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At a cross road what to do…. RP (Gold Standard) or Da Vinci Robotic?

bdhilton
Posts: 752
Joined: Jan 2010

On December 28, 2009 I was diagnosed with PC. I just turned 55. My PSA is between 2.8-4.10 (two test within a week in December 09). I had a 15 core biopsy and have been diagnosed with Stage T2B with Gleason grade 7 cancer (4+3). My bone scan and CT were negative. This was stated during my annual physical on Dec 4th when my doctor noted a “lump” during my DRE and referred me to a Urologist.

My Urologist has a thriving practice here in the Southeast USA (2 da vinci surgeons on staff and one being the director of Robotics at one of the major hospitals here in the south east) but my own Urologist is recommending that I go to Northwestern in Chicago and have a radical prostatectomy performed by one of the first surgeons to perform and perfect nerve sparing surgery in radical prostatectomy operations and has preformed more than 5,000 RP’s.

My Urologist’s main reason is that he believes that this will be my best chance to get the cancer out the first time without radiation because of my bulge in my tumor. If I go with the Da Vinci process (with a very experience surgeon in his group) he is concerned that this process may leave me positive on one side after the da vinci process and I will need radiation…

Outside of PC I am in good health, not overweight and workout 5-6 times a week.

My priorities are eliminating the cancer, continence and sparing my nerves to remain potent (never thought that would be the third item on a list of priorities :-))

Anyway most perplexed right now and if anyone has advice about their experiences between da vinci and RP (gold standard) I am all ears…Da Vinci sounds so much better than the RP Gold Standard process…

Thank you in advance for any advice or help!

marc1957
Posts: 79
Joined: Oct 2009

Personally I would speak with both surgeons you are considering, get their biased inputs, then make your own decision based upon that.

bdhilton
Posts: 752
Joined: Jan 2010

Thanks for your response…Biased inputs isn’t that the truth…that makes me smile.

What makes this difficult for me is that my urologist oncologist who owns the practice with 2 da vinci surgeons on staff is recommending I go spend my money up at Northwestern for an open RP….and the da vinci surgeon (listed as one of the best in the southeast) he has on staff has told me he will get 100% of my cancer… like this is not hard enough…thanks again

whipple
Posts: 11
Joined: Dec 2009

I cant believe someone would say they can get 100% of your cancer. I wouldn't trust that.

whipple
Posts: 11
Joined: Dec 2009

My husband had the Divinci at Northwestern by Dr. Nadler. He is also Gleason 4+3 and the pathology after surgery is T3C. He is going to have radiation but we haven't met with the radiation oncologist and dont know if they will also do hormone therapy. They want to wait and let the body heal before stating the radiation. My sister inlaw just sent me this article that I think will help you. It is from Johns Hopkins Medicine Urology, A publication of the Patrick C. Walsh Prostate Cancer Research Fund. Volume V, Winter of 2009 How to compare results. If you cant find it email me at jude0818@sbcglobal.net and I will forward it to you. Best Wishes Jude

bdhilton
Posts: 752
Joined: Jan 2010

I found it and read it> I am debating open RP at Northwestern or the Da Vinci method in the South East...Best wishes to you and your husband

