Which is best? I need your experience on Open vs Robotic surgery.

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huey
Regular Member


Date Joined Jul 2009
Total Posts : 27
   Posted 9/9/2009 8:14 AM (GMT -6)   
Hi members.
 
I need your advice on which type of surgery is better: open or Robotic. I've read Dr Walsh's book and he has performed open surgery and believes there are advantages above robotic. Has anyone ever had surgery by Dr. Walsh? Can someone comment on why open is better than robotic?
 
Thanks
Huey

Age: 64
Dx: 6/2/09, Age 63
G: 3+3
PSA: 2.04
Samples: 12, 1PC, 20%
DRE:positive
Stage: t2a
Still trying to decide on treatment.
New PSA 7/28/09: 1.3. I don't understand it???
9/8/09: Surgery is my decision for treatment.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4088
   Posted 9/9/2009 8:23 AM (GMT -6)   

Dear Huey:

With your stats it sounds like you might be a good candidate for brachytherapy (though you ddidn't post the volume of your prostate).  Anyway, have you considered that option/discussed your case with a radiation onlcologist?

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"!

CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 9/9/2009 8:28 AM (GMT -6)   
The technology is much less important than the skill and experience of the practitioner. Look around at the urologists and radiologists you have access to, pick the one with the best track record (which can be very hard to discover), and put your life in his hands, using whatever technology he employs.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: <0.01 at 05/09, 08/09


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/9/2009 8:28 AM (GMT -6)   
open or robotic is not as important as quality of surgeon. I went with robotic based on a having a great surgeon. My results were great in terms of healing from the surgery. Make sure you place emphasis on the surgeon more than the procedure type...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
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 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 9/9/2009 8:31 AM (GMT -6)   
Huey
 
I'll just give what my Urology Group recommended. It's a practice of 10 urologists, with two members doing extensive Da Vinci operations (over 700 Da Vinci operations). My urologist was Chief of Surgery for 5 years at the hospital where they are all affiliated.
 
At the time I was diagnosed, my doctor conferred with the rest of the group and they all agreed that Da Vinci was NOT the way to go because of my Gleason scores, the Stage and the 50% sample rate. There was a major concern that it had already spread outside of my prostate and Da Vinci will not allow enough visiability for the surgeon to see that.
 
If they would have caught it 6 months earlier, I'm sure they would have recommended Da Vinci.
Age 60, PSA 2007 4.1, PSA 2008 10.0
Diagnosed April 2008, Biopsy: 6 of 12 cores positive, Gleason 4 + 5 = 9
CT and Bone Scan negative, Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared, Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th, pT2c, lymph nodes negative
PSA Sept 28, 2008 0.00, PSA Jan 22, 2009 0.00, PSA June 29, 2009 0.00
ED Status- Currently using Trimix, Levitra daily for increased blood flow.
Noctural Erections have completely returned on a nightly basis, same hardness as before.


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 9/9/2009 8:32 AM (GMT -6)   
I chose robotic over open. If you do choose robotic though you want a surgeon with LOTS of experience using the robot. I've had a very good overall experience. The main differences I see are - six small incisions rather then the one large incision, Less blood loss which gives a clearer surgical field, Surgical field is magnified so the Doctor can see the nerve's better for the nerve sparing portion of the operation. Also one video I watched of the robotic procedure mentioned that where the urinary tract is cut and stiched back together is up under the pubic arch. In traditional surgery it is harder or the surgeon to see what he is doing and to get his Hands in there. With the robot they just change the camera angle and have a 360% view of the entire area that needs to be stiched back together. Again if go with Robotic find out how many the surgeon has done. Look for someone with the most experience and then see if you can talk to some of their patients. I had a chose between two doctors. One had performed about 200 robotic and the other had done around 2000. I went with experience.

Larry
Father treated for Prostate Cancer in 1997 with Proton Beam - Still doing well.
My Stats
Age at diagnosis 54, PSA 5.1
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
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear
Positive Margin 1.8 cm in length Noted in Right Apex


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 9/9/2009 8:38 AM (GMT -6)   

