.
- Absolutely NO Alcohol or alcoholic beverages 48 hours prior to surgery and 48 hours after surgery. These can have disasterous consequences on the surgery as well as the anesthesia.
The Day before Surgery
- Follow a clear liquid diet with lots of water, NO milk products.
- Do a Fleet enema at 3-5PM to help clean yourself out.
- After MIDNIGHT before surgery do not eat or drink anything. If you are scheduled for an afternoon surgery, you may drink water up to 7 AM the day of surgery, but NO later.
- You may and probably should take any of these if they are currently prescribed to you:
- Heart Medication
- Blood Pressure Medication
- Anti-Seizure Medication
- Insulin (please only take HALF of your normal dose though)
- DO NOT take Water Pills, Diabetic Pills… in addition to anything you have previously stopped taking in preparation for surgery (remember this includes aspirin, motrin, coumadin, warfarin)
- Bring all medications currently prescribed to you in their labeled containers with you to the hospital.
- Leave non-essential valuables (such as watches, jewelry, cell phones) at home to reduce the chance of misplacing or losing them in the hospital.
- If you wear glasses, contact lenses, false teeth or related personal items remember to bring a case to store them in during surgery.
If you have any questions about these instructions, including what you should and should not be taking and any other questions, please contact us. We recommend that you print these instructions out and keep them handy during the time leading up to your surgery. These instructions are given in your best interest and should be followed as carefully and closely as possible.
What to Expect After Prostate Surgery
After surgery you should plan on:
- Spending one night in hospital. Most patients go home within 24-hours
- Being back to normal activities within 1-2 weeks
- An early return of urinary control and sexual function
- A short period of catheterization
- A low complication rate
After your Surgery
Most of our patients start walking within 4 hours of surgery with help from our nursing staff. After you arrive home, try walking every hour for at least 10 minutes. Within a week, you should increase the amount you are walking. It is recommended to abstain from sexual activity for two weeks after prostatectomy. By 4 weeks you should be walking 40 minutes each day to help strengthen your pelvic floor muscles. You can resume biking, golfing, horseback riding, lifting, tennis, and running six weeks after surgery. Your first follow-up visit will be within four to ten days after robotic prostate surgery. This appointment is to check your recovery, remove your catheter, and discuss the final prostate cancer pathology. After prostate surgery, the majority of our patients are back to work within 1-2 weeks. Men with jobs that require heavy lifting need to be on light duties for four to six weeks.
Specific Instructions after your Surgery
While robotic prostatectomy is performed routinely, it is still a relatively major surgery that will take some time and effort to recover from. Life will be harder for at least a few weeks, if not months after surgery, however it is certainly preferable to the life-threatening hardships of letting the cancer progress unchecked. So stay positive, you can get through this.
- Patients can generally be discharged from the hospital about 24 hours after surgery.
- All patients will go home from the hospital with a urinary catheter in place. This catheter is known as a Foley catheter and is held in place by a balloon inside the bladder. It allows continuous drainage of the bladder into a small external collection bag which is emptied as needed. Absolutely, do not try to remove this catheter on your own. It must stay in place until you heal enough that it is no longer needed. Read further down in these instructions for more information.
- Since you will not be cleared to drive yourself, you will need someone to drive you home. You should not drive until the catheter is removed.
- After one week once the catheter is out, you can resume driving and most activities. Refrain from vigorous activity (running, golf, exercising, horseback riding, motorcycles, bicycling) however, for six weeks after surgery to give yourself time to heal. After six weeks you may resume full activities
- You should attempt to walk and climb stairs as much as you can tolerate to help rehabilitate yourself.
- Avoid sitting still in one position for too long (more than 45 minutes).
- Avoid bathtubs, swimming pools, hot tubs or othewise submerging yourself in water for four weeks. Showering is fine 48 hours after surgery.
- When you may return to work depends on your occupation and how fast you recover. Most patients return to work in 2-3 weeks. Use common sense.
- Most of our patients experience only minimal discomfort, and we recommend that you try ibuprofen or Tylenol (acetaminophen) for pain first, as they usually suffice. Stronger, prescription pain killers tend to be extremely constipating and so it is better to avoid them if possible. However, if you still have significant pain despite Motrin or Tylenol, contact your physician for a prescription for stronger pain medication, which will typically be hydrocodone or codeine.
