With all the controversy that's going on, My question is, what surgical procedure is best for nerve

With all the controversy that's going on, My question is, what surgical procedure is best for nerve sparing, less incontinence and erectile dysfunctio
3
OPEN R P - 30.0%
0
LAPAROSCOPIC R P - 0.0%
7
ROBOTIC R P - 70.0%

 
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GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/13/2009 6:29 PM (GMT -6)   
I recently met for 2 hours with a "MULTI DISCIPLINARY GENITOURINARY ONCOLOGY GROUP" A MEDICAL ONCOLOGIST, A RADIATION ONCOLOGIST, AND AN UROLOGIST. My biopsy was read by 3 pathologists ( including JHH ). The 3 confirmed the same. Because of my age, good health and my moderate BPH problem all 5 Drs. agreed on the following.

1st. choice:
SURGERY ( with different outcomes )

2nd. choice:
RADIATION ( with unavoidable damage to surrounding areas due to BPH )

3rd.
WATCHFUL WAITING
( 50 / 50 chance with strict surveillance postponing the inevitable )

4th. BRACHYTHERAPY
( the most damage to surrounding areas. My prostate is about 50cc )

With all the controversy that's going on, My question is, what surgical procedure is best for nerve sparing, less incontinence and erectile dysfunction? ( All the Drs. I consulted with have 700 to 1,800 under their belts in their specialties. )

1- open R P
2- LAPAROSCOPIC R P
3- ROBOTIC R P

It will be very helpful if our friends who had one of the above procedures to share with us their experience and recommendations.

Also will be nice if you could take a chance to rate my poll survey.

Thanks, GTA
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.

Post Edited (GTA) : 10/22/2009 5:15:28 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/13/2009 6:36 PM (GMT -6)   
The questions in your survey are the very ones that there aren't any conclusive studies of at the moment. I think you will find that most here will tell you that its not the surgical method that is used, its the overall experience and expertise of the surgeon that makes the most difference, and even then, there are no guarantees in the side effects departments.

I chose open surgery, as robotic was new and rare in my area at the time. Now they do it all the time here. But we have men here that went to big name surgeons at famous centers, were both side nerve spared, and yet have total ED.

Sounds like the ones you are checking out are fine as far as number of surgeries go, now you need to find out about their real life reputations and better yet, find out about some of their expertise from patients of that partiular doctor.

Good luck to you.
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.


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 10/13/2009 6:51 PM (GMT -6)   
I had nerve sparing open surgery 2 years ago, am fully continent from 2 days after catheter removal, and have absolutely no natural sexual function 2 years later.

The survey won't tell you anything, 'cause its so individual and there's no firm basis to compare.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/13/2009 7:06 PM (GMT -6)   
An excellent doctor. Regardless of procedure...

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!


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 10/13/2009 7:17 PM (GMT -6)   
Greetings GTA.  The skill of the surgeon is the most important criteria.  Find a doc who has done lots of the procedure and  not only has a track record but is also willing to share that experience.  There is also the factor that you can't really put your finger on but its the confidence and chemistry you have with your doc.  I knew after we met the surgeon on the first visit that this was the guy for me.  The more research I did, the more it confirmed he was the guy.  From all indications I made a great choice because he did a great job. 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


Army Guy 80
New Member


Date Joined Oct 2009
Total Posts : 2
   Posted 10/13/2009 8:58 PM (GMT -6)   
Had DiVinci Robot procedure in Germany. My urologist tried to talk me out of it. I did a bunch of research on the doctor and his clinic and convinced him. Have five co-workers who all had procedures done within 18 months of mine. Four had open radical, one had robotic. All who had open have or had issues, two of us with the robotic are doing much better
July 2002 PSA 4.0, had continued testing from than through November 2007 with a steady rise to 13.2 All the testing was done, but nobody read the results!
Jan 2008 PSA 14.5
Biopsy 7 of 12 positive
Gleason score 4+3=7
Operation April 9 2008
First erection still in the hospital with cath still in. Did not know the pill the nurse left at night was a Levitra
Minimal incontinence after 30 days, no leakage or accidents after 90 days
Returned to exercise regime in less than 30 days to include walking a 26.2 mile "Volksmarch" through the mountains of southern Germany on my 50th birthday, 22 days after surgery!
Current treatment is 20 mg Levitra 3 x week
Have to agree that an experienced surgeon is key, but good robot beats a good open procedure IMHO

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 10/13/2009 9:51 PM (GMT -6)   
I think the answer that you would arrive at if you talked to every poster on this forum, that there doesn't seem to be a strong correllation to any technique, or necesarily to number of surgeries a doctor performed, if he had a fight with his wife the night before.

