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Open vs DaVinci RP ?? / also question about Loyola University Medical Center in Chicago

tommygee56
Posts: 5
Joined: Jul 2009

Hello, I am newly diagnosed with a Gleason score of 6. I am considering RP and need to choose between open or DaVinci. I live in the Chicago area and will be seeing Dr. Robert Flannigan at Loyola University Medical Center. I am interested in evaluation between the 2 methods, as well as hearing from those with experience at Loyola.

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

You don't give much by way of stats on your condition. It would be useful to know age, comorbidities, PSA, and such. A Gleason 6 gives you LOTS of options, including doing nothing at all.

I can't help you with Loyola, but for what it's worth:

All the mainstream technologies (open, robotic, radiation) have roughly the same survival statistics. So you're picking based on quality-of-life, expense, access to Really Good practitioners (see next), etc.

I went with robotic surgery, but I could easily have gone with open surgery. If you choose surgery, the most important thing is the experience level of the surgeon, not the technology (ditto radiation). For "open" you want someone who's done maybe 400 surgeries, at least a couple a week. For robotic, maybe 800 surgeries, at least a couple a week. I was fortunate enough to have access to Really Good surgeons in each specialty, so it was a coin toss.

Since you don't give your age, the following may not apply to you. If you're maybe 70, maybe diabetic, maybe obese, it may make sense to do nothing. A 70-something guy with nothing else major wrong with him has about 13 years to live (statistically). A newly-diagnosed prostate cancer, with average Gleason (and 6 is certainly no worse than average), will kill him in maybe 17 years (statistically, more or less). So he has to look at the possibility that the treatment will slow down the prostate cancer and give something else the opportunity to kill him, and have the side effects of the treatment make his remaining 13? years miserable.

I'm no doctor--you need to do your homework and figure out what you trust. The good news is that, with a Gleason 6, you've got plenty of time to figure that out.

tommygee56
Posts: 5
Joined: Jul 2009

Thanks Ishick. My psa was 11.8. I am 53. The cancer was found in 6 section, all in the right lobe. Involvement ranged from 7% to 58% with an average of 30%. No perineural involvement. I do not have the results from the CT or bone scan yet.

NM
Posts: 214
Joined: Jul 2009

Hi my stats were worse in some ways and better in others. My PSA was 7 after antibiotics for a month it went to 5.6. I had 6 areas biopsied and 5 tested positive for cancer all 5 were 50 to 100% involved,perineural involvement in all. I am 52 years old had Davinci on Sept. 3rd of this year. After starting the surgery my doctor (an experienced cancer doctor as well as a surgeon)decided my prostate didnt look that bad so he did some nerve sparing as he was not originally going to. I feel good ,back to work and first psa test was .05 which means I need no further treatment so while stats sound scarey it just shows all men are different and until they actually go in you really dont know. I also had no positive margins and no incontinence so I wish you good luck and remember once you decide let God and your surgeon handle the rest. Sorry for rambling but I remember my fear and confusion when I was first diagnosed.

Nick

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

OK, at 53 "doing nothing" probably doesn't make sense.

I'll stick with the advice in my previous post: get the best, most experienced practitioner you can find and go with whatever technology he (I assume) uses. The small differences in survival outcomes between the different flavors of radiation and surgery are usually trumped by the skill of the person doing the work.

Total number of operations isn't everything of course--some surgeons don't learn from their mistakes. But you can expect that a newbie will have more problems than an old hand. I would hope that if you asked 5 surgeons who THEY would go to, a consensus (or at least a short-list) would begin to emerge.

Last point would be that I'll bet a kielbasa sandwich that you have PNI--biopsies miss that all the time.

Good luck.

Larry

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

For what it's worth, you may find the following helpful:

http://prostatecancerinfolink.net/tips-tools/pick-prostate-cancer-specialist/

http://prostatecancerinfolink.net/tips-tools/pick-surgeon/

Have a look at yananow.net and search through their stories for guys who had their work done in places you'd consider. And consider places outside of Chicago--the wider your net, the better your chance of finding the best.

