davinci procedure or external radiation

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tsusmc
New Member


Date Joined Jan 2009
Total Posts : 8
   Posted 1/17/2009 10:36 AM (GMT -6)   
I have been reading alot on this site for the last couple of days and and have to confess its the first time I have heard of the davinci procedure. I just found that I have prostate cancer and choose radiation over having the prostate removal because of a bleeding condition (vonvillabrands-blood does not coagulate well but I can take something for this).  Bone and CT scan next week. In reading, it seems the davinci method has much less bleeding and better long term results. Is this true and is the procedure performed throughout the US.  All comments are welcomed.

sandstorm
Regular Member


Date Joined Dec 2008
Total Posts : 194
   Posted 1/17/2009 11:00 AM (GMT -6)   
tsusmc,

I,m 8 days post Da Vinci Surgery. My surgeon told me that I lost 120cc of blood during my proceedure. He also told me that when he used to do open Radical Prostatectomies he required his patients to stockup 2 pints of blood before surgery and they nearly always required all of it.

I don't know with your blood coagulation, talk with your doctors and make the best decision for you.
Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa, but stable
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c / post-op 3+4  7  stage t2c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Catheter removed 1-15-09
Pathology Report says it's gone!
First Post-op PSA due 2-17-09


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/17/2009 11:20 AM (GMT -6)   
Your question is simple, but like everything with PC, not always easy. I had open surgery, and was told to stock up to 3 units, in the end, my surgeon didn't need any. As a rule, the robotic surgery is much less likely to need additional blood. As far as availability, depends where you live. When I was at the decision point, found out, there was only one robot in the whole state of SC, and only one surgeon, who happens to be a partner with my dr's practice, and he had limited experience. I could have gone to Atlanta, GA or Charlotte, NC where they are commonly done, but didn't because I didn't want a lot of complicated logisitics with my wife and children. In the end, after my open rp was done, the surgeon said due to difficulties inside me, had it been robotic, it would have been aborted to an open. So you never know what you are going to get. If you live in or near a major metro area, you should have plenty of choices and options. Good luck in your search.


David in sC
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/17/2009 11:21 AM (GMT -6)   
P.S> Make a signature like you see under our posts, it will help others here understand your situation and the scope of your cancer. Go to control panel, edit profile, and then signature I believe
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


tsusmc
New Member


Date Joined Jan 2009
Total Posts : 8
   Posted 1/17/2009 11:35 AM (GMT -6)   
Thanks, just for the info and just updated my sign
age 56
di. 31 Dec 08
t1c, gleason score 3+3
psa 4.6
 


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 1/17/2009 12:27 PM (GMT -6)   
I am also one of the DiVinci survivors. The Doc that did my surgery indicated that he had never had to bring in additional blood. He had done more than 1300 at the time of my surgery. Now, it may be that it has to do with the selection process, but additional blood is obviously rare with the DiVinci procedure.

As far as the extensive use of DiVinci, I read somewhere that approximately half of the PC surgeries done in the US are now DiVinci and the ratio is growing. Obviously, there are many factors to consider, but I would think you would want to explore all your possibilities (including radiation), and other treatments. Your signature would indicate you have caught the problem early and have plenty of time to make the right decision for yourself. I would use this forum as a launching point to do lots of reading until you find a point of comfort in the direction you want to take.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 1/17/2009 12:38 PM (GMT -6)   
I am also a DaVinci prostatectomy patient, and had 50 cc of blood loss with surgery. That being said, much of minimizing blood loss comes with the skill of the surgeon and to some degree, the difficulty of the case presented to him/her at the time by the patient. Although we are all the same anatomically, each of us presents a slightly different scenario to the surgeon, with some prostates being easier to remove from surrounding structures. I have spoken to open surgery patients who also had comparable blood loss. One of the supposed benefits of the robotic procedure is that it is usually less invasive externally, meaning that the overall incisions are smaller, and healing usually occurs faster. The same procedure occurs internally regardless of the surgical method involved. Again, the skill of the surgeon is key, and skill comes with sheer numbers. I hope this helps.
Randy
46 you when diagnosed, now 48
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.
Occasional Success with Oral Meds
Success with BiMix


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 1/17/2009 12:50 PM (GMT -6)   
Hi tsusmc,

I am an IMRT patient for a contrasting view point. In my research prior to the treatment I came across a number of studies that indicated very similar performance in results for radiation vs. surgery for local and organ confined disease. I.E. if you do not have metastasis you can get good results from IMRT. (or proton) In my case I chose the radiation because I had evidence of local metastasis and the radiation could treat the local threat. There were also some financial considerations as well. (Aren't there always?)

