Minimum waiting time between biopsy and robotic prostatectomy

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MoreData
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Date Joined Dec 2010
Total Posts : 35
   Posted 1/27/2011 1:04 PM (GMT -6)   
I just got my biopsy results this week. I'm going to do all the consultations but strongly suspect I'm going to have a robotic prostatectomy. One of the schedulers said they have to wait some number of weeks or months to let the prostate heal before doing surgery. That makes sense to me, but I don't know how much of the waiting time is medical and how much is institutional.

Has anybody heard this? Anyone know what the generally accepted minimum wait time is?
----------------------------------------------------------------------------
Age 43 at diagnosis (2011-01) with PSA of 5.2
PSAs 2008-03: 2.6, 2008-06: 3.4, 2008-07: 2.5, 2009-11: 2.9, 2010-12: 6.4
Biopsy 2011-01 - Gleason 7 in 5 of 12 cores - Staged T1c
Posts telling the story at: http://www.scottontheorwigs.blogspot.com/
At my age with 4 young kids I am in "GET THAT THING OUT NOW!" mode

Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4848
   Posted 1/27/2011 1:17 PM (GMT -6)   

My surgeon said six weeks.  Yours might be different so you'll need to ask him or her.

 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 1/27/2011 1:33 PM (GMT -6)   
Generally 6 weeks.
 
I had my biopsy on 11/30 and surgery on 1/27.
 
Mel

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/27/2011 1:38 PM (GMT -6)   
I have heard about the same as Steve mentioned. Steve you are a knowable guy and seem very open minded enough and have enjoyed your posts, how about you or someone else enlighten Moredata as to why he should look at the other reasonable treatments and take some time on this h-u-g-e decision before rushing in???? English Alf's info on what to expect with surgery is located on this forum somewhere up at the top thread choices (really a must read for anyone considering surgery)!!! Know what to expect and how it would likely go down, the docs rarely cover it in this kind of detail done by E-Alf.

Moredata- best to you in the huge decision making processes.
Hey fellow Michigander I live near Clarkston, Mi.  (I have seen a number of docs in Mich. for opinions, fyi)
 
 
http://www.scottontheorwigs.blogspot.com/       Hey Scott the blog is with humor and sarcasm, and even a video youtube with a dog video 'Bear'...others do a drive by on his blog, and you can post a comment reply.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Post Edited (zufus) : 1/27/2011 12:40:24 PM (GMT-7)


cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 1/27/2011 2:08 PM (GMT -6)   
I totally agree w/zufus, also An had a excellent suggestion of having biopsy slides read by an expert. I noticed your in Mi I would still consider seeing Dr Fred Lee can't hurt. I would want my husband to do alot more research before making a life altering decision. I won't bore you w/details but my husbands [60 ,avid marathon runner] psa has never been below 5.0 and Dr Lee assured us no PCa and told him his psa ran somewhat high, no biopsy. Since you've had a biopsy have the slides read by the experts recommended on here and go from there.........Just my random thoughts and opinion............Cooper

Tim G
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Date Joined Jul 2006
Total Posts : 2358
   Posted 1/27/2011 3:08 PM (GMT -6)   
It takes the prostate six to eight weeks to heal after a biopsy.  I researched about six months before making a decision on treatment.  Treatment is an individual decision that should be well thought out based on what's important to you.  When I opted for surgery I talked to about five patients who had a prostatectomy by my  surgeon to discuss outcomes.  Even a high-numbers surgeon doesn't mean he is good.  I was told by several knowledgeable health-care professionals to avoid a particular high-numbers robotic surgeon.

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 1/27/2011 3:36 PM (GMT -6)   
MoreData said...
At my age with 4 young kids I am in "GET THAT THING OUT NOW!" mode


This is a totally reasonable and expected first reaction.

That being said it's not in your best interest to rush into anything. Please read, research and talk to other Doctors about the other treatment options so you can make a decision that is best for you. Be sure to watch your Dr's closely and check what they say about side effects etc, some Dr's will side step the down sides. Verify what they say by doing research online. Take the healing time to educate yourself using the links at the top of the forum page and any other (reputable) sites you can find.