Huey,

I do not believe a "best" criteria can be applied to either robotic or open.  I also do not believe it is right for those on this forum to lobby for a certain procedure.  What we are here for is to provide information and knowledge.  With that as a guiding principle I will tell you why I chose robotic.  My local urologist that did my biopsy only did open so of course that was his recommendation.  I decided to get a second opinion and I went to Vanderbilt Medical Center in Nashville to get it.  I talked with one of their surgeons that only does open.  I then talked with Dr. Joseph Smith who is the head of the Urology Department.  Dr. Smith had done over 3,000 open radical prostatectomies when the robotic technology came out.  He was not convinced it was better then open and the only way he knew to prove it so was to learn the robotic procedure and perform it.  At the time of my surgery he had done 900 robotics and was doing them at the rate of 10 to 11 a week.  What he told me was the recovery from robotic was definitely better with less blood loss, lower need for pain medication and quicker healing due to the smaller incisions.  He also believed the results were slightly better.  As he said with the robotic the surgical field vision is so much better and clearer it allowed for better technique.  Dr. Smith does not believe robotic is right for all cases.  If the DRE indicates a definite change in the prostate and the biopsy has a high grade cancer and the PSA is high he will not do robotic as he believes that is when the "feel" is important that you do not have with robotic.  I was the perfect candidate and based upon my confidence in Dr. Smith I chose the robotic. 

You are just like me and many others at this stage.  You are seeking that confidence.  You are doing the right thing.  Read the books, ask opinions on this forum and talk with more then one surgeon and/or treatment provider.  If you follow that process you will achieve the confidence in a treatment choise and will make a decision you are comfortable with.

Good Luck!

Tamu


Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/9/2009 8:54 AM (GMT -6)   
huey,

It's not so much a which one is better situation, its what is better for you and your particular case. If you tend to be a "bleeder", then robotic would be more favorable, as traditional open operations can tend to cause more bleeding, though in recent years, that has been fine tuned to where even that isn't as much as a problem. Some surgeons still like to get their physical hands inside you and have tactile feel to everything, a good argument can be made for that. If time in the hospital is important to you or your insurance, then robotic usally wins out. I do think they over sell the healing from robotic a bit, as yes, you may have 5 smaller holes to heal from, instead of one large one from the open, what they are doing inside is just as major in either method. What the other's say is very important, the skill and experience of your surgeon is paramont to this decision if you go with surgery. It's not just the sheer number, I think that gets blown out of proportion too, its the skill level and overall experience. A good local surgeon with 300-500 under his belt ,may be better than a surgeon that cranks them out in the thousands. You would have to examine the post surgery opinions of those men. As far as the side effects of incontinence and/or ED, I have seen no evidence that one way is better than the other.

In the end, I couldn't have robotics, I chose open, because unknowninly, I had a very deep and narrow prostate bed, which made it impossible for a robot to operate freely, even with a traditional open surgery, my surgeon still had a hard time. Also, there have been issues doing robotics with very large heavy men (not sure what the current criteria is for that) and extreme tallness I have read about a case or two.

I agree with Tudpock above, you appear to have a low level case of PC based on your posted stats. If you haven't you may want to weigh out other primary treatment options. On the surface, you seem to be a good candidate for "seeding". I would at least consult with a radiation oncologist before locking into a solution. You definitely have time for that.

Best luck in your search, please keep us posted.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 9/9/2009 9:52 AM (GMT -6)   
It is a very difficult question to answer because nobody as tried both methods so you are left with everyone having to guess I wanted Robotic mainly because I am a bleeder but I am in Thailand and the experience on Robotics are just not here yet so I went open in my case I was walking quite comfortably after 3 days and I had very little pain at all only on painkillers for 1 day so I would have to say open is best but it is not that easy but I would say go for the doctor you feel comfortable and has good experience
 
 
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
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 9/9/2009 12:15 PM (GMT -6)   
Huey,
With your psa dropping and with only one core of a G6 and your age, why don't you slow down and evaluate all options. You may have an indolant PC that would neveer manifest itself in your life time. Before you decide any any invasive treatment that will affect the quality of your life,
see a well noted prostate oncologist for a 2nd opinion and he can guide you in the rght direction. It is estimated that over 1,000,000 men have been treated for a prostate cancer that would have never affected them. On initial observation you seem to be in this group.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 9/9/2009 1:08 PM (GMT -6)   
Don't make a surgical decision based solely upon opinions expressed on forums such as this - that wouldn't be the smart thing to do, IMO.  I think your first priority should be to work with your primary care physician and then work your way through the list of treatment possibilities - with the assitant of your physician - and then meet with the various specialists, have the various tests performed, and then make an INFORMED decision based on your personal health history and the testing results.  There is no one "best" specialist or treatment which applies equally to us all.  Treatment method/procedure is no less important than physician, specialist or surgeon. 

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

 


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 9/9/2009 2:20 PM (GMT -6)   
I've had both. Dog gone if I could tell any difference. LOL
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/9/2009 2:36 PM (GMT -6)   
You are up against the hard part of PC -- making decisions when all of your choices are good. My doctor, who had done many prostectomies of both kinds explained that the greatest lack in robotic was sense of touch. He felt that he had learned to make up for that by observing how tissue "bounced back" when touched with a robot tool. I also talked to a surgeon who did open using a perineal approach (I understand that this is harder to learn) He said that, while he had another doc in his practice who did robotic, he believed that his approach gave him a much better view.

