Husband's Test Results; Dr's Experience with Robotic Surgery and His Comments

Mariateresa:

First of all, what wonderful news about the CT scans - what a load off your hearts and minds.

As for the surgery, I cannot comment on that as I had proton, but all I have read from the guys who have had surgery is that it's very important to find a surgeon who has done alot of these procedures.  I'm sure they will give you their suggestions on this.

Again, glad to hear the CT scans gave you good news and thoughts will continue to be with you.

Dutch

I just went to the Henry Ford Health System website and completed a Urology Consult Request Form. Henry Ford Health System's Vattikuti Urology Institute has performed more than 3,300 robotic prostatectomy operations. They say on their website that thousands of patients from around the world have come to the Vattikuti Institiute for their robotic prostatectomy surgery. Now I'm just kicking myself for not requesting a consult back in May when my husband's PSA first alerted us to a problem!

Yes, please keep praying! Prayer is the greatest untapped power in this world! I pray for all of you, too!

Maria Teresa

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Husband Rod, Age 55 Maria Teresa age 44

Total PSA 8 on 05/21/07

DRE: prostate bumpy

Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
A. Infiltrating, poorly differentiated adenocarcinoma, Glesason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

B. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 50-55% of the submitted tissue.
Perineural invasion identified. Capsular invasion is not seen.

C. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

D. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 60% of the submitted tissue.
No perineural or capsular invasion is identified.

E. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 20% of the submitted tissue.
No perineural or capsular invasion is identified.

CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal


**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

Post Edited (mariateresa) : 8/27/2007 6:19:22 PM (GMT-6)

Hi Maria Teresa,
It sounds positive all the way up until your surgeons sugestions. But my biggest stopper is his six robotic surgeries. I always had the notion that doctors understandably have to start somwhere, but, not on my body. Espeacially now that I need the best skill and experience available in my medical staff. Don't write the sex life off yet. I don't agree for his reason's why to remove the nerve bundles without first inspecting them. I'd get a second opinion.

Tony

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Age 45 (44 when Dx)

mariateresa,

What onderful news on your husband's scans!!  This calls for a celebration!

I am bzup's wife and while I have read hundreds of posts on this forum, I have not commented up until now.  PLEASE consider a 2nd opinion as to treatment, specifically surgery in your husband's situation.  When my husband was diagnosed, we spent a couple of months researching and consulting with physicians.  We spoke to 3 doctors in person and consulted with 2 by telephone before settling on Dr. Vipul Patel in Columbus.  Our local urologist was qualified and willing to perform a radical surgery, but did not have a lot of experience with the robot.  He suggested we consult with one of his partners OR with a doctor from one of the major hospitals in the area.  Next, we consulted with a radiologist to discuss seed implants (our first choice of treatment).  The radiologist was very qualified to perform the implants, but after learning more about the potential difficulties, we reconsidered our thought on surgery.  Third, we consulted a highly regarded surgeon at Duke.  He was VERY qualified to perform radical surgery, and we really liked him, but if we were to opt for surgery, we prefered the robotic.  Next, I emailed the Cleveland Clinic and asked about Dr. Gong.  Dr. Gong graciously called us to discuss our particular situation.  He was very well trained, but agreed that Dr. Patel at OSU was an excellent choice for a surgeon to perform a robotic surgery.  

My point in offering this information is that seeking multiple opinions is a great way to get comfortable with the terminology, the procedures, the options, the variable success rates and outcomes.  Please consider getting at least one other opinion.  I have read wonderful things about Dr. Menon (sp?) at Michigan.  You only get one chance at the operation and you have every right to expect the best outcome for your dear hubby.

As for sparing the nerve bundles - this is an excellent reason to seek out another opinion.  I don't think I'd feel comfortable hearing that news from one doctor.  If you seek other opinions, and those docs concur, you will rest easier knowing that you have double-checked his theory.

