Why not Perineal surgery?

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VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 7/15/2008 6:48 PM (GMT -6)   
When I first came on here I kinda felt out of sorts because I couldn't find one other person that had chosen perineal over robotic or laproscopy. Sometimes it was hard getting answers cause the surgerys are so different. All in all everyone suffers just about the same thing except Kent had his surgery between his scrotum and anus. (hope those words are ok).
Our doctor had done close to 3000 of these surgeries, told us the healing time is alittle longer cause of the wound and walking but the muscles wouldn't be cut, he could see better what he was doing (cause you are opened up), less bleeding and a shorter surgery. (about 1 1/2 hours) and out of hospital in less than 24 hours. Our surgeon/urologist is the head of the cancer center at the hospital here in Richmond. So why is it not an option for the people I see on here? I remember when I posted that he was having Perineal, one member said their doctor told them if they had that kind, they would be incontinent and impotent for the rest of their lives. That hasn't been the case as I'm sure its not any different with the R and L surgery. I'm just curious if other surgeons have given this option to their patient or are most going to surgeons that don't do this anymore. In the practice we went to, they had doctors that specialized in each surgery and it was our choice which way we went.
Its just a thought and curiosity.
Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
July 08 (3mths post op) Cialis 10 mg every other day. Erections starting to return. Movement during the day on its own(its alive!).


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 7/15/2008 10:37 PM (GMT -6)   
VaFan,
Just having a guess but I would think it is because that is just the way each doctor does it. Just as radiologists radiate and surgeons cut then I suppose each within their own specialties has their own techniques. Your doctor obviously feels more comfortable operating that way and you would expect that he would not continue to do so if his outcomes were not as good as using another technique. If he is more comfortable doing it that way and feels he personally can achieve a better result then more power to him.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.1 undetectable


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 681
   Posted 7/16/2008 2:13 AM (GMT -6)   

You ask a very interesting question.  If I remember correctly, I might have answered your early post and described perineal surgery as (and I can't remember exactly...but)an older style surgery.

As far as I know, none of us here are urologists.  However,This group has an incredible amount of "Non-professional" medical knowledge.I am always happy, though cautious to learn from them.

My comment came from a golf buddy, who retired from his urological surgery practice over 20 years ago.  When I shared my new condition with him he described how they use to do perineal prostate surgery back in the 1980's.  He disclaimed any new surgery knowledge and applauded the newer systems with less blood loss.

The interesting point that you make, is that a skilled surgeon, even using an older technique, can have a very successful result. It points out again that there are many successful solutions to this medical problem. 



PSA up to 4.7 July 2006 , bump noted during DRE
Biopsy 10/16/06
T2A, Psa 4.7
Gleason  4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion found
No continence problems
PSA 90 day -.01  , 6 month -.01 , 9 month +.02 , 1 year +.02
Using Bi-Mix or VED 
 
 
 

Post Edited (lifeguyd) : 7/16/2008 1:18:04 AM (GMT-6)


KC9AOP
Regular Member


Date Joined Jun 2008
Total Posts : 85
   Posted 7/16/2008 3:29 PM (GMT -6)   
I read about this style of surgery and the one thing I remember, if I am correct, is that there is no opportunity to biopsy the lymph nodes, so the alternate methods are preferred when that is required.

If you ask me, since the prostate pretty well rests on the paraneum, it seems to make sense, but I'm not a surgeon.
I am age 47 - Father, Paternal Uncle and Maternal Grandfather had/have Prostate Cancer.
Father 74 years old, PSA = 10.6 Gleason = 5 + 5 = 10 (very aggressive) and high involvement in all cores. Seed therapy is the only option. Father died cancer free.
6/4/08 - At physical DRE normal, PSA test returns 4.4
6/20/08 - First Urologist visit. DRE and ultrasound finds nothing conclusive. Doctor says biopsy is the only safe way to go. Prostate volume is 40 grams.
7/11/08 - PSA test returns 4.1. Scheduled the Stereotactic Transpareneal Prostate Biopsy for 7/23


VaFan
Regular Member


Date Joined Mar 2008
Total Posts : 203
   Posted 7/16/2008 8:20 PM (GMT -6)   
Thanks to the replys. Its always interesting to hear others views on different things.

Age 51 Kent Cindy 49
January 08 PSA 5.2 round of antibiotics went to 4.3
February 08 another round of antibiotics went to 4.2
March 17,08 had biopsy, 2 days later told cancer was on
one entire side of prostate.
Gleason 3+3
Doctor thinks its best to get the whole prostate with Perineal  Prostatectomy.
Surgery scheduled for this Thursday April 10th. Only took 1 1/2 hours. In recovery 1 hour.  Both nerves were spared.
Home 4-11. Cath out 4-22. Incision looks completly healed on the outside by 4-25.  Incontinence "a thing of the past" as of 5-28
lst PSA 0.04 June 3. YAY!!!
July 08 (3mths post op) Cialis 10 mg every other day. Erections starting to return. Movement during the day on its own(its alive!).

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