Can a DRs open surgery experience compensate for a lack of robotic experience?

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hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 8/19/2009 1:34 PM (GMT -6)   
I am wondering what you guys think.
An aquaintance of mine, newly diagnosed with pc was considering having Da Vinci surgery with a very well known and experienced Dr. from MSK. However his experience is mostly with open surgery. The nurse told him that his Robotic experience is about 100. I know that the recommended amount is over 300. Do you think that his experience with open surgery can compensate for his lack of robotic experience?
Thanks for your thoughts.

Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08  < 0.05
2nd  post op PSA 12/30/08 < 0.05
3rd  post op PSA 3/30/09 < 0.01
4th  post op PSA 6/25/09  0.01


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 8/19/2009 1:50 PM (GMT -6)   

Hangin-in

When I was trying to decide on who I wanted to perform my DaVinci surgery, I considered that my urologist, who I love and by whom I'm still being followed, had only done 30 robotic operations, even though he had a ton of experience with open. To his credit, he referred me to two other surgeons who had done 750 & 2000 robotics respectively (including the guy he trained under). Coupled with the research that I had done, it became apparent that overall experience and specific experience were not one and the same. I chose the surgeon with 2000 under his belt, and would have been comfortable with the 750 guy as well...........just one man's opinion.

Arnie in DE


Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point.
3 month PSA--<0.1
6 month PSA--<0.1


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 8/19/2009 2:10 PM (GMT -6)   
Dear Arnie:
 
While I ultimately did not choose surgery, I did do a ton of research into the options.  If it was me, the answer would be NO.  I would have gone da vinci but with a guy who had done hundreds of procedures...not 100.
 
Tudpock
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 8/19/2009 2:19 PM (GMT -6)   
Hi hangin-in,

Only MHO but, unless a surgeon is fully experienced in a specific procedure, other procedures don't necessarily count. An associate of mine with PCa, ex-mil pilot, said 10,000 hours on a certain aircraft is great. Those other hours don't matter much when trying to competently fly a Raptor with only 20 hours experience. Those were his comments, made when we were discussing open vs robotic PCa surgery. Again, IMHO, I would consider someone with at least 400 robotic procedures. However, I don't believe that (robotic) would have been a good option for me.

Mike
-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/19/2009 2:34 PM (GMT -6)   
I would answer that with a resounding no. He may be great with the open surgery like I had, but has too limited experience on the robotic. Experience on one doesn't count apples to apples on the other. Same surgerey on paper ,but two entirely different approaches and experience required.

david in sc
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 8/19/2009 2:41 PM (GMT -6)   
I have no idea how many surgeries my Robotic surgeon has done. (and I came out pretty well)  If I went down that road, I’d also be interested if he:
 
recently separated from his wife
recently had a death in his immediately family
how much alcohol does he consume the night before surgery
lost any favorite pets
have any teenage kids he can’t control that are driving him nuts
 
The list can get pretty long and since there's no way to gague how well they deal with any of these issues......
 
I trusted my gut and liked the surgeon...
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 8/19/2009 4:26 PM (GMT -6)   
Minimum of 500 and 1,000 is better. I would never have someone with at least this experience operate on me. As my doc said, why would you even think about getting the 2nd best when the best is available.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 8/19/2009 4:38 PM (GMT -6)   
I have to agree with the rest of the guys. It is a mechanical technique. Takes tremendous eye hand coordination. Practice on the other 500 giys is important before he gets to you. Mine had 750. I am sure I would have a positive margin if a less experienced guy did it. Someone posted on here that a surgeon left 40 % of the prostate in on one unlucky fellow.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


riggerjon
New Member


Date Joined Aug 2009
Total Posts : 7
   Posted 8/19/2009 4:52 PM (GMT -6)   
My surgeon told me he had done right at 100 surgeries with the robot. My surgery went very well. I don't see how it could have been any better. It's been 24 days since my operation and I dribble very little. I've had several erections and could have had intercourse if I had been cleared to by my doctor. I was up and walking about 5 hours after I woke up. I think it depends more on the doctor's training leading up to the surgeries than a specific number. Some people just learn faster and are more competent than others. I'm not sure what his experience is with the open procedure. I think that almost all his surgeries are robotic. The hospital in my town just got the Da Vinci machine a little over a year ago.
Age 58
PSA 9/19/06 5.51
PSA 9/12/07 4.14
PSA 9/17/08 5.67
PSA 05/2009 8.48
Biopsy: 06/08/09 30% on right 5% on left positive
Gleason 6
Cat Scan and bone scan 06/15/09 negative


Robotic Surgery 07/27/09
Mercy Medical Sioux City, IA
Discharged 07/28/09
Nerves spared both sides
Pathology: Gleason lowered to 6, margins clear
Catheter removed 8/3/09


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 8/19/2009 5:14 PM (GMT -6)   
I would say that humility wins every time. My uro had done 500 and told me I should talk to a colleague who had done 2,000. I went with the 500 because it seemed to me he was paying attention to every operation and trying to do better. So, to me, the issue is not so much how many your uro has done, but how he feels about continuing to get better. Your descrioption would make me worry.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 8/19/2009 5:28 PM (GMT -6)   
Hey Riggerjon,

