Recent article compares the three operations

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brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 3/20/2010 9:40 AM (GMT -6)   
[url]http://mail.elsevier-alerts.com/go.asp?/bESI001/mDWMSB1F/qFCIWB1F/uWDCWKTB/xWXGOC1F/cutf%2D8




hmmm, adding closing link messes up the click, so removed

Post Edited By Moderator (James C.) : 3/20/2010 10:08:33 AM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/20/2010 9:56 AM (GMT -6)   
Could only access the abstract...but (no surprise) it's just another paper which concludes by saying: "Further high-quality, prospective, multicentre, comparative studies are needed."

There will never be the "randomized clinical trial" comparative study necessary to show any statistical differences in results between methods...who the heck would want to participate in having their surgery method "randomized"?? Not me.

So, the major take-away from this is simply the point that many of us experienced guys know, and a point we should continue to make with newcomers, that the experience of the surgeon is the most important factor, once the patient has chosen surgery as a treatment mode.

In the words of Dr. Eric Klein from Cleveland Clinic, who wasn't "selling" either method:

"The most important factor in ensuring the best chance for cure and good functional outcomes after radical prostatectomy is the experience of the surgeon and not what approach is used. My best advice is to find the most experienced surgeon you can and let him choose the surgical tools that work best in his hands."

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 3/20/2010 11:32 AM (GMT -6)   
Casey,
There was an article published on the New Prostate Cancer Info Link about experienced surgeons at MSK. In reviewing data among EXPERIENCED surgeons the best surgeons achieved a 98% succes rate and the worst EXPERIENCED surgeon achieved a 75% sucess rate. This is an amazing stat that shows that skill is more important than we think and that some surgeons are true "artists". In another article it was mentioned that 80% of all surgeons doing prostate surgery do less than 10 a year, which is far below what is necessary to develop any type of skill level.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/20/2010 12:42 PM (GMT -6)   
John,

No suprise in the results of the first article you referenced.

I'm really surprised (and frankly a bit skeptical) about the results of the second article referenced. (When I say "skeptical", I mean there might be some catch in the description of "all prostate surgery" that would make that statistic more believable.) Nonetheless, I would estimate that only 20% of all surgeons who perform prostatectomies perform 80% of all prostatectomies...the ol' 80/20 rule.

regards...

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 3/20/2010 8:05 PM (GMT -6)   
Actually I think the article referenced by brainsurgeon is quite good -- especially in terms of the number of different studies which were examined. True, the authors constantly remind the reader of the shortcomings of the available data, but, to my mind patterns do emerge.

In my opinion, the overall results slightly favor robotic surgery over open in terms of lack of positive margins, return to continence and return of sexual function.

I'll try to extract some of the findings that I found interesting and post them later.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day
9 mo. PSA 0.00 -- 1 light pad/day ED remains

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