This week it's RALP that's better...

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/15/2010 9:01 AM (GMT -6)   
Study in Europe says that it looks like robotic assisted laparoscopic prostatectomy that delivers the least complications and better long term results. I stress very sincerely, choose the best doctor who has mucho experience. In this study, they hint at all things being equal with the doctor and facility, RALP delivers excellent results.

That was my experience. It's been three years for me and I lucked out. My side effects are virtually none. Of course hormone therapy was no help on ED, but I see that goes away when T levels return. The surgery itself went quite well...(My surgeon had over 1500 Da Vinci's behind him. He probably has over 2000 by now.)

Oh yea...the study...

http://prostatecancerinfolink.net/2010/01/14/is-ralp-potentially-associated-with-fewer-complications-than-open-surgery/
Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 1/17/2010 12:04:59 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/15/2010 9:46 AM (GMT -6)   
Tony, it's interesting that you subjected this as "this week". I think the debate between robotic and open will never end, probably in another 5 or so years, open surgeries will be far and few between, reserved for men that have specific issues that would exclude them from robotic surgery.

Still comes down to the skill and expertise of the surgeon, I think we would all agree about that here.

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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 310
   Posted 1/15/2010 9:48 AM (GMT -6)   
Thanks, Tony, for posting the link.
 
Keeping up with new medical developments re PC is one of the main reasons I come here, and I really appreciate you and others taking the time to alert us to new study results.
 
Zen9
No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1
 


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 1/15/2010 10:02 AM (GMT -6)   
TC-LasVegas said...
Study in Europe says that it looks like robotic assisted laparoscopic prostatectomy that delivers the least complications and better long term results.
Tony, I agree the study indicated that robot surgery may result in fewer complications. But the study (as abstracted in your link) said nothing about long-term results. In fact, the literature has little to say about results because the procedure hasn't been used long enough to develop valid data.

I'm pretty well established as an anti-robot guy because of several factors. But I think it's important to recognize the advantages of the procedure. As well as the fact that nothing can currently be said about comparative outcomes.
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, lymph node involvement 0/9, perineural invasion present, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: 1 "panty liner"/day, with minor leakage when I get up from long seated position; ED pretty complete: some erection possible but current non-functional


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/15/2010 10:41 AM (GMT -6)   
Max,
I was speaking in the surgical sense and not the oncological sense. In the study, it outlines sharply better results with bladder contractures (Clavian grade IIIB-V) which are commonly associated with long term sphincter control issues. That stated, overall performance is more reliant on the surgeon than the tools. It is clearly noted in the article that the less experienced surgeons are found more susceptible to positive margins with RALP and I have also read elsewhere they are more likely to encounter urethral blockages as well.

My "choose the best surgeon" mantra remains unchanged, and one should choose the surgeon, not the procedure unless they have a physical reason to do so. But the best RALP guys are indeed producing similar results to the best open guys with significantly less complications in this study. So while the article states "MAY", clearly outlining surgical complications that are more prevalent in RRP, it is well known that surgical complications can have a lasting effect on ED and incontinence. We do lack data on the performance on the cancer itself, but I don't expect to see any differences if both procedures are successful in removing the tumor.

Tony
Prostate Cancer Forum Co-Moderator


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 1/15/2010 1:54 PM (GMT -6)   
TC-LasVegas said...
... My "choose the best surgeon" mantra remains unchanged, and one should choose the surgeon, not the procedure unless they have a physical reason to do so.
We're certainly in accord that the surgeon makes more difference in likely outcome than any other factor. I agree with you - pick the best!

TC-LasVegas said...
... We do lack data on the performance on the cancer itself, but I don't expect to see any differences if both procedures are successful in removing the tumor.
And not to beat a horse who's close to being glue, but this is at the heart of my concerns with robot surgery. If you don't have as good a view of the "theater of operation," I think it's inevitable that parts of the tumor are more likely to be missed. That's happened with people I know of, and I see it as a significant problem. Though one, to be sure, that is minimized by having an experienced and talented surgeon on the job.

I appreciate your staying on top of recent developments in the field, Tony. It's likely to help many more people in the future, and it's a tremendous resource to the many good people who already visit this site. Great work!
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, lymph node involvement 0/9, perineural invasion present, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: 1 "panty liner"/day, with minor leakage when I get up from long seated position; ED pretty complete: some erection possible but current non-functional


goodlife
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Date Joined May 2009
Total Posts : 2691
   Posted 1/15/2010 3:08 PM (GMT -6)   
Maxbuck,

Just an ignorant observation, but I fail to see how an open surgeon, viewng everything through all of the surgical paraphanalia, blood, fingers, hands, etc. and using most likely un-magnified eye sight has any better view than the robotic guy who has much less blood, 10x magnification, and small arms of the robot. He can manipulate his camera to any angle, even go in behind the prostate if needed.

