Open, Laproscopic, DaVinci, Oh My; Open ...

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nscott
New Member


Date Joined Sep 2007
Total Posts : 9
   Posted 9/15/2007 4:42 PM (GMT -7)   
Hi all, still looking for more info.  In an earlier post I said I had decided on DaVinci surgery but now have backed off a bit after reading more of Dr Walsh ... that is one thick book.  One point Dr Walsh made regarding an advantage of open surgery is that the Dr can feel/see much easier than with the other two options.  In addition, he/she can take the prostate out to examine it and thereby be able to make a more informed decision on how to proceed.  (I got the impression that Dr. Walsh's prefered method is the open procedure.) With laproscopic and DaVinci, Dr Walch claims (2007 edition), neither of those two options are available, in practice.  To me, that is an important thing to consider.  In all other ways, is description seems make DeVince the better choice. 
 
Opinions or experiences?
 
Also, does anybody out there have any knowledge of how Kaiser Permanente of the Washington DC Metro area rates in this area?
 
Scott
Age 60 (almost)
Pre-diabetic
Biopsy 2005 - Negative on 12 cores
Biopsy Jan 2007 - Negative on 23 of 24 cores, inconclusive on 24th core
Biospy and Dx Aug 07, 1 of 24 core samples, Stage T1c, Gleason 3+3
PSA went up and down from intial 4.5 with an enlarged prostate to 9.1 prior to last biopsy
Free PSA 26%
Still deciding on treatment at Kaiser in Northern VA
 


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 9/15/2007 5:34 PM (GMT -7)   

Scott,

I'm about to be offline for the rest of the weekend but thought I would add some perspective:

With your early detection & low numbers - and pre-diabetes,
  -both the reduction of trauma from surgery & decreased anesthesia with the da Vinci method should be weighted in your decision process.
On the other hand, family cancer histories (most importantly any history of your own) might weight the decision toward "open" and more scrutiny.

I had (ventral) open by default (as predicted) as my other surgeries since 1962 (appendectomy, inguinal hernia, laperotomy/spleenectomy after a car wreck, and post-laperotomy incisional hernia) left too many adhesions to complete the attempted da Vinci method. 
My 6 gleeson and (surprisingly) good physical health led me to seek out robotic laperascopy as the first option.
Buddy (Ms. Blue's Designated Hitter)  had a retropubic open prostatectomy (an open incision through the "crotch").  
Bluebird's journey has some very good information on their reason for choosing this method.
The reasoning seems to focus - as did your citations from Dr. Walsh - on a closer, manual  investigation of the tissues and organs. 
Some members here mention the magnification allowed with the da Vinci method.
I surmise a magnifier is also available in open.

Having been "opened" so many times, I would just suggest that you add a common financial tool to your decision process:
 - weigh the added risk against the expected value of the possible increase in information.

You of course can reduce the risk and uncertainties  
   -  by getting the best services. 
I am certain you can get excellent care at Kaiser Permanente.
However, just like choosing a da Vinci surgeon, if you choose open, make certain the surgeon you choose has done a lot of them. 

open is actually relatively rare now.  
Where before the surgeons flocked to watch a da Vinci, now the newer surgeons gather to watch as many opens as possible. 
There is always a chance the team will just open a patient, anyways -
  - and it is a very different procedure.
I personally had to choose a team with both a young "Jedi Knight" da Vinci artist -
   - and the more experienced "OB-1 Knobe" open Master.
(Yoda says: "Kegal three times a day until surgery, you must!) cool

Wishing you all the best.

CCedar
ICTHUS!


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 9/15/2007 5:47 PM (GMT -7)   
Hi nscott.

I am glad you are researching your options. I don't want to give you my opinions just my experiences. I was wanting to have the robotic for all the reasons you can read on this forum. When I met with the robotic Dr. I told him I had sleep apnea. He then told me I was not a candidate for robotic. He sent me to a Dr. who did perineal surgery. I did not like the sound of that, which lead me to the Dr. who did my open surgery. I had my surgery on wednesday morning and was out of the hospital on friday afternoon. I was ready to go earlier in the morning but as busy as the nurses were I didn't leave until about 2:00PM. Pain was very low and I have not filled my pain prescription he gave me yet. I am almost 4 months out from surgery. Every one is different but don't be afraid of the open surgery. The catheter is a pain no matter what you do.

