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Robotic vs other options - input please

hopeful2000
Posts: 8
Joined: Jan 2007

Going through the literature, I've been debating brachytherapy vs RP. At first glance, brachy appears to have less side effects esp re. incontinence and sex. However it looks like the incontinence and even the sex issue is addressed by Robotic RP (eg with DaVinci system) which provides the surgeon with very precise control. I'm leaning in this direction - I'm in my 50's. I welcome critical feedback. Many thanks.

fcatroneo
Posts: 89
Joined: Jan 2007

I just had surgery on 12/27. I am feeling great. I also was leaning towards "seeded Radiation". % of side effects is the same vs. surgery. The most important reason I selected surgery is you have a second chance with surgery. If you have a reoccurance, you can have radiation, if you do "seeded radiation" an you have a reoccurance....you have no second chance. Also, surgery allows the surgeon to take biopises of lymph nodes and other areas to ensure you are cancer free.
I am sure you have read that the surgeon you select is as important as the procedure you select. I was fortunate living in Atlanta and having Emory Hospital here. The head of Urology at Emory is Dr. Fray Marshall. Dr. Marshall has done over 3,000 surguries and still does 4 every week. The top 3 surgeons for prostate cancer are Dr. Patrick Walsh, Dr. Fray Marshall and Dr.
Catalona. Dr Walsh is at John's Hopins, Dr. Catalona is in Chicago.
I had a catheter for 2 weeks after surgery. It is now about 3 weeks and I 95% continent. It is improving daily. As far as sexual performance, I had sex with my wife the morning after my catheter was taken out. My doctor has me on Cialis (1/2 pill every other day). My sexual performance is great.
I do not know that much about Robotic's. A friend of mine had robotic surgery at John's Hopkin and is also doing great.
Again, the doctor you use is extremely important (no matter what procedure you select). Make sure your doctor is one of the best. It is worth traveling to another city if necessary to get the best doctor. Dr. Marshall has patients coming to him from all over the country. He is very well know and many CEO's come to Marshall for their surgery.
Keep the faith, the cure rate is high for prostate cancer today. My prayers are with you.

AuthorUnknown
Posts: 1563
Joined: May 2006

I had brachytherapy one year ago in January 2006. The procedure was very easy compared to surgery but my Gleason scores, etc. were very low so that was the reason I went with the seeds. I was 58 at the time. I spent approximately one day at the hospital. Went home with a catheter for about 48 hours. After that was removed, everything was normal. I took one week off from work. I think the doctor told me to avoid sex for 2 weeks, but after the 2 weeks it worked OK. By the way, my father had external radiation about 15 years ago and he is doing fine (prostate wise - no reoccurance).

shipjim's picture
shipjim
Posts: 130
Joined: Apr 2006

I had the Da Vinci in Feb 2006. Went well, the catheter was in for 10 days, was cool, first time I've sat thru a whole movie in years.
Had some minor incontinence, NO PAIN after the surgery. I had my gall bladder out years ago with lapro and it hurt worse than this.
The robot seems to be more accurate at nerve sparing depending on the MD. Make sure he's done at least 75 of these. I don'tknow where youare but Sloan Kettering has the machine as does the Vanattuci clinic at Ford Hospital in Detroit. They seem to be everywhere.

Research well, I didnt fancy a long cut in my gut as I'm a coward so I went the lapro Robot.

I agree about the seeds, once you go chemical, surgery is virtually no longer viable.

