Choosing between: da Vinci surgery, regular surgery or radiation???

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Scott M
New Member


Date Joined Jan 2007
Total Posts : 6
   Posted 1/16/2007 11:38 AM (GMT -7)   
Why choose one over the other?  Assume: money is not an issue, time off is not an issue, quality of doctors and comfort with doctors are about the same, that concerns over impotence and/or incontinence are secondary to cure, that my general health is good and I am 60 with 1 of 10 biopsy samples showing less than 5% cancer in one lobe, 3+3 Gleason, PSA 26, no lump can be felt with the rectal exam.
 
If you choose surgery are there reason to not choose da Vinci?
 
Given the above, why choose radiation over either surgery?
 
Again, thanks in advance to all.
 
 

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 1/16/2007 12:02 PM (GMT -7)   

Hi Scott…

 

Each decision is a very personal decision and because we are all soooo different ~  but looking for the same results…  it’s nice to know there are options out there for all of us.

 

Excerpt from Our Journey ~ Sharing is Caring 

(C) We had already made our decision before the Consultation on Feb. 27th 

Radical Retropubic Prostatectomy…..Lift the Hood …We wanted Dr. Staley to visually see and feel the tissue and take out all surrounding tissue that may be hiding… cancer cells. 

 

Each person has their own reasons for selecting a specific treatment!!  Reading threads that give a detailed account of a member’s personal journey will give you insight into why they choose what they did…. 

 

Always remember…..

Your decision is your decision and it will be the right decision!

 

This really is a wonderful forum with so much helpful information that so many are willing to share to help others..

 

Take care and know that we keep you close in our thoughts and prayers.

In Friendship ~ Lee & Buddy


mama bluebird - Lee & Buddy… from North Carolina

Link to our personal journey…>>>     Our Journey ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy with "wide excision"

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

June 29th ~ PSA Less than 0.1 Non-detectable


spinbiscuit
Veteran Member


Date Joined Apr 2006
Total Posts : 818
   Posted 1/16/2007 12:31 PM (GMT -7)   
Hello Scott,

Like Bluebird said picking a treatment strategy is a matter of personal preference. From the data you posted any of the procedures will produce excellent results, and they are equally successful. What will matter most is the doctor that will perform the procedure. He/she should be the most experienced physician you can get. If you wish to stay close to home that will also influence your choice unless you live in one of the 10 largest cities.

I believe most of us that selected surgery(all types)did so because we wanted to know that the PCa was going to be taken out right away. This will give you peace of mind after the months of worry. I will re-state that the different types of radiation theropies are equally successful. It is just a length of treatment issue for some of us.

Good luck with your research.

Glen
Diagnosed at age 60
PSA went from 2.2 to 3.8 in 14 months
2 of 14 cores positive at 10%
Gleason 6(3+3), negative DRE, neg. boundaries
DaVinci surgery on 02/23/06
 


BenEcho10
Regular Member


Date Joined Jan 2007
Total Posts : 133
   Posted 1/16/2007 12:56 PM (GMT -7)   
Hi Scott,
 
I will let other more knowledgable people speak to the advantages and disadvantages of radiation, hormone, etc. In the below, I am only commenting on why I cose the open RP surgery instead of robot assisted laproscopic surgery:  

#1 reason that I chose the open RP procedure is that it was the procedure that my chosen surgeon / hospital had the most experience with. I think that finding someone who is very good at your desired treatment is extremely important.

#2 reason is that, as Bluebird noted above, it allows the doctor to get a more open look inside you and especially to get a "hands on" feel which might allow the surgeon to better locate and remove any caner that is outside but immediately adjacent to the prostate gland. That can be particularly important if it is more likely that the capusule of the prostate has been penetrated which is the case for higher Gleason PCA such as Gleason 8-10. This was a big factor in my case because I had a high Gleason (and my margins did ultimately prove to be positive.)

Based on what I have learned and read (much of it on this site) since I had my open surgery, I think that I would be very comfortable with the DaVinci method if I had a mid range Gleason (6 or 7 or less) and if the surgeon had done lots of them and had a reputation as being highly skilled with this procedure.

Good luck, whatever you decide.

Ben


DIAGNOSIS: 09/25/06. Age 49. PSA 4.6. PSA free 2%. Clinical pathology: Gleason 10. Stage 2a.           
 
SURGERY: 11/08/06. RP at Johns Hopkins. Surgical pathology Gleason 10. Stage T3a (positive margins.) Negative seminal vesicles, lymph nodes, and bone scan.
 
POST OP: First post op PSA was 0.00 in 12/06.

