surgery options

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New Member

Date Joined Sep 2008
Total Posts : 1
   Posted 9/15/2008 10:00 AM (GMT -6)   
Hi.  Brand new to forum.  I have been diagnosed and will require surgery for prostate removal.  Can someone with experience let me know if the robotic surgery is the only way to go if i have the option?  I appreciate any info and i will input specific data as i get it.  The surgery for removal is definite, though.  Thanks.

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 9/15/2008 10:22 AM (GMT -6)   
Robotic or open will share equal results in irradicating the diease. The robotic offers shorter recovery times and less blood loss. More information from you would be helpful. You biopsy pathology numbers ~ Gleason, PSA, DRE results, etc. Surgery is not necessarily your only option. i hope you post more about your case, we have some great folks here you can lean on for support.

Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1 ~ Undetectable!
You can visit my Journey at:

Veteran Member

Date Joined Jul 2008
Total Posts : 637
   Posted 9/15/2008 6:34 PM (GMT -6)   
Captain, let us hear more about your numbers. Sorry that you are visiting here, but it is very helpful, and I can tell you that you will get good advice from seasoned people here. You are lucky that you found the site. Di
Husband Pete
dx Jan 2001 age 67 gleason 4 + 3 PSA 16.5
seed implant and conformal radiation Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06
Fistula operation 2/07 MSK
Many cystoscopies and ER visits with strictures
catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/07
AUS Operation at MSK Sept 8. Dr. Sandhu
Waiting for activation October 21 2008

Veteran Member

Date Joined Apr 2008
Total Posts : 847
   Posted 9/15/2008 6:42 PM (GMT -6)   
I think the kind of surgery you go for depends on what is available, and the experience of your surgeon.

When and where I had my RRP, robotic wasn't available. However my recovery didn't seem to be any worse than others here who have had robotic. Out of bed the evening of the operation (low blood pressure, so a bit dizzy) and one big incision instead of a bunch of little ones.
Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week PSA: 0 

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 9/15/2008 7:11 PM (GMT -6)   
I have seen reports that favour both. While robotic, as Tony has pointed out, has less blood loss, less external impact and thus has a quicker recovery time (this may be as little as a week's difference), the internal surgery is the same. Many surgeons prefer to actually feel the prostate gland and its texture as they remove it (a feature lacking in robotic). My advice would be to find a very experienced surgeon and ask him his preference and most importantly, why he prefers to do it that way.
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 <0.001 undetectable
PSA August 08 <.001 undetectable

Every time I see an adult on a bicycle I no longer despair for the human race.

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 9/15/2008 7:20 PM (GMT -6)   
Welcome to the club Captain, sorry you are here, but since you are join in the fun. Like the others, I think it would be helpful to get a clearer picture of what you are dealing with. I personally favor RRP, but there are great arguments either way. In my case there was not a local surgeon that performed DaVinci and after much study I did not see the benefit of traveling a couple hundred miles, so I opted for the RRP and never looked back. With that being said if your cancer is low grade stage one with minimal involvement robotic might be the way to go. Either way your informed decision will be correct. Understand what I am sharing is opinion only. Some of the other guys are much smarter than I. I look forward to hearing more from you.

peace and love
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores

Veteran Member

Date Joined Apr 2007
Total Posts : 823
   Posted 9/15/2008 8:08 PM (GMT -6)   
HI Captain

If there is one thing I can say here is experience, experience and more experience. That is the key to what ever kind of surgery you have. You need to make up your own mind but this is my surgery journey. I wanted to have robotic because a friend had it. I was not a candidate for it so I had the open. Surgery was about 1.5 hours and was walking the same afternoon. Had next to no blood loss and did not required any blood and went home in two days. No pain meds since I left the hospital. It is becoming a faint memory now since May 2007. Lost the pads after a few months and ED is getting better.

Hope the best for you and let us know how you are doing.

age at dx 54 now 56
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
Tossed the pads this spring
ED still a problem
first year PSA less than zero

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 9/15/2008 11:49 PM (GMT -6)   

Welcome captain75! 


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Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 9/16/2008 6:15 AM (GMT -6)   
Go for the best surgeon you can find. and DO shop around. i saw four surgeons. One said wait, two said RRP, one said DaVinci.  I found the stalwart institutions like Sloan Kettering liked RRP and the younger guys liked Davinci.
i had Davinci, but found the whole thing was oversold. I have had two spinal surgeries and this one hurt far more than those.  I can't imagine RRP would have been more painful.  I was up the evening of surgery - that is common for every surgery - but uncomfortable for several days. Some docs and patients fare much better on the pain scale. 
Both are fine. Both have similar side affects and there is NO rhyme or reason to why continence or ED is a problem or is not.
Don't let the style of surgery concern you too much. Go for a doc who has done hundreds and has happy patients.
47 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6      (Biopsy 3/07 just suspicious)
10/07 PSA 5.06   (Biopsy 11/07  1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC
Saved both nerve bundles.
Path Report:  Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
PSA 0 at six weeks
Pad free on March 14 - (10 weeks.)
ED - Take 100mg viagra every night.
Totally usable erections at 10 weeks.