Good luck

Mika-mvesr

spinbiscuit
Veteran Member


Date Joined Apr 2006
Total Posts : 818
   Posted 9/15/2007 7:51 PM (GMT -7)   
Hi Scott,

I have a friend at Kaiser, and I will ask them. I'll get back to you as soon as I get in touch. By the way I had my daVinci prcedure at George Washington University Hospital. Great facility, and excellent staff.

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. margins
DaVinci surgery on 02/23/06
Last PSA 08/26/07 @ 18 months "0"


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 9/15/2007 8:16 PM (GMT -7)   
nscott,

Your research is the key to eventually reaching a treatment decision you are comfortable with. Despite what you get from us on this forum it is your confidence in your treatment provider and the type of treatment that will impact your decision.

In my case I had not read Walsh's book prior to reaching my decision to schedule Da Vinci surgery but I did read it after that and before my surgery. The surgeon that I chose is located at a university medical center and had done well over 3,000 open prostatectomies before starting to do the Da Vinci in 2004. He told me the reason he elected to start doing the Da Vinci was to prove that it was not as good as the open procedure. After having done enough to be able to compare the facts he became convinced that the Da Vinci was the better choice for those with early stage PCa. If the biposy results in a high Gleason along with a relatively high PSA then he will not do a Da Vinci and refers the patient to one of the surgeons on staff that do the open procedure. The primary reason he gives for the Da Vinci to be better then the open for early stage PCa is the great field of view that he has allowing for more preciseness in the nerve sparing and the bladder neck reconstruction. One of the posters to this forum likened this to the contrast between the surgeon having his eyes 12 to 24 inches from your prostate and within just a few inches. If you have not watched a video and a Da Vinci being performed you may want to add that to your research. There are several on the Internet that have been done by various surgeons.

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


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 9/16/2007 3:54 AM (GMT -7)   
Scott:

I had the same question a little over a year ago when I was diagnosed at 50 with early stage Pca: open or robotic/lap? I assumed robotic/lap after reading the hype on the internet. I spoke to a friend, who is a prostate research oncologist at a highly regarded cancer center in the Northeast and has no dog in the hunt. When I voiced my assumption to him, he replied, "Select the surgeon, not the procedure". You know what, he is correct.

I believe most who post here will attest the #1 criteria is selecting the most exemplary surgeon in terms of clinical experience/training and academic brilliance. A million dollar machine does not guarantee a successful surgery, nor does the "gold standard" open procedure. You've got to first have the expert before you get the advantage and better chance for a success.

My opinion: focus on the surgeon, not the procedure.

41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 9/17/2007 2:33 AM (GMT -7)   
I am going with open...in 3 hours as a matter of fact.  I was scheduled with a wonderful daVinci surgeon until I discovered that they go through the abdominal cavity and it has a risk of adhesions and therefore a risk of small bowel obstructions.  Having had these from another issue in the past, I truly don't need anything that can cause this.
 
Go visit Dr. Catalona's website.  He says laparoscopic surgery is actually more invasive than open.  And there's the issue of microstitches he can do vs. using caudery which he feels can damage nerves more.
 
Oh well, we all have to choose something don't we. 
 
42 yo.
PSA 4.65
Gleason scores from 3 pathologies of the same biopsy (if this isn't confusing to the patient...):
 2 of 12 cores with cancer
1) both cores 3+4 (Weiss Memorial)
2) one 3+4 and one 3+3 (Univ. of Chicago Hosp.)
3) both cores 3+3 (Mass General Hosp.
4) awaiting results... (Northwestern Memorial Hosp.)
 
deciding on treatment...surgery scheduled for Sept. 14. but still wondering about Proton Therapy.
 


