Newly Diagnosed - Open or Robotic Surgery and Who ?

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cpb
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Date Joined Jul 2007
Total Posts : 34
   Posted 7/28/2007 5:01 PM (GMT -7)   
Just received the news on Tuesday - PCa. Age 66 - Gleason 6 (3+3, TS2a). Active and healthy otherwise. Opting for surgery at this point based on what I have been researching. Live in Philly area, but looking for best surgeon can find. I have already received some input under other topics. I am interested in your input on which surgery you found best and why. Looking for names of good surgeons who do a alot of Robotics and data on when open sugery is preferable to Robotics. I would appreciate your input. This appears to be a great support group !! Thanks.  

Post Edited (cpb) : 7/29/2007 10:12:45 AM (GMT-6)


bluebird
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Date Joined May 2006
Total Posts : 2542
   Posted 7/28/2007 5:18 PM (GMT -7)   

Hi  ~ cpb &  Loved Ones,

 

A   “Special”  Warm Welcome  to  You!  yeah  

 

We know ~ we can “all” make “Your Journey” smoother just by being here for you! 

This is truly a great forum!!! ~ You have joined!  You are now part our forum family ~ a group of wonderful individuals who are so willing to share...  It helps “all of us” ~ to help you ~ if we know where you are on your path. So ~ Please stay with us and take our hand when you need it!  Keep posting.... OKAY!!

  

KNOWLEDGE    IS    POWER  ...  and  POWER conquers  fear

 

YOU MAKE THE DECISIONS… YOU HAVE OPTIONS…

~ and ~

Your decision will be the right decision for you!!!

 

Keeping you close in thoughts and prayers as you move forward…

 

In Friendship ~ Lee & Buddy

 

“God Bless You”

It's a little prayer  ~  "God Bless You" ...but it means so much each day,

It means may angels guard you and guide you on your  way.

 

(Direct Link ~ just click on the title below and a new window will open!  

Reminder … click on the REFRESH icon once you get there)

Helpful Hints ~ & ~ Direct Links to Important Topic Threads ~ Hope this helps you!! :)

 


mama bluebird - Lee & Buddy… from North Carolina

J  We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

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

2nd PSA 02-06-2007 Less than 0.1 Non-Detectable :)

 


bluebird
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Date Joined May 2006
Total Posts : 2542
   Posted 7/28/2007 5:25 PM (GMT -7)   

Hi ~ cpb,

 

We are so happy you joined us on your own personal thread!!!  There are many resources here and if you click on the Helpful Hints link above you will find a few of “many” topics… some of which I think you will pull a lot of information from.   Members will share their thoughts with you here as well right here on your thread : )

 

Buddy & I invite you to visit our personal thread located in our signature above…  If you pull one thing from our travels… that will help make your path a little smoother…. It’s our gift to you!

 

This journey is best traveled with friends who know where you’ve been, where you’re headed, and where you will be once you are across the stream…  There are many stepping-stones in this journey with prostate cancer…. And we are there to help you traverse them.  Our hands reach out to you……  thank you for reaching back.  Stay close!!!  yeah   

Keeping you extra close in thoughts and prayers.

In Friendship ~ Lee & Buddy


cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/28/2007 5:44 PM (GMT -7)   
Thanks Bluebird - I appreciate your support and input. I am approaching this journey knowing you all are out there to help. Another Rite of Passage in Life.
 
             

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 7/28/2007 5:47 PM (GMT -7)   
tongue   You are among friends..... Keep reaching out ~ we will "all"ways be here!!! yeah
 
 
 

AEG
Regular Member


Date Joined Nov 2005
Total Posts : 154
   Posted 7/28/2007 7:13 PM (GMT -7)   
Hi Cpb,

I'm glad to hear that you decided to go with surgery. From my research, the best doc that do open are Dr. Scardino in NY and Dr. Catalona in Chicago. One of the best robotic docs is Dr. Tewari in NY. You can't go wrong with any of them.

Best of luck to you. May you have a quick and speedy recovery.

AEG

AEG
Regular Member


Date Joined Nov 2005
Total Posts : 154
   Posted 7/29/2007 6:22 AM (GMT -7)   
Hi Cpb,

I forgot to mention the best of all, Dr. Walch but I think he's semi-retired.