Mike A
Regular Member

Date Joined Feb 2007
Total Posts : 213
   Posted 9/16/2008 7:52 AM (GMT -6)   
Hi Captain,
Sorry to have to welcome you here to HealingWell. My experience is much different than Paul's. Two of my friends and I experienced very little pain with the robotic surgery, but another friend had a much more painful and longer (though equally successful) recovery with the RRP. I think the best advice you have received on this thread is the one about experience. Find a surgeon who has a good record with PCa, and you'll feel much more confidant with your decision.
Good luck, and keep us all posted.
June 2005 - Age 53 PSA 4.8 at regular physical
October 2005 - After several rounds of anti-biotics, PSA 5.2 at Urlogist November 2005 - Biopsy negative
July 2006 - PSA 5.9 at regular Physical October 2006 - After several more rounds of anti-biotics PSA 8.1 November 2006 - Second biopsy - Positive December 2006 - Gleason (3+4=7), Tumor T1c, CT Scan and Bone Scan Negative
January 2, 2007 Robotic Prostatectomy, University of Rochester Medical Center - Tumor confined but larger than thought, only one partial nerve able to be spared. Margins clear.
February 2007 - Three to four pads a day, no erection with viagara.
April 2007 - First Post-Surgical PSA 0.02. Down to one pad a day.
July, 2007 - Six Month Post-op: PSA 0.04 No change in ED.
October, 2007 - Nine Month Post-op: PSA back down to 0.02! Almost totally dry! Only slight improvement in ED - Will try injections if not improved by next appointment.
January 2008: One Year Post-OP PSA 0.02 still dripping, but improving. Tried 500 dose of MUSE for ED, no luck. Will try 1000.
July, 2008 PSA 0.04 again, will recheck in October. Use .15cc Trimix injections, partial success. Will try .20cc.

Regular Member

Date Joined Jun 2007
Total Posts : 176
   Posted 9/17/2008 9:11 AM (GMT -6)   
Just to weigh in on open for robotic, I went with open. Dr. Catalona, my surgeon, has done more open surgeries than anyone in the country...over 5000. Blood loss was nominal, recovery was the same as everyone I read about on here who had robotic. As my surgeon said to me...choose 5 one inch scars or one 5 inch scar. My scar does not offend my sense of vanity at all. I was walking the halls of the hospital the morning after my surgery and I was lifting my suitcase into the overhead bin on my first business fligth 5 1/2 weeks post op.

Good luck with the decision process
43 yo. now
5/07 PSA 4.65 at routine physical
6/07 biopsy Gleason 7 (3+4)...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - RRP at Northwestern Memorial by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op path report confirmed Gleason 7 (3+4). negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
9/27/07 - catheter removal...let the games begin...
12/31/07 - threw out the pads (I only had used 1 pad per day for protection against minor drips)
I started Trimix 8 weeks after surgery with success.  I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.
9/17/08 One year past surgery and doing well.  PSA less than .1 and ED continues to get better and showing reasonably good results using Levitra which for a long time did nothing. 

Regular Member

Date Joined Sep 2008
Total Posts : 78
   Posted 9/17/2008 2:24 PM (GMT -6)   
One option not mentioned here yet is Laproscopic (non robotic). I had mine at MSK and it went well. I will echo what everyone else is saying. Experience experience experience.
Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 Positive
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Catheter removed 8/26 - reinserted 8/29 - removed 9/2

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 9/17/2008 2:56 PM (GMT -6)   
Aye ya Captain,
I opted for the robotic only because I wanted to minimize the down time away from work. It isn't any less invasive as open surgery is. My surgeon uses both but prefers the robotic because he can see much closer where it counts (like margins and nerves) due to the 10X magnification. But they do lose the "tactical" feel that many surgeons like with the open method. Just don't be afraid to explore the many other options available to you. Chose what you feel is right for you, not what an oncologist, medical oncologist or a surgeon will suggest as they are only experienced with their specific field of treatment. Talk to all of them and then decide for yourself. Remember you won't hurt their feelings if you don't choose their treatment recommendations.

Good luck
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery scheduled Sept 18, 2008

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