Goodlife
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/15/2010 3:46 PM (GMT -6)   
When deciding which way to go the one concern I had about RALP (robotic) was the loss of tactile feedback. The surgeon can see well, can put the camera and tools at any position and they will stay in place. The positioners use anti-vib/shake software with proportional feedback to permit precise placement. But! The surgeon can't feel the nerves.

Remember - a long time ago, in AP bio class when you dissected the earthworm? I still recall trying to lift out the subneural blood vessel with #10 blades. It was like working with angel hair pasta. Could we have done it using only position tools? Probably. But Lowly Worm had ED when I was finished with him. He had other problems too since he came out of a bottle of formaldehyde.
No matter. I made my choice and went robotic.
Hey! Maybe it was the formaldehyde fumes in Mr Basil's class that gave me PC.

This reminds me, I've got to call my wife and have her pick up an other 52 pack of Men's Guards.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next? See Uro 1/20/10
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04 undetectable.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/15/2010 3:48 PM (GMT -6)   
Goodlife, most open surgery surgeons use magnification means during the open surgery, not quite the way you described.
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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Herophilus
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Date Joined Sep 2009
Total Posts : 663
   Posted 1/15/2010 5:46 PM (GMT -6)   
Just my opinion, but in 2 years it will no longer be a question of; if
Robotic surgery is better, the onus will be on the physician to provide
documentation as to why the patient is not a candidate for robotic
surgery.   My expectation is that data analysis being done at this time
is going to provide a decisive answer. One of the problems with the past
data analysis is all the noise that is mixed into the available numbers.
As an example, lots of the early data had a remarkable amount of
laparoscopy procedures in the mix.  The lap procedure and the robotic
procedure are completely different, as different as the robotic and open
procedures.  Early data also included a learning curve for the
development of the actual robotic surgical process.  open prostatectomy
has been in existence for years but you must remember that it did have a
genesis and while that process was being described and developed
outcomes were equally mixed.  The robotic technology of today can’t be
compared to the earlier robotic technology and that early technology is
another noise that needs filtering.  With continued meta-analysis of
available numbers, which include the currently available technology and
the generally accepted surgical process, robotic intervention will be
the undisputed standard accepted by the overwhelming majority. And
remember that this is not just a prostate surgery issue.  The robotic
applications in renal and cardiac surgery are impressive.  But relating
to prostate robotic surgery, I also believe that the recommendation will
not be because of a superior cancer survival rate, open RP will continue
to be as an effective procedure for cancer control as robotic surgery,
the advantage of the robotic procedure will be economic (reduced length
of stay which is a real big issue in health care) and superior
non-cancer related mortality and morbidly numbers.  This is just my
opinion of what is going to be published and as of this time is only my
opinion.

Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 310
   Posted 1/15/2010 6:10 PM (GMT -6)   

Herophilus,

I'll go you one better.  In two or three decades NOTES [Natural Orifice Translumenal Endoscopic Surgery] may be the standard or at least an option.  Risky as it sounds now, robotically in through the anus, perforate the colon, remove the prostate (while keeping the contents of the colon in the colon via differential pressure), repair the colon, and out.

Today, of course, a surgeon wouldn't dream of intentionally perforating the colon.  But a doctor friend of mine tells me that in my kids' lifetime a lot of the old rules are going to change and that NOTES is a very hot topic these days.  Not in our lifetime for prostate surgery, probably, but maybe in our sons' lifetime.

Zen9



No family history of PC.  PSA reading in 2000 was around 3.0 .  Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.   
Urologist advised a repeat PSA reading in six months = 4.0 .  Diagnosed May 2008 at age 56 as a result of 12 core biopsy.  Biopsy report by Bostwick Laboratories = Gleason 3 + 3. 
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3. 
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist.  Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.   
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008.  Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear.  Gleason = 4 + 3. 
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances. 
PSA readings: 
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1   
December 2009 = <0.1
 


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 663
   Posted 1/15/2010 7:15 PM (GMT -6)   

Actually trans-gastric-colonic appendectomy, tubals and such are a reality. In the time line your talking I see deployment of nano-technology via an injection into a vein. The botoid then targets the prostate. Once inside the prostate it multiplies by several trillion, replacing each effected cancer cell with a genetically modified prostate tissue that is completely resistant to cancer development. Then one special botoid becomes dormant and repeats the above process if any PSA is detected… Just like it should be>>>>>>>>>>… but then again I live in Hero world.