- Upon discharge from the hospital, you will also be prescribed an oral antibiotic, which will most likely be Levaquin. You will take this daily with food until they are finished.
- You may resume any of the usual daily medications you may have been taking before surgery for other medical conditions, as soon as you are discharged. Coumadin can be restarted 3 days after surgery, unless otherwise instructed by your cardiologist or primary care physicians.
- At the time of discharge, you will be given a stool softener to be used for constipation. We recommend that in addition to the stool softener you also drink prune juice or milk of magnesia until you have your first bowel movement after surgery. You many continue taking the stool softener as needed to combat constipation.
- You may experience bladder spasms while the catheter is still inserted. Bladder spasms are typically associated with a sudden onset of lower-abdominal discomfort, a strong urge to urinate, or with sudden leakage of urine from around the catheter. We can provide you medications to ease these symptoms if the discomfort is severe. Do not take these medications however, within 24 hours of catheter removal, as it can prevent you from properly voiding.
- To make it easier on you immediately out of the hospital, you may initially want to stick to a mostly liquid diet until you have your first bowel movement. Avoid carbonated beverages.
- Once you have had a bowel movement, you should move to a soft food diet and then work your way back to your normal diet as you feel comfortable.
- Try to spread out eating throughout the day with snacks and small meals, to avoid eating large meals at once for a few days after surgery.
- Immediately after surgery, your abdomen will be slightly bloated so you may have trouble fitting into your regular clothes. For comfort, wear lose fitting clothing such as sweatpants or other loose fitting pants. You will probably need to do so initially anyway to accommodate the catheter and collection bag.
- Two days after surgery, remove the clear gauze covering your wound sites. You may shower after the second post-operative day. We encourage you to shower 1-2 times a day at home. For example, if your surgery was on Tuesday, you may remove the dressing and resume showering on Thursday. The collection bag may be removed during showering. Gently pull the colored catheter straight off of the clear plastic tubing from the bag and allow urine to run into the shower. After showering, gently pad the suture sites (do not rub or otherwise irritate them) with a towel.
- Application of antibiotic or other ointments (such as Neosporin) to incision sites is not recommended.
- Sutures were utilized which will dissolve on their own, there is no need to have them removed. A small amount of redness at the edges of the incision sites, as well as a small amount of clear or bloody leakage from the wound, is acceptable. Drainage of sufficient quantity to soak dressings, or redness greater than 1/2 inch from the incision should be reported to the physician.
- As mentioned above, you will be discharged from the hospital with a Foley catheter in place which continuosly drains urine from your bladder. It must stay in place while your anastamosis heals. Do not attempt to remove this on your own. If it should accidentally fall out, you MUST IMMEDIATELY notify your urologist to have it replaced. Do NOT allow a non-urologist (even if they are a nurse or a doctor) to replace it. The catheter was carefully placed by your urologist with specific regard to your prostatectomy and cannot be replaced by just anyone.
- You can use K-Y Jelly or antibiotic cream/ointment to lubcricate the outside catheter where it enters the tip of your penis (the uretheral meatus.) This ointment will reduce inflammation to the uretheral meatus and reduce discomfort. Apply the ointment as needed.
- You will be provided with a strap around your thigh to hold the catheter tubing in place. Adjust this strap as necessary to prevent tension from being applied to the catheter. You may also purchase an ACE bandage to hold the catheter in place.
- You will be provided with two urine collection bags of different sizes, a smaller bag to be worn under your pants during the day( leg bag), and a larger bag to be used at night. The smaller bag usually lasts about 3-4 hours before needing to be emptied, but of course this varies with how much liquid you consume. The larger bag should last you all night, so you do not need to wake up to empty it. Remove, empty, and exhange these two bags as needed.
- Alert the surgeon if the catheter does not drain well, or if you have any other serious problems with it. Don’t watch the catheter drain urine. Urine drains inconsistently. If your urine is very yellow, you will need to increase your fluid intake to make your urine more dilute.
- This catheter will stay in place for 5-7 days while you heal, and can generally be removed by your urologist at the end of this time. Sometimes it may have to stay in place longer if you are not sufficiently healed, perhaps two weeks instead of one. You should have already scheduled a follow-up appointment for this purpose. Remember as stated above, to continue to take your antibiotics.
- Do not do any Kegel exercises while this catheter is in place. However, once the catheter has been removed, resume doing male kegel exercises.