Here is an excellent article that our son forwarded to us, yesterday. http://www.cnn.com/2007/HEALTH/conditions/07/24/cancer.prostate.reut/index.html

Best wishes. Our thoughts are with you as you work through the decision-making phase of your journey.

This site has been a blessing to those of us who have personally traveled on the road to Pca recovery and cure.

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PSA rose from 1.7 to 3.1 over 2 years.

Maria Teresa

First great news on the bone scans that's wonderful news. As for the rest I agree with what has been stated by the others about getting a second opinion. When first diagnosed I was told by the surgeon that he would be taking at least one nerve bundle and the biggest reason I was given by him was that was the way he did it, he too felt it needed to be taked out to be more sure of getting everything. He also only did about 20 to 25 PC surgery a year. I found a doctor at a state university hospital in the cancer research center and this was all he did was study the prostate. Although he had only preformed about 100 robotic procedures before me I felt comfortable after meetig with him and he told me based on the biopsy reports that he should be able to save the nerves and take just the prostate. It has now been 7 months since my surgery and so far so good and everything is working pretty well, not that one does not go through ups and downs and it's the same as before. I have been happy with the results to date keeping it all in prespective. I would highly recommend a second opinion and another view I am glad I did, at least then you can validate if there is something more to your husbands situation that requires the type of surgery that your first surgeon has detailed. At any rate good luck and our prayers are with you.

norskie

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norskie

Maria Teresa,

While the choice of a rookie robotic surgeon is a bit uncomfortable to most, I assume he has a long track record for doing open prostatectomies? If so, and he's got data to back up his talent, stay with who Rod feels comfortable using. If he isn't (and Rod isn't), find a suitable surgeon. Rod's cancer isn't waiting for him. It should be treated sooner than later. I'd be making sure the surgeon of choice has exceptional urinary function outcomes and hope for the best on the prostate nerves bundles. Be ready for the same reaction from every surgeon you meet with Maria Teresa. Rod's surgeon is right... both nerve bundles have to go. The surgeon has to do a wide excision with a clinical pathololgy such as Rod's. To do anything else is irresponsible. So far, evertyhing this surgeon has told you has been right on the money

Swim

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Swimom and Cedar Chopper make some great points. I agree that an open procedure by an experienced surgeon (who Rob feels comfortable with) would offer the same high level of treatment as that of an experienced robotic doctor. That said, if time allows, I would still seek out at least one other opinion. Maybe your husband can get on the surgery schedule and during that time he can try and get another opinion.

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PSA rose from 1.7 to 3.1 over 2 years.

Bzup's wife mentioned Dr. Vipul Patel at The Ohio State University. That is where my husband's urologist said he received his Da Vinci Robotic Surgery Training.

Maria Teresa

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Husband Rod, Age 55 Maria Teresa age 44

Total PSA 8 on 05/21/07

DRE: prostate bumpy

Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
A. Infiltrating, poorly differentiated adenocarcinoma, Glesason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

B. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 50-55% of the submitted tissue.
Perineural invasion identified. Capsular invasion is not seen.

C. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

D. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 60% of the submitted tissue.
No perineural or capsular invasion is identified.

E. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 20% of the submitted tissue.
No perineural or capsular invasion is identified.

CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal


**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

Post Edited (mariateresa) : 8/27/2007 6:20:43 PM (GMT-6)

My thoughts are scattered all over the place this evening.... I asked my husband about the open prostatectomies, but it wasn't discussed. I read swimom's, "isn't an indolent cancer". I looked up the word "indolent" and that is what I've been thinking, too, that we're not dealing with a slow growing cancer. I feel like we have to hurry up and get this thing out! The original urologist said the robotic surgery is booked until October, but he told my husband that this wouldn't put him at risk.

I have another question: Is the nerve sparing done just for sexual function or is it done to also preserve urinary continence?


