Didn't realize my original posting here post a while ago.

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/24/2008 6:41 PM (GMT -6)   
I appreciated all the replies to my original posting, I never could find it here, so I entered the new one instead.  On my last biopsy, they said there were two distinct tumors in 2 different areas of the gland, one was 4+3 and the other was 3+4, I don't know if that is normal to have two gleason scores at the same time.  The reason it will be open surgery, is because here in the Greenville SC area, there is only one hospital with a robot, and only surgeon has little real time experience, my dr. was not comfortable with that in mind.
 
The decision to go with external beam rt will be made after the surgery of course, but with my past track record, I would almost expect it to happen.  My other 3 cancer episodes involved porocarcinoma, so rare, that at the time, I was one of only 38 known cases in the US and less then 300 in the world.
 
I don't know if I will get nerve sparing or not, the dr. said it really depends on what they find after the surgery.
 
Thanks again, as I await nervously for this surgery, and the fun of a catheder, incontinence, and ED.  Gee, at 56 and being in good general health, it sounds really thrilling.
 
David

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 10/24/2008 8:29 PM (GMT -6)   
Good health counts for a lot. I was Gleason 9 at biopsy, and had RRP. I felt my recovery was comparable with many others who post here having had Da Vinci. One large incision instead of five small ones.

I found the catheter to be an inconvenience as much as anything, but was still very glad to have it out. No incontinence, but I sure do have ED. But even that turns out to be not so bad.

We are all nervous before this major operation, and nearly always things turn out better than we expect -- I'm sure that will happen in your case too. Good luck.
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 and 7-month PSAs: 0
Bimix injections working well 


Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 202
   Posted 10/24/2008 8:50 PM (GMT -6)   

I wonder if that's one of the differences between open and the robot.  I had the robot and the doctor told me he had to decide whether to do nerve sparing or not before the surgery.  He said that wasn't a decision he could make during the surgery.  He decided based upon the biopsy and my desire, after explaining the pros and cons.

I guess with the open, the doctor is able to get an overall picture during surgery, which would give him the ability to decide  whether he could spare the nerves.

I don't know if there is any merit to this observation, I'm just wondering.
Age:54
PSA 5/22/06: 5.6
Divinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 10/24/2008 9:34 PM (GMT -6)   
The decision to do any nerve sparing is dependent upon the extent of the disease, ie extension through the prostatic membrane, nerve involvement, even positive margins. None of these can easily be determined prior to surgery, when the surgeon can actually see the prostate field, and frozen sections are examined by the pathologist. My surgeon was quite clear, his first priority was to remove the cancer, the decision to spare some or all nerves was dependent on his satisfying his primary objective. Some surgeons feel they have a better feel for determining the extent of disease with open surgery, while others feel the robotic method gives them a greater field of view, it really depends on the surgeon. The outcomes are similar, with respect to continence and ED, you have to be comfortable with the choice. There are pros and cons to all treatment forms. I chose robotic because it was less invasive, the surgeon had performed literally hundreds of procedures, and data from his practice were favorable to me. However, I would not have hesitated to go the "open" route if need be, esp is the hands of an experienced surgeon. The discomfort and the hassle with the catheter are temporary for most of us, and I feel fortunate that my continence returned the day following cath removal, the ED has been a longer battle, but is improving week by week. Good Luck, it is a battle, but one worth fighting, whichever route you choose.
Randy
46 you when diagnosed, now 47
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01, 9 Month PSA 0.01
One Year PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Cialis 5 mg every night.
Success with BiMix

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