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I have similar stats to you which I will post below here....but prior to surgery mine looked better 3+3=6 only right side with a palpaple tumor felt in DRE. Did a MRI with coil and they said it was organ confined. So I stuck with Da Vinci surgery 12/29/09. I really never considered RP because of the down time afterward...probably not right when we are talking about cancer but I just saw all the benefits from Robotic that I liked...away from work less. quicker recovery to get back to doing things...and the nice success rate of the experienced local team here in Indianapolis. Now my post op path came back with more aggresive cancer as you can see below...and the part that is ugly for me is the extraprostatic extension that occured on both the right and left side anterior=front. I look at this as a huge ? of whether I will be dealing with this down the road again some day with radiation. The really good part of the path report is no positive margins...and the only other concer was the perineural invasion....which I found out today is extremely common on Post Op path reports because there are nerves that go into the center of the prostate and run through it so if there is cancer in there it goes to reason the nerves inside the prostate would like have invasion. I was concerned that it was with the nerves attached to the outside of the prostate which it was told most likely not...since there was none in the surgical margin which is all the tissue they take from around the entire sphere of the prostate. I like the other comment about interviewing the docs and see what they say then making a decision....I can tell from reading on here for several months that no matter what path you choose...and no matter what results you get after the choosen treatment...cancer can come back....I honestly think it's somewhat luck that determines who gets it back and who doesn't. My best advise find the one that turns you on the most with his answers and the one you feel the most confident with as far as his skill level.....what I found leading up to my surgery after I had made the decision was everyone around said ...you got the best guys....even other docs said they would use who I used if they had it and were going to do the robotic. I am now two weeks from the day from my surgery...and honestly...I could go out and play at least 9 holes...maybe even 18 tomorrow. I have never really felt tired or out of energy...I was out runining around shoping for 5 hours yesterday and yes when I got home felt a little tired but man this has been a peice of cake with the worst part for me being the bowel movements and catheter...which I had to keep an extra week and got out today...YEEEEEEEEHAWWWWWWW! I'm friken free...and actually going to the bathroom and peeing on my own. I am on my second pad since the removal at 11 am this morning but its pretty darn dry....so hope I am continent soon....I am also doing a no, no drinking a beer right now...but heck a person has to have some fun....heck its a flat two week old home brew so the carbination is not a factor...well see how the bladder reacts. Good luck with your decision! here are my full stats.

52 years old
PSA 9/09 7.25
PSA 10/09 6.125
Diagnosis confirmed Oct 27, 2009
8 Needle Biopsy = 5 clear , 3 postive
<20%, 10%, 10%
Gleason Score (3+3) 6 in all positive cores
11/09 Second Opinion on Biopsy slides from Dr. Koch
(4+3) = 7 5%
(3+4) = 7 10%
(3+4) = 7 10%
Endorectol MRI with Coil - Indicated the Palpal tumor was Organ confined
da Vinci 12/29/09 - Dr. Hollensbee & Scott
Post Surgery Pathology:
Prostate size 5 x 4 x 3.5 cm Weight: 27 g
Gleason: Changed to (3+4) = 7
Primary Pattern 3, 80%
Secondary Pattern 4, 18%
Tertiary Pattern 5, 2%
Tumor Quantitation:
Greatest Dimension, Largest tumor focus: 19 mm
Additional Dimension 18 x 15 mm
Location, largest tumor focus: Right posterior quadrant
Multifocality: Yes
Greatest dimension second largest focus 10 mm
Location: second largest focus: Left Posterior quadrant
Extraprostatic extension: Yes
If yes, focal or non-focal: Nonfocal
If yes: location(s) right and left antero-lateral
Seminal vesicle invasion: No
Cancer at surgical margin: No
If no, closest distance with location: less than 1 mm, right posterior quadrant
Apex involvement: No
Bladder involvement: NO
Lymph-vascular invasion: No
Perineural invasion: Yes
Lymph nodes: 9 from right pelvic 0/9 positive
Stage: pT3a, pNO, pMX
All nerves sparred - found two additional pudendal arteries

bdhilton
Posts: 752
Joined: Jan 2010

Sounds like you are doing great and that makes me happy as we are all now members of this “reluctant” club… I love stats and I sincerely appreciate you providing the details you did. I believe what you do in that “no matter what results you get after the chosen treatment...cancer can come back.... it's somewhat luck that determines who gets it back and who doesn't….” Your advise in that “find the one that turns you on the most with his answers and the one you feel the most confident with as far as his skill level..” is what I continue to struggle with.

My urologist is a well regarded oncologist I the States and is giving me treatment advise he gave to his own brother (who I know) go to Northwestern and get an “open RP” outside of his clinic… but my first “gut” was da vinici with this particular surgeon in Atlanta before I saw my urologist and that is why I keep struggling…As you know you can only get it right once …My wife says I am crazy and should listen to my urologist advise and I am still listening to my gut and go with da vinci and this other surgeon…I am also talking with Vattikuti Urology Institute tomorrow but bottom line for me is that “what will be will be” and I am a surgical candidate plus I have an obligation to climb Half Dome this Summer (do not know I will be recovered with an open RP by then) and dispose of my fathers ashes as one of his last request (taught me how to climb and love the outdoors many decades ago …) still a quandary for me ,,,thanks again for the thoughts and information