I'm not saying surgery is a bad decision, I had it and am happy with my choice, but I remember being in the grip of the "get it out now" monster and know that I rushed a bit with my decision even though I did do some research.

Best of luck to you whatever your decision may be.
Dave in Durango CO
07-06 PSA 2.5
01-08 PSA 5.5
09-09 PSA 6.5
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 1-25-11 <0.04

Father of Two
New Member


Date Joined Dec 2010
Total Posts : 14
   Posted 1/27/2011 7:56 PM (GMT -6)   
I am probably the exception here. I got my diagnosis (Gleason 3+3, PSA 5.0 after six weeks of anti biotics) on December 6, 2010 and had Da Vinci surgery on December 23rd. Mostly it was due to the fact that I have a huge insurance deductible that would have reset on January 1st. I don't recommend making this big a decision on that basis, but for me, a 40 year old happily married father of two, surgery was the only option. And once I made that decision, it was just a matter of when. I was confident in my doctor's reading of the biopsy, so I thought: "why go through it again." I spoke with other urologists about the results and all agreed that given my age, surgery was the right choice.

So now, less than six weeks post op, I mostly have the incontinence thing under control (though not completely - hint: don't drink alcohol close to bed time) and I am convinced that I am enshrouded in the new normal. My pathology report confirmed everyone's suspicions.... for me, it was the right choice
Robotic Surgery 12/23/10
Age 40; PSA - 6.2; 3+4 Gleason

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/27/2011 8:56 PM (GMT -6)   
8 weeks from my last of 3 biopsies to my open surgery.
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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 1/27/2011 10:09 PM (GMT -6)   
Surgeon who did my RP said he wouldn't operate any sooner that 10 weeks after biopsy.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 1/27/2011 10:29 PM (GMT -6)   
Surgeon told me to wait at least 6 weeks from biopsy.

MoreData
Regular Member


Date Joined Dec 2010
Total Posts : 35
   Posted 1/27/2011 10:34 PM (GMT -6)   
So I'm hearing 6-8-10 weeks. I have an appointment with Dr. Stricker at Henry Ford in Detroit on Monday. I'll be interested to hear what he says.

I know I shouldn't rush into this. A couple of reasons I'm feeling okay about moving ahead, though.

First, I've been doing a LOT of reading since our initial freak-out with the PSA spike in December. I decided then I had PCa. I've read the appropriately-titled "Really Useful List" at the top of this forum several times. I believe that list more than I believe the marketing copy from any surgeon's website. I'm reading the Walsh book. I scan the signatures here obsessively looking for post-surgery continence, ED, and PSA information. I'm going into surgery with my eyes open. I know things aren't always as positive as the best-case scenarios we hear about.

Second, a number of people I trust have urged me to go the surgery route. Some of them are doctors. None are surgeons and none have any stake in my case. One is a medical oncologist who works with advanced PC patients. Some are PC survivors. I'm certainly open to someone changing my mind but so far nobody seems to be trying. Everyone familiar with my case has said to investigate my options but that surgery is the only way to go given my circumstances.

So again I'm wide open to looking at other options but it seems likely surgery is the way I'm going to go.
----------------------------------------------------------------------------
Age 43 at diagnosis (2011-01) with PSA of 5.2
PSAs 2008-03: 2.6, 2008-06: 3.4, 2008-07: 2.5, 2009-11: 2.9, 2010-12: 6.4
Biopsy 2011-01 - Gleason 7 in 5 of 12 cores - Staged T1c
Posts telling the story at: http://www.scottontheorwigs.blogspot.com/
At my age with 4 young kids I am in "GET THAT THING OUT NOW!" mode

MoreData
Regular Member


Date Joined Dec 2010
Total Posts : 35
   Posted 1/27/2011 10:41 PM (GMT -6)   
Oh and Dr. Lee keeps coming up. I really should try to get an appointment with that guy.