Larry

tommygee56
Posts: 5
Joined: Jul 2009

Larry, What is PNI?

tommygee56
Posts: 5
Joined: Jul 2009

PNI. I figured it out.

mkd51
Posts: 9
Joined: Mar 2009

What is PNI?

lshick's picture
lshick
Posts: 63
Joined: Apr 2009

Peri Neural Invasion

mkd51
Posts: 9
Joined: Mar 2009

Thanks!

tommygee56
Posts: 5
Joined: Jul 2009

Well, I do hope that's a bet you lose.

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

You are on thr right track. I ended up at John Hopkins with Dr. Jarow in Baltimore. Yes, it was an 8 hour drive, but worth it. I live in Aiken, South Carolina.
Ask Dr. Flanagan for the names of some of his patients with PC. I know I was asked if my name could be used if needed. Many do this in the light of obtaining research data.

Good Luck,
and it sure beats watchful waiting

Jim (shubbysr)

jnetc
Posts: 19
Joined: Jul 2009

Hi we are from Illinois .. My 48 yr old husband PSA 6.32, GLeason 9, pre op clinical stage T2c, path report after sugery T3C N1 Mx.. He had PNI and lymphnode involvement found and nerves were not spared and he had positive margines.. Surgery at a NorthWestern on 5/14/09

Anyway we drove three hours to have Dr William Catalona at Northwestern University Hospital.. Dr Catalona had done more of those surgeries than anyone in the USA.. Well over 5,000 and that is ALL he does.. He is a leading researcher and is now working on genetic research. he developed the PSA test!!!.

My husband's blood and medical records are part of that research.. My Husband had an open radical prosectomy- Tim desided from his own research that he would rather have 4 inch opening than six one inch opening.. Tim was back to work in 6 weeks..

The hospital and Catalona's staff is top notch on the ball and wonderful.. He is very interested in quality of life issues for men after surgery ... If you are in Chicago you are in a top NOTch place for help.. Look around Research and know your Dr's experience.. We are so glad we did and feel like Dr Catalona was an answer to prayer.....
Jnet

wilstar
Posts: 1
Joined: Oct 2009

I was just diagnosed.. A gleason of 7, psa 2.7 , 4 of 12 samples 40/50 % cancer. Dr Turk at Loyola recommends robotic removal.. I will be 55 tuesday.
How has your treatment been at Loyola ? I have had good experiences in other areas there.. but would sure like more info on this subject as it concern Loyola..
Bill

WHW's picture
WHW
Posts: 189
Joined: Jul 2009

From where you live it can't be too much of stretch to check out Dr. Mani Menon at the Henry Ford Institute in Detroit.

My search and journey are well covered on this site. I live in Orlando and wanted the best I could find that was a right fit for me. With really good insurance coverage traveling was not a big deal.

Dr. Menon was the first surgeon in the US to use the da Vinci for prostate surgery. Many of his techniques are what is being taught for da Vinci surgery today. He has further developed and re-fined procedures that address continence and ED. For instance, he does not use the Foley Catheter following surgery. Rather a Supra Pubic catheter tube is put into place at the time of surgery. It is a small tube through the lower abdomen connected from the bladder to the collection bag. They have been using this method for over two years now. It was an outgrowth from his development of refined surgical procedures and follow-up with this patients who complained about the frustration, aggravation and pain of using the Foley.

His group has preformed over 5000 surgeries and he personally has done over 3000. I had complete confidence in he and his staff. I spent 2 days interviewing everyone on his staff that I would come into contact with if I were to chose him for my surgery. I went home and returned 4 weeks later for my surgery.

He will gladly provide you with the statistics that have been kept for the last 5 years on more than 4500 patients. They have followed up at regular intervals on every aspect; PCa, continence and ED.