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 9/17/2007 10:37 AM (GMT -7)   

Good Luck 41

Hope your surgery went well.

I haven't read any articles by Dr Catalona.  However, if he made that statement regarding DaVinci being more invasive than open surgery, then I believe he is at odds with much of the medical community. Maybe his statement was made some years ago before the 1000's of DaVinci procedures showed it's effectiveness. With so many doctors making claims and offering their pet theories it can become very confusing. It is often difficult for the patient to find what is best. Good wishes on your recovery in coming months.

 


 
Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8
no extra extension/invasion identified
age 65
no continence problems
Back on the golf course...
90 day PSA  less than 0.01 (undetectable)
Six Month PSA still undetectable
ED problems- 20mcg Caverject and 50mg Viagra-success
 
 
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 9/17/2007 10:52 AM (GMT -7)   
Hey NS,

Well, you have found that there are many options for the type of surgery to have. I told my wife one day before my surgery that I wished there was only one way to take care of this disease. The options and information can be overwhelming.

My opinion is that the skill and experience of the surgeon is more important than the method used. You can find excellent results with both open and laproscopic surgery and you can find others that did not turn out so good. So ask questions. Ask about the surgeon's continence success rate and his/her ED success rate. These two items will be most important to you once the cancer is gone. Good surgeons have nothing to hide and should be able to provide these numbers.

I had open sugery and would do the same thing again if I had to do it over. I was dry the day after the catheter came out and now (9 months post-op) I have an active sex life with the help of Viagra and penile injections. My erections are becoming more and more natural and I now use very little Trimix in the injections. I take L-Arginine every day as well as 50mg Viagra.

So, that was my decision. Good luck with yours...

Jim


Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 7/18/07 0.00. 
T level on 4/2/07 - 48     On 7/16/07 - 613
Started Tri-Mix on 8/7/07.  .02 ml and 50 mg Viagra.  It works!!!
Next PSA and T tests on 10/17/07
 
"Patience is essential, attitude is everything."
 


broker59
Regular Member


Date Joined Apr 2007
Total Posts : 88
   Posted 9/20/2007 7:08 AM (GMT -7)   
nono  41/42
 
Hope ALL is Well!! You should be up & around in a few more days!  Just have to deal with MR. HANG!!!
Let us know how long he will be with you.  HEAL quickly, & welcome to the other side!!! yeah
Broker 59


Date of Dx 3/20/07

PSA: 2.5
Gleeson: 3+4
Stage: T2
Bone Scan Clean

Date of Surgery: 6/21/07  Open RP
 
Post Opp: ALL NEGATIVE margins & L/N, S/V.
Cath out after 18 days = BIG RELIEF!!!
 
PSA: 7/23/07 0.01
PSA: 9/04/07 0.01
 


LLG2000
New Member


Date Joined Aug 2007
Total Posts : 5
   Posted 9/20/2007 4:54 PM (GMT -7)   
I had the Da Vinci surgery and I was told that they would open me up if the cancer was bad inside.  Fortuantely, my cancer was contained and the Da Vinci process really worked well for me.  I would recommnend getting a doctor who will do the Da Vinci surgery but open you up if necessary if your cancer has spread.  And, hopefully you will not need the later. 
 
I just have four 1/2 inch scars and one 1 inch scar from the operation.  I had no blood tranfussions during the operation which lasted 4 hours.  Last, they saved enough nerves that I am 75% the same as before the operation and my activities are about 90% as befoer the operation and it has only been 7 weeks since the operation. My current condition is much better then I ever expected.
 
But as others said you need to choose with what you are comfortable with.  Good luck wiht you rdecision.
Age: 57
PSA: 4.6
Biopsy: 5+4 on the left side of prostate
Da Vinci Aug 9, 2007: saved nerve bundle on right side which was  non-cancerous
Final pathology: Confined to prostate, 4+4 on the left side


Michael's Wife
Regular Member


Date Joined Aug 2007
Total Posts : 150
   Posted 9/21/2007 5:27 AM (GMT -7)   
If my husband had decided to have surgery, we would have been very comfortable with Dr. Guarnaccia doing the DaVinci surgery (Kaiser/NoVA). Ultimately, though, he has decided to go with brachytherapy due to a number of factors.

