RRP Vs. DaVinci

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Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 12/17/2007 8:47 PM (GMT -7)   
I am now laughing at the curves life has thrown. I was determined to find a dr in NYC (there are 20 machines in the city) who would do daVinci on me. How is it that after three guys - including Sloan Kettering and now NYC-Presbyterian (5 and 6 in the country). They are unanimous in their opinion that I should go open. Of course, they all tell me that it is totally up to me, but they have all professed that I will do better and have a better recovery with open surgery.  The one told me that if I came back at six weeks and was not dry, he would be flabbergasted. I did finally talk to a holistic urologist at NYC-Pres who suggested Robotic, but he is not a surgeon. They are all world class surgeons and they don't diss the robotic, just have stated that the benefits have been perhaps marketed a bit.  I have since heard that Johns Hopkins does over 90% open vs. robotic. Has anyone else heard this?
 
I guess my question is, who here had the open surgery and, overall, how was it?  I have had two discectomies, so I am not afraid of surgery at all, but am curious about the recovery period of the open. How bad was it?
 
As you can imagine, this gets a bit confusing. I would love to hear from those who have gone through it.
thanks
Paul
 
DOB 12/08/59
 
1/06 PSA 3.15
1/07 PSA 4.6
10/07 PSA 5.06
Biopsy 3/07 just suspicious
Biopsy 11/07  1 of 12 with 20% involvment
Gleason (3+3)6
T1c
Father died of Pca 4/07 at 86.
The journey has begun!
 


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 12/17/2007 9:07 PM (GMT -7)   
I'm probably not the best one to tell you about my RRP surgery. Over all most of the pain I had was from my back that I had hurt 5 days before the surgery. Yes I did have a bleed that clotted my cathiter the day following surgery. But I have had bleeding problems before. My cath time was 17 days due to that bleed and slow healing. Yes I am 14 months and still incontenant using up to 6 pads a day. My erections are comming back even without Viagra. My 4 post op PSA's have been 0.00 - 0.01.
I can not tell you what to do. I'm not sure I would even change anything if I were to do it all over agian. I did not find this site untill after my surgery but I did read alot about the DiVinci before hand. I just liked what my Dr had to say to all my questions and felt good about my outcome. The Dr. even admits he is surprise and displeased wity my incontenance troubles.
Just ready the info, talk to everyone. Then make your decision and go for it! Good Luck.
KW
    43
    PSA 5.7 - Discovered during Annual Physical with Family Practice Dr.
        Biopsy Sept. 27, 2006 - Diagnosis Sept. 29 - 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
        RRP on Oct. 17, - Nerves on right side saved.
    All Lab's clear.  No Cancer outside prostate
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00
    Office visit on Jan. 19th due to continued excessive urine leakage.
    Feb.20th Cystoscope and 2nd Post Op PSA. Another 0.00.....:)
    Dr. said everything looks fine.  Continue to work Kegeal's. Leaking appears to have improved  after Cystoscope?!?!?!  Down to 3-4 pads per day!
    March 1st  Leaking has crept back up to 6 - 8 pads a day ??????? 
    March 29th Collagen injection into sphincter / bladder neck area to control excessive leaking.  Worked for a couple of days then back to leaking.
    April 17th (Six Months Post Op) 2nd Collagen Injection to control excessive leaking.  Leaking started back next day at work!
    May 14th Second Opinion about my leaking and Options at OU Medical Center.  After reviewing my records the Dr. feels I will probably need some surgical intervention to stop my leaking.  But did agree to try Bio-Feedback and work hard on the Kegeal's first!
    May 30th Follow up with my Dr. and 3rd Post Op PSA 0.00 agian!!!
    June 1st Start Bio-Feedback to try to control my leaking.
    Oct 17, 2007 1 year Post Op - Still fighting moderate / Severe incontenance. Using 4-6 pads a day.  Erections usable....sometimes!  Almost like before with 100mg Viagra!
    December 5th, 4th post op PSA 0.01!?!?!?   Is that still a 0?  Still leaking!!!!
   