Personally I have been "Dry" since the day the cath was removed and at just 5 weeks following surgery I am seeing good signs of recovery on the ED front. I would gauge that I am at about 50% of where I was pre-surgery and seeing improvements weekly. Good signs all.

Just a quick note about the man and not the doctor. When I went to see him for the interview I related to him that my wife was in rehab after just completing 6 weeks of hospital stay and 5 of those in ICU on a ventilator. I would have to schedule my surgery after she came home and I was comfortable leaving her with her sister while I came to Detroit.

The day of my surgery I passed Dr. Menon in the hallway and reintroduced myself to him telling him we had a surgery scheduled in 2 hours. Now think about all the people he had seen since my only meeting with him 5 weeks earlier. He shook my hand, called me by first name and asked "How is your wife doing? Is he home from the hospital?" If that wasn't enough to speak of his compassion and caring, I got another little surprise following my surgery.

I had made arrangements to have one of his staff call my wife following surgery and let her know how things went. In the recovery room, when I had come around enough, I called her and asked if she had been called. She replied with an emphatic "Oh Yes!" Dr. Menon had personally called her. They spoke for about 15 minutes and she said that about 10 of those had been him asking about her health and her condition.

Many doctors are described as technicians or mechanics and to a degree that is what you want. A highly skilled and competent doctor. But I also wanted a highly compassionate and caring doctor who was highly skilled and experienced. In the end I am happy to say I found both and to a very high degree.

Of course this is just my opinion, but it is passed along here as additional information for you to ponder.

Good luck in your search and God bless,

Sonny

ma-from-naperville
Posts: 1
Joined: Aug 2010

I am newly diagnosed with a Gleason score of 6. I am considering RP DaVinci. I live in the Chicago and have no choice at this point but to go to Loyola University Medical Center because I have an HMO and I guess I am stuck. I am interested with others experience at Loyola. Who should I see at Loyola? Second question, am I really stuck if the HMO tells me to go Loyola?

hopeful and opt...
Posts: 1293
Joined: Apr 2009

the doctor that you chose depends on the type of treatment that you chose. What's going on with you is the factor, so, it would be a good idea for you to share

how many cores postive, percent involvement in each, gleason in each, your age, your general physical condition, how has your PSA been during the last few years.

We are here for you

Ira

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Ma, welcome to the forum but we're so sorry you're here. It's the club nobody wants to be in. As your urologist probably told you, a Gleason 6 is the most common newly diagnosed cancer grade and usually indicates a very treatable, early detectable cancer with plenty of options for treatment.

As Ira pointed out, other information about your pathology is important to know before anyone can give you subjective advice. For example, what was your PSA at diagnosis, how many cores in your biopsy were postive for cancer and at what percent involvement, what stage did they classify your cancer at, how old are are you, and are there any other health issues that could affect potential treatment.

Certainly DaVinci RP is one option to treat your PCa but make sure the doctor explains all of the potential side effects such as urinary incontinence, erectile dysfunction, penile shrinkage, and the liklihood of cancer recurrence after surgery. Also, there is pretty strong evidence that the success of your robotic surgery is largely a function of the experience of your surgeon. If I were considering surgery I wouldn't let anyone work on me who hadn't done several hundred procedures. Amazingly, most doctors who practice robotic surgery have done less than 50.

There are other options for treating PCa as well and your doctor should have given you an overview of some of them such as radiation, brachytherapy, and so forth. There is also proton therapy, HDR brachtherapy, cryosurgery, CyberKnife, castration, hormone therapy, and so forth. I hope you take the time to thoroughly investigate each one of these and look at the pros and cons as to how the potential side effects of each could affect your quality of life. There is also active surveillance which is appropriate for many men who had their cancer detected early like yours.

I strongly suggest that you consult with others besides your urologist who is most likely a surgeion. A radiologist and oncologist can give you different perspectives. I consulted with six specialists before making my decision.