I opted for robotic for several reasons. First was my confidence in the surgeon. Second was that I am very bad at indolence and so the quicker recovery appealed to me. I also thought that at my age, the prospect of less potential blood loss and trauma was not to be ignored. Finally, I am an engineer and a sucker for technology. If someone invents a 300 mph mag-lev train to hell I might just sign up.

In conclusion -- what everybody else said, go with the surgeon you are most comfortable with.
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


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 9/9/2009 3:18 PM (GMT -6)   
Huey,

I know you have made a decision for treatment, however I will have to side with JohnT...really think through your decision based on the stats you presented here. Regardless of treatment, there will be side effects and you don't have to rush to treatment just yet. I for one being on the other side of robotic surgery, will tell you if I had your option up front, I would have waited and enjoyed life just a little longer without any side effects.

Just my 2 cents worth.
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 Apr 2009 .06
                   9 month Jul  2009 .08


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/9/2009 3:53 PM (GMT -6)   
I had robotic. My specs and results are in the signature below.
From what I've seen here by looking at other guys' results it looks like Robotic was quicker out of the hospital but slower to continence.
Look around and see what you think.
Good luck,
Jeff

Edit I spelled "results" wrong i my original post (swapped the l and the u resulting in a censored word. I hope that doesn't put me in HW jail. )

Post Edited (Worried Guy) : 9/9/2009 7:05:47 PM (GMT-6)


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 9/9/2009 4:44 PM (GMT -6)   
As many have written, go with the procedure that your Dr is most experience at

Note: that if you go in Robotic and a complication arises they will proceed and do the open
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 9/9/2009 5:43 PM (GMT -6)   

As others have said, the skill of the surgeon is the most important consideration.  For what it's worth my doc said he believes robotics is the wave of the future and is where most surgeries are headed in the future.  He, however, prefers open and that is his skill set and he does lots of them.  I had great confidence in him so went with open and am glad I did.

It never hurts to get a second opinion and consider all your options.  It would be so much easier if there was some kind of chart that said if you have this, this and this then you should choose this treatment.  If you have that, that and that, then you should choose this other option.  Unfortunately, there is nothing easy about it.  Hang in there and best wishes on your upcoming treatment.  David


Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


dogyluver
Regular Member


Date Joined Sep 2009
Total Posts : 35
   Posted 9/9/2009 7:30 PM (GMT -6)   
My husband recently underwent open prostatectomy. He choose open because of the drs experince. The robotic sounds great but it's not been around long enough. Would you rather have a dr with 5 years experience or 20 years with open. Also the doctor can get in and actully feel things and a robot can't, the can also have a better scope on how other areas look. Keep in mind although there are more risks involved with the open vs robotic. If you decide on open make sure that you donate your own blood in advance. Transfusions are not uncommon with open prostatecomies my husband had several complications from 2 transfusions. Also longer hospital stays, more pain meds, longer recovery period and of course the incision. My husband was lucky with the incision his is only about 5 inches from his pubic bone up toward his navel. Most are about 8-10 inches. When the doctor says this won't hurt a bit don't believe him. Even through the complications I feel that this was the best decision.
Good Luck,
Pam
 

dogyluver
Regular Member


Date Joined Sep 2009
Total Posts : 35
   Posted 9/9/2009 7:36 PM (GMT -6)   
On another note if you choose a specialist in either robotic or open they will say that theirs is the best. The best way to good a good decision is a doctor who does both even though they  will probably say robotic because it is more money in their pocket. Not only that keep in mind that most insurances won't pay for the robotic and the difference is about $55,000. that's right $55,000.

huey
Regular Member


Date Joined Jul 2009
Total Posts : 27
   Posted 9/9/2009 7:51 PM (GMT -6)   
I want to thank each and everyone for your valued comments on my post. I have read all of them carefully and I'm fortunate to have found this forum with a bunch of guys that have been through this. What great advice. As recommended by Tudpock, I will see an oncologist to have a different perspective of my case. And as many of you have said, I will find a doctor that has alot of experience in both open and robotic surgery to get their opinions and to find someone I have confidence in. And finally, I will slow down, take a deep breath, and try to be sure I'm making the right decision.
Again, thanks for your help and I wish all of you good luck in your journey. I will keep you posted.
Huey
Age: 64
Dx: 6/2/09, Age 63
G: 3+3
PSA: 2.04
Samples: 12, 1PC, 20%
DRE:positive
Stage: t2a
Still trying to decide on treatment.
New PSA 7/28/09: 1.3. I don't understand it???
9/8/09: Surgery is my decision for treatment.