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 12/17/2007 9:26 PM (GMT -7)   
Hey Paul,

I had open surgery a year ago. I had very little pain and went back to work teaching school 3 weeks after the surgery. The catheter was left in for 6 days and I was dry and threw out the pads on the day after it came out. My surgeon had done about 800 procedures when he did mine. He spared both nerves and I am overcoming ED with meds and shots. All my PSAs have been 0.00. I would do the same thing again if only I had a prostate...

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 10/17/07 0.00. 
Next PSA test on 1/15/08
 
"Patience is essential, attitude is everything."
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 12/17/2007 10:47 PM (GMT -7)   
Paul--I had an open surgery.  It went well and I quickly recovered physically, although I did not go back to work until 4 weeks post surgery.  I was fully continent within about a  month of the catheter removal.
 
Both nerves were spared but ED continues to be a problem.  We are using penile injections; not my first choice, but the one that works best for us.
 
Each person's recovery is individual and dependent on many factors. I was in supremely good health before my cancer diagnosis and continue to enjoy excellent health following surgery.
 
DaVinci robotic is probably how most prostatectomies will be performed in the future and while there is some bells-and-whistles-woohoo-latest-greatest hype about this procedure, the fact remains that it has proven itself. 
 
I don't regret having chosen an open surgery.  I trusted the surgeon and felt comfortable with him.  He did open prostatectomies only  but was more than happy to refer me to a surgeon who did DaVinci robotic surgery if I wanted that. 
 
Johns Hopkins University urologists are odd ducks of a sort.  Their sterling reputation regarding prostate cancer was built on Patrick Walsh and Alan Partin and others who set the standard for open prostatectomy, including nerve sparing surgery.  They may not have jumped on the DaVinci robotic bandwagon because their practioners have had such amazing success with open prostatectomy.
 
My biopsy slides were sent to Jonathan Epstein, JHU pathologist, who is the best interpreter in the world of prostate cancer cells.  


Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable

Post Edited (TimG) : 12/17/2007 10:52:58 PM (GMT-7)


anniea
Regular Member


Date Joined May 2007
Total Posts : 234
   Posted 12/17/2007 11:30 PM (GMT -7)   

Hi Paul,

Rick had the open surgery 1 month after triple spinal fusion surgery. The prostrate surgery was a breeze in comparision. For the prostate surgery he was in the Hosip. for 2 days, He was up and walking the next morning after surgery ( Very important to walk) He came home that afternoon and we took it easy for about a week until the cath came out. He regained his urinary control pretty much completely at 4 months post op. We are now 8 months post op and once in a while if he over does things too much he will have a drip or 2. They were unable to save either of the nerves and that along with heart meds have killed any sexual functions, again he is on heart meds that affected him prior to the surgery.

I think the most important things on this journey is decide which treatment to go for and once that is done never look back. What ever treatment you choose remember to allow yourself any time needed to recover & TAKE CARE OF YOURSELF and follow up with your Dr. Appointments. Remember never feel hesitant about picking up the phone and calling your Dr. with follow up questions. about 8 weeks after Rick's surgery he started having a little blood in the urine I called the Doc. 8:30PM he had us come in the next morning and it turned out to be Rick had lifted something to heavy and pulled on the surgery site. He was fine and the blood stopped on its own in a couple of days.

Good Luck with your decision making & please keep us posted.

Diana


Rick & Diana
Age 68/ 67@ Dx
6-30-06  PSA 2.54
1-22-07  PSA 4.98
1-26-07  PSA 5.09
Diag: 2-14-07 Gleason 8 Stage T1c PSA 5.09
Bone Scan 3-1-07 Clear
3-6-07 Triple Spinal Fusion (due to old back injury)
Radical retropubic surgery 4-2-07  Post surgery Gleason 9 Stage T3a Positive margins
4-29-07 PSA 0.02
6-9-07   PSA 0.02
7-6-07   PSA 0.03
8-1-07   CT Scan & Chest X-Ray   Clean
 9-26-2007 PSA 0.07
11/1/07 PSA 0.1
11/30/07 PSA 0.12


JCL
Regular Member


Date Joined Jul 2007
Total Posts : 242
   Posted 12/18/2007 6:58 AM (GMT -7)   

We’re all different, so I never give a recommendation when it comes to making a decision for the type of treatment or whether to have open or robotic surgery, but I’m always glad to relate my experience in order to help someone make a decision.

