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Wednesdays AMA Publication

lja3
Posts: 4
Joined: Sep 2009

Hi Everyone,

I am new to this whole discussion board concept. I have been reading this one for awhile and must say it has been very helpful. Everyone is very nice and specific with helpful details. I was diagonosed with prostate cancer August 27th. I am 55. My Gleason was 4+3=7. My psa was 3.2 (doubled in the past 18 months). I was positive in 3 out of 12 samples. I am scheduled to have da vinci prostatectomy on November 9th. I like the doctor and hospital I have found very much.

But here (among other things) is my concern. The Journal of the American Medical Association just release a report stating da vinci surgery is better for less pain and blood loss during surgery and post operative recovery time, but not much, if any over traditional surgery when it comes to incontinence and impotence. In fact, it states the impotence recovery is better statistically with traditional surgery. This is certainly throwing me a curveball mentally. I am meeting my surgeon again on October 30th, along with my wife to discuss the post operative preparations and procedure, but now wonder if da vinci while very good is still not the gold standard for post operative issues. Maybe I am just over-thinking and worrying too much given the circumsatances. But so many of you here seem so genuine, smart, and considerate that I would appreciate any feedback. Thanks.

Larry

celliott7
Posts: 10
Joined: Sep 2009

Hello Larry, excellent question. I am 55YO, Gleason 6, getting ready to schedule daVinci as I want it out and gone. I am also a medical professional x 30 years.

Short response to the study is that it was a review of Medicare patients, so they would be minimum of 65YO or older. Also, the data went back to 2003, so some of it is several years old. This would be an eternity in modern medicine in areas such as daVinci.

This is not to say that the study was flawed, just don't think it applies directly to you and me. :)

Blessings on your upcoming surgery.
Charlie

injuredbyDaVinci
Posts: 35
Joined: Aug 2009

Dear Larry,
I just read the same thing. Scroll down to injured during surgery. You'll see all the good luck I have been having. I'm living a prostrate surgery night mare. I gave two units of blood during my pre-op in case something went wrong with my da Vinci surgery. My doctor should have done open surgery on me after he saw he was going to have a problem with the robotic surgery. He didn't and I ended up being injured.
What I started out saying is, just because something is new does not mean it is the best. The artical I read said a doctor must preform at least 200 procedures be fore they become good at the surgery.

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

Larry,
YOur numbers are very similar to mine. I just turned 55 and had my Davinci Surgery in August 2009.
If you take a look over at www.healingwell.com and their prostate forum there has been much discussion about this report so I won't rehash all that is being said over there. I find some issues with the study since it does not show how a Dr's experience was accounted for in the surgery. I went to Vanderbilt and had an EXCELLENT Surgeon. I'm very pleased with my results.
Pre surgery psa was 4.1 Gleason 4+3=7. Post surgery pathology changed the Gleason to 3+4=7.

I've had excellent urinary control post surgery and have been having success using Levitra.

I had a choice between two surgeons. First surgeon was local and had done about 300 Davinci's. The second surgeon had performed around 2,000 Davinci and had trained the first. I went with Experience. Frankly I read of some men stating their surgery was about 1.5 hours. I know each surgery is different but that seems on the short end of time. How careful was the Doctor with the robotic arms? How aggressive? I actually watched three videos on the web from three different doctors performing actual Davinci surgeries. I watched the one of my Doctor 3 times and then it struck me what the difference was that I was seeing. My Dr.'s movements of the robot appeared to me more calm and less jerky then watching the other video's. Perhaps it was just the camera's but again if you have a skilled surgeon who is patient and takes care I wouldn't worry to much about that study. Studies and statistics can be written to express the authors viewpoint just like this post is expressing my viewpoint.

Wishing you well on your treatments,
Another Larry

NM
Posts: 214
Joined: Jul 2009

My surgery took over 3 hrs, no incontience. My surgeon took his time I believe after many meetings between my wife and myself, telling him our fears and because hes an excellent surgeon he took his time and his concern since has been overwhelming. I dont feel like a number when I visit his office

Nick

txbarton's picture
txbarton
Posts: 80
Joined: Aug 2009

A friend sent a link to the NY Times article (http://www.nytimes.com/2009/10/14/health/research/14prostate.html) while I waited for my cystogram on Wednesday. Another friend sent a shortened version from a San Antonio newspaper which ended in an inference that the daVinci manufacturer has hidden information for financial gain. Send me an email and I will send the clip.

I don't understand how someone can determine that naked or loop covered eye can do a more precise procedure than a highly magnified robotic procedure. I discussed the report with my surgeon. He reflected both disgust and mirth. He pointed out the data is from early in daVinci existance (when daVinci was used <9%) and that experience is very important. Also note that standard laparoscopic procedure data is lumped into daVinci. I think open surgery would be more precise than laparoscopic. He feels the report was made simply becuase someone needed a report.

Duration of procedure. My procedure was a little over an hour and a half and to do that I was gone from my family almost 4 hours. Subtract 2 - 2 1/2 hours from the time you left your family until they came to recovery to find how long your procedure was. My son is a surgeon who said 2 1/2 - 3 hours is too long for this type of procedure, that 1 -1 1/2 is more reasonable but he is considering actual operating time, not gone from family time.

You have to make sure data being compared is accurate and directly related whether it is for outcome or duration.

VB

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