Open vs. Da Vinci - Side effects

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triker
Regular Member


Date Joined Sep 2007
Total Posts : 22
   Posted 9/25/2007 7:24 AM (GMT -7)   
I am trying to make an educated decision on treatment options, and sometimes I feel that the more I read, the more confused I get. I know that there are short term benefits of the Da Vinci surgery over open surgery, but are there studies out that quantify the longer term benefits of one versus the other? I have a consult scheduled for October 5 with a Da Vinci surgeon that has completed more than 1000 operations. He is ""out of network" for me which means that it will cost an extra $2K-$8K to have him do the surgery. I know that I can't let $'s be the deciding factor, but it is another piece of the puzzle.

Thanks for any knowledge that you can share on whether ED and incontinence issues are less over time with either of the two methods.

Thanks for your support and help!
Walter
 
Age 58
10/06 - 1st PSA ever - 4.6
11/06 - PSA retake - 5.3
12/06 - Biopsy, 12 cores - negative
7/07 - PSA - 9.0
7/07 - PSA - 13.8 (after 10 days antibiotics)
8/07 - Biopsy, 12 cores, 1 positive @1%; Gleason 3+3=6
9/17/07 - Bone scan - negative
9/18/07 - CT scan - negative


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 9/25/2007 8:36 AM (GMT -7)   
Hey Walter,

As you have discovered both surgical methods have their plusses and minuses. open surgery is said to have more blood loss and robotic has produced hernias. Some docs (like my surgeon) say that open provides the advantage of "feel" and robotic surgeons say they have better "visuals".

Its a crap shoot. Picking the surgeon with the most successes seems to be the way most of us go. I chose open because I had 100% confidence in the surgeon. I would do the same thing again. I had very little pain and healed quickly. I went back to work teaching school 3 weeks after the surgery.

The important thing is that you will know the exact extent of the cancer. IMHO this is the biggest advantage of surgery. So make your decision and don't look back...

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."
 


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 9/25/2007 8:40 AM (GMT -7)   

From what I have read on this forum, the Robotic or Da Vinci takes less time to heal but the outcome seems to be the same.  I had the open.  There have been times I felt I should have had the robotic, but the more I've read on here the more I see that regardless of the method, it takes time to get over the surgery. 

It appears to me that to have any method of surgery that the outcome is (1) incontinence for a time...less time for some and more for others... I'm in the category of having very slow recovery of incontinence. (2) impotence for a time.  More time for some and less time for others.

My analysis of this may not be trustworthy.  I've had little improvement with incontinence or impotence.  If I had robotic, would I be much improved by now?  Nobody seems to know for sure.  Surely others will respond to your question.

Gene


Age: 63
First biopsy 07/05;
Diagnosed: "Suspicious looking cells". Dr. says wait and watch.
Second biopsy: 12/27/06
Diagnosed cancer: 01/24/07
Gleason Grade: 3+3=6
Radical Open Nerve-sparing Prostatetomy: 02-14-07
Cancer confined to prostate
Pathology Stage of cancer: T2c
First Post-Op PSA on 04-18-07: 0.011
Bleeding problem at 6 weeks post surgery...No resolution despite several trips to surgeon, antibiotic treatment.
05/31/07: Cystoscope reveals "stone", due to "Stricture" (narrowing of uretha at prostate removal site).
06/12/07: Procedure to remove stone & dilate uretha at stricture: Successful procedure, but is most likely a temporary fix, and incontinence continues.
8/16/07: Start bleeding again in urine.  Get to see a new urologist same day.  He thinks stricture is back, but send home with Cipro.
8/20/07: Go back to dr. for cystoscope.  "No sign of stricture"!  Wonderful news! Still leaking.
8/31/07: Back to new urologist for regular check up & received 2nd post-op Psa.  It was 0.05 (non-deteactable).  PTL! But still leaking
8/31/07:  First Bio Feedback session.  The little lady is very positive that I can gain control.  That's what I want more than her.  New urologist is not very sold on effectiveness of Kegals???
9/19/07: Finished 4 Bio Feedback sessions.  No imporovement with leaking. Recommended possible callegen implant. She noticed from 8/20 cysto that my sphincter was ... too short?... huh?   
 