Good luck keep us posted on what you do. Make sure you get bone scans and a Catscan as well, cover all the bases!!! jj

lardog
Posts: 17
Joined: May 2006

Had Robotic in New York with Dr Tewari
Had catheter removed in 6 days and never had one day of Incontience or leaks. Spoke to three friends who were Doctors and one referred Urologist by another friend. All recommended removal vs long term potential problems with the seed. Make sure you check it out before you go with the seed. As with any surgery the key if the experience of the Doctor. Dr Tewari had over 1500 surgeries prior to Nov 2005 according to the Da Vinci website, just make sure the Doctor does the surgery and doesn't hand you off to an associate with lesser experience.

fcatroneo
Posts: 89
Joined: Jan 2007

I agree with Lardog, the doctor is as important as the procedure. My doctor assured me he was going to do my surgery from start to finish. He made the first cut and finished with the last stich. As I mentioned, Dr. Marshall has performed over 3000 surgeries and still does 4 every week. He was great.
Do not settle for less than the best even if you have to travel to another city or state.

tpelle
Posts: 151
Joined: Aug 2003

Hi lardog: Congratulations on your continence success. My observations seem to indicate that those who regain full urinary control immediately or soon following prostate surgery are in the age 59 and under age bracket. Those age 70 and above are seldom continent following surgery. Would you tell us your age at the time of surgery. Appreciate your comments too.

lardog
Posts: 17
Joined: May 2006

Hi Tepelle
Sorry late getting back to the forum. I am 53 years old. Had surgery July 2006. As far as surgeries Dr Tewari usually does at least 6 a week and did nine the week I had surgery. Sorry on my typing It should say 2500.
Has been 7 mths and I am progressing well in the potency department according to another Urologist also.

TomS1039
Posts: 6
Joined: Dec 2005

Diagnosed 7/2005, I read the books, met with 2 practices, decided on RP surgery by hand (11/2005), keys to success are skill of the surgeon and competency of the hospital. I went to Johns Hopkins (Walsh, Partin & Burnett) are the best and Prostate Cancer is one of their many core competencies. There have not been enough DaVinci surgeries and enough time to study the outcomes to determine if it is as good as hands-on surgery. For me it came down to, I can't imagine that a set of joysticks will improve the percision of a surgeon performing this extremely delicate surgery. Burnett operated on me, he has done approximately 2500 over the past 8 to 10 years.

tkemp
Posts: 1
Joined: Feb 2007

I am new to this chat process, but I don't see anything about how Tom's surgery went, and how his "parts" worked after. What is your psa now,etc.thanks

lardog
Posts: 17
Joined: May 2006

Tkemp
Don't know about the other people but again the list are usually bogus. Just do you research on each Doctor and make your decision. There is a lot aof controiversy on robotics vs open. I guess if you were a Doctor and in the end or down side of your career you too would be reluctant to learn a new surgery method. There fore a lot of open surgeons po po the robotic method. I have now spoken to over twenty patients and almost all care most about the contiency issue. And most will gloss over the potency issue. less than 25 % percent of the patients will have no potency problems after surgery. If there is an issue it can take 12 to 18 months for the issue to resolve itself if it does. If there are usually signs ie partial erection etc. the prognosis is good for return for potency. Most patients respond to Viagra or Cialis.

shipjim's picture
shipjim
Posts: 130
Joined: Apr 2006

hopeful2000 what did you do?

hopeful2000
Posts: 8
Joined: Jan 2007

Many thanks to all for the feedback. In late Dec/early Jan, my PSA was reading was 10, increasing from 4 in previous year and upper 2's two years ago. I immediately embarked on a journey of information gathering about natural and medical treatments and immediately switched diet to very low fat vegan diet with exception of fish. I also began taking supplements (fish oil, flaxseed hulls, curcumin, vitamin D, selenium) and using cayenne pepper and drinking pomegranate juice. I found this thread to be most useful for medical issues and the yahoo "natural prostate treatment" thread for natural treaments, also the prostate cancer foundation volunteer was also very useful for natural treatments. My urologist also began treating me with antibiotics as prostatitis is sometimes cause of elevated PSA. Based on feedback my thoughts were to opt for Da Vinci RP if diagnosed for cancer - it never got that far. My new PSA results are in the 2's - whether its the antibiotics or the natural treatment or both - it worked. In the process I have learned an enormous amount about medical treatment (I favor DaVinci robotics) and natural treatments (there are many out there who have achieved dramatic PSA reductions over sustained time periods). Many thanks to all.

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