fathersson's picture
fathersson
Posts: 121
Joined: Nov 2009

Incredible how confusing all of this can be. I was diagnosed as a gleason 6 with one core out of 12 containing less than 5% of cancer. Also 2 other cores were indicating some precancerous abnormalities.. Urologist recs robotic removal. Go for a 2nd opinion and consult with another highly reputable surgeon/urologist next week. In the meantime, I am getting hammered from anyone who cares with all sorts of reccomendation as to who to see, whether to watch and wait, what type of surgery I should get..when I should get it..and... you name it. All great input from people who truly care. That said, it kinda sucks because it confuses you as to "what to do". and I have read and researched everything and truly understand the ramifications of any decision I make...I think the advise as to whatever turns you on is right on target because in the end.. we need to feel comfortable with whom and what we choose to do.. So .. good luck and hopefully we both make the right decisions...

Best.

bdhilton
Posts: 752
Joined: Jan 2010

Thanks for your response and the best to you in your personal selection process. I have had to make snap decisions most of my professional life and I remain in a quandary on this one….but I know for me in the end I have to “believe” that my selection is the best no matter what the outcome is….

It is interesting how “one” think about cancer based on “their” degree/state of cancer. I’m a Pre-Op stage T2B with a Gleason 4+3 =7 … I am struggling with Open vs robotic because of my stage and the advantages vs disadvantages between Open vs Robotic and the primary reason is the surgeons ability to “feel” your tissue in the Open process…anyway if I had a Gleason 6 (which I do not) I would be pointing towards da vinci with an experience surgeon but again at the end of the day it is what you believe is best for you …best of luck in this process

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txbarton
Posts: 80
Joined: Aug 2009

Just because your urologist has daVinci surgeons on staff does not mean he is supportive of daVinci. My urologist advised against daVinci for me but I sought another opinion and went with daVinci on 7 Oct.

My pre-op was Gleason 3+3 with PNI. My post-op was Gleason 4+3 with cancer outside the capsule. My 8 weeks PSA was "<0.04 (undetectable)".

My 36 year old son is a pancreatic surgeon. He and my urologist who is ~65 years old both admit that daVinci is new enough that older urologists/surgeons are reluctant to accept/recommend it.

Seek another opinion befor you commit.

Good luck.

VB

bdhilton
Posts: 752
Joined: Jan 2010

You sound like you are doing great and made the right decision for you. Your advice is solid-thanks I'm a 4+3 pre op but what was your turning point for open vs robotic?

Trew
Posts: 891
Joined: Jan 2010

I just finished radiation at Loma Linda U in CA. I had Da Vinci surgery back in March 09. My oncologist at LLU told me he seldom sees more than 3 lymph node samples with the Da vinci sugery then he wouldlike to see 15, especially with positive margins.

Reading your report above I think you have a very good surgeon.

hopeful and opt...
Posts: 1282
Joined: Apr 2009

we can provide better advice if you mention the surgeons that you are considering and their experience.......specifically, please tell us more about the robotic surgeons that you are considering........you can mention the names of the surgeons....for us, its like collecting baseball cards when we were children........there are stars and superstars, and pretend stars.

ira

bdhilton
Posts: 752
Joined: Jan 2010

Da Vinci:
Nikhil Shah-St Joe/Atlanta
Mani Menon-Henry Ford/Detroit

Open RP-
William J Catalona-Northwestern/Chicago
Emory University-Still interviewing

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

BD,

Try this article for a comprehensive review of the two techniques.

http://www.expert-reviews.com/doi/pdf/10.1586/14737140.8.6.843

I also have a bookmark on the outcomes of the two procedures. I am trying to locate it and will post it as soon as I can.

Sonny

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

Here is another worth reading article.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2014804/

By the way, as many here know, I had my da Vinci surgery done by Mani Menon at Henry Ford in Detroit.

I went through much the same discovery process as you. I live in Orlando, Fl and my local Urology office is well respected. They also have open and robotic surgeons in house. I decided on surgery as my first form of treatment, which would leave me other options if I needed them.