This is a very individual thing. Our anatomies are different. Our prostates are attached to our bladders or rectum in many cases. Our nerves are different in the way they are adhered to our prostate. Our tumors are different in the way they manifest themselves.

I know some guys who have good results believe it is becasue they chose the right surgeon or had the best technique. I don't see that as I read everyone's signature.

It is just a series of differences in all of the parameteres that make some guys incontinent and some guys hae ED. I'm not saying a surgeon can't or dozen screw things up at times.

I see no logical way we can explain men who have erections with the catheter in, or no leaks from day one, other than its just in the cards. Otherwise, we would have some surgeons who would be doing all the prostatectomies. The same surgeon who has no side effects in one surgery will have a patient with total incontinence or total ED in another.

Picvk your surgeon to the best of your ability, and make sure he is experienced in the technique he is using, and then deal with the results. There are no guarantees with surgery or radiation. The odds may be different with whichever technique yoiu choose, but your personal resulkts remain to be seen.

I wish it wasn't so. but the more I read the posts here, the more I am convinced.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
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)
5 month PSA <.03 (undetectable)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/13/2009 9:59 PM (GMT -6)   
goodlife,
that was a very sensible post, and i think you speak the truth there. every human body is different, even though so similar in many ways. the points you bring up may very well explain the myriad of results we have even among us here at HW. My surgeon didn't tell me this until several months after my main surgery, but he was really upset that he had to do mine starting at 4 PM in the afternoon. He liked to do the big operations in the early morning slots only on a certain day. The hospital thought they were doing me a favor by having the last spot on a Friday afternoon, in order to have the full weekend in the hospital for the roughest part of the recovery. Sounded good to me at the time as the patient ,but in retrospect, would rather had it the way my surgeon wanted it, so that he could operate on me when he felt he was at his best time frame of the day. Not sure it would have changed the end results for me, but we will never know, just another of those many "factors" that determine our ultimate fate.

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% 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.


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 10/13/2009 10:24 PM (GMT -6)   
Goodlife nailed it, and much more eloquently than I could. The surgeon and our anatomy are huge variables that swamp the probably only small variations in surgery type.

open surgery has more blood loss, and a blood transfusion may be necessary (not in my case). The other types pressurize your abdomen, so there is minimal blood loss. One claimed advantage of open is that the surgeon has a better feel, but the other types give a clearer view -- more magnification.

As far as recovery time is concerned, I don't think there is much difference. One six-inch incision compared with five (or is it 6?) one-inch incisions. I had open and felt my recovery was much the same as that reported here by the robotic guys.

Oh, and one other advantage of robotic -- the hospital makes more money. :-)

It's a crap shoot, so I think it best to go with whatever technique your chosen surgeon is most comfortable with.
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?)
19-month: ? (next week)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 10/14/2009 12:48 AM (GMT -6)   
I had open surgery due to the lack of experience in the Robotic field if you are worried about ED and continence ask each doctor what his percentages are for both and ask him to show his figures for both mine had a 95% success rate for continence and 50% for ED which I was happy to go with

The thing that I have been wondering about whether the Robotics are the best in complicated surgeries mine was difficult over 5 hrs and I came out OK on continence and ED (lost one nerve bundle) after watching a video of a Robotic operation I have also wondered if the pincers could be damaging the nerve bundles human fingers will be much more delicate in this department which could account for why the results in Robotic surgery vary so much
 
 
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
 


GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/17/2009 4:45 PM (GMT -6)   
Thank all you guys for your inputs and comments. My primary doctor told me to make sure the "famous" and experienced doctor who I choose to perform the surgery is THE ONE WHO IS ACTUALLY GOING TO DO THE OPERATION, not an assistant or an internist. Most of the experienced urologists are located in teaching hospitals. During my consultations I made sure all doctors understood that, and all made a note of it in my records. I also asked them what was the best day and time for them to do my operation, some how Tuesdays was the chosen day and the months of January & February were the best.

