Article about Robotic Prostate cancer surgery

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JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 10/13/2009 12:58 PM (GMT -6)   
Hello all. I thought some of you might find this article interesting. http://www.msnbc.msn.com/id/33291388/ns/health-cancer/
 

Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1
Post Op PSA: Mar 09 <0.1
1 YEAR PSA: Sept 09 <0.1


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/13/2009 1:06 PM (GMT -6)   
Good post,
The article points out that surgeon skill could be the culprit and it makes sense. As with any surgery, you want the best surgeon not the modality doing the work. There is a disadvantage to DaVinci in that many surgeons are new to the console.

I believe it is very important that the patient knows the surgeon's experience well.

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!


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 10/13/2009 1:43 PM (GMT -6)   

Nice article but like so many others - no clear winner.

Tewari, who receives research funding from Intuitive Surgical and had no role in the study, faulted the research for lumping all minimally invasive surgeries together, both robotic and those using older laparoscopic techniques.


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.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/13/2009 3:05 PM (GMT -6)   
Jersey,

Interesting article, but seemed to be all over the board. I have an unscientific ,not back up by hard evidence that perhaps there are worse cases of incontinence and ED associated with robotic surgery. Might just be a coincidence, but even here, some of the worst side effect guys in those areas all had robotic as opposed to open surgery.

Like all PC news, it would be nice for once to see, as it was put above ,a clear winner in any category. Just doesn't seem to work that way.
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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


JerseyG
Regular Member


Date Joined Feb 2009
Total Posts : 65
   Posted 10/13/2009 3:20 PM (GMT -6)   

First off Purgatory,

 I wish you well in your radiation treatments. I had the Robotic and my incontinence was cleared within one month after my procedure. The biggest improvements in ED didn't occur until around 8 or 9 months after. Now I'm just about back to pre-surgery in the sack at 14 months out.

I do wish there was a clear winner, but there isn't so I just keep it moving and enjoy life.


Age now 44 (43 when dx)
 
Pre-op PSA:  0.9
Biopsy: 3/12 cores pos  20% 30% 50%
Gleason 3+3=6
Robotic RP:   Aug 08 1 day hospital stay, cath out on 8th day.
Post Surgery Pathology Report: Gleason 6, pT2c, tumor 10% contained in prostate gland, all margins negative. Negative lymph nodes
Post Op PSA: Dec 08 <0.1
Post Op PSA: Mar 09 <0.1
1 YEAR PSA: Sept 09 <0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/13/2009 3:23 PM (GMT -6)   
Jersey,

My incontinence was a month at most. Fortunate there. And still in the miracle group of no ED ever, with only one side nerves spared.
Just shows the utter inconsistencies of PC and its treatments and side effects
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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 130
   Posted 10/13/2009 3:45 PM (GMT -6)   
AP Medical Writer said...
Hu had his own learning curve. He's now done more than 700 robotic prostate surgeries, but "it took several hundred cases before I thought I was doing really well in preserving erectile function and continence," he said.


Ugh. And who are these doctors practicing on before they get the knack of the machine? For some of us who have health insurance which limits who we can go to, I guess I have to tell my doctor who is a novice with the Da Vinci, "When you get a little more experience with the machine I'll get back to you."

Maybe doctors should practice on murderers who have prostate cancer who are on death row.

O Buddy Boy
Regular Member


Date Joined Oct 2009
Total Posts : 106
   Posted 10/13/2009 4:50 PM (GMT -6)   
Yes, interesting. And all festooned with breast cancer awareness decorations.

Oh well.

I know at my clinic, the surgeon was well-trained. The senior practitioner there told me their DaVinci Surgeon had come to them with MIS experience with his residency at University of Chicago for six years, but they had him go to Pittsburgh for Fellowship Training on the Da Vinci, then to Ohio State Med School, and also to the Cleveland Clinic. Another prostate patient in town had his second opinion at Cleveland Clinic and was told this surgeon was excellent.

The two of us both had our surgeries within the last month. He has reported no ED problem -- full function, and as I wrote in my intro post I had discovered I am functional within 48 hours of my surgery.

