He wants robotic prostatectomy

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Regular Member

Date Joined Feb 2011
Total Posts : 45
   Posted 3/1/2011 2:47 PM (GMT -6)   
My husband, 58. PSA 7 Gleason 6. 2mm outside spread of margin adenocarcinoma, otherwise all else visibly clean. 4 cores biopsy postive adenocarcinoma. Urologist wants Brachy and Rads.  Rad Oncologist wants the same. Surgeon wants to scoop him out.  Husband really wants the surgery, I'm not so sure its the right thing.
Whats a wife to do???

Veteran Member

Date Joined Feb 2011
Total Posts : 4093
   Posted 3/1/2011 3:07 PM (GMT -6)   
Go interview a few robotic surgeons and see what they say.

I had robotic surgery and the results were fantastic ( so far ).

It's important he does what's comfortable for him. I think his instincts are right but you could speak with specialists in various disciplines.

He does sound like a perfect candidate for robotic surgery.

How do you know about the outside spread?

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 3/1/2011 3:17 PM (GMT -6)   
Welcome to HealingWell.

Satisfactory results can occur with a positive margin and Gleason 6 but there are several factors that could lead to differing results.

Before anybody chooses surgery, we always mention that physician experience is important. If this surgeon has extensive experience (1000+ procedures with the techniques he plans to use) then I would ask why he feels that surgery is still a viable option. One possible answer is that he suspects that he can either acheive desirable results or another possible answer is he suspects that the disease may have a more aggressive grade. In any case, where to go from here with prove to be controversial regardless of choice.

Do you know what technique the urologist used to determine that there was likely a positive margin? It is very rare for a clinical diagnosis to be a stage 3 diagnosis.

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

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 3/1/2011 3:33 PM (GMT -6)   
Hi wifeandmother, and welcome to HealingWell. Sorry to hear about your husband's biopsy findings confirming prostate cancer.

While I am not a doctor, I have read a fair number of prostate biopsy reports but I am a bit confused by one part that you wrote: "2mm outside spread of margin adenocarcinoma." [If I understood Tony's comment, above, he was also following the same thought process that I was.]

"Locally advanced" prostate cancer is a clear contraindication for surgery. "Locally advanced" means spread outside of the prostate. It would be unlikely that a biopsy would identify a "locally advanced" stage or cancer at the margin of the prostate, but this wording SEEMS like it possibly indicates this...thus my confusion.

How did his doctor describe this part of the biopsy to you? To your question "What's a wife to do?", as a starting point/next step I think that both of you should seek to understand this completely.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 3/1/2011 4:17 PM (GMT -6)   
As stated in the above posts it is unusual to spot a capsular penetration with out some type of a scan like MRIS or Color Doppler. The oncologists are recommending seeds/IMRT because the normal margins treated are 10mm to 15mm outside the gland. With surgery there is no way to know if the margin is clean. With seeds/IMRT the side affects will also be much better. Any time you have capsular penetration there is a high probability that you will need salvage radiation after surgery increasing the total side affecst vs just one treatment modality.
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.

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 3/1/2011 4:18 PM (GMT -6)   
Hi wifeandmother, I second the question that Casey has asked. A biopsy can't identify cancer outside the prostate since it only sample the prostate itself. They can suggest that it might have spread if the cancer is considered advanced stage, meaning high Gleason. A Gleason 6 is not considered advanced. Did they tell you how many cores were sampled? How many cores were positive and what percentage of each core was cancerous?
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 3/1/2011 5:12 PM (GMT -6)   
You may notice that the preponderance of guys here are surgery guys. (me too)

With a Gleason of only 6 your husband has both lots of time and lots of choices. As others have said, get a copy of the biopsy report. You might also include a sig (see the top of the forum list to learn how to do this) since your husband's PSA history, DREs, and family history can matter. While you are at the top of the topics list, note that there are several very good books about PC which are worth reading.

My younger brother (a Gleason 6) did brachy and at 6 years post-seeds seems to be cancer free and with fewer side effects (ED controlled with pills)

In any case know that we are here for help and support
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day
9 mo. PSA 0.00 -- 1 light pad/day ED remains
12 mo. PSA 0.00 -- still one light pad and ED
16 mo PSA 0.00 -- light pad just for security, ED still an issue

Regular Member

Date Joined Feb 2011
Total Posts : 45
   Posted 3/1/2011 5:25 PM (GMT -6)   
Hello All,
Thank you for your comments. When I get home, I will re-read the MRI, and other reports, I think it said MRI shows 2mm outside of margin, thats what I meant. Surgeon thinks it may be wrong too, it may be something else. I will write again. Thank you very much.

Regular Member

Date Joined Feb 2011
Total Posts : 173
   Posted 3/1/2011 5:44 PM (GMT -6)   
Maybe HT, Hormone Therapy, is an option. I am leaning that way of late and studying the different options that allow quality of life. I am not going to try Lupron or Zoladex but rather other HT drugs that may have less affect on my QOL.
For me, not a recomendation, HT seems like a place to start. All that matters is his success IMO. Great people here all.

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 3/1/2011 6:23 PM (GMT -6)   
I think without our new member giving a fuller or perhaps entire version of her husband's biopsy report, there's a whole lot of guessing going on here. Hopefully she will report back with more complete wording.
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

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 3/1/2011 8:13 PM (GMT -6)   
If the MRI showed extracapsular extension then both your doctors are correct in the treatment they are recommending as it gives the best chance for a cure.
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.
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