Once that decision was made I researched heavily the differences in open vs robotic. I decided on robotic and then went on a search for what I felt was the best. There are many notable and really good da Vinci surgeons in the country but my quest lead me to Dr. Mani Menon.

I could not have been more pleased with my experience. My surgery, recovery and return to continence were all non events and are well documented here.

Unfortunately my cancer decided not to cooperate. At present I am two treatments away from completing 35 IMRT radiation treatments. However, there is no doubt in my mind that nothing could have been done further in my surgery to guarantee success. That is truly the world of PCa and it operates differently in each and every individual.

I was totally continent from the time the catheter was removed and at only 3 1/2 months post surgery am seeing strong signs in recovery of normal sexual function. I attribute both of these successes to Dr. Menon and the surgical techniques that he has developed to address these two issues. Many of the top surgeons in the country as using the techniques and refinements that were developed by Dr. Menon.

Good luck in your quest for knowledge and the comforts of your decision,

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative
da Vinci 9/17/09
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT began Nov 30,2009 (74 days post surgery)35 treatments total 70Gy

bdhilton
Posts: 752
Joined: Jan 2010

Sonny...thanks for the article and your details above. I have also read many of your comment within this discussion group.

I love your belief that your choice was the best choice...and that is the only thought you can have after your treatment. I feel I need to make my decision in the next 2 days or so(6 week anniversary of my biopsy on Friday) but I am sure I will ponder this over the weekend...Thanks again BD

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jminnj
Posts: 129
Joined: Nov 2009

bd

I am 47 and was diagnosed in November, PSA was 2.9 and had 1 core positive (10%), 2 others that showed abnormalities. My urologist walked me through the various options, made his recommendation (da vinci)and then told me to go get a second opinion. I went to Sloan Kettering in NJ and met with their urologist/oncologist. He again walked me through all the options (pros and cons). Ulimately I decided to have the da vinci (scheduled for next Thursday). I did a lot of research and feel that this is the right option for me. I personnally do not think that there is one right answer that applies to everyone. Each one of us has our own unique set of circumstances and in the end we need to feel comfortable with our decision. I wish you peace of mind during this time and all the best with whatever treatment option you decide upon.

Good Luck
Joe

bdhilton
Posts: 752
Joined: Jan 2010

Joe,

Thanks and what I am seeing are a few common themes or threads with folks that have gone through this and are confident with their decision::

1. There is one right answer that applies to everyone.
2. Each one of us has our own unique set of circumstances
3. In the end we need to feel comfortable with our decision.

Thanks again,

BD

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RichardRS
Posts: 44
Joined: Nov 2007

I was a surgical technician (like a operating room scrub nurse). What convinced me to go robotic was the visualization and magnification possible in the robotic procedure. Look at some of the clips online (You Tube and Doctor's sites) showing the procedure. I was totally pleased with the quality, outcome, and lack of pain in this procedure.

NM
Posts: 214
Joined: Jul 2009

Hi ,Nick here and im going to throw my hat into the ring. First of all did you get a second opinion? John Hopkins is a good option if you didnt,that said I chose Davinci for 2 main reasons.

I had to keep working,I know this sounds like a dumb reason but mortages must be paid and food bought and I am not yet wealthy,lol

And the second reason was removing the cancer,obvious of course with as little side effects as possible. I had Davinci on Sept 3rd and am back to work,lifting weights and doing whatever I like.

On a lesser note I had no dietary restrictions and didnt watch my liquid intake from day 1 and no incontinence,meaning I was the same as before.(beer was included in my diet)

Hope this helps and prayers to you.

Nick age 52...

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I am surprised you had did not have any incontience from day 1....even at night. Who and where did you get the Da Vinci done? I am currently on day 17 and have some incontinence using about 1 pad per day and 1 at night...last night was the most leakage about 2 ounces but I had about three beers last night also. The one good thing is the Viagra is working...had a 3/4 usable erection last night and it worked but orgasm was not the same...not nearly as powerful...but at day 17 I will take it!

Randy in indy

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

THose orgasms should also improve with time. I'm at 5 months post davinci.