Maria Teresa

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Husband Rod, Age 55 Maria Teresa age 44

Total PSA 8 on 05/21/07

DRE: prostate bumpy

Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
A. Infiltrating, poorly differentiated adenocarcinoma, Glesason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

B. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 50-55% of the submitted tissue.
Perineural invasion identified. Capsular invasion is not seen.

C. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

D. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 60% of the submitted tissue.
No perineural or capsular invasion is identified.

E. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 20% of the submitted tissue.
No perineural or capsular invasion is identified.

CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal


**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

Post Edited (mariateresa) : 8/27/2007 6:30:28 PM (GMT-6)

Maria Teresa,

I'm greatly relieved to read that you are in touch with Dr. Menon.  He is one of the most experienced da vinci surgeons in the world.  I considered having him perform my surgery. One of the main reasons I went with Dr. Vipul Patel at Ohio State was that my insurance would cover, in addition to the medical treatment costs, all the travel and lodging, etc.

Regarding the question posted above about how a surgeon could be over 1,000 surgeries, I can answer that. My surgeon is doing 5-6 surgeries a day, 3 days a week. He is now at 1,700+ surgeries. Menon is similar.  There are no more experienced da vinci surgeons anywhere in the world.

Regarding nerve sparing, DO NOT GO TO your current urologist who expressed doubts about being able to spare the nerves.  Let an expert like Menon or Patel or one of the other top guys make that judgement call. With da vinci, nerve sparing is the norm, not the exception.

I read your other thread in which you expressed (understandably) your frustration at your urologists slowness in attacking this disease.  It is regrettable but not necessarily a complete disaster.  This is a comparitively slow growing disease and you are in touch with a top Doc. If anyone can treat this disease, Menon can.

BTW, I'll just mention that you may want to confirm whether your insurance has any additional resources available to you, as a cancer patient. I found my ins (UHC) has a cancer resource center. When you're diagnosed, and you call them, they basically open another insurance policy on you that provides access to 20 "centers of excellence" for treatment.  Depending on who your insurance is with, you may have something similar.

Best regards and you will be in my prayers

 

Hi sterd82,

I may be on information overload ... Just for clarification...you wrote, "I'm still puzzled that Menon was still proposing a nerve-sparing procedure", is this in reference to my husband because he doesn't meet with Dr. Menon until next Wednesday so we won't know until then what Dr. Menon recommends. Maybe, he too, will say that the nerves have to go.

I feel like I carry all of you in my pocket and I've been telling people how kind, supportive, and knowledgeable everyone has been!

Love you guys!

Maria Teresa

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Husband Rod, Age 55 Maria Teresa age 44

Total PSA 8 on 05/21/07

DRE: prostate bumpy

Biopsy on 07/16/07: 5 out of 8 cores positive, Gleason Score 8 (3+4+5)**
A. Infiltrating, poorly differentiated adenocarcinoma, Glesason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

B. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 50-55% of the submitted tissue.
Perineural invasion identified. Capsular invasion is not seen.

C. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue.
No perineural or capsular invasion is identified.

D. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 60% of the submitted tissue.
No perineural or capsular invasion is identified.

E. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 20% of the submitted tissue.
No perineural or capsular invasion is identified.

CT of the abd/pelvis; Bone Scan; Xrays done on 08/13/07: Normal


**"Report to the Nation on Prostate Cancer" published by the Prostate Cancer Foundation, page 11: "In some cases, the pathologist might identify a third pattern, which is less common but that has a higher grade than either of the first two patterns that comprised the Gleason score. The presence of this third pattern might indicate that the tumor is more aggressive than the Gleason score would otherwise imply. For example, if a Gleason 4+3 tumor also has some grade 5 cells, the cancer would be considered as being of higher grade disease overall."

Post Edited (mariateresa) : 8/27/2007 6:33:47 PM (GMT-6)

Maria,

I was puzzled that Dr. Menon suggested that I do the nerve-sparing procedue.  In all fairness, it was only a phone consultation, but he had my biopsy information.

I'll be intereted in how your meeting goes --- he's considered to be one of the best.......