Prostate Cancer surgical options

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kohrageous
New Member


Date Joined Jun 2009
Total Posts : 1
   Posted 6/21/2009 4:42 PM (GMT -6)   
I'm new at this, but will try to see if I can communicate correctly!! 
 
My brother was recently diagnosed with prostate cancer (my Dad passed 9 years ago from same disease).  He was told by a Dr that he didn't recommend laproscopic prostate surgery because it was too new and experimental.  My husband had a radical prostatectomy 17 years ago at age 58 and had total ED that he was never able to overcome with Viagra or any other meds.  He has since said he wishes he had never had the surgery.  I keep telling him "well, you are still alive and might not be without that surgery".  My brother is only 55.  I really wanted him to explore laproscopic option as I thought it wouldn't have the bad side effects.  However, when I tried to research on the Internet, I see where alot of men are talking about long term incontinence problems after this type of surgery.  However, many of those postings were from 2005-2006.
 
So I guess I am wondering if anyone could suggest where I might find information on lapro surgery, if anyone out there would like to share their experiences who have had the surgery, and what the general concensus is from all of you as to which procedure is the best to undertake.  Radioactive seed implants is not an option for him as he works in the nuclear industry field.
 
Thanks for any help.

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 6/21/2009 7:02 PM (GMT -6)   
Any kind of prostatectomy runs the risk of side effects. Yes there is a risk of long-term incontinence, but the last figures I saw indicated that at only a few percent. I don't think the kind of surgery has a bearing on the matter, or ED either. What is of much greater importance is the skill of the surgeon.

Of course on the internet and in forums like this one, you will find a higher percentage of people with problems. You will hardly ever hear from those with no problems -- they just don't hang around places like this. So it's the few percent with the problems making all the noise :-)

In your brother's case, if he is committed to surgery, I suggest he first finds a surgeon he can trust, and go with whichever procedure the surgeon recommends.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 6/21/2009 7:12 PM (GMT -6)   
If you look at the permanent links at the top of the forum you will find several books that are well respected.

Laproscopic surgery is little performed these days having been almost entirely replaced by robotic (robot assisted) surgery. I would be shocked that an American doctor thought that either of these was "experimental"

As other people will tell you , we can respond much more knowledgeably if you can post your brother's stats such as PSA tests and biopsy report.

If this site has a bias, it is towards surgery, both open and robotic. And yes, incontinence and ED are issues with ANY prostate treatment including radiation. Treatment in all forms has improved greatly since your husband's surgery. My general opinion is that most cases in incontinence can be cleared up over time. ED is still an issue but many men find ways to deal with it. While you research you might look at penile implants for your husband -- an idea which at first horrified me, but which several members have given good reports of.

In any case we are here to listen and to tell you whatever we can.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 6/21/2009 8:45 PM (GMT -6)   
Hello,
After doing alot of research I determined that laproscopic was a good choice for me. my sugeon had done about 1400 procedures and has had the same results with robotic and laproscopic. It is not experimental at all any more. Some say that the difference between robotic and laproscopic is that the surgean can "feel" the procedure better. This is the same rationale that Johns-Hopkins surgeon Patrick Walsh uses to advocate open surgery. Ultimately each doc develops his/her own expertise in a method. Find someone who has done lots and lots of whatever procedure your research and interviews leads you to.
TeddyG 
Background:
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.
Stats:
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 6/22/2009 7:16 AM (GMT -6)   
Hi Kohrageous,

First welcome to Healingwell. You have come to a great place for information from some very caring folks.

Surgery today, is not the same as the surgery your husband went through 17 years ago. Lots of things have changed and improved with regard to the side effects normally associated with surgery. You didn't mention your brothers stats, but if surgery is an option I would certainly think that either form of surgery as long as it is done with an experienced surgeon will have the same out comes with incontinence and ED. I had the robotic and so far no issues with either incontinence or ED...but it did take several months.

Just out of curiousity...why are the seeds out of the question? You mention he is in the nuclear field, but I thought that the seeds were of such low dosage that it was pretty much undetectable outside the body. As always, I am trying to learn more, so forgive me for the question if it is out of line.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

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