Post Edited (BenEcho10) : 1/17/2007 7:47:52 AM (GMT-7)


not me!
Regular Member


Date Joined Jan 2007
Total Posts : 30
   Posted 1/16/2007 4:12 PM (GMT -7)   

I chose Da Vinci for some of the reasons that the others chose open surgery. My research indicated that da vinci caused less bleeding which actually improved visual inspection of the surgeon. I also chose because of recovery time. I own a business and needed the quickest possible recovery. I went back to work the day following my surgery. The statistics that I have seen indicate little or no difference in results (meaning being cancer free). The daVinci procedure is newer procedure so there are not as many long term results available. My original doctor was a highly respected urologist, but his hospital had not invested in the 1 Million dollar robat and so he did not offer the Da Vinci option. He actually tried to convince me against it- remember its just business to them  - Once I chose the Da Vinci procedure I searched for the right doc. The Henry Ford clinic in Detroit is considered by many to be one of the top Prostate Clinics in the country and offer cutting edge protate treatment . There recently published results show better results with Da Vinci than with conventional open surgery.I encourage you to visit :http://www.henryfordhealth.org/19085.cfm

I actually ended up selecting a doc in Kansas City David Emmott. He had experience at the Ford clinic and had completed several hundred Da Vinci procedures prior to my operation. In selecting the doc I talked with my personal doc, who is a social friend and he stressed experience as you have seen on this site.  He said there's an old saying about selecting a doc and a procedure - "you never want to be a doctors first first or the last patient". 


56 year old male. 02/06 PSA 5.5  Subsequent Gleason 3+3=6 DaVinci Surgery 7/06 fully contained, returned to work (desk) the following afternoon, clear at 3 month check up, no pad 1 week after cath removal, but still occas. leaks after long day. No ED prior to surgery. ED since without improvement. Able to orgasm with help from wife and vibrator, but no sense that erection is returning. Drugs, no effect. Going to try the pump.

 


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 1/16/2007 6:55 PM (GMT -7)   

What I gather from your question is that if all things were as equal as possible why choose one type of treatment over another.  I am not sure that you can get to where all things would be equal but in my case it was a simple answer.  I wanted to know whether or not my cancer was contained to the prostate and was gone.  I wanted to know this as positively as possible.  The only treatment that gives you that outcome is surgery and the post op path analysis.  Other types of treatments can give you statistical assurances but you are still a mental slave to the constant PSA test.  If that does not bother you then all treatments are on the table for you and it becomes a personal preference.  One thing for certain, you could not ask this question of the medical community that treats prostate cancer and get an unbiased answer.

Tamu


Diagnosed 7/6/06
1 of 10 core samples, 40%
Stage T1c, Gleason 3+3
Da Vinci on 11/01/06
Catheter out on 11/13/06
56 Years Old
Post Op Path
Gleason 3+3
Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 1/16/2007 8:55 PM (GMT -7)   

Scott--My urologist, after delivering the news that surprised both me and him, said three important words:  "You've got time".  That was a real help to me to have the time to do the research we needed to do to make a decision my wife and I felt was the best option for us.

The  first decision was whether to have surgery or brachytherapy or another option.  We spent a long time researching and thinking about our choice, and settled on surgery.  It was not a black-and-white decision, but one we knew was right for us after weighing all the factors that were important for us.

Then it was a question of open vs. robotic.  That, too, was a personal choice based on a number of factors.  I believe that robotic prostate removal will be the surgical treatment of choice in the near future.  We went with open RPP because we trusted our urologist and his expertise with this surgery.  That was the most important aspect to us.

I was in top physical condition before surgery and came out of it in good shape and recovered rapidly.  I may have recovered a little sooner with robotic surgery, but that wasn't the most critical piece of our decision. I don't regret this decision, although I might have gone with robotic under different circumstances.

To repeat, the most important three words are "You've got time." Make your decision based on research, talking to those who have gone thru different approaches, and you will feel comfortable with the decision you make.  Best to you, Scott! 

 


Age 58 PSA 2.6 Gleason 5
Bi-lateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA non-detectable


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 1/16/2007 9:09 PM (GMT -7)   

  I chose the open RRP due to the fact I really liked my Dr.  We are close to the same age and he even said it kinda hit close to home for him that I was this young.  I knew he would do everything he could to spare the nerve on the one side that appeared to be free of cancer in the biopsy to help keep my sexual function.  I also liked the fact that when My Dr. does the surgery he is assisted by another surgeon in the practice (He is also in his mid 40's and a friend of some of my wife's family).  I have not heard any of the DiVinci guys say that there was a second Dr. assisting.  I liked the fact that there were 4 hands and 4 eyes looking at things in there.  He also said that his best tools are his fingers. To be able to feel anything and everything he wants too.  As far a blood loss and vision My Dr. said he can see everything just fine and they do so many of these that they almost never have to give blood during the operation.  I did have a bleed that caused some complications, but it was later that evening or the next morning after the surgery.

  My Dr's office and the hospital he uses is only a mile from my house.  Made it great for the family and the return visits for check up's.

  Also, at this time in Oklahoma City there is only one DiVinci machine and only two urologist that do the surgery with it.