Larry age 55

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

That's some really good news! I figured it might but with this stuff you just never know what is going to happen. One thing was I got there really fast and I know that usually makes it less intense at least pre-surgery for me anyway. Thanks for the uplifting news!

Randy age 52

NM
Posts: 214
Joined: Jul 2009

I went to a cancer/surgeon who only deals with and operates on cancer patients. He has done over 500 open and almost as many Davincis.

He recommended Davinci over open both because of the side effects and I wanted to return to work ASAP.

I had no special diet from day 1 and was even told on the day after the surgery go home and have a couple of beers.Seemed to work so far on the incontinence issue at least.

I went to Danville,Pa for my surgery on the advice of my family doctor.

I said one time on this site if you have no incontinence you love your doctor if you do it seems to be your doctor didnt do as good.I truly believe that some luck plays a part as you may go either way even with an experienced surgeon.

Peace to all who have any side effects or worse yet lose their life to this disease. It is not a minor thing like many people have told me.I still look forward to my second PSA reading in Feb with a bit of dread as I dont know what it will find.

Nick....52 years young..had Davinci on Sept 3rd of 2009.....

Lindorf
Posts: 11
Joined: Apr 2009

Howdie:

I had 4+3 preop but high psa of 24. Did quite a bit of research, and have noted that though the number of patients requesting DaVinci is definitely rising, the notable advantage of the robot is not really supported by research, except that robotic patients pend 1 day less on average in hospital. Still, all in all, the most important statistic is the number of operations that the surgeon and hospital do. I would use that as the first and most important consideration. I chose open, did radiation after just in case, PSA is undetectable.

I wish you the very best

harry

bdhilton
Posts: 752
Joined: Jan 2010

As we all know the thought process it is not an easy task with all of the “snake oil” salesmen out there…. all of the information given to you by some with a whole lot of bias… I live in Atlanta and have elected to move forward with the open surgery instead of Robotics. I personally would have selected Robotics if I had been a 3+3 and did not have a palpable nodule. I was diagnosed on Dec 14, 2010 with a Gleason 4+3 present in 9/15 biopsy specimens. I have a palpable nodule right base and right mid and presented with a PSA of 4.29. On Dec 28 I had a negative bone, CT scan and my first consultation…I am scheduled to have open surgery on March 3 up in Chicago at Northwestern with Dr. Catalona (over 5000 surgeries)… I have a great Uroloic oncologist (not biased in my opinion) out of St Joe Hospital in Atlanta if anyone is looking for another opinion…let me know

Trew
Posts: 891
Joined: Jan 2010

I am surprised more men do not consider proton therapy.
Loma Linda University has a very good CD and book they send out free to any who request it. The testimonials from hundreds of men who have been through proton therapy are very encouraging.

Consider the benefits of proton therapy:

NO surgery
Little or no change in sexual function
Little to no incontinency problems
No recovery time
Patients are very active during the 40 or 45 treatments needed, playing golf, working out in the gym, and having intercourse.

There are 5 or 6 certer in the US that offer proton therapy now. Talking to men at Loma Linda who were using proton treatment as their primary treatment for PC they were very happy, but most got very little support form their urologists back home who really favor surgery. Imagine that.

Go ahead, do a google search on Loma Linda U proton therapy and see what you find.

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lewvino
Posts: 1004
Joined: May 2009

Trew, I agree with you that there are some benefits with proton but not every thing is peachy cream rosy either. My dad was treated at Loma Linda in I believe 1997 or 96. He is still alive and doing well however.....He has very frequent need to urinate and Has to go IMMEDIATELY. About 3 years after treatment he lost the ability to have erections. From what I understand things are A OK for awhile then the Prostate scars and dies.
Also I friend from Church went to Loma Linda and he is now battling Bladder cancer. They told him this can occur after Proton. So all treatments have plus and minus to them.

Larry (davinci was my choice) age 55

bdhilton
Posts: 752
Joined: Jan 2010

Yes I looked into Proton very much and it was not for me...

