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Regular Member

Date Joined Mar 2010
Total Posts : 37
   Posted 3/14/2010 10:11 PM (GMT -6)   
I thought I had just about made my mind up about the treatment to pursue until I read the Q@A's of Dr Catalona provided by a link in one of the posts today.  He obviously is not sold on laproscopic surgery whether robotic-assisted or not.  He provides a good argument with his background of 5,000+ open surgerys and references a study that tends to support his conclusions that, all things considered, open surgery is the preferred method.  I did notice, however, the study he referenced was from 2003-2005 comparing open vs laproscopic.  How on earth has everyone made up their minds which way to go when it's suspect-if not obvious- each doctor thinks their procedure is the best.  I hope to get my stats/info entered tomorrow.  dx2-16-10. Gleason 3+4, 1 adenocarcinoma, 2 PIN, high grade, appointment with Dr Shah, a diVinci surgeon, in Atlanta 22 March.  This forum and everyone on it is a Godsend!  I sure would appreciate hearing from you who have been there done that-either procedure!
John in NC (Chatuge)

Regular Member

Date Joined Apr 2008
Total Posts : 140
   Posted 3/14/2010 10:50 PM (GMT -6)   
I'm glad you found Dr. Catalona's site informative.  There's another article you should read from dated October 13, 2009.  It begins with the statement...."Heightened risks for post operative incontinence and impotence may outweigh any benefits from minimally invasive "keyhole" surgery for prostate cancer , a new study suggests........I'm five weeks out from "open" prostatectomy, and I have 0 regrets.  I'd do it again at the drop of a hat.   Once I decided against radiation or seed implants, I too, wanted robotic surgery.  Then I came across the above referenced article.  When my surgeon  told me he wouldn't perform robotic on me due to prior colon cancer surgery,  I was more than happy to go with "open" surgery.  I was 98% dry when the catheter came out and "took matters to hand" successfully later that day.  When it comes down to peeling those nerve bundles away from the prostate to preserve erectile function, I think I would want a surgeon's "feel" performing that task, but then again, that's just my personal opinion....
1996, Age 48, Stage III Colon Ca, Colon Resection followed by 18 chemo treatments.
2000, Colon Ca Metastasis to upper left lung lobe.  Lung lobe surgically removed.  24 chemo treatments scheduled.  Took 1, declined the rest.
9/08 PSA is 2.8, 12/08 PSA is 4.56??  Chalk it up to prostatitis due to urinary retention after Nissen Fundo Surgery.  VA docs prescribe 30 days of Septra.  Prostate feels normal.  PSA hovers around 4.1.  VA docs want prostate biopsy but can't seem to get me into the schedule.  Continue through Spring and Fall of 2009 thinking I have prostatitis.  Bacteria cultures are always neg.  PSA drops to 3.1 10/09.
12/09 Prostate Biopsy performed
3 of 10 cores positive, 5%, 25%, & 35%, 3 + 3= Gleason Six with perineural invasion.
Doc wants CT Scan due to prior Colon Ca. Findings: "The seminal vesicles are irregular & there is nodularity in the periprostatic fat such that local extension cannot be excluded.  Shotty lymph nodes in both groin measuring 2.3 cm."
Doc wants Endo-rectal MRI (OUCH!) Findings: Mild central zone BPH, no discrete focus of carcinoma is identified, no evidience of invasion into the periprostatic fat or seminal vesicles.  Normal size iliac chain lymph nodes.
2/08/10 Open RP surgery.  Findings: Gleason Six upgraded to Seven.  3 + 4, Stage pT2c, Bilateral w/perineural invasion, No pos lymph nodes,  margins uninvolved, no extraprostatic extension, no seminal vesicle extension,  39 grams, blood loss 1200 ml (didn't want a transfusion & didn't get one) nerve bundles spared bilaterally.  current age-61

Regular Member

Date Joined Dec 2009
Total Posts : 163
   Posted 3/14/2010 11:02 PM (GMT -6)   
I believe the most important thing is to pick the surgeon and let him perform the procedure with which he is most proficient.
I will be having robotic surgery with Dr Joseph Smith at Vanderbilt Medical Center on April 7. I too considered all options.
Once I decided on surgery, I considered both open and robotic for several weeks. I had 4 surgeon interviews.
In the end I chose Dr Smith. He is the only surgeon that I interviewed that had done a great number of both open and robotic. He had done over 2000 open surgeries before switching to robotic some years ago. He has since done over 3000 robotic and stated he is convinced that robotic is superior with the caveat that the surgeon is the most important part of the equation.
Good Luck

Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09: 1 of 12 cores positive with less than 5% volume
Gleason 3 + 3 = 6
Prostate Size Estimate on 12/2/09 = 28 cc
RALP is scheduled for April 7, 2010 at Vanderbilt University MC with Dr. Joseph Smith (over 3000 RALPs)

Veteran Member

Date Joined Aug 2007
Total Posts : 1015
   Posted 3/14/2010 11:11 PM (GMT -6)   

You have a right to be confused for many reasons. Here are at least four of those reasons:

(1) Everyone's actual internal anatomy is a little different from the textbooks
(2) Everyone's cancer localization and potential for external migration is different
(3) Every surgeon's preferences and skill levels are different
(4) The statistical "jury" is still out on what is the "best" treatment

We make our own decision regarding the right treatment, the right treatment approach, and right doctor for ourselves.

I feel confident you will make the right treatment decision for you. Your decision is something that you can and will live with regardless of the outcome. None of us will be second-guessing you for that reason. When we offer our experiences, it is for information sharing only. You'll see that regardless of the treatment approach chosen by each member of the forum, all of us have different outcomes... some with great outcomes and some with challenges remaining.