I chose the robotic and was glad I did. The surgery took one hour and forty-five minutes and there were no complications. As I state in my signature below, my surgeon told me the surgery was "textbook," nerves were spared and the prostate peeled away easily. Yes, there was discomfort afterwards, but I never needed any pain medication other than Tylenol. I had no bloating, gas pains, or bladder spasms, and was walking the halls a few hours after surgery. Make no mistake I was very sore for the first couple of weeks, but as each week passed I saw big improvements. Seven months later the only indication on my body of surgery are five very minute incision marks that aren’t even very noticeable. Other than some very small stress incontinence that is infrequent, I’m totally continent and have no trouble achieving erections with the assistance of Cialis. When all was said and done, Robotic was definitely the right choice for me.

Good luck with your decision and please keep us updated.

Jack

 

 



Age: 49
Diagnosed: March 25, 2007
PSA: 3.0
Biopsy: Gleason 6. Five of twelve core samples positive with <5% each. No perineural invasion seen.
DaVinci Surgery: May 21, 2007 at Florida Hospital, Orlando, Florida. Surgery took one hour and 45 minutes. According to my surgeon, everything went textbook and the prostate peeled away nicely.
Post-op Pathology Report: Upgraded to Gleason 7 (3+4), negative margins, negative capsular penetration, negative seminal vesicles, lymph nodes left intact, multifocal perinural invasion, 15% of prosate involving cancer in both lobes.
Continence: Out of the pads at five weeks. Still have some very minor stress incontinence at times but it's not an issue. Still Kegel every day and will continue to do so.
Erections: Yes! With the assistance of Cialis.
1st Post-op PSA: <0.1 2nd Post-op PSA: <0.1
Family history: My Father had his prostate removed at age 67 in 1997 and has had a <0.1 PSA for the past 10 years. I was diagnosed at a much earlier age and had a more agressive cancer than my father. Go figure.
 
 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4461
   Posted 12/18/2007 8:03 AM (GMT -7)   
I had open surgery 3 months ago. I had very little pain once I got out of the recovery room. The catheter was left in for 10 days and I was dry during the day on the second day after it came out. I was dry at night within the the same time, except for 2 early on accidents as I relearned the body signals to wake up for urination.  My surgeon had done about 400 procedures when he did mine, alll open. He spared both nerves. I had an uneventful recovery, healing quickly and never in any real discomfort. I figure my 5 inch open incision, midline and centered between the pubic bone and the belly button amounts to the same amount of incisions that is left by the robotics 5 or 6 entry points.  My prostate was grossly enlarged, weighing 110 grams, which made open surgery easier for the surgeon and me, although he didn't know the actual size until he got there.  I have not had any recovery from ED yet.   I expect that the historical statistics will prove that I will recover function around the 9 month mark.  We will see.  I think the most important thing is to decide which road you are taking as soon as possible, then don't second guess that decision.  Be confident in your choice of procedure and surgeon and go forward.  There's enough worry and stress in dealing with this disease without second guessing decisions. 
James C. 
 
Help support the forums so they can support you:  http://www.healingwell.com/donate 
 
Age 60 
4/19/07   PSA 7.6, referred to Urologist, recheck 6.7 06/05/07
7/11/07   Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07   Path report:  3 of 16 PCa, 5% involved, left lobe , GS 3/3:6. 
9/24/07   Retropubic Radical Prostatectomy performed 
9/26/07   Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07  ED- 25mg Viagra nightly-no joy 
10/19/07  Dry 24 hrs, pad at night just in case
11/15/07  ED-continue 25mg Viagra, no response, begin Vacorect pump-
11/15/07  1st PSA-0.01, fully continent- no pads
12/17/07  ED- 3 mts.-continue Viagra and pump-no change-no response


mvesr
Veteran Member


Date Joined Apr 2007
Total Posts : 823
   Posted 12/18/2007 5:31 PM (GMT -7)   
Hi Paul. I had open surgery May 30th of this year. Pain was not an issue. I had a prescription for pain meds and never had it filled. Gas was bad, so was constipation but had that problem anyway. I had the cath in for 10 days and leaking tapered off and now I just have a little leaking when going to the bathroom and try to hold it too long so I wear a pad for insurance. I stayed out of work for 6 weeks because the boss said to. Both my Dr and wife. Ed is still a problem but take those $12.00 pills and have a pump on the way. Life is good. I have a new grandson who is the light of our lives. Good luck to you and have a merry Christmas and a happy new year.