I do think the procedure is over marketed and over promised. Some people think I should be farther along with recovery, including me. But all in all things seem to be going OK.
55 yo
Dx:9/29/09
DRE: Susp
PSA: 3.5
Gleason: 3+4/7
6/12 Cores Positive
1%, 3%, 8%, 15%, 12%
RALP: 10/0/09
PATH: Not back yet


brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 10/14/2009 8:58 AM (GMT -6)   
Medical literature rarely deserves the credit given it. Medical research is best done by clinicians who do both lab and real patient practice. I believe that the majority of medical research reports are done for one of two reasons. One, a resident/ fellow needs to do 6 months in a lab and gets an idea given him by the grand doo dah whose name goes at the front of the author list, or two, some person aspiring to become a grand doo dah some day feels that to publish is a good way to get there. If one considers the vast number of research articles submitted to various journals and the size of these journals' editorial committees, one can see that little time is available to seriously critique a lot of these papers. Take all medical reports with a LARGE grain of salt. I have been in the lab, written a paper, and seen it first hand. My paper was the result of a lot of hard work and time, but it failed to prove anything. I guess the value in that is to show others what NOT to do.

open prostate surgery can be a grubby and bloody mess, if the wrong doctor and the wrong type of male pelvis get together. Laproscopic surgery without a robot is a different breed of cat from robotic, and I don't see how the two can be compared. I do know from years of doing micro-neurosurgery, that the better the light and magnification, the easier the surgery. A great surgeon with poor conditions is no longer great, while a mediocre surgeon can look very good in optimal conditions. The same can be said of variations in anatomy over which no one has control. open, lap, or robotic lap may all have a place. Ideally one would see one doctor skilled in each, or a clinic that had three docs doing one of each type. Then decide and have an experienced surgeon. If that factor is constant, then other factors such as peri-op morbidity and other long term complications can be evaluated in a meaningful way. Remember, rid of cancer, continence, and then sexual function. A stiff penis will be worth very little in a coffin.
70 years old USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0
Neg. CT and BS
4 of 8 biopsies positive (all right side) Gleason Score 3+4=7
Robotic assisted total prostatectomy and node excision July 2009 in Luzern, Switzerland
pT2c G3 pN0 (0/14)
Catheter out in 5 days (home in 3 days)
No incontinence
Potency: beginning tumescence??? at 3 weeks post-op. Still happens at 3 months PO


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 10/14/2009 9:25 AM (GMT -6)   
Good read for someone on the fence about which one to chose

An open procedure that is going to require transfusions in and of itself is a whole other can of worms that people rather not have to deal with, the additional time in the hospital, and additional heal time of the much larger , invasive wound are negatives

I suspect a surgeon would be able to work better if the bowel area was completely open and he were able to use his hands to feel around while working.

Its not surprising that each is documented as having Pros and Cons, the patient needs to weight those in their decision

Any procedure is only as good as the experience of the surgeon and the staff that handles you
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


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 681
   Posted 10/14/2009 10:13 AM (GMT -6)   
brainsurgeon said...
Medical literature rarely deserves the credit given it. Medical research is best done by clinicians who do both lab and real patient practice. I believe that the majority of medical research reports are done for one of two reasons. One, a resident/ fellow needs to do 6 months in a lab and gets an idea given him by the grand doo dah whose name goes at the front of the author list, or two, some person aspiring to become a grand doo dah some day feels that to publish is a good way to get there. If one considers the vast number of research articles submitted to various journals and the size of these journals' editorial committees, one can see that little time is available to seriously critique a lot of these papers. Take all medical reports with a LARGE grain of salt. I have been in the lab, written a paper, and seen it first hand. My paper was the result of a lot of hard work and time, but it failed to prove anything. I guess the value in that is to show others what NOT to do.

open prostate surgery can be a grubby and bloody mess, if the wrong doctor and the wrong type of male pelvis get together. Laproscopic surgery without a robot is a different breed of cat from robotic, and I don't see how the two can be compared. I do know from years of doing micro-neurosurgery, that the better the light and magnification, the easier the surgery. A great surgeon with poor conditions is no longer great, while a mediocre surgeon can look very good in optimal conditions. The same can be said of variations in anatomy over which no one has control. open, lap, or robotic lap may all have a place. Ideally one would see one doctor skilled in each, or a clinic that had three docs doing one of each type. Then decide and have an experienced surgeon. If that factor is constant, then other factors such as peri-op morbidity and other long term complications can be evaluated in a meaningful way. Remember, rid of cancer, continence, and then sexual function. A stiff penis will be worth very little in a coffin.