I have not made up my mind yet, but I will share with you my research journey and my decision.

Thank you all
GTA
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.


Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 10/17/2009 6:11 PM (GMT -6)   
My sister in law (nurse) gave me that tip before my daVinci RP four weeks ago. She suggested I ask the surgeon out loud in public, which I did while lying in the pre-op area. Dr. Hu responded he does all the robotics himself but needs two assistants in the room to help with the operation. That was fine by me, although I don't know what I could have done at that point if I had gotten another response from the surgeon.
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


Modelshipwright
Regular Member


Date Joined May 2009
Total Posts : 215
   Posted 10/18/2009 8:13 AM (GMT -6)   
It may be more appropriate to ask what surgeon is best rather than the procedure. Any procedure can be made a mess of in the wrong surgeons hands.

Keep well,
Regards,
Bill
Pre-Op:
 
Age 64. Diagnosed with Pca January 2009.
PSA 5.6, Gleason 3+3=6, T1c
 
Biopsy:
 
TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear.
 
Treatment choice:
 
Robotic Assisted Laparoscopic Prostatectomy - September 29/09. 
Pre-op PSA down to 5.28 which I attribute to visualization techniques and a new vegetarian diet.
 
Post-Op:
 
Robotic Prostatectomy - 09/29/09, back home 10/02/09.
 
Pathology - 10/14/09  Gleason Score remained at 3+3 = 6 as it was when originally diagnosed. There were no positive margins. Tumors were found in both lobes and involved 3-5% of the prostate. There was no Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and the bladder neck was also cancer free. 
 
Continence
 
10/16/09 - 3-4 pads a day and working on pelvic floor exercises as prescribed.
 
Potency:
 
10/16/09 - Zip, nada
 
State of mind:
 
Excellent - always positive.
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/18/2009 9:26 AM (GMT -6)   
Red,

I know its academic now, but what you could have done lying in pre-op had you not gotten the answer you wanted, would be to abort the opertation, and rescheddule another time with another doctor. It's your body and your peace of mind.

Like I told my daughter when I walking her down the ailse to get married, that at any point you know in your heart you don't want to do this, then we will turn around and walk out.

We always have choices with our bodies, and that includes surgery.

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% 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.


GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/18/2009 3:39 PM (GMT -6)   
Hi Red Nighthawk,
I hope you are doing fine and things work very well for you.
Being from NE area it will be helpful if you could share with us your experience so far with Dr. Jim Hu and the Brigham & Women Hospital. Did things went the way expected, and how was the hospital stuff treatment? Why did you choose Robotic R P vs open R P?
Thanks
GTA
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 10/18/2009 3:54 PM (GMT -6)   
A study in Boston gives the following results after 36 months for patients with normal sexual function before surgery: results are normal function, intermediate; poor.
Non nerve sparing: 6% 31% 63%
Nerve sparing: 8% 28% 64%

The results for nerve sparing and non nerve sparing were similar in the study of radical open. I would imagine similar results for robotic.
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


GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/18/2009 4:40 PM (GMT -6)   
Hi John T,
I followed your advice and many of our good friends and meet with multi specialist. What I came out with is that the Robotic was invented specifically to minimize the bruising of a Dr. hands and what they do to our delicate tissues. Robotic in the 'right hands" bruising is greatly reduced due to the size, flexibility and manoeuvrability of the Robotic "arms". Robotic can turn 360.
I have not decided what method to go with yet, but my preference will go with the Dr. who has the best records in the following order:
1- Continence
2- Bowel movement
3- ED

Thanks John for all you help.
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.

Post Edited (GTA) : 10/18/2009 5:08:07 PM (GMT-6)


Siewife
New Member


Date Joined Jun 2009
Total Posts : 14
   Posted 10/18/2009 4:54 PM (GMT -6)   
Especially for GTA:
 
We were very happy with the Brigham (except for $$ parking!!) - great nursing staff, great care throughout - my hubby even needed another day b/c of excessive drainage and I was stunned that they kept him when my experience has been kicking folks out as long as they are breathing!
 
