Robotic conundrum

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New Member

Date Joined Apr 2010
Total Posts : 16
   Posted 5/20/2010 5:35 PM (GMT -6)   
Had RALP on 5/12, everything went well. Of course anxious to get first PSA reading in a few weeks. Today a signifcant majority of prostatectomies are done with the Da Vinci. I am curious if some new surgeons coming on line will have the vast majority, if not all, of their experience on the Da Vinci? One of my criteria in choosing a surgeon was extensive experience using open and robotic, even if currently focused on robotic. In the rare, but not unheard of, event that a switch from robotic to open during surgery is necessary, I would be covered. Am curious if any on this forum have had similar thoughts? I have several friends who have just had PCa diagnosis and this question has come up. Thanks to all on the forum, you have been a great help with several questions I have asked!

Elite Member

Date Joined Oct 2008
Total Posts : 25380
   Posted 5/20/2010 5:46 PM (GMT -6)   
In a perfect world, you would have a surgeon that clocked a lot of experience prior to robotics, and now has clocked a lot of robotic time. Its not altogeter rare to have to abort from robotic back to open. A number of things could cause that.

My surgeon is 100% open only experienced, but has partners in his practice that have now clocked up a lot of robotic experience. He has no regrets about the value of robotic, in fact, he said if he had PC and needed to have his prostate removed, he would want robotic just for the lesser healing time aspect generally associated with robotic vs. open.

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, next one:  July
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- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in

Regular Member

Date Joined Dec 2009
Total Posts : 163
   Posted 5/21/2010 2:11 AM (GMT -6)   
My surgeon, Dr Joseph Smith at Vanderbilt, had done over 2000 open surgeries before switching to robotic and has now completed over 3500 robotic. He gave me a lot of confidence and my results are quite good. No pad at night and one small pad in the waking hours(soon to be no pad). My leak rate is about 0.25 ml per hour and improving. ED responds well to Vitamin L or Vitamin C. My Surgery was 4/7/10.
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 performed on 4/7/10 at Vanderbilt University MC with Dr. Joseph Smith (3000+ RALPs)
Final Pathology on removed prostate:
Prostatic Adenocarcinoma present bilaterally from apex to base and extending to inked margin at right apex.  Gleason 3 + 3 = 6, stage pT2c
Prostate Size  = 59 grams, Tumor 5% of total prostate volume.
SV negative, EPE negative, PNI present. Lymph nodes - not checked

Veteran Member

Date Joined Nov 2007
Total Posts : 598
   Posted 5/21/2010 11:46 AM (GMT -6)   
This thought was very much part of the reason I chose Dr. David Samadi for mine. He was at Sloane Ketttering for many years doing open, then did laproscopic. Now he does 50 DaVinci a month. I any event, I felt covered.

I believe medical schools still teach open first. I will check on that.
Paul ED website for PCa guys

46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
Two year PSA - undetectable!

Veteran Member

Date Joined Nov 2009
Total Posts : 7213
   Posted 5/21/2010 3:12 PM (GMT -6)   

I did a LOT of reading/research when I realized I had a problem (a rising PSA and a real bad PCA-3 test, even before my biopsy).

Anyway, at the end I was leaning towards robotic surgery, but the key element was the experience/skill of the surgeon. That was the determining factor and why I chose Dr. Menon. Had there been a comparable expert who did open instead of Dr. Menon, I would have gone that route.



63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3 was about 75 (way above the 35 threshold). That led to:

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent! Uh...OH. As of about 3/16/10 problems with constant urgency although no pads needed--feels like an infection but none showing in urine.

Update: since late March all is well in that area. I would say 99.9% continent (a spurt here and there, maybe 5 spurts per week).

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in mid-June.

Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 5/21/2010 5:14 PM (GMT -6)   
I know we have cases here on HW where switches from robotic to open have been made , but I believe statistically  they are rare.  IT is probably more of a case where a surgeon with open experience just felt more comfortable.  My surgeon never even mentioned the possibility, nor was it mentioned on the surgical release form.
Number 1, find  a surgeon you are comfortable with.
Number 2, make sure he is experienced in his method, be it open or robotic.
Number 3, then go for it, and don't look back. 
In my case, going to a major cancer such as Cleveland Clinic gave me great confidence just walking in their doors.
When I met the surgeon, he gave me such great confidence, that when we walked away, their was absolutely no doubt in my mind.  He could have used a pen knife and I would have been ok.  It was such an amazing calmness I felt.
With a Gleason 9 and having a .01 after 1 year, I still have that same feeling.
Good luck.  Don'[t make it too complicated for yourself.
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,  9 month PSA < .01
1 year psa (364 days) .01

Regular Member

Date Joined May 2010
Total Posts : 21
   Posted 5/28/2010 12:40 PM (GMT -6)   
I am search of a surgeon in the Twin Cities area?  Who performed your surgery?
You had surgery about a few days after I was diagnosed, so I am on your foot steps through this unbelievable journey. 
Any direction would be greatly appreciated.
Diagnosed with Prostate Cancer 4/10/2010
Age 58
Stage: T2B
Greason Score: 3+ 3 = 6
PSA: 3.0
Prostate volumne 19cc
Tumor present in 3 of 5 cores on both the right and left with 6 of 55  mm or 11% on the right  and 4 of 59 mm or 7% on the left
No angiolymphatic or perineural invasion.  No high grade prostatic intraepithelial neoplasia.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4237
   Posted 5/28/2010 5:54 PM (GMT -6)   
A recent survey of urologists on what type of surgery they would have if they had PC was very interesting. If a low grade PC was diagonosed the majority would opt for robotic. If a higher grade was DXed the majority would opt for open.
If urologists, who suppossedly are in the know, would chose open over robotic in high grade cases this should tell patients something.

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.


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