  Although I'm having a harder, longer time getting the bladder control back that most of you seem to have I'm still happy with my outcome.

  I would probably make the same decision today if I were to do it all over agian!  You have to go with your gut feeling on what is best for you. 

 


    43
    PSA 5.7 - Discovered during Annual Physical with Family Practice Dr.
    Gleason 7
    Biopsy - 3 of 12 positive (up to 75%) all on left side of prostate
    RRP on Oct. 17, 2006 - Nerves on right side saved.
    All Lab's clear.  No Cancer outside prostate
    Cathiter in for 3 weeks due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00
    Next Office Visit Feb. 12, 2007
   


jetguy
Veteran Member


Date Joined Sep 2006
Total Posts : 741
   Posted 1/16/2007 9:12 PM (GMT -7)   

Hi Scott, sorry to welcome you to the club, but better here than not.

As you will have noticed, all the guys here have chosen one form or another of surgery.  I have chosen radiation.  I think you choose the option that frightens you the least and that's the way you go.  There are a bunch of high quality people here and I assure you that they want the best for you.  To that end they strongly recommend their choice of treatment.  For them to do otherwise would be dishonest and they are honest to a fault.  In my opinion, you should research thoroughly and then make your own decision.  I say this because my choice is different than most, but I think the world of these fine people.  I am truly sorry that you must make such a decision.

Illigitimi non bu carborundum,

Bill


Gleason 3+3=6, T1c, one core in twelve, another pre-cancerous.
62 years old and good health.  Married 37 years.  To same woman!


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 1/16/2007 10:20 PM (GMT -7)   
kw said...

  I also liked the fact that when My Dr. does the surgery he is assisted by another surgeon in the practice (He is also in his mid 40's and a friend of some of my wife's family).  I have not heard any of the DiVinci guys say that there was a second Dr. assisting.  I liked the fact that there were 4 hands and 4 eyes looking at things in there.  He also said that his best tools are his fingers. To be able to feel anything and everything he wants too.  As far a blood loss and vision My Dr. said he can see everything just fine and they do so many of these that they almost never have to give blood during the operation. 

 KW--I, too, liked the fact that a second urologist assisted with the surgery. I didn't need a blood transfusion during or after the surgery. As it turned out my primary urologist and his family moved out of state, so my new urologist is the doc who assisted with the surgery.  I think she is terrific and have appreciated the continuity.  I've had some sexual dysfunction issues post-surgically--who hasn't--and she has helped with that.  At six months, pills haven't worked, but injections (Caverject) do.  We're thankful to be able to have enjoy sexual relations in this way again. 

Age 58 PSA 2.6 Gleason 5
Bi-lateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA non-detectable


not me!
Regular Member


Date Joined Jan 2007
Total Posts : 30
   Posted 1/18/2007 8:44 AM (GMT -7)   
DaVinci method requires at least two doctors. The doctor who operates the robot is seated at a console 10-15 feet away from the operating table - one or two additional doctors attend to the patient.

56 year old male. 02/06 PSA 5.5  Subsequent Gleason 3+3=6 DaVinci Surgery 7/06 fully contained, returned to work (desk) the following afternoon, clear at 3 month check up, no pad 1 week after cath removal, but still occas. leaks after long day. No ED prior to surgery. ED since without improvement. Able to orgasm with help from wife and vibrator, but no sense that erection is returning. Drugs, no effect. Going to try the pump.

 


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 1/31/2007 8:39 PM (GMT -7)   

See 1st Thread started by Scott MacAdam….

(direct link ~ just click on the title!  Reminder to click on the REFRESH icon once there)

 

1-10-2007 Partial Quote…  from Need info in the Pacific Northwest

 

Scott MacAdam said...
I've just been diagnosed with prostate cancer.

 

60 years old, otherwise good health

Gleason 3+3=6

PSA:4 tests since October-22.0, 36.0, 19.2, 26.1

less than 5% in right lobe, none in left lobe

1 out of 10 samples positive

prostrate size 64 cc

no lump can be felt  in rectal exam

early stage, slow growing (judged by Gleason score)

I was treated with anitbiotics for an assumed infection between the 36.0 PSA and the 19.2 PSA.  The PSA scores are high and changing fast, up and down (prostate cancer plus an infection?). 

 

Hi...Scott ~

I hope you're finding answers...  Please stay with us and let us know how you're doing.

I placed a link to your 1st thread and added your "Specifics" above so those reading would know where you are on Your Journey.      In Friendship ~ Lee & Buddy

Post edited 8-25-07 to add Scott's threads:

08-24-07  Muse Questions

01-16-07  Choosing between: da Vinci surgery, regular surgery or radiation??? 

01-10-07  Need info in the Pacific Northwest

 

Post Edited (bluebird) : 8/25/2007 8:04:01 PM (GMT-6)

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