Article - Quality of Life and PCa Treatments

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IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 4/14/2010 5:10 PM (GMT -6)   
Hey guys... Don't know if you saw the article referenced below from the Prostate Cancer Foundation, but we have a recent report on quality of life comparisons among popular treatments. The article discusses cryotherapy, seeds, open surgery and robotic surgery treatments.

Enjoy!

Title: Is robot prostate surgery best for quality of life?
www.pcf.org/site/c.leJRIROrEpH/b.5936977/k.FBA4/Is_robot_prostate_surgery_best_for_quality_of_life.htm

Here is a short quote from this article:

[quote]

As for the lack of difference between open and robotic surgery, Fabrizio said that while there are advantages to the robot -- including far less blood loss during surgery and shorter hospital stays -- that may not necessarily translate into better long-term quality of life.

He noted that there is a "big push" to promote robotic surgery, and many patients "assume it's the way to go."

But the current findings, the researchers write in their report, "serve as a reminder that popular enthusiasm for robotic prostatectomy merits temperance."

Nor do the findings come down in favor of any single therapy, however. "This study doesn't tell patients what's right for everyone," said lead researcher Dr. John B. Malcolm, and men still have to talk with their doctors about which treatment might be best for them.

The study did not look at the four treatments' effectiveness against the cancer, Malcolm told Reuters Health, but other research has suggested that surgery is more effective than radioactive seeds.

[end of quote]

I'm very happy with my choice of treatment and I am wishing the best for those who are in the midst of making their choice. Do a lot of pondering and get second opinions.

Barry
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; 12/'09 =0.05;
Latest PSA 3/'10 <0.04


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 311
   Posted 4/14/2010 5:46 PM (GMT -6)   

Thank you for posting the link to this article.

Zen9


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 4/14/2010 6:29 PM (GMT -6)   
You're welcome, Zen. yeah

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/14/2010 6:32 PM (GMT -6)   
Barry, good link. Good info.

Thought robotic surgery is definitely the way to go for most prostate surgery, I had seen hints before, that some of its merits are being oversold by doctors and hospitals. The bleeding issue in our day and age with open surgery is not a large risk, many open surgeries are down without requiring any extra blood needed, even if it were banked ahead of time. I know my open surgery was that way. Since hospital stays are so expensive, its kind of hard to argue which saves money, one day with robotic or up to four days with open. I needed 4 1/2 days due to complications and the need to be on hospital dispensed pain meds, but there are men that have open surgery that go home after only 2 days. So not convinced that alone is a good selling point.

I am not saying one is better than the other, either. Just concerned its being pushed to pay for the hardware costs, which are huge. And there are plenty of good, old school surgeons, like my guy, that like to get their hands inside you. He said the supposed magnication advantage with robotics is over played, as he wears lit and magnified head sets while operating open.

Good article though

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 4/14/2010 11:30 PM (GMT -6)   
Hi David,

I agree with your statements and concern about the expense. I have good friends who are physicians who tell me that there are much too many "throw aways" with the robotic procedure that add to the expense of the equipment itself.

I think a very well trained open surgeon could have given me a similar experience that I had with the robotic procedure.

I have had a couple of open hernia surgeries in the same area and the robotic procedure was a snap for me compared to them. However, everyone's experience is a different.

The thing I like about this form is all that I have learned from those who participate who have diverse treatment therapies.

Thanks, my friend.

Barry
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; 12/'09 =0.05;
Latest PSA 3/'10 <0.04


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/15/2010 8:56 AM (GMT -6)   
Barry, still comes down to a point that I feel 99.9% of us here at HW agree with. It's not the mode, its the surgeon. And I think the point of how many he/she has done gets overplayed too, that is but one factor. How about the quality of their surgical skills, not just the shear number of them. A surgeon that has only done 200-500 quality surgeries may be much better than one that cranked out 2,000. The higher number doesn't prove the surgeon learned anything better or learned from his mistakes. Hopefully he did, and its good extra experience.

And then of course, what is the condition of his patient's let's say a full year later.

If that data were available and accurate, I think there might be some surprises for people to learn about. Even in our small group, we have an unfortunate few, that went to the best of the best, and didn't get good results, either in eradicating their cancer, or quality of life issues.

On the personal side, I never like to push open or robotic. At the time of my surgery, only 15 robotic PC ops had been done in my area, on a new robot. That surgeon was a partner of my uro/surgeon, and my own dr. said to stay away, as the learning curve was just starting.
So I went for the obvious, open with a lot of experience. In the end, due to complications in my prostate bed, my surgeon said that robotic never would have worked, and had it been chosen, it would had to have been converted to an open procedure anyhow.

No matter how smart we think we become here and elsewhere learning this and that, and I am a big believer in the "due diligence" part and the "buyer beware" aspect (been in the biz world too long, lol), when push comes to shove, we all have to make complex and major medical decisions to the best of our abilities, and there is always a certain gamble, roll of the dice, chance, or whatever other adjective someone choose to use when we make these huge decisions.

Then what happens, happens, and like the rest of humanity, we learn to deal with it, and learn to adapt and compensate for problems.
Such is life.

My best to you

David
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 4/16/2010 12:16 AM (GMT -6)   
Well said, Mr. David!

Best to you,

Barry

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/16/2010 8:18 AM (GMT -6)   
Thanks
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5866
   Posted 4/16/2010 6:16 PM (GMT -6)   
Talking about experience, and I am a big believer in it, it reminded of what was said about the capt of the Titanic . " he had 30 years of experience working against him ".
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
8 week psa 0,o

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.

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