Robotic Surgery Study

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Regular Member

Date Joined Aug 2008
Total Posts : 328
   Posted 10/18/2010 12:20 PM (GMT -6)   
Saw this today published thought I would pass along....

Post Edited (SHU93) : 10/18/2010 11:25:47 AM (GMT-6)

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 10/18/2010 2:30 PM (GMT -6)   
That is good news, Is gives all of hope.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Veteran Member

Date Joined Sep 2010
Total Posts : 1163
   Posted 10/18/2010 2:45 PM (GMT -6)   
"Dr. Menon or his colleague, James Peabody, M.D., performed all of the robot-assisted surgeries in the study."
Interesting article, but studying the outcomes of a superstar surgeon doesn't tell us much about what the average guy's experience might be with a surgeon who is a mere mortal.
I think this says more about what can happen with the best surgeons in the country. If you happen to have one of them for your doc, whether they prefer open or robotic surgery, this is very encouraging news. 

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 10/18/2010 2:55 PM (GMT -6)   
Jazzman, you have (perhaps unintentionally) just reinforced the axiom that one should seek out the best possible surgeon in order to stack the odds on one’s favor for the best possible outcome.

The experienced guys with outstanding reputations generally accept insurance, just like the mediocre guys do.

Veteran Member

Date Joined Nov 2009
Total Posts : 7270
   Posted 10/18/2010 2:57 PM (GMT -6)   
Not to rain on anyone's parade, but Dr. Menon did mine and I MIGHT be in that 14%!
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

Veteran Member

Date Joined Sep 2010
Total Posts : 1163
   Posted 10/18/2010 3:55 PM (GMT -6)   
Casey, I'm good with that axiom. Everybody should try to get the best surgeon their insurance will cover, within the bounds of practicality. That's certainly been my approach. Stacking the odds is what we all need to do, and yes, many people really can afford the best.
Compiler's experience, on the other hand, shows that these kinds of studies only reflect probabilities. It's what happens to you as an individual that matters, and none of us get any guarantees.
However, I wouldn't get too bummed out just yet, Mel. It's early in the post-operative PSA game for you. I'm still watching for that PSA score to go back down. I'll keep a good thought for ya.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 10/18/2010 4:49 PM (GMT -6)   
Without publishing risk classifications and cure rate by risk classification we really can't tell a lot from this study as it could be overweighted with low risk cases, like Walsh's numbers. One point to take away is that excellent surgeons can achieve better results than the average.
Scardino said that at MSK the range of positive margins ranged from 11% for the best and 48% for the worst with a 23% average. It would be nice to see the rates for individual surgeons so a patient can make an informed choice.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Regular Member

Date Joined Jun 2010
Total Posts : 416
   Posted 10/18/2010 4:50 PM (GMT -6)   
The Drs do note "they cautioned that the study period included their own learning curve in developing the robot-assisted technique.." So the were some who were operated on by this guy before he was at his best, he admits himself.
Of course everybody should try and get the best surgeon..
But i'm not convinced that one can say that Dr "A" is so superior in both knowledge and physical stamina and ability so that onle he and a few of similar abilty can produce a great result.
The wisest may not also be the most educated, or have the best hands or nerves, or marriage..
I think the stage, the disease and the individual patient's situation have more of an impact most of the time.
Do I want the best - YES - obviously.
But i'd be surprised if you found much difference in the results of any of the top 20% of surgeons.
There's the tissue, we know what needs to be done. It's clear to dr #1, it's clear to dr #2, and #3.
If and when it IS clear, I guess i'd want my surgeon to be the one who played video games for his entire childhood.
I dunno. When I see statements such as the following, I have to try REAL hard to understand what they are trying to convey.
"that deaths from prostate cancer occurred in only 1 of 1,000 patients per year"
Best to all on a magnificent day on Cape Cod.
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