Odds are that you're going to do fine. I wish you the very best in your personal journey.

Like Tony of Las Vegas says, the best thing to do is "stay positive!"

Kind regards,

Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/07 <0.04; 12/07 <0.04; 03/08 <0.04;
06/08 <0.04; 12/08 <0.04; 06/09 =0.06; 09/09 <0.04;
Latest PSA 12/09 =0.05

Forum Moderator

Date Joined Sep 2008
Total Posts : 4271
   Posted 3/15/2010 5:49 AM (GMT -6)   
From everything I have studied on the subject, it is the experience level of the surgeon that makes the difference.  Many of the studies that showed da vinci as inferior included docs with inferior experience as well.  While there are no long term studies with da vinci,  my opinion is that it is just as good (maybe better) with the caveat that you want a surgeon with 250+ procedures.
Having said that, I don't see from your post here that you have explored other options.  Irrespective of the fact that most men on this forum have chosen surgery, it is a big deal.  Just look at all of the posts about ED, incontinence, strictures, shorter penises, ejaculating urine, depression, etc. if you don't believe me.  You are not doing yourself any favors if you don't discuss options with a radiation oncologist to look at less invasive options.  Just MHO.
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 3/15/2010 6:03 AM (GMT -6)   
Don't be confused, look at the years of the report, we are in 2010 now, 5-7 years After that report, improvements have been made in procedures and equipment

2003 ? How many robotic Prostate removals were performed leading up to that report ?

Thats like saying that in 2003 a single core processor is all a PC user will ever need. Would you look at that report and go out and look for a single core PC ? If you did you would never find one, every one made now has multiple cores, some even 3 or 4 processor cores. But wait that 2003 reports says I do not need a dual core PC

Things change, new surgical procedures are developed.

I suppose there is a place for the phrase "old school" its up to you to go back there
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4848
   Posted 3/15/2010 6:24 AM (GMT -6)   
If you have crummy or no insurance - the one night versus 3 or 4 nights in the hospital could be part of the consideration.
Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Veteran Member

Date Joined Jan 2010
Total Posts : 2845
   Posted 3/15/2010 6:48 AM (GMT -6)   
John in NC-
I think Idaho Survivor and RickyD said it best - we are all different - find the doctor you are comfortable with (his experience) , and the technique , so you won't have any after thoughts.

-sorry to see the negative "my procedure is better than your procedure" reference in one of the postings - "I suppose there is a place for the phrase "old school" its up to you to go back there" -

-it is your life - don't be bullied into a procedure that you are not comfortable with.

Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - will go for trimix in April when I see doc
Incontinence: 3-5 pads/1-2 clothes changes/day- finally seeing improvement - March 3, 2010 - week 14 after surgery -
location: Peteborough, Ontario, Canada
Post Surgery-PSA: to be announced - April 8, 2010

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 3/15/2010 7:05 AM (GMT -6)   
John in NC: when my husband was choosing his treatment two years ago, we too were confused. It seemed like every time we were completely comfortable with the treatment choice, we'd read or hear something that caused us to question our decision.

My husband wanted surgery - he considered radiation but discarded it early on in his decision making. Our surgeon had been doing robotic surgery for years and while he does both open and robotic, felt that robotic was best in my husband's case. Our surgeon prefers robotic over open because of the excellent visual clarity. The camera allowed him to view the entire prostate from all sides before starting to cut. Since one of the two positive cores from the biopsy was very close to the edge of the prostate, he was concerned about cutting too close to that edge which might have resulted in a positive margin. In our case, the robot gave the surgeon an advantage in that he was able to view the area and plan how and where he was going to cut.

As others have said, I too believe that picking the surgeon based on their skill and success rate is more important than the surgical technique. Incontinence and ED are side effects of surgery, regardless of whether robotic or not.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!

Veteran Member

Date Joined Sep 2009
Total Posts : 664
   Posted 3/15/2010 8:23 AM (GMT -6)   

First of all good luck to you!

Second it is a win, win situation as both the open and robotic surgeries have proven to be very effective.

Find a physician that has the experience/outcomes you feel are important. Vet him/her with usual prudence and your good to go!


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.

Veteran Member

Date Joined Jan 2009
Total Posts : 2243
   Posted 3/15/2010 8:31 AM (GMT -6)   
I think that is a valid question and you got some good responses to your thread. I would ask Dr. Shah if he has also done open surgery. One other option that you might consider, at least as a consult, in Gainesville, Ga they started doinf Robotic last year. Dr. Wu and Dr. Ornstein had both done thousands of open and are now doing Robotic. It might be helpful to also talk to Dr. Ornstein to get his opinion about which surgery would be helpful given your stats. Not sure if I spelled their names correctly but they are now with NE Ga Medical Center. You are in the drivers seat my friend.
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10
Great family and friends

Veteran Member

Date Joined Apr 2007
Total Posts : 823
   Posted 3/15/2010 9:16 PM (GMT -6)   
Hi Chatuge

If you want a second opinion from an excellent Hospital, contact Duke University. They have a multidicliplinary approach to treating PC and you can see various specialists to try and decide on what to do. You can make your own appointment. Go to their website and try and see Dr. Judd Moul who is my Doctor. There is a good clean and affordable hotel across the street. Just let me know if you want to go that route.

age at dx 54 now 57
psa at dx 4.3
got the bad news 1/29/07
open surgery Duke Medical Center 5-29-07
never more than 2 pads
ED is getting better
the shots work great, still can't give them to myself
two years of zero's
Retired again after 36 years February 1, 2010

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