I wouldn't waste too many of those things. Just don't habg from the chandeliers !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/19/2009 5:32 PM (GMT -6)   
geezer, i tend to agree with you. t he sheer number of operations shouldn't be the single deciding factor. there could be lots of sloppy operations for the money, or it could be a production assembly line clinic. a good surgeon even in the 300-500 range can be expertly experienced.

david in sc
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 374
   Posted 8/19/2009 6:57 PM (GMT -6)   
While I agree that some surgeons' learning curve are faster than others, and the actual number of surgeries may not be as important relative to that, it's the unexpected situational difficulties a surgeon might encounter that would lead me to someone for whom there are no surgical "curveballs"...the more one has seen, the less chance there is of any surprises. Also, I posed the assembly line question to Dr. Lee, and his response was "the day it becomes assembly line is the day I quit" because of the above stated reason...........My uro responded "why wouldn't you want to be the 2000th patient down the line"
 
Arnie in DE
Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point.
3 month PSA--<0.1
6 month PSA--<0.1


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 8/19/2009 8:57 PM (GMT -6)   
    I did not find HW until after my RRP (open) surgery was over.  But, I'm still not sure I would have changed my decision eventhough I had a long LEAKY bumpy road with recovery.  My Uro did my surgery.  He had about 300 under his belt at the time.  I liked the fact he and his associate URO were both about my age.  I felt that they could easily see themselfs on the table in my place.  He fully understood all of my concerns.
    One thing I think about the number count is that sometime it is some sales pitch!!!!  Also,  some of the high number guys are at "teaching" hospitals.  Who is to say that they are the ones at the table or driving the robot when your lights go out?
    Good Luck with your decisions.
    KW 
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
     Dec. 2006 – Oct. 2008 Cystoscope, Two Collagen injections,Second Opinion   
    Consultation for Incontinance at OU Medical Center, Bio-Feedback       
    training, Chiropractic, Accupuncture , AdVance Male Sling, Two More Collagen 
    injections, AUS Installed and Activated (Dr. Morey at UT Southwestern Dallas TX)
    All to try to resolve incontinence (using 6-8 Depends Guards a day)

    To Date All PSA's 0.00.

   http://www.healingwell.com/community/default.aspx?f=35&m=721171

    http://www.healingwell.com/community/default.aspx?f=35&m=978691


hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 8/20/2009 7:37 AM (GMT -6)   
Thanks for the posts. The discussions on this site has been very helpful to me.
 
I think that experience is the major factor but certainly other factors such as "care", "humility", "striving to do better", etc must be taken into account too.
 
For me, deciding which Dr to go with was the hardest part.
 

Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08  < 0.05
2nd  post op PSA 12/30/08 < 0.05
3rd  post op PSA 3/30/09 < 0.01
4th  post op PSA 6/25/09  0.01


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 8/20/2009 8:07 AM (GMT -6)   
Majority of articles state that the Davinci has a high learning curve. I found three videos on the web of the ACTUAL Surgery. One thing I immediatley noticed was that with two of the video's the robot movements were very 'jerky' which surprised me. When I watched a video of my surgeon performing I believe it was 270th operation with DaVinci at Vanderbilt I actually commented outloud...The movements are so smooth. I would and did go with experience.
Age at diagnosis 54, PSA 5.1
Father treated for Prostate Cancer in 1997 with Proton Beam - Still doing well.
My Stats
Biopsy 04/08 12 cores, 5 positive
Gleason 3 Cores at 4+3=7
              2 Cores at 3+4=7
Perineural Invasion Noted on biopsy

Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
 
Post Surgery - Dr. Spared 100% of Nerves on the left side.
Estimated that 50 - 70% of the nerves were spared on the right side.
 
Final Path report
20% of the prostate Invovled
Overall Gleason 3+4 (7)
Lymph Glands Clear
Positive Margin Noted in Right Apex


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 8/20/2009 8:47 PM (GMT -6)   
My surgeon had only done 50 and am fine. I agree with Steve n Dallas, there are lots of things to consider.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/20/2009 10:15 PM (GMT -6)   
MSK has a number of experienced DaVinci surgeons. Why go with someone who is just learning?My wife's cousin had a DaVinci surgery there. He is very happy with. I think the doc's name was Dr. Colman. He even wrote a letter to Scardino to express his thanks. He is an MD, BTW.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 8/20/2009 10:31 PM (GMT -6)   
This is a hard call, but I think it all depends on the surgeon.

I believe that open surgery and robotic surgery still have nearly the same outcomes with competent surgeons.

The one benefit I've heard from several health care professionals is that robotic may have lower blood loss for some patients as compared to open surgery.