Chose open RP b/c our initial meeting was with Dr. Richie and this is his expertise as he quickly told us.  Welcomed us to see Dr. Hu for a consult re robotic procedure but Dr. Hu was traveling and he has busy schedule - concern was waiting too long given Gleason 7.  Dr. Richie also spoke with us about what he could feel with his hands - prostate CA is sticky.  I come from family of surgeons so was comfortable with him and his approach.
 
My apologies for dropping off this board as things calmed down for us - you all provided enormous support.  One problem is that I returned to work after three weeks and can't log in - too many trigger words that bring down the computer overseers tongue
 
Happy to report the good news of ZERO PSA .... but also zero erections....that is one of our concerns b/c Dr. Richie takes what seems to be conservative approach compared to many of your stories - no treatment for another 3 months so we'll see.  Meanwhile hubby almost completely continent (except sneezing, or when he's been doing too much yard work and gets really tired) so that's good.  Walking is absolute key.
 
My best to all of you and my gratitude as well...
husband, age 56
psa 4.3
biopsy 5/20/09 - 2/14 positive, 3+3=6
consultation 6/4/09 - revised to 3+4=7
open surgery 7/31/09
T2a, N0, Mx, Gleason 7 (3+4)
ZERO PSA 9/9/09
 


GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/18/2009 6:05 PM (GMT -6)   
Hi SieWife,
Nice to hear from you, was a little worried for not hearing from you. Happy for your husband PSA. I am sure things will work out fine for both of you, it will take some time for sure.
Dr. Hu ( Robotic) and Richie (open) are 2 of the best in our area. I am very close to making a decision. Drs. told me to take my time b/c of PC stage and slow growing PSA. My wife is more nervous than me and wants that thing out. Good luck with your work and thanks for letting us know your husband is fine.
Good luck
GTA
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.

Post Edited (GTA) : 10/18/2009 5:14:03 PM (GMT-6)


Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 10/18/2009 6:10 PM (GMT -6)   
GTA, you are doing the best thing for yourself right now by researching and asking questions. I believe many guys simply follow the initial instructions given by their urologist, without question. I could have been one of those guys, if it wasn't for this forum and another one I read daily. From the insight provided by guys who have gone down this road, I learned to get second opinions on my initial PSA, my initial pathology, and in the end, leave my urologist who found my PC and had laid out a plan for me to have surgery by him. At the time, he had done only 40 daVinci robotic surgeries so, again with the counsel from health forums, I new it was vital to find the most experienced surgeon possible. I found two surgeons in New England who had both done over 1,000 da Vinci surgeries. Dr. Hu came as a personal reference by a dear friend who had surgery by Dr. Hu two years ago and he is very satisfied with the outcome. I decided on robotic vs. open because I believe given equal and vast experience of the surgeons, the results will be better with robotic assisted. To hedge, I made an appointment with Dr. Wagner in Connecticut, just in case I didn't like Dr. Hu. Once I met Dr. Hu, I realized he would be my surgeon. I had surgery at Faulkner Hospital, which is very near Brigham, because Dr. Hu operated there two days per week and that provided me more flexibility on choosing a date, and also, the patient automatically stays in a private room, but at Brigham it would be a double. The staff at Faulkner was superb. Previous to this episode, I had never stayed in a hospital overnight, so I wasn't sure what to expect. I had my first post-op PSA blood test on Friday and I now await the results. Incontenence has been surprisingly not a real problem. I only use one pad per day, just in case, but I really could get by without it. If I over Kegel during the day, I think that encourages a little dribble, but it's really not a big issue. The other one though, impotence, is still an unknown for me. So far, not much happening down there. Dr. Hu was not a big fan of viagra therapy. I brought up the subject and he said it'll take time and the research doesn't support the expense. That disappointed me because I know all about ADC and their cheap generic. BM's started on the 4th day after surgery and have not been a problem at all. I hope all of this helps. JohnM141@cox.net
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


GTA
Regular Member


Date Joined Aug 2009
Total Posts : 27
   Posted 10/18/2009 6:36 PM (GMT -6)   
RedNightHawk, thanks for the info. You are totally right about the many GOOD people in our forum, without them many of us guys will be lost.
I will be posting my learning and research journey and hopefully will help someone.
Keep us posted, I hope everything will work fine for you.
The Best of Wishes,
GTA
57 year old
1st. biopsy atypical
2nd. biopsy 7/07/09 3 out 12 cores positive all 3x3's gleason 6
PSA 3.4
T1c
Had a moderate BPH for past 4, 5 years. Medication did not help.
Deit: 98% animal fat free for past 25 years at least.
Drinks: Mostly red wine with lunch/dinner
Activity: Walking 5 to 7 miles every other day. Cycling 12 to 15 miles every other day.
Action taken: Still in the research and learning stage.


