keyhole prostratectomy help

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tremona
New Member


Date Joined Dec 2009
Total Posts : 4
   Posted 12/9/2009 4:16 PM (GMT -6)   
hi i am new to the prostate cancer forum
background is
age 57 
psa 9 on june 09    gleeson score 7 on august 09
surgeon offered me radiation theropy , brachy treatment or radical  surgery
then was contacted today and offered keyhole surgery on 1st feb 2010
am i doing the correct thing and what has others found
sorry if details are a bit sketchy but that is what us brits are told on the  nhs

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/9/2009 5:06 PM (GMT -6)   

What is keyhole surgery?

 

Is it one hole? Never heard of this

Mel


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


tremona
New Member


Date Joined Dec 2009
Total Posts : 4
   Posted 12/9/2009 5:10 PM (GMT -6)   
i dont know but can only assume its da vinci do we have different terminology in the uk?

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/9/2009 5:25 PM (GMT -6)   
http://www.cancerhelp.org.uk/type/prostate-cancer/treatment/surgery/radical-prostatectomy#keyhole

This link seems to explain, hadn't heard it used before either, must be a British term

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


tremona
New Member


Date Joined Dec 2009
Total Posts : 4
   Posted 12/9/2009 5:29 PM (GMT -6)   
thanks for that link it certainly looks like its the same thing.
is 9mths from psa test via biopsy mri scan to surgery a common timescale?

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 12/9/2009 5:29 PM (GMT -6)   
tremona said...
hi i am new to the prostate cancer forum
background is
age 57 
psa 9 on june 09    gleeson score 7 on august 09
surgeon offered me radiation theropy , brachy treatment or radical  surgery
then was contacted today and offered keyhole surgery on 1st feb 2010
am i doing the correct thing and what has others found
sorry if details are a bit sketchy but that is what us brits are told on the  nhs
Keyhole surgery is (was) the name given to laproscopic surgery at one time.  Unless I am wrong, I would be concerned that the doctor using that term is way behind on his medical knowledge.  Studies have shown that early laproscopic (keyhole) surgery for prostate cancer required a superstar surgeon to be effective. http://www.medicalnewstoday.com/articles/144826.php The addition of the DaVinci Robot for laproscopic surgery has shortened the learning curve for surgeons, but be sure yours has a least several hundred before he cuts on you.
 
So the answer is yes, DaVinci Laproscopic surgery is very effective and is now the number one method used for a prostatectomy surgery in the US.  If your doctor is suggesting laproscopic without the DaVinci Robot, then I would look at other options, which might include open surgery or brachytherapy.
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


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 12/9/2009 5:35 PM (GMT -6)   
tremona said...
thanks for that link it certainly looks like its the same thing.
is 9mths from psa test via biopsy mri scan to surgery a common timescale?
In my opinion, nine months from diagnosis to treatment is a long time.  However there are many other factors to consider.  If your cancer is contained within the prostate then it might not make a big difference, but whatever... 'you are where you are' and should now make a decision and proceed with your treatment choice.
 
I waited 7 months and it made no difference.
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


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/9/2009 8:17 PM (GMT -6)   
The term "keyhole surgery" is still in wide use in many English speaking countries as, for patients, it is very descriptive of the actual procedure. I would not worry that use of the term implies outdated medical knowledge.....sometimes it appears that our US members seem to believe that excellent medical care is not available outside of their borders. Keyhole surgery (laproscopic) involves surgery using instruments (including a camera) on arms (think of wands) that are held by the surgeon. With this method you have to actually operate in reverse .......meaning the surgeon moves the "wand" to the left on the outside and the section inside you goes to the right. It does need a great deal more skill than the open operation. It does however give the surgeon a little feel though whereas the robotic version gives none. Personally I would be reluctant to go for this method. The other laproscopic uses much the same "wands" but the wands are controlled electronically with much improved vision and contrl. Although I had robotic you might find this a valuable read on page 2 (holding the mouse down on the article helps) comparing open surgery and robotic: Much of the robotic 'advantages' are oversold. My main piece of advice would be to research what all the terms mean (ask your doc for a copy of your biopsy report so you can educate yourself) and learn as much as you can. You could not go to a better site and come across better people than those here to help you do that. You will be amazed at how much you will come to understand this disease and can then make your decision on your course of action based on sound knowledge of what is best for you.

epubs.democratprinting.com/publication/?i=26858

Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm

Post Edited (BillyMac) : 12/9/2009 7:51:48 PM (GMT-7)


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 12/9/2009 9:49 PM (GMT -6)   
Welcome and best of luck, as you have figured out, this is one of the best places to be.
Hero
Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. 75% of one core.
da Vinci at Wash U, Barnes on 11/02/09
Pathology Changed Gleason to 4 + 3 = 7. Gleason 7 present in all 4 quadrants
All(4)periprostatic Lymph Nodes Negative, All(10)pelvic Lymph Nodes negative
Seminal Vesicles tumor free. No prostate extension


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 12/9/2009 10:49 PM (GMT -6)   
Hi Tremona I am a fellow Brit but live in Thailand I can understand your problems with the NHS getting info but you must try to get as much info as you can I know that can be difficult but it will be worth the effort try to see the consultant again or go to another one if you can I do not think that you have enough info to make a good decision on your next move find out the correct Gleason (3+4 or 4+3) there is a difference find out how many cores show cancer and how many cores were taken
 
 
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 lost one nerve bundle
Gleason upgraded to 3+3 Tumour not close to prostatic capsule Seminal Vesicles not involved by Tumour 6 Lymph Nodes negative for Malignant cells
First PSA Nov 2009 was 0.06 Continence 99% occasional stress dribbles no ED from first day after catheter removed

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