Good luck to you in making your decision. Make the one that is best for you and do not second guess yourself.
Don
Diagnosed 04/10/08
Age 58
PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear
Chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
PSA test on July 14, 08 after 8 weeks hormone .82
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
Second Lupron shot 09/11/08
Next PSA test by oncologist 03/09
 
 


jerseycity
Regular Member


Date Joined Nov 2008
Total Posts : 123
   Posted 1/17/2009 3:04 PM (GMT -6)   
I was going to have Di Vinci but decided to have open based on a study I read. It indicated that there had been a 3 fold increase of the need for radiation and hormone treatment after robotic surgery. Keep in mind though that the study also said that those results were less when surgery was done by high volume doctors. Being able to actually get your hands on the organ to examine it during surgery I felt was very important. With my open surgey there was no need for blood and my recovery was the same as robotic procedure. Yes, there is a bigger scar but that was the least of my concerns. Keep reading, it will come to you what is best. Try to have a uro with at least 500 surgerys. Mine had done 1,200.

 3-17- 8 went to Bruce Springsteen concert , great time
3-18-8 routine exam
3-19 doctor called said psa was elevated
what's a psa?
referred to Uro, had several more blood tests.
PSA steady at 4.75
biopsy  June 08 , 12 cores, 4 on left confirmed , right clear
gleason 3 + 3 T1c
research time.
decieded on open RP, Head of Uro  is my Doctor
Surgery done 10-1-8 by Dr See at Frodoret Hospital in Milwaukee
Cathater out 10-13 no problems
Post op,  organ confined, gleason up to 4 + 3, all clear margins
T2c 20% volume, very good outcome I feel
Incontinent and ED.  Time will tell, was told all nerves  saved.
back to work 11-5-8.
 
Rich man in a poor mans shirt.


NewJourney
Regular Member


Date Joined Jun 2007
Total Posts : 30
   Posted 1/17/2009 10:50 PM (GMT -6)   
I also had the robotic surgery. Approximately 100ml blood loss. As stated, the skillset of the surgeon plays an important role. One year later the incision sites are healing very nicely.
Age: 53
PSA: 4.8
Stage: T1C
Prostate, right base, core biopsies:
Adenocarcinoma.
Gleason’s grade 3+3=6.
Carcinoma involving two core biopsies and 50% of sampled tissue with a linear measurement ofapproximately 3 mm.
Perineural infiltration present.
Surgery: 10-Jan-08. Dr. Vipul Patel, Celebration Hospital in Celebration, FL.
Post Surgery PSA Test result:
1. <.1ng/ml 10-Apr-08


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/18/2009 12:29 AM (GMT -6)   
I have to agree that the surgeon is more important than the method. The best surgeons will be fully cognizant of the bleeding issue and take the necessary precautions. True the da Vinci robotic is less invasive, and so is the Laproscope. But none of the three can boast better results over the other with the cancer. You do need to understand that there will be side effects with any treatment. As one doctor told me ~ you are always at your best the day before your treatment for prostate cancer starts. David (Purgatory) is on to something, tell us more about what you know about your prostate cancer. We'll help with the options and our experiences with them.

Peace!

Tony


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 (January 13, 2009): <0.1
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 1/18/2009 11:17 AM (GMT -6)   
Hi

I had open surgery with minimal blood loss and did not stockpile any blood for the surgery based on my Dr's recommendation. Was only in the Hospital two days after surgery. No paid meds after surgery and no bladder spasms either. PSA have always been less than zero. this is my experience and like the Dr's will tell you, it is your body and your decision. Good luck to you and let us know how and what you do.

Mika
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
Got a shot last week and it was great
A year an a half of zero's
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/18/2009 11:52 AM (GMT -6)   
Mika, was just reading your post. We are both similar age, both had open RP. I was in hospital 4 days could have used 5 or 6, but insurance wouldn't hear of it. I required pretty steady pain meds the first 2 weeks at home. And if you have followed my catheter sagas for over 2 months now, I have had tremendous problem with bladder spasms from the longterm cath use.

Just shows people how different one person/body is from the next. Different pain tolerance levels, different healing rates, etc.

Happy for your 18 months of zeros, looking still for my first in a few weeks.

David in SC
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/19/2009 6:23 PM (GMT -6)   
Welcome, I am new myself.

You are moving too fast.

You first need to have the results of the nuc scans and other diagnositics to see it it is still local.

And as has been said the skill of the surgeon is more important than the method. The open anatomical surgery done by skilled surgeons is referred to as a bloodless procedure.

I want to urge you to look into alternatives particularly HIFU. Just do some internet searches and inform yourself, I don't want to say more.

Please continue to let us know as you get your mind around this and decide how to proceed.

It is a very serious and possibly life altering descision.

Very best to you . Scott
Diagnosed @ 48yo 04/07
focal low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 1/19/2009 7:15 PM (GMT -6)   
gpg, I just read your signature. Are you saying that you had a prostectomy, and that the doctor left a lot in, so that you could have another biopsy? And then you also had radiation? Diane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and 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 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Forging ahead to health!

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