O Buddy Boy
Regular Member


Date Joined Oct 2009
Total Posts : 106
   Posted 10/19/2009 9:43 PM (GMT -6)   
A few comments.

I think I was fortunate that I had robotic surgery. I had a chronically inflamed prostate when diagnosed with PCa. The condition, I believe, covered up an earlier diagnosis.

This condition meant the surgery was very bloody -- inflamed tissue bleeds profusely -- I lost as much blood as the typical open surgery. And open surgery would have been worse. My surgeon shudders when he thinks about it. I know, because my wife works for him. (No, she was not part of the procedure, just part of getting me in for an extra exam this year, thank God).

She was a big part of the decision process. First because she would suffer the consequences of a bad decision, too. And second, she had been a surgical nurse for over 25 years, all kinds, crannie, nuero, thoracic, ortho, uro, etc. She has been on the front line of technological innovations for years.

Older surgeons rely on touch and that is how they learned. If they got good at it that way, then they are good at it that way. They are like old-school pilots who flew by the seat of their pants and the feel of the joystick. One problem with any open surgery is "adhesions" where your innards get bumped around with the hands banging around and the organs and bowls stick together later. Adhesions are nasty complications.

The new surgeons grew up in the world of video games -- a lot like today's modern pilots who fly by wire, or robot pilots who are controlling the drone strikes in Afghanistan -- they are very visually oriented and touch has nothing to do with their skill sets.

She has me thinking"Sopwith Camel or FA-18?"

As for radiation. All the Mrs. had to do was ask me to recall the time when I was a kid and used my dad's propane torch as a flame thrower on plastic toy soldiers, "That's what happens to your prostate when they use radiation -- I've seen it over and over again." Your back up plans are limited. Then again if Elvis has left the building, then that might be a good first choice.

I live in Western Michigan. The senior surgeon at the clinic told me an ironic story. "I have patients come to me and say they want to go the Northwestern for their surgery and then come back home and have me handle the complications."

Think about that for a moment. It's a bit of a hand grenade.

TIME OF DAY COMMENT: Surgeons doing delicate surgery often prefer early times because it's quieter and the scheduling was consistent. Later in the day, times can get bumped and the surgeon is working overtime/second shift on YOU. Then again, one cardiac surgeon she knows preferred a bit later, after the jitters from his morning coffee wore off. Then there are the ortho guys who like doing the delicate work early when their hands are sensitive and haven't been worn down by the hip or knee replacements, which is more like carpentry. They reserve the heavy-duty work for later, "They're banging and sawing and it sounds like remodeling." How would you like to be doing something delicate with remodeling going on in the next room?

Anyway, I'm still new at this. Surgery 10 days ago. Catheter still in. Three erections in the last week that hurt with the catheter. My sphincter seems to be at war with the catheter. It's constantly contracting and seems like it wants to pull the catheter out. Weird feeling.

OBB
55 yo
Dx:9/29/09
DRE: Susp
PSA: 3.5
Gleason: 3+4/7
6/12 Cores Positive; Sextants were 1%, 3%, 8%, 15%, 12%, 0%
RALP: 10/10/09
PATH:
Margins: Clear
Lymph Nodes: Clear
Seminal Vesicles: Clear
Gleason: No increase from biopsy 3+4/7
Some perineural and capsule invasion.
T2c,NO,MX


O Buddy Boy
Regular Member


Date Joined Oct 2009
Total Posts : 106
   Posted 10/19/2009 9:52 PM (GMT -6)   
GTA,

One more comment.

There is no history of cancer in my family at all.

A long time ago, when I was a competitive cyclist, an experienced racer who would ask me after a good training ride or when I had won, "Is it worth it?"

"Worth what?" I'd ask.

"The prostate surgery you're going to have when you're 55." he'd reply.

