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perineal total prostectomy vs. Robotic laparoscopic total prostectomy

gmen308
Posts: 4
Joined: Feb 2009

I am 61 y/o diagonosed with prostate CA, PSA 3.7, on my biopsy, 12 specimens were submitted, all but 1 were positive for adenocarcinoma; gleason score 3+4=7. The entire prostate is affected, both lobes. My surgeon who has done 1000 peineal total protatectomies advises this procedure and against nerve sparing, although if during surgery if he is able to spare one nerve he will try.
What benefit would a robotic procedure give me, could they spare at least one nerve this way? Is it easier with robotic surgery to spare the nerves? Are incontinence problenms less with robotic surgery?
How many surgeries would you want a surgeon to perform before you were comfortable with him as your surgeon? (Is 80 enough or 200?)

whubbs
Posts: 77
Joined: Sep 2008

First off, I'm sorry to hear of your diagnosis. Your with friends here and you'll find a wealth of experiences to be shared, good and bad, so please keep an open mind and do as much homework as you can.
I would suggest that with your Gleason score of 7 and the fact that your entire prostate is affected, that some doctors may opt for an aggressive procedure.
I've been hearing a lot of chatter about the benefits of perineal prostatectomy for a few different factors. It is preferred for obese men and the recovery is well tolerated.
Nerve sparing will not be an issue if it has spread to the nerves, which a highly trained surgeon can tell visually during surgery. If there is any suspect, they will remove them.
One of the benefits of robotic is the delicate movements and tremor negating ability of the robotic tools. When nerve sparing is an option, robotic is the gold standard for sparing nerves.
Consider the prostate as being encapsulated in an onion skin. The skin consists of thousands of strings of nerves and isolated bundles. Generally during a typical surgery the bundles can be seen, but not all of them. The skin needs to be pierced, peeled open and prostate removed. With the robotic method of doing this, erectile function can be returned.
However, in cases of high Gleason scores and metathesis outside of prostate, the ability of sparing these nerves is difficult and is risky in terms of oncological results.
I would recommend getting another opinion on the technique.
What city do live near?
Good luck and continue to ask lots of questions.

manybless
Posts: 6
Joined: Jan 2009

Good evening,
I had the DaVinci Robotic Prostotectomy on December 8th, 2008. I'm 42, PSA 3.8, Gleason scale was 6. I started doing the keegle exercises before the surgery and had just minor leakage issues the day the catheter was taken out. Those issues have since resolved to almost non-existent. I wore depends for 3 days. The nerve sparing procedure was successful, I have minimal erection issues. The doctor put me on 2.5 mg of Cialis the day after surgery and I stayed on it 2 weeks. "It works!" He ordered a Vacuum Erection Device, which I have not used much, since I am almost back to normal. I know 4 men who have had the robotic procedure and all have had good results. From my research, at least 50 is experienced with the DaVinci. My doctors had almost 200 surgeries. I would encourage you to get another opinion from a Physician that does the robotic surgeries. For my situation, I am completely satisfied with my choices. Best advice is to pray about it and choose what you are most comfortable with.

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