I'll be taking my slides to Dr. Stricker so I hope to get a second opinion on the interpretation there.
----------------------------------------------------------------------------
Age 43 at diagnosis (2011-01) with PSA of 5.2
PSAs 2008-03: 2.6, 2008-06: 3.4, 2008-07: 2.5, 2009-11: 2.9, 2010-12: 6.4
Biopsy 2011-01 - Gleason 7 in 5 of 12 cores - Staged T1c
Posts telling the story at: http://www.scottontheorwigs.blogspot.com/
At my age with 4 young kids I am in "GET THAT THING OUT NOW!" mode

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 1/27/2011 10:59 PM (GMT -6)   
For a person diagnosed in their early 40s surgery would be my first reaction too.
However you have years to live with the decision you make, including years of anxiously waiting for PSA test results. That's why it is so important to get it right now and I think it would be a good idea to establish the probabilities of whether this cancer is completely within your prostate.

I think you need to consider three main things in my opinion:
1. A re-read of your pathology slide by an expert. (Bostick, Epstein). If the results come back at 4+4 or a 3+3 instead of a 3+4 this would give you something to think about.

2. A MRI-S or a colour doppler. This would be mostly to check whether thre are any extra prostatic extensions visible - allowing your doctor to cut or radiate that area more carefully.

3. Investigate brachytherapy: The seeds destroy your prostate from the inside and radiate the area a couple of mm beyond the outside of the prostate. Its these couple of mm that make this option attractive - you are basically doing a removal and radiation all at once. Brachytherapy's cure rates are as good as surgery with fewer side effects. Worth looking at. The big psychological hurdle to get over is the fact that the prostate is still in you - not something that someone newly diagnosed wants. It's important though to go beyond a knee jerk reaction and think about the scenario where you have a biochemical reccurrance after surgery - in this case Brachytherapy will look very attractive.
 
My husband waited 4 months after the biopsy to have the surgery but the surgeon said the minimum time was 6 weeks.

An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01

Post Edited (An38) : 1/27/2011 9:59:18 PM (GMT-7)


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 1/27/2011 11:50 PM (GMT -6)   
6-8 weeks..Then there can be the problem of getting time on a DaVinci machine...Lot's of stuff goes on backstage...You might ask for "pre-approval" from your insurance company so you will know in advance what your co-pays will be..

At age 43, I agree surgery is your best option. Just choose your surgeon carefully...It might be worth your time, money and effort to contact one of the nationally recognized surgeons who consistently have results above average...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2679
   Posted 1/27/2011 11:51 PM (GMT -6)   
My surgeon said we would wait two months after the biopsy.  His explanation was that the prostate, while healing, becomes "sticky," making it difficult to excise cleanly. Those two months give a guy a lot of time to educate himself about PCa and to come to terms, at least to some extent, with what's happening to him.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 1/28/2011 12:17 AM (GMT -6)   
MoreData:
 
Are you in Michigan?
 
I had my surgery at Ford also.
 
Mel
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. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/28/2011 6:13 AM (GMT -6)   
Compiler he is in Saline Michigan
 
On pathology Dr. Grignon in Michigan (assumed still working here) was on Dr. Strums longer list of expert USA pathologists (fyi)

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 1/28/2011 8:01 AM (GMT -6)   
I understood the time needed for recovery between biopsy and surgery was at least 6 weeks.

Biopsy needles jabbing into the gland and damaging tissue and blood vessels make it swell up and that takes a while to recover and heal. A surgeon does want anything opening up again and causing bleeding etc while he's working inside you.

Biopsy needles also go through lining of rectum and that has to recover too. A surgeon wants that area to be nice and strong again when he starts pushing and shoving inside you to get at the prostate.

Biopsy needle also passes from rectum (= very dirty) into the prostate and the space in between rectum and prostate (= very clean): contamination of this area by faeces etc may cause an infection, thus all biopsies should be accompanied by a course of antibiotics (I was started on the antibiotics the day before the biopsy!) The body may thus also need time to deal with any infection and the antibiotics etc.