Thank you for your comments.  I was about to say the same thing but with less authority.  It seems all the big news agencies have picked up this story and have once again misrepresented it's content. 
 
The study admitted that it got it's data from "medicare" codes. Unfortunately that gives very little insight into the duration or severity of a problem. It did not differentiate between robotic and non robotic surgery.  So based on that, their conclusions are worthless.  There is nothing in this study that even measures the skill of the surgeon, so that comment from the author is irresponsible, even if it is a possibility.
 
However, I would welcome a study that uses good data and can help future patients make decisions.  Studies like this are just self serving to the authors and further confuse the issues.


PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941

Post Edited (lifeguyd) : 10/14/2009 12:55:18 PM (GMT-6)


Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 10/14/2009 6:33 PM (GMT -6)   
"it's not the machine, it's the experience of the surgeon"

Those are not my words, they are Dr. Hu's reply to me today after I wrote him an email asking for clarification on today's research findings.

Dr. Hu removed my prostate by daVinci robotics one month ago. He has done a total of over 1,100 deVinci surgeries, 700 at Brigham & Women's and 400 previously. My urologist who diagnosed my PC had done only 40 daVinci surgeries and is why I went to Dr. Hu. It's all about the experience of the surgeon.

john

B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 10/15/2009 12:02 AM (GMT -6)   
Show me who paid for the study....

Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery, then intermittent drips 4 wks out

Full erection, 12th day after surgery

2 mo’s post-op, some ED after penetration

3 month PSA 0.03

6 month PSA non-existent

1 year   PSA  non-existent

1 1/2 yr PSA  non-existent

Erectile function--up and running!

Two year anniversary on 2/27/09-Sex life back to normal!

 


Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 10/15/2009 6:50 AM (GMT -6)   
It makes sense that since open RP has been around for over 25 years, the surgeons who practice that method would be more skilled on average than the surgeons who are now 'learning' daVinci RP, and were included in the study. My former urologist is a perfect example. He has 17 years experience with open RP, but has recently transitioned to daVinci RP. He admitted to having done only 40 when he diagnosed my PC, and based on that limited experience, I had to leave him for Dr. Hu. He is a good example of what was referenced in the study. It was through demand for daVinci that forced this surgeon to switch to daVinci, even though he was most likely a far better surgeon when he did open RP than he is now while on the daVinci learning curve. The point Dr. Hu was making is that daVinci robotics have been overmarketed by hospitals and surgeons who use daVinci need lots of experience on the machine before they gain proficiency.

I'd like to see research that compared the patient outcomes of a group of experienced daVinci surgeons who have done at least 700 surgeries to a similarly experienced group of surgeons who practice open RP. Let's determine the outcomes for cure, and I & I.
Age: 62
Pre-op PSA: 4.1
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 day in hospital, cath out on 9th day
Post-op PSA: have not tested yet
Surgeon: Dr. Jim Hu, Brigham & Women's Hospital, Boston


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 10/15/2009 9:31 AM (GMT -6)   
If it takes a surgeon 700 to 1000 operations before they become good at what they do I feel sorry for the men that they practice on but surely there figures should be taken into account you just cannot leave these people out of the equation
 
 
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
 


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 10/15/2009 7:23 PM (GMT -6)   
Hi Jersey
 
This debate will go on for a while as to which surgery is better.  I know Dr. Freedland and have been in a video interview with him at Duke.  I found it strange for him being a younger surgeron he feels better with the open surgery.  I had open surgery with his boss Dr.  Moul and I could not be happier with my outcome.  Zero's for almost two and a half years and no leaking unless I drink too much coffee and try to drive long distances.  ED is getting better too and some times it works without the shots or pills.  By the way, the insurance companies should be closed down for not helping us with the cost of the pills.
 
Just my two cents worth tonight.
 
Take care everyone
 
Mika
age at dx 54 now 57
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
ED is getting better
the shots work great, still can't give them to myself
two years of zero's

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