Me


goodlife
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Date Joined May 2009
Total Posts : 2691
   Posted 1/15/2010 8:54 PM (GMT -6)   
David,

I do understand that surgeons have magnification in open surgery, but I was really talking about the statement that he had a better view of the 'theater of operation". I'm not sure that statement is really accurate.

In your own case, didn't you say because of your narrow cavity, they couldn't get to all of the prostate. I just visulaize it as being very crowded in there with retractors, suction, blood, hands, etc. From a mechanical point of view, I think I can see a less crowded area with a pumped up abdomen, a camera and light, and some skinny arms with tools.

I think jeff's point on tactile feel is a better argument against robotic than field of view.

Anyway, it's not important. I was just curious that maybe I didn't understand the procedure.

Goodlife
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 1/15/2010 8:59 PM (GMT -6)   
goodlife said...
Maxbuck,

Just an ignorant observation, but I fail to see how an open surgeon, viewng everything through all of the surgical paraphanalia, blood, fingers, hands, etc. and using most likely un-magnified eye sight has any better view than the robotic guy who has much less blood, 10x magnification, and small arms of the robot. He can manipulate his camera to any angle, even go in behind the prostate if needed.

Goodlife
I don't see your observation as ignorant in the least, Goodlife. But my surgeon told me basically that his overall view of the surgical site is better when he does open surgery (he also does robot). And my daughter, who is a surgical resident and has observed several prostatectomies, told me she did NOT want me to have the robot surgery because in her opinion the visibility of the site is inadequate (she's even more opinionated than I am).

As always, I'm dependent on the wisdom of others. (Sounds almost Blanche DuBois, doesn't it?)
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, lymph node involvement 0/9, perineural invasion present, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: 1 "panty liner"/day, with minor leakage when I get up from long seated position; ED pretty complete: some erection possible but current non-functional


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/15/2010 9:24 PM (GMT -6)   
Goodlife, still see your point too. Yes, my surgeon said my prostate bed was very deep and narrow. Too narrow for a robotic procedure had I chosen to have it that way. He said if that had been the case, they would have had to abort the robotic procedure and gone to open anyhow. Glad my heart wasn't on getting robotic. My surgeon (and his practice now does lots and lots of robotics, compared to when I had to make the choice), says that while the magnification aspect is a definite plus in robotic, he personally feels strongly about the tactile file of having his hands inside as he proceeds. I am sure we would get a mix of opinions from all of our surgeons used with us surgery guys at HW. I don't think its a right or wrong situation. It was the right side access to my prostate that gave him all the trouble, and why originally, he was going to remove the nerve bundle on that side as well as the left. Couldn't do it cleanly, so it was left "as is". As it were, all the cancer reported in my pathology was left sided. Makes me wonder what would have happened if it had all been right sided instead? Guess its a mute point now.

Even thought the ultimate purpose of my open surgery failed, I still have no regrets based on my pre-surgery stats about going that route, and no regrets on my uro/surgeon. I could have a higher level surgeon, perhaps, no guarantee, if I had wanted to go out of area to Atlanta or Charlotte - that would have made more sense to me had I wanted robotic, as those bigger cities have more experienced robotic centers.

My best to you too. Glad you are still pulling zeros, that's the important part.
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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/15/2010 10:10 PM (GMT -6)   
Thanks David.

This is all academic for me. Just trying to understand it all, and hopefully sone of the newbies can make better decisions.

Goodlife
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/15/2010 10:21 PM (GMT -6)   
That's what I want too, Goodlife.
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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/17/2010 1:28 AM (GMT -6)   
I don't believe that the field of vision is better in an open procedure by any means. In fact I was shown in a demonstration how using a da Vinci robotic system it was easier to thread a common sewing needle with a thin wire, from both front and back without moving the needle AND without touching the needle with the wire. Try that by hand using any magnification device.

Da Vinci operational demonstration:
www.youtube.com/watch?v=0NZLpWrJGgk

A comment was made about feeling palpability of a tumor extending beyond a prostate, this is true to a degree. Facia tissue is easily felt by a surgeon during an open procedure, where as a robotic surgeon has to remove the tissue to feel it. However he has the ability to feel anything he samples once it's removed. My surgeon told me that all my tissue felt normal (I had negative DRE's) so were not remarkable.