Mika

SJC
Regular Member


Date Joined Jul 2006
Total Posts : 113
   Posted 12/20/2007 4:50 AM (GMT -7)   
Dear Paul1959:

There are times when the open procedure is recommended by robotic surgeons. I can't say I am aware of all the reasons, but I've heard the leaner you are the easier the procedure for the robotic surgeon. I'm sure the robotic guys told you the reason why they deferred to an open specialist.

I've professed here before my personal belief that the #1 criteria is not the procedure. Rather, the #1 criteria is selecting the most proficient surgeon in terms of clinical skill and academic brilliance. Search for the urologist who has performed the procedure hundreds, if not thousands, of times. I noticed you've been to some fine clinics. Memorial Sloan-Kettering has a couple of open "experts": Scardino and Eastham. I take issue with TimG's description of the Johns Hopkins urologic surgeons as "odd ducks". They represent some of the most renowned physicians in the prostate game. Alan Partin, Chairman of the Department at JH, is another one of those experts and my surgeon. No regrets after a 48 hour hospital stay, 10 days of catheter, and total continence four weeks post catheter removal. Partin completed the surgery in one hour. No blood transfusion necessary. Very little loss of blood during the procedure. I used only 28 pads (one per day), and the pads were 95% dry each day. No lie. I returned to my running program six weeks post-surgery. I was up to five miles in seven weeks, 10 min. mile pace. I increased to seven miles at the eight week mark at a 9:30 mile pace. I haven't looked back since.

Also, the ratio of open and robotic is a lot closer to 50 - 50 at JH.

Hope the above provides you with food for thought.

SJC

Little Jem
New Member


Date Joined Sep 2007
Total Posts : 16
   Posted 12/20/2007 6:43 AM (GMT -7)   
Hello Paul1959,

I would agree with SJC's comment above that it's more to do with the surgeon than the procedure. My hubby was 54 when he had open sugery in June 2006 which went very well with both nerves spared. He was in hospital for 4 days and only had paracetamol for pain once the morphine pump was removed. He did have trouble healing & had to have the catheter in for 12 weeks though and because of this trouble he had no 'rehab' treatment for ED and it continues to be a problem now and he now uses Caverject injections. He was however dry as soon as the catheter was removed and has never used even 1 pad.

Choose the surgeon carefully and keep in touch on here as you'll get lots of support from the guys on here who're ahead of you on the path you're about to embark on. I wish you well with your chosen treatment.

Little Jem

Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 12/20/2007 9:03 AM (GMT -7)   
Paul,

Compared to robotic, open surgery is no big thing and is often "most recommended" - if not the only type of surgery possible - for those of us that have had previous surgeries.  Where connecting tissues were disturbed in previous surgeries, internal scar-like tissue called "lesions" grow and interfere with the robotic tools.  As SJC said, there are other reasons the surgeon opts to open.  I can only recall obesity and some medical need to "survey the area."

Even with open surgery, there is a surgeon's choice between "ventral" (from the belly side) and "retropubic" (from inside your crotch below the testicles).  
I read a very good argument for retropubic. 
I had ventral with no issues and was back at work in 4 weeks.

As for a surgeon's pledge to be "flabbergasted"  if you are not continent in 6 weeks, that is a good sign.  Normal is 12 to 16 weeks. 
However, my surgeon's track record suggested 6 weeks. 
I'm very active and in fairly good health and I tossed my pads at 14 weeks. 
    Yes, I'd say he was flabbergasted... for 8 weeks. 
May you toss them from the moment the catheter is removed!

As for the Johns Hopkins surgeons disavowing daVinci robotic, M.D. Anderson surgeons, no slouches, disavowed robotic prostatectomies until after mid-2006.
  It reminds me a little of music people sticking with vinyl LP's or
    somewhat of churches paying a premium for real pipe organs over digital.
Of course there is a difference!  But which "difference" is for you?! 
Like Little Jem and SJC said, 
   most important is the surgeon, his/her skill, 
     and your relationship with her/him that really counts. 
I would add the choice of facility can be important as well.