A.

cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/29/2007 2:08 PM (GMT 0)   
Thanks AEG - I appreciate your response. I should have posted my topic correctly. I meant open or Robotic. I would prefer Robotic if I am proper candidate for it. My Urologist says I am but that assumes Pathology- Gleason 6 (3+3) coupled with low PSA 2.7 with T2a is correct. What about Samadi or Guillonneau also in NY for Robotics ?  Thanks again.
 
CPB

Izzyblizzy
Regular Member


Date Joined Oct 2006
Total Posts : 411
   Posted 7/29/2007 8:04 AM (GMT -7)   
Hi cpb!

Just wanted to say hi! Not familiar with docs out east, so can't help you out there.

We chose robotic surgery. Although either seems to give good results. I guess our main reason for choosing it was that we believed in the surgeon and his results. Incontinence cleared up about in average time (6-8) weeks. Although we are still struggling with ED.

Anyway welcome and good luck with your decision and choosing a surgeon!

Tanya
Age: 63
Diagnosed: 10/30/06
PSA: 3.7 (2005: 3.4, 2004: 4.0)
Biopsy: 1/10 cancerous, 5% of one core, right apex.
Gleason: 3+3=6
Da Vinci: April 10, 2007, Denver CO
Path results: 1% of prostate involved. Very small tumors on both right and left apex. Negative margins, negative seminal vessicles, lymph nodes left intact. Gleason upgraded 3+4=7.
1st PSA Results: May 11, 2007 <.01
 


AEG
Regular Member


Date Joined Nov 2005
Total Posts : 154
   Posted 7/29/2007 8:10 AM (GMT -7)   
CPB,

It sounds like you're a good candidate for robotic esp if the PC is confined to the prostate. This is only my opinion. I've heard the names Samadi and Guillonneau for Robotics, they probably are some of the top ones in NY but I would probably go with Tewari. From my research, Dr. Tewari is excellent for robotics. Perhaps you can consult with him and decide for yourself.


I found some videos / interviews of Dr. Tewari, I hope you can watch/hear them on your computer. If you can't, you can go to a local library to watch them:

Please keep us posted.

Links:

http://www.brightcove.com/title.jsp?title=307719464&channel=301783375
http://www.brightcove.com/title.jsp?title=307739154&channel=301783375
http://www.youtube.com/watch?v=cswcGoxVZi4
http://www.youtube.com/watch?v=0malkSW6PtY
http://video.aol.com/video-detail/id/1799718909
http://video.google.com/videoplay?docid=2622472122799081510
http://pl.youtube.com/watch?v=3c0SlMvlTGw&mode=related&search=


Best of luck to you.

AEG

cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/29/2007 9:15 AM (GMT -7)   
Thanks - changed posting to reflect correct inquiry. While doc thinks it is confined to prostate - cannot guarantee it. So how do you determine for sure PCa is confined to prostate prior to surgery ? 

AEG
Regular Member


Date Joined Nov 2005
Total Posts : 154
   Posted 7/29/2007 9:28 AM (GMT -7)   
Transrectal MRI will give you a decent idea, although not 100% accurate. Best way I know how.

There are probably other tests out there, let's see what the other members have to say about this.

A.

puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 7/29/2007 10:08 AM (GMT -7)   
Welcome. All of us have gone through the same uncertainty and questioning. I chose robotic because of the minimal invasion and easier recovery. I was up and walking within a couple of hours and home the next dayby noon. Luckily, incontinence was not a problem and I was basically pad-free after a month. ED a bigger issue, but I'm assured that most (not all) guys need at least three months to see any real improvement. So I wait and hope. As to pre-surgery dx, it's my understanding that there is no way to absolutely determine extent of PCa absent removal and visual and/or pathological examination of the gland, vesicles and surrounding lymph nodes. An experienced dr should be able to offer some insight based on digital exam and biopsy, as well as size and location of the tumor(s) he has identified. I may be wrong on this, but that's my understanding. So far, my dr has been right on. I went in with a Gleason of 3+3=6 and had the same score post-op; clear at margins. My first post-op PSA is in September, and I hope he continues to be right!

Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 7/29/2007 10:13 AM (GMT -7)   
cpb,

There is no "for sure" when you are dealing with prostate cancer. What you have to do is collect all of the information that you can and then use it to determine your choice of treatment. Your staging indicates that the DRE was abnormal. There are numerous prediction tools that have been developed to use statistics to help provide information. I plugged in your information in the one developed by Memorial Sloan Kettering. The calculator came back with an organ confined prediction of 88%. It also predicted a 1% chance of seminal vessel and lymph node involvement. Once again this is just a tool so use as information not as a hard and fast outcome. All this indicates a very early detection with a Gleason that is the most normal for prostate cancer.

I chose the robotic for the less surgical trauma and because I believe that the improved field of view for the surgeon gives the best chance for regaining continence and a successful nerve sparing. There are several surgeons within a reasonable distance of you that have done hundreds of robotics. My surgeon is at Vanderbilt University and was only two hours from my home but I would have gone any distance to find a surgeon that had done hundreds of robotic surgeries. You can go to www.davinciprostatectomy.com and get to the web site of the manufacturer of the robot. They have a list of surgeons and hospitals that are doing the robotic surgery.

Stay with us as you go through your journey. This forum has become a band of brothers and sisters.

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
Began injections in April '07
Undetectable PSA on 6/25/07


cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/29/2007 10:17 AM (GMT -7)   
Thanks Puget - AEB.  As I review previous posts looking for answers as to WHO I should choose to perform Robotic(leaning that way). I note that both Dr Lee from Penn and Dr McGinnis from Bryn Mawr have been mentioned as very experienced in Lap or Robotic Surgery. Anyone have any experience or hear about these two doctors. While I am looking to NY, Hopkins, Clevland Clinic and Wash U of St Louis for a surgeon, it certainly would be easier to do it in home town, if the right doctor. Any input would be appreciated.  

cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/29/2007 10:22 AM (GMT -7)   
Thanks Tamu - My Doctor used the Sloan Kettering Calculation as well - he thinks I am a good candidate for Laproscopic procedure. Will continue research.

DanMc
New Member


Date Joined Mar 2007
Total Posts : 8
   Posted 7/29/2007 5:05 PM (GMT -7)   
You will have many other questions as you move through the process but when I was facing this very same decision 6 months ago, this site was of immeasurable benefit to me so I urge you to continue monitoring feedback and asking questions.  The decision on the best doc for you will largely depend on so many factors; location, research, references, comfort level and confidence after your consultation.  I don't know much about Philly docs, but I do know that in Baltimore, not that far from you, I found a surgeon who was highly recommended to me and subsequently I would highly recommend to anyone.  The way in which "we" approached the final decision, his treatment, follow-up, sensitivity to the challenges facing all of us and appreciation that we are individuals not a assigned patient number.  In any case, I had the good fortune to consult with Patrick Walsh as my second opinion and although he is arguably the "best", I still went with Dr. Dan Dietrick of Chesapeake Urological in Towson, Maryland.  So, whatever you finally decide, all the very best.
DJM
ps:  second PSA last week following DaVinci 5 months ago:  0.0% !!!!!!!!!
DanMc:  56 yrs. old....6.1 PSA with 3 + 3 = 6 Gleason and T1c. Diagnosed from elevated PSA.  DaVinci was best option given my research.  Very good final pathology, margins and lymph nodes negative. PSA "0" at first test 90 days following surgery. 


naimnut
Regular Member


Date Joined Jan 2007
Total Posts : 93
   Posted 7/29/2007 7:07 PM (GMT -7)   
cpb,

I faced the same choice this year. For me, the more I researched it, the less it became a choice and I was convinced that robotic was the way for me to go.

There are more and more experienced da vinci surgeons around. I decided to focus on the most experienced I could find, which boiled down to two who are up above 1500 procedures. Dr. Mani Menon, at Henry Ford, in Detroit may be above 2000 procedures. His claimed recovery statistics are impressive. I chose Dr. Vipul Patel, at James Cancer center in Columbus, Ohio. I think he is now over 1700 surgeries. He impressed me with his confidence, openness about the skills and qualifications of other surgeons and, well, he is just a great communicator. And, very importantly, his clinic runs like a swiss watch. I mean, it isn't just him, it is his entire support staff. Until I went through this I didn't realize how many different people would be involved in the whole thing.