When you understand the technology, there are some distinct advantages to using digital robotic tools. I'm an engineer in the digital world so I love this stuff. I can see more and more surgeries being done robotically. I can see that once the skill is learned well by surgeons, it is easy to understand why the complications rate is being reduced.

Tony
Prostate Cancer Forum Co-Moderator


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 1/17/2010 6:19 AM (GMT -6)   
Frankly, I think that many of the comments in this thread are overlooking a key point…a point that the posters probably knew, but simply got carried away with their comments and overlooked.

Surgery with intent to cure, either open or laparoscopic, is primarily intended for guys who have PC contained in the gland. If there is known cancer spread outside the prostate, then doctors wouldn’t even start surgery…radiation, or other treatment is the best course of action in these cases. Of course, the issue is that one doesn’t know 100% whether there is spread or not in advance, which is why there is such attention paid to the diagnostic data that is available (such as it is) and the Partin Tables (or other predictors)…to estimate the likelihood of spread. At least one can make an educated guess (Partin tables) as to whether to go forward with surgery or not based on statistical experiences of others with similar diagnostic data.

The prostate gland is like an apple, with the fruit in the middle contained in a skin (forget about the different zones in the prostate; not relevant here). If the cancer has escaped the skin, surgery was not the best option. The objective in surgery is to pull the gland out with all the skin intact, and that can be done very successfully with either method.

Post Edited (Casey59) : 1/17/2010 9:38:31 AM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/17/2010 12:07 PM (GMT -6)   
Casey,
Your point was not the point of this thread. The study I posted for informative reasons, had found improved results using a robotic tool versus the open procedure. And while most surgeries are intended for confined disease, a very large number of procedures encounter otherwise. As far as Partin tables are concerned, they are moot once the surgery begins. Reality has it that here will be times when the Partin tables appear favorable but once a surgery begins, but they find extension beyond the capsule and robotic tools are no less geared to deal with that situation than an open procedure. One poster brought up the point about tumor palpability and I "touched" on that lightly, no pun intended. A skilled surgeon will have encountered that many times and know the best ways around that complication. It won't matter what the intent was once the procedure began.

There are times a surgery is performed without intent of a cure as well. Tumor debulking is one reason, but for example, radiation complications can result in a surgical approach to improve patient quality of life. Both of these examples are very rare, but there will be surgeries that are done for other reasons than for a cure. To date, I have only seen these done in an open procedure.

LOL, I wasn't talking about apples, I was talking about oranges...

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 1/17/2010 11:40:28 AM (GMT-7)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/17/2010 12:22 PM (GMT -6)   

Ah…perhaps I did not give enough preamble, Tony, to properly narrow the scope of my response to the 98% or more of all PC surgery cases where a cure IS the intent.  I do humbly agree with your rebuke, with examples you cited, that there are cases where cure is not the goal, and in those cases open surgery is by far preferred. 

 

By the way, I also agree with your mantra to “choose the best surgeon.”  However, many people who are lucky enough to live in or have access to major metropolitan areas may be able to choose between outstanding open surgeons and outstanding robotic surgeons.  So, in those cases where capsular containment is likely, the patient who has decided on surgery can then engage secondary criteria looking at other factors which differentiate between open and robotic:  blood loss, recovery, etc., etc.   Agreed?


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/17/2010 12:49 PM (GMT -6)   
Addendum to my last posting...

I really wrote my initial response to say that with regards to Dr. A saying he likes the 10x magnification and inflated belly in oder to see better (but hands-off), and Dr. B saying he prefers the tactile feel amongst the bloody mess...in the vast majority of cases, there is only INDIVIDUAL OPINION as to which is better or worse. A lot of people (patients) are forming strong opinions themselves not by their own experiences, but because they go to Dr. A or Dr. B. Both can produce very good results when a good surgeon is selected.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/17/2010 12:49 PM (GMT -6)   
Agreed,
But I would only put stock in the Partins tables as tables of probability when deciding what to do, but advise to be prepared if the lesser negative probability happens. All the more reason to have a very experienced surgeon and a plan B after the procedure. :-)

Tony
Prostate Cancer Forum Co-Moderator


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/17/2010 12:57 PM (GMT -6)   
TC-LasVegas said...
Agreed,
But I would only put stock in the Partins tables as tables of probability when deciding what to do...
Tony, it looks like our last two postings arrived simulateously (only because of me adding an additional "addendum"). 
 
Yes, this (your quote, above) is the purpose of Partin tables.
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