Gleason 7, Psa 4 weeks ago 4.1, Robotic or Open? Please help...PART 2

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Regular Member

Date Joined Dec 2009
Total Posts : 316
   Posted 12/10/2009 5:18 AM (GMT -6)   
Hi I was hoping some of you can give advice either from your experiences or experiences of others with similar stats.

My father was diagnosed with PC about 4 weeks ago.

12/12 biopsies came back positive, 10 (3X4) and 2 (4X3)

He has Gleason 7 and a Psa of 4.1 with one perineural invasion.

Went for Bone Scan and Ct Scan and both negative.

He is considering Robotic surgery because he is concerned about the loss of blood and the side effects of open. After reading so much statistics online it seems that open is the best way to go. Better cure rates, more extension into the lymph nodes, etc. I am worried his choice to go robotic will be a huge mistake considering he is Gleason 7.

If anyone can help me or give me feedback, advice I would really appreciate it.

Post Edited By Moderator (James C.) : 12/10/2009 11:10:10 AM (GMT-7)

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 12/10/2009 6:51 AM (GMT -6)   

Welcome, and sorry you (and your dad) are here.

I'm sure you're just about to gets lots of tips and help, (it's still early in the day in the USA, so not everyone is on line yet! I'm in Europe.) but I think it may help to know how old your dad is. And if you create a profile, then his details will also appear automatically for people to look at when you post.

Have the doctors made any recommendations?

Does your dad have any other health problems?

Which side effects is he concenred about?

I don't think I have enough knowledge to list all the differences between open and robot (but don't forget all the other options too)

Yes open can mean more blood loss than robot (but that may still only be of the order of 300ml with open)

And my surgeon told me that while robotic will leave you with a smaller scar on the outside the things that get done on the inside are just as major with both operations.

I had Gleason 6 before my op and 7 after, and a higher PSA, but nothing like 12/12 from the biopsy, which I think may be just as relevant as your dad's 7 in determining how good or bad things may be and what is the optimum treatment to go for is.

I hope that the fact that the diagnosis was 4 weeks ago means that you are taking things slowly, which is what you have to do at this stage. It's a big shock for both of you and, difficult as I know it is, you have to take time to make the decisions.

(If you are waiting for a response to your post try typing a few suitable words in the search box and you may find some older threads were the wisdom of HW can be found.)


Regular Member

Date Joined Nov 2009
Total Posts : 98
   Posted 12/10/2009 7:04 AM (GMT -6)   
+1 to Alfred's advice. I'm one of the "new" guys here and have learned a lot from the reading the threads. They aren't telling me what to do or what decision to make, but they do provide valuable perspective to my research and the books I've read (Strum, Walsh, etc). You may consider asking the Doctor, considering the stats of your Dad (12/12), and that you may take another 30-60 days to make a decision, how that wait may affect your Dad's condition and if there is anything he would recommend in the interim. I'd also add that the shock of learning a loved one have the dreded "C" word causes all kinds of strong thoughts and emotions. PCa is a slow progressing cancer and that allows time to research so your Dad can make the decisiont thats right for him. You dad needs to become his own best advocate as he weaves through this jungle.

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 12/10/2009 7:14 AM (GMT -6)   
Hello there Luv,
Welcome to the forum. Ask away with any questions you have and you will receive plenty of helpful answers from the members here.
Your Dad's stats are virtually the same as mine with the exception that I had 4 out of 10 positive with two 4+3 and two 3+4. As I found out post surgery all this meant was the biopsy hit places without tumour 6 out of 10 times as there was plenty more in there (doc must have been a crook shot). As was established with a PSA of 4.1 he was unlikely to have any visible sign of tumour elsewhere. Robotic is the majority choice of surgery today but there is much to recommend open. Unless he has other problems and is in reasonable health open should not cause him any great concern. Many here had open (I had robotic) and bounced back as good as gold albeit a little delayed. I am sure they will chime in with the details. Sometimes doctor's statistics can be a little skewed by those trying to convince you to go with their treatment. There is a bit of good reading here (page 2) on open vs robotic you may find it helpful.

