Type of surgery based on tumor location?

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/17/2010 5:05 PM (GMT -6)   
During my consultation at Umich, the surgeon, Dr. Woods, suggested that robotic surgery is better for me since the tumor is at the lateral apex. I know he does both open and robotics and did open on a friend due to the location of his tumor. However, I suspect he also senses that I was leaning towards robotic surgery, so maybe he told me what I wanted to hear?
 
Has anyone heard or read anything about this (that the location of the tumor might indicate which type of surgery is best)?
 
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. Result of biopsy:

5 out of 12 cores 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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2010 1:20 PM (GMT -6)   
Mel...haven't heard that tumor location would make any difference to the type of surgery. The size of the prostate and the physical condition of the patient, such as obesity, or prior hernia repairs etc. are the only factors that I am aware of that would make a difference between robotic and open.

Good question. Others may provide more diffinite answers.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


Mike H
Regular Member


Date Joined Jan 2010
Total Posts : 72
   Posted 1/18/2010 2:04 PM (GMT -6)   
Mel,
 
My doctor performs traditional laprascopic and robitc laprascopic prostate removal surgery.
 
I wanted robotic but in my case he said he preferred the touch and feel of the traditional laprascopic procedure.
 
At the time there was concer that my tumor was larger than it turned out to be.
 
I wanted the doctor to use what ever method made him most comfortable and confident.
 
Best of luck.
 
Mike
8/12/09 Diagnosed at 49 years old. DOB. 6/11/60

10/29/09 Surgery at Memorial Sloan Kettering Cancer Center, NYC
11/25/09 Catheter Out (4 weeks)
99% continent the day the catheter came out
Wore the pads for 2 weeks to be safe but had minor drips at most.
12/16/09 First PSA (7 weeks) < .05 Undetectable

2003 Biopsy Negative
7/23/09 Biopsy Positive. 10% cancer in 1 of 12 cores. Gleason 3+3=6.

Post Surgical Pathology:
Gleason 3+3=6
Tumor confined to prostate
Seminal vesicles not involved
Bladder neck not involved
Surgical margins free of tumor
Lymph nodes not involved


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 1/18/2010 2:49 PM (GMT -6)   
Mel
I am attending a lecture given by a urologist that does Robotic surgey on the 25th.  I'll be sure and ask him that question regarding, location of tumor and type of surgery.  I can't remember your surgical date so it may be a mute point by the time I get the answer. 
 
I have been most intrigued about the superpubic catheter approach that you have described.  I just could not think how this would be possible.  However the following article has two very good pictures on how this approach works.  Very interesting to say the least.  Just an FYI take a look at this when you have time. 
 
Hero

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/18/2010 4:41 PM (GMT -6)   

Hero:

 

Very interesting. I assume Dr. Menon's procedure is similar. Clearly, the supra-cath is preferable.

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. Result of biopsy:

5 out of 12 cores 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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/18/2010 4:52 PM (GMT -6)   
At this point, the foley is still widely used after prostate surgery, the suprapubic method has some distinct advantages, and who knows, may be the improved way of the future as more surgeons turn to it. It makes it easier if the surgeon wants to allow additional healing time to the bladderneck/urethra connection.
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

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