I obviously don't know the details of your HMO but you should be open to exploring options that your HMO may not cover. I know some men on this forum have abandonded their HMO and got other coverage in order to get the treatment option they desired.

Can you provide us more details on your diagnosis?

==========================================
Age at Dx: 59, diagnosed in March 2010. PSA at DX 4.3. PSA at Tx: 2.8 (after eliminating dairy from my diet)
Gleason: 3+3=6, 1 of 12 cores positive with 15% involvement, DRE normal, Stage T1c.
Treatment Choice: CyberKnife radiation in June 2010. Side effects: None.

bdhilton
Posts: 758
Joined: Jan 2010

Ma...I had William Catalona do my open surgery at Northwestern. He is undisputedly one of the best in the world and his group not far behind. I flew from Atlanta to have him cut. I would for sure talk to him as one of my second or third opinions….

Best to you in this journey

Swingshiftworker
Posts: 626
Joined: Mar 2010

You've already gotten a lot of good advice, but no one has said this to you yet.

You need to investigate ALL options and IMHO surgery should be the therapy of last resort. With a Gleason 6, all avenues are open to you (including active surveillance) and, unless surgery is absolutely necessary, I recommend that you consider the potentially less damaging treatments, such as Brachytherapy, CyberKnife and Proton Beam Therapy first.

With surgery, you are almost certainly going to have issues with urinary and erectile dysfunction following the procedure and some men NEVER get regain normal urinary and erectile function afterward -- having to get a urinary sphincter and/or penile implant in follow-up surgery. Just check the many other threads on this network for stories about the problems that can occur w/surgery. Some urinary and erectile issues arise w/radiation treatments as well, but CyberKnife and Proton Beam Therapy are very focused methods of treatment which (based on reports so far) minimize the potential negative effects.

I also have a Gleason 6 and did research of all of the available treatments, including surgery, and chose CyberKnife over all of the rest.

Good luck in your search for the best method of treatment for you!

kimber45
Posts: 18
Joined: Aug 2010

A friend of mine just asked a prominant surgeon from Johns-Hopkins the same question. The surgeon felt that open surgery did a better job on cleaning out the margins. He has stopped doing the robotic and only does the open surgery.Hope this helps

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

I'm not in the medical field...just a PC Survivor...1 year post davinci.
My opinion is that with the Davinci you can get the same results as open...the difference in the positive margins is how far the doctor 'cuts' either with the robot or with the traditional scapel.

The problem I've read is cut to far and then you have more problems with urinary control.
Cut to shallow and then higher chance of positive margin. A very fine line with either method.

I believe the surgeons skill level with either method is the key.

Larry

Skid Row Tom's picture
Skid Row Tom
Posts: 118
Joined: Apr 2010

I had surgery at Johns Hopkins in 2006 and my doctor said the same thing. Maybe it was the same doctor. He said he does robotic kidney surgery but not prostate surgery because he can get cleaner margins.

kimber45
Posts: 18
Joined: Aug 2010

Skid- I'm curious- what was your doc's name?

Skid Row Tom's picture
Skid Row Tom
Posts: 118
Joined: Apr 2010

Dr. Ronald Rodriguez.

GolfWi
Posts: 5
Joined: Jun 2010

I interviewed 3 surgeons before choosing the one I wanted cutting me open. I picked Dr. Catalona at Northwestern and am very pleased with my treatment. Surgery was 7/15/10 and my follow up PSA is now 0 and use 1 pad a day just for sneeze/stress leaks. ED issues are slowly improving but nothing usable yet, nerves could not be spared on one side. Dr. Catalona does only open surgeries and as others have said is a pioneer in treatment of this disease. You can get more info on him and his philosopy at www.drcatalona.com Don't be afraid to take time and reasearch which treatment is right for you and the Doctor doing the surgery.
Best of Luck

kimber45
Posts: 18
Joined: Aug 2010

No - it wasn't him. But that's 2 docs at Johns Hopkins that have the same opinion.

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