NOTE: this is part of an ongoing series of posts about my journey with prostate cancer. So far the posts include:
1. January 30: “When Cancer Comes Calling”
2. February 16 – “Waiting in Mutual Ambush”
3. March 11 – “My Prostate is History” (on the surgery)
4. March 13 – “Letters Before Surgery” (saying goodbyes)
5. March 14 – “Cancer Prognosis: Uncertain Grace”
6. March 22 – “Post-Surgery Incontinence”

My Prostate is History: How It All Went Down
David R. Weiss – March 11, 2025

[Read this as a 5-page pdf if you prefer.]

I’m now on the far side of cancer surgery. And, temporarily at least, cancer-free. But I’m far from recovered, and I’m still reflecting on everything I’ve been through. This is the next chapter of my story. In this essay I’ll write about the surgery itself. Caveat: I am not a surgeon, plus I was asleep during the surgery! I’m doing my best to be accurate here, but don’t rely on my notes for your own diagnosis or treatment. Find a doctor!

PRE SURGERY

Back on January 16, the same day my urologist reviewed my biopsy results with me, we penciled in March 5 as a tentative date for surgery. This was the soonest we could safely schedule it, allowing 7-8 weeks for my rectum to heal after the biopsy (on January 10) that confirmed cancer—and confirmed it as aggressive. In fact, aggressive enough to require a January 27 PET-PSAM scan to assess whether the cancer had spread beyond my prostate—a finding that would’ve made surgery pointless … and sent me and Margaret down a very different path of treatment.

Thankfully, that scan showed that all the cancer appeared to be still “in-house”—in my prostate. So, we inked in March 5 for a radical (complete) prostatectomy. All I could do in between was hope the cancer cells would still all be right there when the urologist (also my surgeon) went in to get them.

This is how that all went down.

Besides stopping all vitamins and supplements a week beforehand, the only real “prep” I had for surgery was to pack an overnight bag for my one-night stay in the hospital—and to shower. Twice in the twelve hours before surgery. No, I’m not that dirty! It seems all of us (you, too!) play host to whole communities of bacteria on our bodies. Some downright beneficial, a few free loaders just passing through, and some with less than honorable intentions. Thing is, any one of them—even the beneficial ones—have the capacity to start a riot of ruin if they wind up on the inside. So, with the plan being for my gut to get pierced five times on Wednesday morning, my job, beginning Tuesday night, was to make myself squeaky clean.

I showered twice, Tuesday night and again early Wednesday morning, both times washing myself first with my usual soap (high-quality artisan soap, made by a friend, I might add!) and then slathering myself up with an antiseptic soap. And I slept in fresh pajamas on fresh sheets. Next to a fresh woman. For about four hours.

SURGERY DAY

Surgery was scheduled for 8am; we needed to be at the hospital (about a 20-minute drive for us) at 6am. Which is why (of course!) it started snowing—heavy—the night before. After maybe four hours of sleep, we got up at 4:15am. I shoveled a path through six inches of heavy snow from our front door out to the car, cleaned the car off, and then took my second shower—and put on fresh clean clothes. By 5:30am we were in the car, and I was squeaky clean. A little nervous, a little tired, and mainly just ready for my prostate to be history.

Assuming we got there. It was still snowing, and even the interstate was sketchy that early. We passed several cars slid off the road on our way. Margaret drove with extra care as I silently willed her to drive faster lest we be late. We got parked and checked in by 6:15am and after a short wait I was taken back for my first round of prep. We were reassured that Margaret could join me once I was gowned, and then she could wait with me until I headed off to the operating room.

I had my vitals checked and then changed into my gown and a pair of those always ill-fitting non-slip socks. I was given three hospital bracelets: one for my name, one listing my medical allergies, and one designating me as a “fall risk.” This last was not due to any Mardi Gras celebrating the night before but because of the anesthesia I was about to be hit with it. Once the IV line was placed, Margaret came back by 7:20am to chill with me.

It was a bit like social hour in our little cube room. My prep nurse chatted with us. The anesthesiologist stopped by to explain his part (basically to review my file and then supervise the nurse-anesthesiologist who would actually put me to sleep). And my urologist-surgeon came in to say hello. Everyone we interacted with at the hospital made a point of treating me like a person, which was calming and reassuring. As 8am approached there were still no nerves. Just a readiness to do this thing so I’d be on the far side of it.

