So, do I dance with the robot?

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Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 9/16/2010 5:13 PM (GMT -6)   
I talked with the surgeon today. He says my prostate is too big for seeds and I am not really keen on other types of radiation. I want Laproscopic surgury, the question is go to Walnut Creek (hundred miles away) or do it without the robot here in Sacramento. He has done a hundred or so of each of the surguries with good outcomes both ways and the surgeon suggests that either would be well for me. With a slight edge going to robotic if my prostrate is sticking way up into my bladder. The difficulties of travel and care would be easier here in town.
I am going to talk to my urologist again before I make a decision. The robot is scheduling in Jan and the Lap is scheduling in November. So my wife and I are still thinking about it. We both liked the doctor and my urologist suggested him.
Just writing this down is theraputic. We face (or have faced) many decisions with PC.
Age 48 w/diagnosed
10/25/06 PSA 3.0
11/13/06 PSA 3.8
11/13/06 PSA FREE 0.5
11/13/06 PSA % FREE 13.2
10/25/07 PSA 3.4
12/18/07 Biopsy-neg
6/2008 PSA 3.5
1/7/09 PSA 4.6
6/18/09 psa 5.8
2/9/10 psa 8.7
5/13/10 psa 10.5
7/19/10 PSA 10.8
8/19/2010 3rd Needle core biopsy- single focus of prostatic adenocarcinoma, Gleason Grade 3+3=6, Tumor involves one of eight cores -2%, Prostate 78 (big)

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/16/2010 5:31 PM (GMT -6)   
Hello Highway,

Your prostate is on the big size, but hardly a giant like some men here have had prior to treatment. Sometimes for seeding, they have you take some HT to bring down the size of the prostate, so that seeding is possible. Was this option discussed with you?

Either form of surgery should be equally effective, assuming the surgeon is well qualified.

From your posted stats, you have one positive core, low % and a Gleason 6. Most every option should be available to you, including AS.

Good luck in your decision process.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3889
   Posted 9/16/2010 5:36 PM (GMT -6)   
Are you saying Walnut Creek has a Davinci robot available but Sacramento does not?

Here in cow town Denver, 5 of the 9 major hospitals are equipped with Davinci machines and getting time on one of them is not that difficult...Will your insurance cover out of network procedures? G-6, one core, 2% is reassuring but your PSA score and velocity is a little on the scary side so I would not postpone your surgery for too long..

"or do it without the robot here in Sacramento. He has done a hundred or so of each of the surguries with good outcomes both ways and the surgeon suggests that either would be well for me."

Somehow, in a town the size of Sacramento, there should be a surgeon who has done more than a hundred..Has he done 12 or more this year? I would try a little harder to get what you want. It's your money...

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 9/16/2010 5:52 PM (GMT -6)   
Dear Highwayman:
 
100 surgeries in a procedure is on the low side.  There have been several studies that show a significantly improved outcome as a surgeon exceeds 250 procedures.  That is no guarantee of course, but if I were you I would look for a more experienced doctor.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Post Edited (Tudpock18) : 9/16/2010 4:58:46 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/16/2010 5:57 PM (GMT -6)   
Highwayman,
I was one who travelled for the daVinci. I live as my screen name implies in Las Vegas and had surgery near Pasadena California at the City of Hope. I did have family living in Laguna Beach so my wife and I made it a 10 day trip, but that was not necessary. Laguna is about 40 miles from the CoH facility. The drive did not bother me a bit.

I have had the rare opportunity to being operated on by daVinci, and also operating the device at the AUA conference this year (The Reps from Intuitive Surgery would not volunteer their prostates so it was in a test sand box I played on) So I have danced both follow and lead...:-)

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 9/16/2010 6:00 PM (GMT -6)   
My health care is Kaiser and the doctor does surguries every Monday, so yeah he has done 12 this year. I would have to travel to the Bay Area where Kaiser has all the goodies. We did ask ourselves the question would this doctor prefer to do it here and not travel? From his demeanor I don't think so. We both felt confident about him. I am seeking another oppinion.
But thank you Fairwind, you are right, it is not just my money but my health.
There are some top notch cyberknife guys at Sutter which is down the street from my place.
To be honest though, I live in the capital of the richest, most populous state, in the most powerful country in the world and it's third world, back ass politics around here.