The most important thing is to select a doc with extensive prostatectomy experience whatever the method he uses. You really should investigate other treatments as well. There are many cases where radiation externally or via seeds is an excellent option. Knowledge is the key to dealing with this disease. Age and general health are major considerations.
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
PSA December 09 <0.01

My Journey:

Post Edited (BillyMac) : 12/10/2009 5:20:00 AM (GMT-7)

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 12/10/2009 7:20 AM (GMT -6)   
Luv, you've come to the right place and should be receiving alot of useful information.

My husband was a Gleason 7 (3+4) and had robotic surgery in March 2008. The surgical method is not that important - the skill of the surgeon is what counts. Yes robotic is a little easier on the patient and requires less hospital time but the operation is still the same, and it's a major one regardless of the surgical method used.

Your dad's Gleason 7 warrants action but I'd more concerned about all 12 cores being positive. You don't give your dad's age but his PSA of 4.1 sounds pretty good to me (my husband's was 6.4 before surgery and he was 57 at time of diagnosis). What was your dad's PSA history for the three years prior to diagnosis (in other words, has his PSA doubled and, if so, how quickly did it double)?

Perineural invasion is commonly noted on the biopsy but can provide a means of escape. Also, if one of the cores was close to the edge of the prostate (like one of my husband's was), there's a chance the disease has broken through the capsule and invaded surrounding tissues. You need to ensure that the surgeon is planning for this and will cut a wide margin around to achieve clean surgical margins. If (and I say IF) the disease is invasive, your dad may need additional treatment whether it be shortly after surgery or down the road.

There are many here with far more knowledge than I who should be responding to your post.

Stay with us and hang in there.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!

O Buddy Boy
Regular Member

Date Joined Oct 2009
Total Posts : 106
   Posted 12/10/2009 7:51 AM (GMT -6)   
Really, I'd agree that the experience of the surgeon is important.

There are a lot of new surgeons getting into robotic because it is promoted as the hot new ticket.

My wife was a surgical nurse for 25 years and tells me she knew one surgeon who could perform an open in 45 minutes and had great results. She recommended RALP to me because she had confidence in the surgeon's ability (she works at the clinic).

The story I got from my clinic is that a couple of docs who had been doing open were getting ready to retire, so to help them assure a healthy practice (and good sale of the business) they went out and recruited a crack DaVinci surgeon. They made him jump through some hoops and get a good number of surgeries at some noted clinics before they hired him.

So either find an old hand who is very experienced in open or a younger surgeon who has a large number of successful robotic surgeries under his belt. Your doc should at least encourage a second opinion and let your dad make a decision on that.

I'm eight weeks out of surgery. No ED, very light leaking, using 1/3 a pad a day with many dry. Riding bicycle again and lifting light weights.

Hope this helps. Hope things go well for your father.

55 yo
DRE: Susp
PSA: 3.5
Gleason: 3+4/7
6/12 Cores Positive; Sextants were 1%, 3%, 8%, 15%, 12%, 0%
RALP: 10/09/09
Margins: Clear
Lymph Nodes: Clear
Seminal Vesicles: Clear
Gleason: No increase from biopsy 3+4/7
Some perineural and capsule invasion.
Incontinence: Minor. 1 light pad a day. Some days don't need it.
ED: Natural with encouragement. 20mg Cialis and pump just makes things more fun.

Regular Member

Date Joined Jul 2009
Total Posts : 137
   Posted 12/10/2009 8:59 AM (GMT -6)   
One thing to consider is that all prostate surgeons have been taught the open procedure. Robotic is fine with me. I had it done this way, but I also knew that robotic can be aborted in favor of open in case there are difficulties. You want a surgeon who can do a good job at both. Also, a good question is what percentage robotic do you have to convert to open? If he says never, he hasn't done enough. If he gives you an approximate percent,that is OK too. I would think anything below 10% would be OK. Maybe someone here knows a better answer to that.
70 years old (1939) 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 by Dr. Mattei in the Kantonsspital
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. Nearly usable one month later.
3month PSA less than 0.01

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 12/10/2009 12:57 PM (GMT -6)   
Um weird
I Thoguht I was seeing things or having computer trouble, but this thread seems to be running in two places

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 12/10/2009 1:09 PM (GMT -6)   
No, your right, there's 2 threads with the same start but slightly different ends. I'll just change this one to be called Part 2, to stop any confusion...
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

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