BTW, pardon my ignorance, but there may well be other 1500+ surgeons who I am simply aware of. I hear good things from the guys who have been treated at City of Hope in California but don't recall the specifics.

Tewari and Menon worked together and I know Tewari is very highly regarded, a total pro. There is a guy at Johns Hopkins (can't recall his name now, he is asian) who is somewhere over, I think 800 procedures and very well respected.

I think you'll find that, as others have said, the choice of type of surgery is less important than the skills of the surgeon. Scardino at Sloan-Kettering is second to none.

God bless you in your decision making. BTW, have you heard about a recent study that seems to classify prostate cancer into two distinct forms? The classification is by dna and there is one which apparently is very agressive and the other one is very slow growing and less dangerous. Don't have the citation handy, but wish the study had been completed before I had to make my decision...

Good luck, my friend.

<FONT color=#0000ff>PSA 3.76, Gleason 6, T1c, scans negative




<FONT color=#0000ff>Da vinci robotic surgery May 31, 2007,




<FONT color=#0000ff>Clear margins, clean pathology report




<FONT color=#0000ff>down to about one pad/day at 6 weeks.




<FONT color=#0000ff>Back to work and getting back to normal. AND I'm now a new grandfather and discovering more reasons to survive well than I ever could have thought of before...




<FONT color=#0000ff>


cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/30/2007 2:51 PM (GMT -7)   
Thanks Naimnut - It seems as I get further into this research - unless I am ruled out as a surgical candidate - I will go Robotic. Like you - I want one of the most experienced surgeons doing this procedure. David Lee from U Penn has done over 1000 - I believe. I have appointments with Lee, Tewari, Guillonneau and will be talking to Patel. They all have great credentials. Patel's staff over the phone seems terrific. Did you stay in Columbus for the week after surgery ? It seems that some of his out of town patients are so impressed with him after talking to him over phone that they schedule an appointment and surgery to be done at same time. How about follow care with him ? If you are not from Columbus area - how often after first week did you need to see him or his staff. What about follow up issues re incontinence and ED. Sorry for asking so many questions. Thanks for your insight.

bzup
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 7/31/2007 1:05 PM (GMT -7)   
Hi Cpb,
52 years old, PSA of 3.1, Pre-op Gleason of 6 and post-op of 7 and clea margins(all confined).
I too chose Dr. Patel at Ohio State and though originally from Ohio I live in NC so I made a rather lengthy trip-but it was worth it. Dr. Patel has supposedly done as many as anyone else and has taught many other surgeons. My surgery was at approx. 3:30 on a Monday and I was released at noon the following day-very little blood loss. It is now one month later and I use about one pad per day with daily improvement. There are many factors effecting a successful outcome including your age and health, are there good nerve bundles found, and of course, the quality of the surgeon. I felt that Patel offered the best potential based on the number of surgeries he has performed and on discussions with him. One thing I did find a little concerning was the lack of real good follow up.  I think this was in part, to me being out of state and not following up with Dr. Patel. The important thing here is to ensure you have a local urologist that will be willing to follow up for on-going therapy(potency) and follow up tests
 
best of luck
 
bzup
Pre-op PSA rose from 1.7 to 3.1 over 2 years.
Biopsy confirmed cancer in 2 of 12 cores (3% and 4%)
Gleason 6, T1C
Post-op T2c, gleason 3+4, 5% cancer, clear margins, no spread beyond prostate
Nerve sparing, robotic surgery, Ohio State, Dr. Vipul Patel, July 2, 2007
 


cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 7/31/2007 1:27 PM (GMT -7)   

Thanks Bzup - Patel and staff seem to be very good. If I chose him, I will most probably spend the week in Columbus (until catheter out). I guess need Urologist who specializes in incontinence and impotence when you need follow up after surgery. Will let you know what I do. You seem to be doing well under the circumstances. Thanks again.