David, we did discuss HT at length as well as radiation, I'm just leaning tword surgury.
Thanks much Guys
Age 48 w/diagnosed
10/25/06 PSA 3.0
11/13/06 PSA 3.8
11/13/06 PSA FREE 0.5
11/13/06 PSA % FREE 13.2
10/25/07 PSA 3.4
12/18/07 Biopsy-neg
6/2008 PSA 3.5
1/7/09 PSA 4.6
6/18/09 psa 5.8
2/9/10 psa 8.7
5/13/10 psa 10.5
7/19/10 PSA 10.8
8/19/2010 3rd Needle core biopsy- single focus of prostatic adenocarcinoma, Gleason Grade 3+3=6, Tumor involves one of eight cores -2%, Prostate 78 (big)

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 9/16/2010 6:16 PM (GMT -6)   
Hello, Highwayman

I live in San Francisco, and given the population difference between Sacto and the Bay Area, and the large number of Kaiser clients in the Bay area there's a good chance you could find someone with much more experience and regularity in the robotic procedure. I would go for that if it were me, and I couldn't look at options off the Kaiser list. I can guarantee you won't want to sit on a car seat for the 1.5 hour drive home, so I'd borrow a van or something big enough to lie down in for the ride back. I found it really tough to sit for long periods with a catheter in there.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3889
   Posted 9/16/2010 7:48 PM (GMT -6)   
I will vote with proscapt..Head for S.F. I was not that uncomfortable when I was discharged the next day. One of those doughnut hemorrhoid cushions will make the drive home tolerable I think.. The first 48 hours post op are a little rough..You want a Davinci specialist, not a part-timer, and you want at least 300 procedures under his belt..
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP performed Sept 3 2010

sm416
Regular Member


Date Joined Sep 2010
Total Posts : 27
   Posted 9/16/2010 7:58 PM (GMT -6)   
I know when my doctor indicated to me surgery was the best option for me, and that he had done over 200 procedures.  He also asked me if I wanted someone else to perform the RRP.  I assured him that he was the one to perform the task.  Has your doctor giving you the option of who should perform the surgery?  If not, maybe that is something you be something else you would want to consider.  Remember it is your body and your life.  I am sure you will come to the right decision.
 
Steve f
 
Age: 58 Married 28 Years.
Initial PSA 2.9 elevated to 5.7 before Robotic RP surgery
33% of 1 of 12 biopsy points (left side near bladder)
August 9th Prostectomy with 3D Robotic Surgery
August 16 Staples and cath removed

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3987
   Posted 9/16/2010 8:00 PM (GMT -6)   

Highwayman -- here's the guy i was considering (los gatos). 

http://www.drgholami.com/

he's partnered with my uro, who does open prostatectomies.  good luck with whoever you choose!

ed


age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 9/16/2010 9:09 PM (GMT -6)   
Steve, He sugessted that could talk to a urologist at Morse. I have an apt on the 30th. Thanks everybody for the info.
Mike
Age 48 w/diagnosed
10/25/06 PSA 3.0
11/13/06 PSA 3.8
11/13/06 PSA FREE 0.5
11/13/06 PSA % FREE 13.2
10/25/07 PSA 3.4
12/18/07 Biopsy-neg
6/2008 PSA 3.5
1/7/09 PSA 4.6
6/18/09 psa 5.8
2/9/10 psa 8.7
5/13/10 psa 10.5
7/19/10 PSA 10.8
8/19/2010 3rd Needle core biopsy- single focus of prostatic adenocarcinoma, Gleason Grade 3+3=6, Tumor involves one of eight cores -2%, Prostate 78 (big)

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 9/16/2010 9:31 PM (GMT -6)   
I would definitely say go to where the experience is. I would 200 to 300 at a minimum, 500 is getting closer.

It really is important. I went 2 hours away.
Goodlife
 
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
15 month PSA <.01

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/17/2010 1:12 AM (GMT -6)   
An experience level of 1500 RALP's was my set limit, though you won't likely find that level of experience within the Kaiser HMO. In fact you probably won't find that level of experience with any version of prostatectomy within Kaiser.