As 8am sharp, the nurse-anesthesiologist came by with an OR nurse to take me away. Margaret and I said our sweet farewells, I surrendered my eyeglasses, and I wandered wide-eyed but barely seeing down the hallway and into the operating room. The last two things I remember are the nurse asking me to moon her and the nurse-anesthesiologist telling me to relax. I complied with both requests. (To be fair, the nurse actually just asked me to back up to the table and untie my gown before sitting down, but we both knew that was code for “Moon me,” which is exactly how it played out.) If the nurse-anesthesiologist asked me to count backwards from anything, I expect I did that, too. But from the moment he told me to relax, I was gone—until 2pm. By which time all the exciting stuff was over.

THE SURGERY ITSELF

The exciting stuff was a RALP: Robotic-Assisted Laparoscopic Prostatectomy using a DaVinci surgical robot. I missed all of it—except the searing pain in my gut afterwards. So, this next section is gleaned from the surgeon’s notes posted in MyChart and a couple other reputable sources. This all happened to me, but I experienced none of it.

Once I was asleep, the nurse-anesthesiologist intubated me (put a breathing tube down my throat). I was given a dose of antibiotics (to guard against any germs in the room making their way into my insides). And I was positioned on my back as needed for the robot to engage. Then someone called, “Timeout.” Seriously, not because anyone was misbehaving, but because that’s what they do in an OR before making the first cut. They made sure everyone agreed I was me, and they were there to remove my prostate, and everyone’s role was thus and thus. Basically, they go through a very specific checklist, which might seem a little over-dramatic, but had I woken up with my gall bladder missing … well, that’s what the timeout is for.

At 8:39am I was cut open. The first small slit was above my belly button; it went through the skin and allowed a Veress needle to be inserted into my abdominal cavity. That’s sort of a 5-inch version of the type of needle used to inflate a basketball, but this one is shielded inside a protective tube until it’s inside me. Then it was used to inflate me like a basketball (with CO2) turning my abdominal cavity into a mini-inflatable dome, literally raised up so that the light, camera, and robotic tools would have room to maneuver.

After I was inflated, the needle was removed, and a “trocar” was pushed through in its place. A trocar is a rigid hollow tube about 8 inches long and somewhere between the diameter of a pencil and a dime—fitted with a point like an awl. It can take quite a hard push to get it through the underlying abdominal wall. I’ve watched videos; imagine pushing an awl (or a lawn dart!) through a chicken breast. Oof. Anyway, once it was in place, the inner point was removed, leaving just a hollow tube—a port—through which the robot light and camera were inserted.

Then four more slits, also small were made; two on the left side, two on the right side of the first one. Each of those got the “trocar push” until those points, too, pierced my abdominal wall in four other places. Yeah. No wonder each of those five puncture holes is still tender. Each trocar then had its inner point withdrawn, leaving four more ports. Each port was a hollow tube large enough to slide a pencil through, with a flat “cuff” at the top (used to connect to the robot). Next, as my surgeon put it, “The robot was then docked.” Basically, that means the DaVinci robot was rolled over to my body and lined up above the ports. Each of the robot’s four arms—a camera and three surgical tools)—was attached to one of the ports so its tool could enter me through the port. (The “assistant port” is for manual use during surgery; I think to irrigate with saline and drain away blood as needed.) The ports held the robotic arms secure, and the surgeon, seated at a console that would be right at a home in a video game arcade, guided the robot. The robot provides the camera feed and allows for ultra-fine motor movement inside me, but the magic rests with the surgeon, whose hands at the console move the tools. His (or her) skill provides the magic.

Cue up a moment of ominous, expectant music followed quickly by something more like Fantasia. Because from here on, for the next two-plus hours my gut was a frenzy of activity, and those ports protruding from my belly were twisted this way and that as the robot tools did their work.

I got a summary of it in MyChart, most of which is in big words than even I would need to look up. So, this is only offer a very basic sketch. My bladder was peeled away from the abdominal wall. Working in tandem, a knife and an electrocautery tool (which uses electric current to cut-and-cauterize), cut and cleared away tissue around my prostate, seminal vesicles, and the associated nerve bundles. The prostate itself was excised from the bladder neck “with care not to damage the ureteral orifices” (thank you!) while also trying to spare part of the right-side neuro-vascular bundle (again, thank you!). And then “the urethra was transected sharply (ouch!) to completely free the prostate.” Both lymph nodes were cut away using electrocautery and these, along with the prostate, were placed in “an endocatch bag” to be removed at the very end of the surgery.