zampilot
Regular Member


Date Joined Aug 2009
Total Posts : 152
   Posted 9/10/2009 4:20 AM (GMT -6)   
huey,
I had my 'open' 6 months ago. I chose 'open' because I had confidence in the surgeon, who has been doing them since 1981. He explained that while robotic is less time in the hospital, less healing time, the end result is the same. His concerns with robotic were blood loss and limited vision "by the time the surgeon has a red-out in his viewer from nicking you on the way in, it's no longer a prosatectomy procedure, you will have to be cut open to stop the bleeding to save your life". While some men dont like the idea of a 6 or 8" scar from the open surgery and will actually base their desicion on vanity, it was no concern to me. The surgeon's vision is magnified, like the robotic, but he is there 'on-site' so to speak, can see everything at once, can use his sense of touch, etc. He can tie a stitch in 3 seconds vs two minutes via robotic. I didnt feel comfortable with the robotic. A friend of mine had robotic a year and a half ago, the Doc nicked a nerve....

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4088
   Posted 9/10/2009 5:22 AM (GMT -6)   

Huey:

I'm glad you have decided to explore all of your options.  At your early stage you have lots of choices and you will sleep a lot better knowing you have made an informed decision.  Like many men here, I spoke with MULTIPLE doctors including open surgeons, robotic surgeons, radiation oncologists, prostate oncologists and proton therapy doctors.  This is a big deal as you are messing around with important real estate and you want to feel totally comfortable with your decision.  It is not only a cure you should be concerned about but also quality of life.

Also, I would highly recommend considering what JohnT said in his post.  You should probably at least consider using AS at this point.  That takes some strong psychological will since the cancer is still there but, having a doctor who is experienced with AS patients could help in that matter.

I wish you the best of luck and please let us know what you decide and if we can help further.

Regards,

Tudpock

P.S.  Unlike what one poster said, I believe most insurance companies WILL cover robotic surgery.  I know mine would have.  The only way to know, of course, is to check with your own company.


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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/10/2009 6:39 AM (GMT -6)   
I was on BC/BS of SC at the time, and they pre-improved open and robotic surgery equally, as well as brachytherapy and conventional radiaition. They would did not approve the "freezing" method, can't ever remember the name of it. So with Blue Cross, it was never a hassle.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 9/10/2009 7:38 AM (GMT -6)   
The primary concern should be dealing best with the cancer, how to remove it, treat it, etc., and I believe concerns about ED or incontenence shouldn't play a part in the treatment decision.  Do we want to live a longer and better life, or live a lesser number of days, pee better and have more sex?  The answer to the questions become simple when you prioritize the matter . . . at least that was how I felt at the time I was confronted with the "news."
 
A good primary care physician, someone who you've been visiting over time, who does your physicals and knows your health history, your lifestyle, etc., is so essential a figure/influence at this particular time that it's important to focus on that relationship - a relationship that should allow the primary care physician to lead you through the myriad of options.
 
I don't think it's fair or accurate for an impression to be created that there are physicians/urologists/surgeons who will talk you into a course of treatment that's not in your best interest . . . because it happens to be their personal and practice specialty.  That's a very cynical view of things - and so is suggesting a physician will steer you to a course of treatment because he or his practice will earn greater profit from doing that. 
 
The primary care physician should be acting as sort of a referee in the process - explaining things as they go along and helping you make the choice you're most comfortable with.  Independently bouncing from one specialist to another without someone such as a primary care physician coordinating the process creates the opportunity for increased risks and an eventual decision which may not be what you really want to or need to do in your particular case.
 
Because the body and health history of each of us is different, there are often compelling reasons to choose one course of treatment over another - trumping the argument about the "skill of the surgeon" being the primary factor to consider.  There are men for whom the open surgery is the best, for others da Vinci and for others non-surgical treatments.  Nobody here can say which is right for you.
 
And I think the suggestion, posted above by someone else, that da Vinci surgery costs approx. $55,000 more than open surgery and that most insurance companies won't pay for the procedure are not factual statements.  I know that in my situation Blue Cross paid every penny.
 
This is a good forum to read and participate in, but it's the medical professionals you should be having these discussions with.
 
 
 
 
 
 

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

 


huey
Regular Member


Date Joined Jul 2009
Total Posts : 27
   Posted 9/10/2009 7:51 AM (GMT -6)   
Mavica, Tudpock, and Purgatory,

Thanks again for the advice. It makes alot of sense.

Huey
Age: 64
Dx: 6/2/09, Age 63
G: 3+3
PSA: 2.04
Samples: 12, 1PC, 20%
DRE:positive
Stage: t2a
Still trying to decide on treatment.
New PSA 7/28/09: 1.3. I don't understand it???
9/8/09: Surgery is my decision for treatment.

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