 

 

 

 

Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 7/31/2007 2:36 PM (GMT -7)   
I went with robotic by Dr. Dasari out of Centennial in Nashville.  I have had absoulutely no adverse issues other than a PSA that bounces between .03 and .05 at the 22 month point.  The one thing I wish I had checked on is whether the surgeon has the pathology report done while the robotic equipment is still in place.  I would have gone with that option if I had checked it out better becasue I did have some adverse path findings that may have prompted the surgeon to go back in and do a little more carving if he had immediate access to the Path report.  The key with robotic is to find someone that has done over 200 to 300 procedures, I would not consider it with less experience than that.
 
Good luck!

GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 8/1/2007 6:56 AM (GMT -7)   
Hi, CPB. For all of the above reasons, we also chose robotic as soon as we discovered it was even available (and our surgery was one year ago 8/2/06). At the time we had every reason to think the cancer was contained, although that was not the case. Knowing what we do now, we would still have chosen robotic (if they would have taken us with the possibility of escaped cells) and then dealt with the spread through other means. We are right now in the clear and hope to stay that way. It's really often not until the pathology report that you know and getting it out is the only way to obtain a path report.

Even with the great recuperation period of robotic, the less far you have to travel afterward, the better.
Husband age 66
PSA on 5/1/06: 4.2 (had doubled in 13 mos. and rising monthly)
DaVinci Surgery 8/2/06 - Austin, TX w/Dr. Randy F.A.G.I.N.
T2a (at biopsy)
At pathology - cancer cell leakage into fatty tissue
Post-Surgical PSA on 10/3/06 - undetectable!
Update: 11/1/06 - perhaps bladder neck involvement; 30%-50% chance of recurrence
Future: PSA tests twice-yearly for now - Next one: 4/17/07
 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 8/1/2007 8:15 PM (GMT -7)   
hi cpb

i just posted this reply in answer to another question similar to yours:

Dr. Tewari at NY-Presbyterian Hospital (Cornell) in New York City is considered one of the top robotic surgeons in the US. I believe that he has performed over 2000 prostate robotic surgeries. He was a pioneer with Dr. Menon in robotic surgery at the Henry Ford Hospital in Detroit. Dr. Tewari was hired to head up the prostate robotic surgery team at NY Presbyterian when it was established a few years ago. If I had elected robotic surgery, I would have selected him. I consulted with him, but decided that the proton therapy was best for me at my age. Get the best robotic surgeon you can find even if you have to travel. Best of luck!

You asked the following question: What about Samadi or Guillonneau also in NY for Robotics ?

Dr. Samadi transferred from NY-Presbyterian (Columbia) in the past year to Mt. Sinai to head up their robotic surgery. From my research I believe that he has a very good reputation. Dr. Guillonneau with MSK has been considered top notch in laparoscopic surgery, but I was not aware that he now performs robotic surgery. Dr. Scardino at MSK only performs open prostate surgery, but is considered superior if one wants open surgery. I believe that MSK has been slow in transitioning to robotic surgery, if they now perform it there.

Dave
68, 29-core biopsy 9/27/06, PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area],  Gleason 6 [less than 5% in two other areas], negative DRE, bone scan and Endorectal MRI. Completed 39 Proton radiation treatments 2/22/07-4/18/07.  First PSA test 7/19/07 (3 months after treatment) was 2.1 or a 70% reduction in my PSA before treatment (this was better than the average expectation of a 50% reduction in PSA at this juncture, according to my radiation oncologist).
 


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 8/1/2007 8:22 PM (GMT -7)   
CBP:

Suggest you buy and read Patrick Walsh's recently revised book, "Guide to Surviving Prostate Cancer" in which he discusses the A to Z of prostate cancer and treatment options, including the pros and cons of robotic vs. open surgical procedures. You should find the book's contents very informational and helpful as you make your decision.

I concur with your approach of searching for the "best" surgeon out there. I followed that approach and decided to select the surgeon, not the procedure. The true experts perform one procedure, not both. In other words, a robotic expert is most likely not an open expert. The reverse is also true. I could not find a surgeon who was an expert at both.

You asked about NY and Hopkins. Scardino at Memorial and Walsh at Hopkins are the grand masters; however, their colleagues, James Eastham at Memorial and Alan Partin at Hopkins, are also skilled masters in their own rights. I celebrate my one year surgical anniversary tomorrow and give thanks for an excellent recovery to God and the skill of my surgeon, Alan Partin.

Hope this information is what you are looking to receive from those of us with prior experience.
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