But experience severely matters. I cannot express that enough...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 9/17/2010 7:30 AM (GMT -6)   
Some here call it dancing with the robot. tongue
So you think you can dance? This dance requires no prior experience, you will find yourself upside down(no spin zone and no break dancing or hip-hop) and full of air...out on drugs, not sure if they play any music if so maybe techno so the robot can get into it all (LOL). After the big dance you will find yourself in bed and nurse holding your hand, then you can say that was some kind of bash. Hope you like a little humor thrown in, sometimes this is needed. yeah

Good luck in whatever you decide to do. 

Post Edited (zufus) : 9/17/2010 6:34:59 AM (GMT-6)


Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 9/17/2010 11:14 AM (GMT -6)   
blush  Zufus,
thanks for the laugh, I probably had some similar feelings after a night of disco- of course nothing was missing..........

Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 9/17/2010 12:23 PM (GMT -6)   

It seems that you have already made up your mind on this one and I hope you find a surgeon that fits your needs but it just seems to me that your PCa is pretty much the  "low risk" category except for the last two PSA readings.  I've read recently that some urologists belive that since PSA generally increases with the size of the prostate that there should be some sort of "PSA Adjustment" correction to keep things in perspective, and if that were done in your case some doctors would advise you to continue to pursue AS.

Also, I don't understand why you feel that other forms of radiation might not be for you even though you seemed comfortable with seeds.

There was a recent Pubmed report about "low risk" PCa you might find useful.  The PubMed number is:  20800964

Good luck to you.

I


============================
Age:  59
Dx:  March 2010
PSA @ Dx:  4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason:  3+3=6 (confirmed by second pathologist)
Biopsy:  1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
DRE: Normal
Stage:  T1c
Bone scan and chest x-rays:  Negative
Prostate Volume: 47 cc
PSA Velocity:  0.19 ng/ml/yr
PSA Density:  0.092 ng/ml/ccm
PSA Doubling Time:  > 10 Years
Treatment Decision:  CyberKnife radiation treatment in June 2010.  Side effects:  None
 
 
 

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 9/17/2010 7:40 PM (GMT -6)   
 
Mike
If you choose to go outside the Kaiser System, please contact Dr Brian Naftulin in Folsom.  He did my surgery at Sutter 3 1/2 years ago.  He has done hundreds of surgeries, but only accepts a few ( only 5 or 6 a week ) so he is not like the 'surgery mills" that I have criticised in the past.
 
Good luck with your decision.  Twelve is not enough, go where you can get someone with more experience.

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 9/17/2010 7:52 PM (GMT -6)   
Fairwind said...
Are you saying Walnut Creek has a Davinci robot available but Sacramento does not?

Fairwind
Sacramento has many DaVinci Robots that are booked solid with all kinds of surgery.  The very best DaVinci prostate surgeon in our region is Dr Brian Naftulin of Folsom, Ca.

PSA July 2006 4.7 , Nodule found
biopsy 10/06 very agressive gleason4+4=8 identified
DaVinci surgery, Sutter Hospital, Sacramento, Ca. January 2007
Post Ob confirms, gleason 4+4=8 with no extension or invasion
no long term continence problems
post surgery PSA continues to be undetectable at 3 years
ED continues, bimix only solution
born 1941

Post Edited (lifeguyd) : 9/17/2010 7:15:18 PM (GMT-6)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 9/18/2010 10:13 AM (GMT -6)   
Highwayman, your story sounds similar to mine. Upon initial ultrasound during the biopsy, the uro measured mine at 76 gms. He said it was much too big for seeding, and he didn't put much stock in the idea of HT or something else that could reduce it enough to get seeds done. Also, he didn't think I would be a good candidate for robotic, for the same reason- a very large gland that might be difficult to remove and require a larger opening cut to get it out. I decided to go with an open RP, and am glad I did, as the gland removed was 110 grams, much larger than the ultrasound measured it. The surgeon was surprised and said that if I had to have had robotic, they would have converted during the operation to an open to successfully complete it.

You may wish to discuss with your surgeon the possibility that yours is larger than shows on the current exam, whether you realy are eligible for even a laproscopic at that size, and what they would do if they did discover a much larger one. I am sure there are limits to size, even for laproscopic. Good luck and let us know if you get any answers.
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., margins clear GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, reoccurance?
ED continues: Bimix- .3ml or Trimix- .15ml

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 9/18/2010 7:10 PM (GMT -6)   
James:
 
And my doctor thought my 53 gm prostate was somewhat large!!
Ha!
 
Mel
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