Finally, the most delicate bit of magic involved repairing my urethra. Delicate because the moment that knife cut my prostate free (taking with it the length of urethra running directly through it), the now loose end of my urethra went scurrying back toward my penis where the rest of it was trembling in fear. (You would, too, if you’d just been “transected sharply” by a robotic knife!) And look, there’s a lot of anatomical nooks and crannies in there. So, yeah, my urethra took cover.

Thankfully, my surgeon, using a technique I shall christen “woo-u,” managed to draw my urethra, wounded in more than mere pride, back out into the open. Then, using a pair of gentle(?) robotic forceps, he deftly brought it up to the bladder neck—that is, he stretched it across the 1–2-inch gap of now missing urethra—and sutured it securely into place at the bottom of the bladder using a “V-lock suture.” (Think a tiny thread-thin bit of barbed wire; no knots needed since the tiny barbs keep the thread from sliding backwards. Still, yikes.)

After this, a catheter was inserted from the great beyond (unfortunately not using one of those five just-created “ports” but using my own built-in port: my penis). Catheters go in by traveling the very wrong way up your urethra. Alas, this tender tube is designed for one way traffic: out. It’s sometimes medically necessary to go in the other direction, but I’ve had this done several times while wide awake on account of kidney stones. It is not my favorite pastime! I am so glad I was asleep for this. Throughout surgery, the nurse anesthesiologist was my best friend.

With the catheter set in place, a small balloon about the size of a plump green grape and positioned at the inner end of the catheter tube (thus, just inside my bladder) was filled with about a Tablespoon of water. That little balloon holds the catheter in place so it can drain my bladder for the nine days it will take for my severed urethra to make fast friends with the neck of my bladder, held secure by those barbed sutures. Saline solution was injected into my bladder to determine if it the repair was urine-worthy. The surgeon’s summary reports it all too dryly: “The vesicourethral anastomosis was noted to be watertight.” I’m pretty sure the entire OR team let out a cheer like they’d just landed a rocket on the moon. I know I would’ve.

Finishing up, they placed about a twelve-inch drain tube across the “work area” (that is, my gut, right to left), exiting the port farthest to my left side to drain off any bleeding after surgery. All the robot arms were withdrawn, one of them bringing with it the endocatch bag containing my prostate (a bit larger than a walnut), lymph nodes, and other manly bits out through the center port, which was cut wider here at the end so everything could fit through. The ports were removed, leaving just four puncture holes(!) and one 2-inch slit above my belly button. That was stitched up a bit with a dissolving suture, and then “skin glue” was used to seal everything up. Who knew?

It all sounds like a great show for anyone with a ticket. Odds are it saved my life. Still, I’m glad I slept straight through.

The last note in the surgeon’s summary read: “At the completion of the procedure, all surgical counts were correct.” In other words, all specimens, tools, supplies, and persons accounted for. Nothing was missing! Whew.

POST-SURGERY

At 10:59 surgery was concluded. Sometime after that I was awakened, extubated, and wheeled into recovery. But don’t ask me when, because I remember nothing until around 2pm when I found myself in room 2218, greeted warmly by Margaret, my cousin Katie, and her husband Byron. (They’d taken the day off to be with Margaret while I was in surgery.) Everyone was happy to see me. But I was so tired, I could’ve cared less who was there. Okay, of course I was happy to see them all. But I have never been so entirely exhausted in my life. Four hours of sleep the night before. And even though I was “sound asleep” during surgery, you just heard what my body went through while I was out—that’s NOT a restful sleep!

Physically and emotionally, I was spent. And sore. And tender. Every tiny movement in my bed sent shivers of pain racing from my abdomen to the far walls of my room and ricocheting back to me. I’m pretty sure I made some small talk—I’d like to say I was my usual gracious and eloquent self—but I’m not sure that’s accurate. Despite my best efforts to be hospitable to my guests I was groggy all afternoon. I rallied for a short stretch of time, from 6-7pm, if it’s fair to say that less-slurred speech and more energetic wincing counts as a rally. But then I gave up and told them I’d had about as much fun as one person could have in one day and I just needed to rest.

And I did. Though not very well. But that’s next time.

*******

David Weiss is a theologian, writer, poet and hymnist, “writing into the whirlwind” of contemporary challenges, joys, and sorrows around climate crisis, sexuality, justice, peace, and family. Reach him at drw59mn@gmail.com. Read more at www.davidrweiss.com where he blogs under the theme, “Full Frontal Faith: Erring on the Edge of Honest.” Support him in Writing into the Whirlwind atwww.patreon.com/fullfrontalfaith.