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 8/21/2009 2:26 PM (GMT -6)   
I think Steve in Dallas said it well. There are many variables. 100 prior da Vinci surgical procedures doesn't indicate lack of proficiency. Other factors/variables are important to consider, also. I know I wouldn't have a surgery by one of the guys who reports thousands of procedures in less than 5 or 7 years, though - too dangerous to risk it IMO.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0

 


55 and healthy in NJ
Regular Member


Date Joined Apr 2009
Total Posts : 58
   Posted 8/22/2009 10:16 AM (GMT -6)   
My urologist told me straight away that his experience is with open surgery and at this point in his career, he was not interested in taking the time to learn the robotics procedure.  He was also concerned that some robotics surgeons treat the operation like an assembly line and are only in it for the money, and he insisted that if I choose the robotics surgery, I only go with someone who has done at least 500 of them.  When I interviewed Dr. Esposito, who did my surgery, one of the questions I asked him was whether there would be any circumstances where he would tell the patient not to have surgery but to have radiation instead.  His response was, "the way I was trained, what's most important is what's in the patient's best interests:  I'm a doctor first, a urologist second, and a surgeon third."  My point is, yes, you want someone with experience, but what's at least equally important is the character of the doctor.  That's why some opt for the open procedure over robotics.  Trust your instincts.
 
Greg

Age 55
PSA history: 2.9 (Oct 04), 3.7 (Dec 05), 2.79 (Nov 07), 4.54 (Jan 09), 4.9 (Feb 09)
05/18/2009 - Robot-assisted (daVinci) laparoscopic radical prostatectomy by Michael Esposito, M.D. and Vincent Lanteri, M.D. http://www.roboticurology.com/ both nerve bundles spared
Surgical Pathology: Prostate gland 51.8 grams; Gleason score 3+3=6; Pathologic stage T2c, N0, Mx; Left/Right Pelvic lymph nodes clear (no tumor present); No presence of extra-capsular invasion;  No margin involvement
05/26/2009 - Catheter and incision staples removed
05/30/2009 - Started Viagra 25mg 3x/week
07/06/2009 - 1st post-surgery PSA <0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/22/2009 11:55 AM (GMT -6)   
Greg, great post, your reasons are why I had open surgery, and my dr/surgeon had the same priority list when discussing treatment options.

david in sc
 Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 8/22/2009 10:14 PM (GMT -6)   
Hi Greg

I had similar problems in Thailand one doctor had 100 robotics under his belt and a doctor that was not against Robotics but see no advantages in it so he will not do them at the moment The robotics doctor was giving me the hard sell telling me that he could do them in under 90 Min's the open gave me the impression that while he would be happy to do surgery on me it was completely my decision and made me feel very comfortable with him I went the open route and at the moment all is well no pads after 12 days (not completely dry but very nearly) do not think that I have any ED problems but really to early the find out for sure but early signs are very good and I had very little pain at all and the surgery was 60% cheaper than Robotics so I feel very lucky that I had done my homework and although I first wanted to have Robotic surgery I kept an open mind until I had looked at all options

Colin
 
 
Age 64 From UK now in Thailand Baby boy born 2/14/2009
 First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/0924 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear 
Open surgery 7/27/09
Prostate Gland weighting 34 grms
Gleason upgraded to 3+3 Tumour not closeto prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/22/2009 10:56 PM (GMT -6)   
Colin, glad you are still doing so well. The important thing is that you did get opinions and weighed them out yourself. The method, robotic vs. open is far less important than the skill of the surgeon, as discussed often here, and the comfort and trust factor that you, the patient has with his doctor. That is talked about less for some reason. I am definitely a first impression kind of person by nature, if I get bad vibes or gut feeling on someone, I rarely if ever change my opinion about a person. Not saying that is good or bad, right or wrong. I am very much that way with doctors and other specialists. When it comes to subjecting myself, my body, or possibly my life in light of a medical or surgical matter, those gut feelings of mine are going to be the deciding factor with me, despite stats and percentages.

You living in an Eastern country far from the United States, made your decision process even more difficult but interesting to say the least. I admire you for working through it, getting the answers you needed, then making your primary treatment, and then of course, following through.

I sincerely hope your post surgery positives continue in that direction. You got to be feeling pretty good about things so far.

David in SC
 Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, still talking option, 8/18 - had laser scope surgery to clear blockage, now on Catheter #7
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 8/23/2009 12:29 AM (GMT -6)   
David I am some what the same as you I make opinions very quickly sometimes for the good as well as for the bad It was something that worried me with the Robotics doctor from the word go but I had 3 meetings with him what really turned me against him was when he said that he could do the operation in 90 min's I was concerned that he was more interested in doing them quicker that anybody else where as my open doctor was not at all concerned how long it took in fact it took over 5 hrs and in Thailand he does them after his normal consultations at 4.30pm and his morning rounds were before 6am and I think if I had known that before I am not sure that I would have let him do surgery on me

On a side note I am so glad that I have learned to keep an open mind about people and not go by first impressions only because I did not like my lady at first I thought that she was a stuck up cow boy how wrong was I and over 2 years and a baby boy later she is nothing like it and is more down to earth than me
 
 
Age 64 From UK now in Thailand Baby boy born 2/14/2009
 First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results show no adenocarcinoma
5/15/0924 Core biopsy results Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side no perineural or angiolymphatic invation identified
One side PIN High Grade Bone scan clear 
Open surgery 7/27/09
Prostate Gland weighting 34 grms
Gleason upgraded to 3+3 Tumour not closeto prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
 

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