 
 


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 9/25/2007 9:36 AM (GMT -7)   
Walter,

It is confusing when you try and digest all of the information. I know of no study that has compared long term impact of the two types of surgery. I have read statistics that indicate that the Da Vinci is rapidly becoming the standard for prostate surgery. Whether this is just because fo good marketing by the manufacturer of the robot or due to better results is a question. I had a Da Vinci and when I queried my surgeon on this topic he shared his experience. Before starting to do Da Vinci's in 2004 my surgeon had done over 3,000 open types. He felt that the da Vinci was just a fad and did not provide any benefit over the open. He is the head of a major university based urologic clinic so he decided that the only way to prove what he thought was to start doing the Da Vinci and compare his personal results between the two. At the time of my surgery he had done over 900 Da Vinci's. He told me that the results of the comparison was that his immediate post surgery complication rates were significantly better with the Da Vinci which he credit to less trauma. He also said that the long term complication rates for incontinence and impotence were also improved. He did point out that not all prostate cancer victims are candidates for the Da Vinci. If the cancer is aggressive and the biopsy indicates significant prostate involvement then he always recommends the open type. In your case you are a perfect candidate for the Da Vinci.

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


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 9/25/2007 4:19 PM (GMT -7)   
HI triker.

I would agree with the posts you have already been given here. For the record, I had open surgery. Pain after surgery was a 2-3 out of a 10. Small amounts of light pain meds the rest of the day of surgery. Hospital was two days after day of surgery. Down to one pad at 3 months, pretty dry now but still wearing a pad for insurance. No other problems. ED still a consideration. Hope the best for you.

Take care

Mika

PianoMan
Regular Member


Date Joined Feb 2007
Total Posts : 365
   Posted 9/25/2007 6:21 PM (GMT -7)   
Hi Triker:  My two cents?? -- Spend the dough.  Now is the time to invest in the "Cadillac," in terms of your care and treatment.  It's about you right now and don't feel bad about laying down some cash for your situation.  A few grand isn't going to mean beans in the "long run," which is what we are all hoping for in this club of ours -- a long run. 
 
The surgeon and facility I chose was also out of my network and I paid a ton (believe me, a ton.)   Like you, at first I felt guilty about the choice I was leaning toward but my wife said, "Let's go for it.  Let's get it taken care of in a place we feel comfortable with."
 
It set me back financially, but I got excellent treatment from pre- through post-op.
You must feel good about where you go and whom you choose for your treatment.  What sounds like a lot of money today will be nothing five or ten years from now.
 
Go for the Cadillac.  You deserve it and it will pay off.
 
As far as ED/incontinence issues, they seem to be about the same, whether your chosen therapy is open radical or DaVinci robotic or radiation for that matter.  The side effects of any treatment vary, they are more-or-less intense per patient and they are a pain in the A-S-S, but tolerable.
 
For now, focus on taking care of the main issue.
 
Best to ya,
Tom
 


D.O.B - 8/9/52

PSA: First ever was 9.8 in late Oct. ‘06, two weeks later, 10.1

DRE: Negative

Biopsy results 11/22/06.  Both lobes involved.  Six out of eight cores positive - from 100 percent to 90, to 60, to 50, two 20s and two zeros.

Gleason 3+3 = 6

Da Vinci Robotic RP surgery, City of Hope, Jan 12, 2007

Post surgery pathology – Organ confined, Gleason still 6, margins clear.  Volume of tumor much less than biopsy suggested.  12 percent overall.

First post-surgery PSA -- Undetectable, 2/20/07

Second post-surgery PSA -- Undetectable, 9/11/07

Post Edited (PianoMan) : 9/25/2007 8:09:44 PM (GMT-6)


SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 9/26/2007 3:20 AM (GMT -7)   
The common experience of all is the surgeon will tout the procedure he performs. I have not found a surgeon who does them both. That's why I concluded a little over a year ago to choose my surgeon, not the procedure. A million dollar machine does not guarantee a successful surgery. Nor does an open procedure by a surgeon who rarely performs the surgery. Rather, the advantage goes to the patient who selects the surgeon who is an expert, a person who has clinical expertise and academic brilliance. The expert has a proven track record supported by results from hundreds, if not thousands, of prior procedures. My suggestion: check your network, go to one of the quality facilities in your network, and select an expert who practices at that quality facility. That's how you get the advantage all seek when looking for the best, and most successful, result.
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