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Sounds like you are committed to a very good surgeon (over 5,000) With those kind of numbers I would think your recovery time would be lessoned some just from his massive experience. My thought processes were I needed to have someone local that I could be in contact with for any followup problems....however in your case you have what seems to be a pretty good support group around you in Atlanta with your Dr. suggesting the Northwestern surgeon. Beside the fact if you need further treatment it will be yet another doctor in Oncology which I think you also already have set up in Atlanta. I will tell everyone if I am completely satisfied with my choice on 2-17 after getting my first PSA...With no positive margins all indications would point to a non-detectable PSA even though I had a palpable nodule that was multifocal in both the right and left side with extraprostatic extension. Stats are above in this thread.

On day 26 of Da Vinci recovery and here is my recent thoughts....when you party dowm for a Playoff game...YEAH COLTS..played like the Champs they are....and drink ample amounts of beer...you will leak often and without being aware...completely filled - which I have not done to date yet up to the game...TWO pads...Alcohol is the devil for incontinence! I guess I will have to give up that for a while to try and get this under control. Hopefully I can get to several days without any leaking. I think I am going to start exercising again soon...starting with the Elliptical machine I have in the basement...I need to start training for my Spring project of building "man cave" number 2...workshop below a screened in porch on my walkout. All for now - Hope your team won yesterday...I liked the Saints but was very sorry to see how they tried to beat up on Farve...that was totally bush league and now they deserve to get punished for that in two weeks!

bdhilton
Posts: 752
Joined: Jan 2010

Randy it is what you guys told me about 2 weeks ago and it is what feels right to you. You made the best decision for yourself and I made the best for me. Truth is I am blessed. My urologic oncologist could have "pressed" one of his surgeons (all three plus him highly regarded here in the southesast as surgeons) and they are all excellent and experienced surgeons but for reasons unknown to me he gave me Northwestern as one of my options on top of his folks plus he will be my urologist when I return …

True local would had been nice...and right now I am not looking forward to flying home 5 days after surgery (staying in a hotel across the street for 2 days before leaving even though I was told I could go home after I was released) I feel blessed I had this option with such an experienced surgeon and yes it is true his down time “statically” is as good as robotic surgery and right now I am believing the best will happen…cancer free, limited pad time and a fast erection recovery…seriously I am interested in any workouts that you are considering plus your time lines during your recuperations with getting back in shape.. and perhps you should limit the beer...now scotch is another story...

Best to you-BD

tcm123
Posts: 1
Joined: Jan 2010

First, this thread has been very enlightening. Thanks to all who contributed. Here's my story, which is similar to others. I'm an otherwise healthy 43-year old who was diagnosed with PC on new year's eve. My last PSA (early December) was 2.3 and my Gleason score is 3+3=6, with 10-20% affected cells on 3 of 6 samples from my biopsy. Because of my age and health status, I've all but decided to go the surgical route with a prostatectomy, but my dilemma lies in which approach (open, robotic/davinci, or perineal). All indications are that my PC was detected early-stage and has not spread to lymph nodes, which makes me a good candidate for any of these approaches, with strong prospect for full recovery, though I'm taking nothing for granted.

I work in downtown Chicago, walking distance from Northwestern, where my urologist resides. He recommended Open, performed by Dr. Catalona at NW. I've met with Dr. Catalona and was impressed - his experience means alot. In addition, I met with Dr. Nadler at NW, who recommended robotic, and Dr. Laurence Levine at Rush, who suggested perineal.

Question: Did anyone consider perineal? I like the concept of less invasive, faster recovery, and the "quickest path" to removing the prostate via that route. On the other hand, it does not seem to be a very popular or well-practiced approach, at least not as much as open RP or robotic.

Also, if anyone had a prostatectomy performed by Drs. Nadler, Catalona or Levine, I'd appreciate hearing about your experience. Thanks in advance.

--Tom

az4peaks's picture
az4peaks
Posts: 1
Joined: Jan 2010

Hi bd, - You certainly can't go wrong with Dr. Catalona, a man for whom I have a great deal of respect and who is one of 2 men in the U.S. with over 5,000 Prostatectomies under his belt (the other is Walsh at Johns Hopkins).