Husband Age: 58
Stage: T1c
Gleason: 6 (3+3)
PSA: 4.4
Biopsy: 12 samples, Adenocarcinoma involving 3 cores, right side only (95%, 90%, 30%, discontinuously)
Brachytherapy being scheduled


JCL
Regular Member


Date Joined Jul 2007
Total Posts : 242
   Posted 9/21/2007 6:57 AM (GMT -7)   
Good luck with brachytherapy. Each decision must be made on an individual basis. That is why I never advocate surgery to an individulal but am more than happy to relate my successful experience with the DaVinci. God's speed.
Age: 49
Diagnosed: March 25, 2007
PSA: 3.0
Biopsy: Gleason 6, 5 out of 12 core samples positive for cancer with <5% on all 5.
DaVinci Surgery: May 21, 2007 at Florida Hospital, Orlando. Surgery took 1 hour and 45 minutes. According to my surgeon, prostate peeled away nicely and everything went text book. Nerves spared.
Pathology Report: Upgraded to Gleason 7 (3+4), Negative margins, seminal vesicles negative, lymph nodes left intact, 15% of prostate involved by cancer.
1st Post-op PSA: <0.01
2nd Post-op PSA: Scheduled September 27, 2007.
Continence: Out of pads 5 weeks post-op. Still have some minor stress incontinence from time to time but it's not an issue.
Erections: Yes! With the assistance of Cialis.
Family History: Father diagnosed with prostate cancer in 1997 at age 67. Prostate removed and has had a <0.1 PSA ever since.


Michael's Wife
Regular Member


Date Joined Aug 2007
Total Posts : 150
   Posted 9/21/2007 7:21 AM (GMT -7)   
Thanks, JCL. We'll keep you all posted. It's tough when there are multiple options that will achieve essentially the same results. You're right about it being an individual decision. Reading all the information and experiences everyone has posted here and elsewhere certainly has helped us to make the most informed decision possible for our situation.

not me!
Regular Member


Date Joined Jan 2007
Total Posts : 30
   Posted 9/21/2007 7:36 AM (GMT -7)   

Each doctor has their favorite way of doing the surgery and will build a case for it. My original doctor who didn't offer DaVinci sited all kinds of data to support the open method including some of the same info you were told or have read. I had done a *considerable amount of research on the treatments available and when I questioned him about the DaVinci method, I realized that he actually knew less about it then I did. Never forget that in addition to being doctors, these are business people who are selling a service. If you don't choose their service, they don't get paid. Base on what my investigation showed, I chosethe DaVinci method.  There are a number of reasons that I could give, but those are my reasons not yours. Once I decided the cource of treatment, I searched for a doctor that was experienced using the DaVinci method. I utimately found one who, by early 2006, had completed about 300 of the procedures. He had published results for his first 200 surgeries which helped me decide to hire him to do my surgery.

As other posters have said, it is important for you to make your own choice and in order to do that you need to do your own research rather than using our testimonials or one doctors opinion to make your decision.  

*There are two highly respected medical centers, Baylor Medical Center in Texas and the Ford Cancer Center in Detroit that offer every treatment option for PC. Both of these centers have been using the DaVinci method for a number of years and both have printed statistical comparisons of the two surgical methods. 

best of luck  


 

56 yr old -2/06 PSA 5.5 – 3/06 PSA 5.4- 3/06Gleason 3+3 (6)

7/06 DaVinci Surgery –contained, nerve bundles spared,

7/13 cath removed – used pad for one week

PSA undetectable at 6 and 12 months

No ED prior to Surgery – Substantial ED post surgery

Not much improvement with the drugs

Pump helped a lot  (6 mo after surgery)

9/07 tried the Caverject  shot – Works Great

 

 

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