Godspeed!

CCedar
ICTHUS!
2 Years of PSA between 4 and 5.5  + Biopsy 23DEC06 
Only 5 percent cancer in one of 8 samples.  +  Gleeson 3+3=6
Radical Prostatectomy 16FEB07 at age 54.
1+" tumor - touching inside edge of gland.  + Confined:)
Pad Free @ 14 weeks.  Six Month PSA <.003  :)
Nine month PSA <.008
:)
At 9 months, ED treated with Pump Exercises & 100mg Viagra Daily
Texas Hill Country FRESH Produce Department Manager
Have you had your 5 colors today?


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 12/20/2007 9:11 AM (GMT -7)   
SJC said...
 I take issue with TimG's description of the Johns Hopkins urologic surgeons as "odd ducks". They represent some of the most renowned physicians in the prostate game. Alan Partin, Chairman of the Department at JH, is another one of those experts and my surgeon. No regrets after a 48 hour hospital stay, 10 days of catheter, and total continence four weeks post catheter removal. Partin completed the surgery in one hour. No blood transfusion necessary. Very little loss of blood during the procedure. .

Also, the ratio of open and robotic is a lot closer to 50 - 50 at JH.
SJC--I was not questioning the world-class expertise of the JH docs. I've read Patrick Walsh's excellent book on prostate cancer, used  Alan Partin's (who took over as chairman from Walsh) cancer nomograms, and had my biopsy slides sent to Jonathan Epstein, JH pathologist.
 
My  point was that if these guys were doing 90%/10% open v. robotic, as Paul stated in his post, I thought that it may be because they wrote the book, so to speak, on open prostatectomies and might be hesitant to jump to the robotic procedure as other medical centers have done.  William Catalona is another world-class prostate surgeon (I think at Northwestern now) who only does opens. JHU prostate surgeons have proven to be among the best in the world!
 
Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable

Post Edited (TimG) : 12/20/2007 9:20:23 AM (GMT-7)


kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 12/24/2007 11:43 AM (GMT -7)   

    Cedar,  Not a Dr. here.....but you may want to check terminology.  The Retropubic (which is what I had) is where they go in from the front.  Incision is from belly button to just above penis.  The Perneal is where they go in through the crotch between the scrotum and anus.  From what I have seen there are very few perneals done any more.  I understand there is more chance to damage the erectile nerves and anus control structures?  No matter which one it is, it is still a Radical Prostatectomy!

    If anyone has more info on this please let us know.

    Please do not think I am a know it all.  Just want to try to help everyone stay on the same page.

    Regards,  KW

 

 


    43
    PSA 5.7 - Discovered during Annual Physical with Family Practice Dr.
        Biopsy Sept. 27, 2006 - Diagnosis Sept. 29 - 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
        RRP on Oct. 17, - Nerves on right side saved.
    All Lab's clear.  No Cancer outside prostate
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00
    Office visit on Jan. 19th due to continued excessive urine leakage.
    Feb.20th Cystoscope and 2nd Post Op PSA. Another 0.00.....:)
    Dr. said everything looks fine.  Continue to work Kegeal's. Leaking appears to have improved  after Cystoscope?!?!?!  Down to 3-4 pads per day!
    March 1st  Leaking has crept back up to 6 - 8 pads a day ??????? 
    March 29th Collagen injection into sphincter / bladder neck area to control excessive leaking.  Worked for a couple of days then back to leaking.
    April 17th (Six Months Post Op) 2nd Collagen Injection to control excessive leaking.  Leaking started back next day at work!
    May 14th Second Opinion about my leaking and Options at OU Medical Center.  After reviewing my records the Dr. feels I will probably need some surgical intervention to stop my leaking.  But did agree to try Bio-Feedback and work hard on the Kegeal's first!
    May 30th Follow up with my Dr. and 3rd Post Op PSA 0.00 agian!!!
    June 1st Start Bio-Feedback to try to control my leaking.
    Oct 17, 2007 1 year Post Op - Still fighting moderate / Severe incontenance. Using 4-6 pads a day.  Erections usable....sometimes!  Almost like before with 100mg Viagra!
    December 5th, 4th post op PSA 0.01!?!?!?   Is that still a 0?  Still leaking!!!!
   

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