Once having chosen, go forward with confidence, knowing that it is being done by one of the widely acknowledged "best", and realizing that NO ONE can ever know what the result of any alternative decision would have been. Your choice has also made you the recipient of surgery that provides the added benefit of a post-surgical Pathology Report, that will be provided by a department with volume enough to have an expert in Prostate tissue examination on the staff. A luxury that is only available at high volume institutions like some University Cancer Divisions and recognized "centers of excellence".

If you wish any "tips" about your immediate post-op considerations (like dealing with the catheter), don't hesitate to contact me. - John@newPCa.org (aka) az4peaks

bdhilton
Posts: 752
Joined: Jan 2010

Thanks my decision is made I believe it is the best for me…now I’m running around finalizing some additional tests, etc…I believe I am so saturated with information I will pass on the cath stuff right now …but I am sure I will reach out for this soon :-) as it is something everyone talks about…thanks again for the positive and well wishes-BD

Ralphie62
Posts: 47
Joined: Feb 2010

Just diagnosed this week..........i live in Atlanta...would appreciate referrals to physicians and outcomes ...thinking davinci .....ralph

bdhilton
Posts: 752
Joined: Jan 2010

Ralphie62... I know a few Urologic Oncologist in Atlanta:
I am bias towards St. Joe in general and their staff (even though I am going up to Northwestern in Chicago):

If you are looking for an Urologist/Oncologist -William Nabors and his entire practice are excellent 404 255-3822

Dr Shah is part of this practice + is director of Robotics at St Joe + has trained 1000’s of surgeons in the di vinci robotic method and I believe has done about 1200 +/-…CNN did a spot on him in 2008 (goggle and see video-he actually did a friend of mine on this procedure for CNN)

Emory is obviously excellent along with Northside. From my perspective, you need to make the decision and believe in the treatment and doctor you select…There are lots of choices. Again from my perspective you need an experienced surgeon/doctor and their stats need to reflect the same…lots of good doctors out there..

Best of luck

Ralphie62
Posts: 47
Joined: Feb 2010

BD, thanks so much for your help!! I think you are way ahead of me, and i am realy appreciative of all the info. A friend suggested Scott Miller, but we have also heard of Dr Shah....we will look into all of your suggestions and pray for your successful surgery and speedy recovery!! Ralphie

bdhilton
Posts: 752
Joined: Jan 2010

...I have heard great things about Miller as well as many other surgeons in the Atlanta area...just be comfortable with the surgeon and/or treatment you decide on...No one can do that for yourself...but from my perspective you want experience and success rates…. Best of luck

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shane59
Posts: 86
Joined: Jan 2010

Glad you have made the decision now you can move forward.I had open radical prostectomy had very similer stats to you gleason 5+2 psa 2.4 as I have mentioned on other boards Doc removed all cancer very possitive .also good nerve sparing results just over 3 months on recovering well 1 pad a day .yet to try the viagra etc but very happy with surgery .things will get better now so best advice try and keep your fitness up and if needs be lose a bit of weight it makes a differance .best wishes for the future Shane

gjeck6874
Posts: 9
Joined: Feb 2010

Diagnosed with a PSA in Nov. '03 of 4.0 and 5.8 in Jan. '04 w/biopsy indicating cancer in my prostate; I had my radical postatectomy in March 2004. The post-operation pathological report indicated that my Gleason Score was 7 (3+4) and although the surgical margins were clear; the tumor had broken thru the capsule. I was informed that the cancer had not left the localized area of my prostate.

The recomendation was to have a series of 37 external beam radiation treatments aimed at the prostate bed region which I began in May '04 and finished in July '04.(5x/week w/none on weekends).

In regards to my radiation side effects, I tolerated the treatments quite well. I was lucky that the irritations to my "back-side" were minimal and I had no loss of continence. I looked at this treatment as assurance that the cancer NOT re-occuring would go from 40% to 85% .

My PSA has been 0.1 the entire time after the operation & radiation. However, in December 2009 PSA rose to 0.2 and after a second test this week it has stayed at 0.2 ... But that's another story ...

A side affect that is not that common but has remained with me since only days after the surgery was numbness, tingling & occasional burning sensation in both upper legs caused by damage to the respective nerves during the RP. The prescription drug Gabapentin is used to control the pain.

Hope this helps out in your decision making.

Geoff K.

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