If it comes to emergencies hospitals and surgeons can do operations at short notice, but Prostatecomies are not emergencies, thus the lead in time is now established in most hospitals based on who is in the queue in front of you. The guy having the operation today is the one who made the decision 6 weeks ago and had the biopsy 12 weeks ago. The guy being operated on last week had his biopsy earlier, the guy waiting to be done next week had his biopsy later and so on. If you want to be operated on sooner you will boot someone else out of their position in the queue. Though in the case of my hospital they could be very flexible.
It is thus not a waiting list, but simply a queue.
Between making your decision and the surgeon making the first cut, a surgeon will also want to allow you time to have a really good think about what you are doing. My surgeon said it would not be a problem to postpone the op or delay it if I was having second thoughts etc. This all followed on from my original uro having said it would be a good idea to go on holiday before making my mind up (Before my diagnosis we had arranged a holiday to France to celebrate our 25th anniversary) And even when I had decided to go for surgery they also thought it a good idea to go away to England for a few days to see my relatives and family to celebrate my birthday with them.

Also before major surgery they want to have time to check you over so they have to schedule in meetings with you to discuss your full medical history in detail, and you will also have to meet the anaethetist etc. Yes you could do that in one day and have surgery the next day if all is well, but surgery for PCa offers the chance for you to be dealt with slowly and calmly instead, so I say why not make the most of that aspect.

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr CT
66Gy 28 Apr to 11 Jun 10
Tired + weird BMs
14 Sep 10 PSA <0.1
12 Jan 11 PSA <0.1
Erection OK

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7078
   Posted 1/28/2011 3:16 PM (GMT -6)   
English Alf must be sitting in the drawing room with a cup of tea - always the complete answer.
 
My uro/surgeon wanted 8 weeks between biopsy and DaVinci for all the healing reasons already mentioned. It was not possible to do it that quickly, as there was a serious backlog on the DaVinci equipment (they use it for an amazing list of procedures).
 
I still had incontinence issues at 20 weeks out, and those have gotten a little worse after having had IGRT - 1-4 pads per day, most often 1 or 2.
 
ED is not an issue - they took the nerves, so it's not an issue of disfunction, just no function. (The "new normal" takes getting used to).
Biopsy G 4+4 in 7 of 12 cores, 4+3 in 2, none in 3. PSA 7.4
Post op was G 4+5, EPE, Lymph nodes & seminal vesticles clear.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

brampy
Regular Member


Date Joined Jan 2011
Total Posts : 42
   Posted 1/29/2011 12:42 AM (GMT -6)   
Biospy on 11/30/10 and RALP on 12/27/10.

--------------------------------
Age: 54
Routine Physical on 10-20-2010 DRE Normal
PSA 4.3, up from 0.6 5 years prior
PSA 0.6 on 10-25-2005
PSA 0.4 on 7-30-2004
PSA 0.5 on 5-9-2002
Followup with Urologist on 11/10/2010 after elevated PSA; DRE noted slight bump
November 30th, 2010 had prostate biopsy.
December 9th, 2010, Biopsy results 3 of 12 cores positive.
LLB: Gleason's 4+3=7, 11 MM Tumor Length/15MM Core Length (73%)
LLM: Gleason's 4+4=8, 12 MM Tumor Length/15MM Core Length (75%)
LM: 0.1 MM Tumor Length (1%)0.1 MM Tumor Length
Urologist recommended robotic removal using da Vinci method.
RALP Surgery 12/27/2010 Released: 12/30/2010
Thunderbird Banner Hospital, Glendale, AZ
Post-Surgery Pathology: GS 4+5=9
Pathologic Staging: pT3a, N0, MX; location: Left Side; Volume: 10%
Margins: Left posterior inked margin focally involved
Extraprostatic Extension: Observed
Seminal vesicles: Not observed
Lymphatic/Vascular Invasion: Not observed
Catheter: Removed 15-days after surgery

Post-OP Followup on 1/11/2011; Catheter/Staples removed
Adjuvant IMRT 8 Weeks Post-OP.
No exercise for 4 Weeks Post-OP.

Radiation Oncologist Initial Consultation on 1/18/2011

Mackattack
Regular Member


Date Joined Jan 2011
Total Posts : 78
   Posted 1/29/2011 6:34 AM (GMT -6)   
I got mine scheduled 7 weeks after my biopsy and i thought I was sprinting.  By the time you get the biopsy, wait on the results, get up off the floor, find a surgeon, , get on a schedule...I think you will find the healing of the prostate will not be your constraint. 
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

Scheduled for open RP on 2/14/11 at Mass General
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