I thought it was a joke. I know there is no science to it. But over the last few weeks that question has been playing in my head over and over and over.

OBB
55 yo
Dx:9/29/09
DRE: Susp
PSA: 3.5
Gleason: 3+4/7
6/12 Cores Positive; Sextants were 1%, 3%, 8%, 15%, 12%, 0%
RALP: 10/10/09
PATH:
Margins: Clear
Lymph Nodes: Clear
Seminal Vesicles: Clear
Gleason: No increase from biopsy 3+4/7
Some perineural and capsule invasion.
T2c,NO,MX


Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 10/19/2009 10:54 PM (GMT -6)   
I had open surgery 3/09. Now 18 months later I am not only fully continent but
also fully potent. This is thanks mostly to a great surgeon than the open procedure.
Experience is key no matter the procedure.
 
    1. Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Open Surgery. Northeast Georgia Medical Center, Gainesville Ga. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible (less than four months post op) with the assistance of Cialis.  Post Op Biopsy : No malignant cells in lymph node. Gleason 3=4=7. Tumor on both lobes. Urethral margins/apex free of neoplasia. Right and left seminal vesicles free of neoplasia. No invasion of prostatic capsule of the resection margins are noted by the tumor. Tumor occupies 10 to15% of the prostate gland. Path staging T2c, NO, MX- Group staging II.  Focal areas of perineural invasion by tumor are noted. 80% natural erections and full erections with 10mg Cialis. 9/22/08-Took 10mg Cialis on Monday night, had very usable full hard erection at night, the next morning, and the following Thursday morning, 60 hours after original dose !! Orgasm quality Excellent.!!!!! I am pleased with the progress so far. Married to same wonderful woman for 39 years. She is still beautiful and sexy as ever. A great help in my recovery !!: 3/12/09: Full natural erections with penetration. 10mg Cialis makes them easier to maintain but I have had several med free full erections lately, Yipieeee !!!!!!!  3/24/09: One year PSA <0.1.  3/28 & 3/29: had sex with full naturals with no meds. Erections are gained and maintained with very little manipulation. Getting more like pre op every day. 5/30/09, I take only 5mg Cialis every 2 or 3 days. This greatly assists my full naturals and provides great staying power and no manipulation required and allows sex anytime !! Lenght and girth are back to pre op size due to regular "workouts".
    1.  


      pcspes
      New Member


      Date Joined Oct 2009
      Total Posts : 4
         Posted 10/20/2009 9:06 PM (GMT -6)   
      I am hoping the Siewife is still reading this and not gone again, as I signed on especially to talk with her, because I am imminently considering surgery with Dr. Richie (vs. a few other possibilities) and want more information on her/husband's experience. I like him very much and had biopsy with him in August (Gleason 7 (3+4)) and surgery suggested, but I am interested in the actual results of surgery for her husband or anyone else who may have been treated by Dr. Richie. I'm not sure what she means by his "taking a conservative approach and no further treatment for 3 mos
      compared to other's stories" (i.e. no drugs to encourage potency [viagra, cialis, etc.]), but - though cancer cure is the absolute primary concern for me; with continency next - I'm interested in the success of any nerve sparing. No results in terms of potency would probably be expected this soon after surgery, but longer term results for anyone who has had surgery with him would be of interest.

      A more immediate question to her would be whether she/husband felt good about "open" (vs. robotic) choice, and felt Dr. Richie was still "in trim" and did enough of these for them to feel confident that his skill was still
      completely up to speed? Obviously, they must have, as they chose him and were persuaded away from robotic. My concern, as I learned more about robotic, and how much many men have turned to this, was that there might be a real decline in business for open surgeons and a loss of active experience keeping up their skills. Much of this robotic interest is driven by heavy marketing (not that the procedure isn't good also, provided it is done by *very* experienced surgeon), but I lean towards open myself, as I want more human tactile contact and judgement as part of the surgery. But using knee surgery as an analogy, one wonders if the open technique is past its prime (would we go back to open knee surgery in place of arthroscopy?), or even if it is not actually, the rush of patients to robotic may effectively deprive open surgeons of a sufficient continued level of activity to be at the top of their game.

      Anyway, I would very much like to talk further to Siewife, on the forum or directly (but no e-mail given).
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