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Another Open vs Robotic

dav5942
Posts: 16
Joined: Feb 2010

Trying to decide on surgery type. Dr. who does both(only a few robotic) recommends open due to my numbers. He believes he can minimize margins better with open. Have not talked to a Dr. who has done lots of robotics.

PSA 6.9
8-12 specimens with 6(3+3), 1(3+4 100%), 1(4+3 100%)
Endorectol MRI with coil-indicated palpable nodule organ confined
Bone Scan negative.
Papable nodule on right lateral base.
Prostate size 49.5
Age 65-health excellent.

Thanks, Dave

bdhilton
Posts: 752
Joined: Jan 2010

I studied all treatments and like you I came back with the Open vs Robotics debate for myself. I believe your treatment is a personal choice that you have to believe in but from my review I found that Open from my perspective is a better choice because of my palpable nodule…. I am having Open on March 3 by Dr Catalina out of Northwestern…

Best to you

Pre surgery
PSA 2.82-4.29
Gleason 4+3 present in 9/15 biopsy specimens
Palpable nodule right base and right mid
Negative Bone and CT Scans

dav5942
Posts: 16
Joined: Feb 2010

Sounds like we are in the same boat. What was it about your palpable nodule that made Open more feasible than Robotic? thanks, Dave

bdhilton
Posts: 752
Joined: Jan 2010

First, if you qualify to have surgery, most experienced surgeons that do the Open procedure do not make "decisions" beforehand... they actually wait and assess the extend of a tumor during surgery. They can see it, and most importantly (from my perspective) they can feel it. During surgery, if a they feel cancer on the edge of the prostate-this can be done during open surgery only-and decide if the nerve bundle needs to be removed or not (since we have a palpable nodule most robotic surgeons might make the decision to remove the bundle on the side of the nodule prior to surgery since they cannot feel or touch during the robotic process...If it should be removed if, at any point during its release (when they slowly peel it away from the rectum), if it seems adherent or sticky...RED FLAG-this is often a sign for Cancer is beginning to escape the prostate...However, if no firmness is felt and the nerve bundle falls away from the prostate, it's safe to preserve it...etc...read page 281-282 in Dr. Patrick’s Walsh's Guide to Surviving Prostate Cancer second edition (if you do not have buy)...The second reason for me personally based on the above opinion of Open Surgery of Walsh and Catalona is that they have less failure with positive margins with Open vs Robotics with guys like us...food for thought and that last statement is based on their studies from my understanding...

But no matter what treatment or process you choice just get someone experienced with excellent stats and believe in you treatment 100% good, bad or indifference with the outcome as no one can every second guess your decision after the fact...

Best to you

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

Very thoughtful, insightful and fact based post!

We will all be praying on Friday and Your day Wednesday, up in the windy city, March 3rd.

bdhilton
Posts: 752
Joined: Jan 2010

I am sure I will be anxious on the day of surgery but right now I am confident and truly believe I am having the best for my situation… All I got to say is damn the torpedoes!

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

If I had the involvement you shared above in your biopsy results, personally, I would find one of the best open surgeons, like Bd in Dr. Catelona and never look back.

Check this out. He, Dr. Catelona is one of the premier Open Prostectomy ROCK STARS!!!

http://www.drcatalona.com/ <<<< cut and paste into your URL bar.

He has done more than 5,000 reportedly the most in the WORLD!

I was lucky - caught mine prior to escape from the organ - according to my post op pathology report - had a local Da Vinci mini Rock Star Over 1,200 da vinci's and have had excellent results.

My 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

FIRST PSA TEST 2-11-10 <0.1 NONDETECTABLE

Best of Luck on path and final choice!

Randy in Indy

dav5942
Posts: 16
Joined: Feb 2010

Thanks, for all the great comments. Have posed some of the comments as questions to a couple of top Drs. who have provide answers that indicated the most important thing is a good experienced Dr. in whichever direction is decided. So far, no decision, still doing my due dilligence(while watching the Health debate on TV).

EstherMSKCC
Posts: 20
Joined: Feb 2010

Dear Dave,

I’m an employee of Memorial Sloan-Kettering Cancer Center, and I’m aware of how confusing it can be for patients to decide among prostate cancer treatment options. You might find the following link useful...It’s a video clip that addresses the topic of open versus robotic surgery (as well as minimally invasive surgery): http://www.mskcc.org/mskcc/html/62034.cfm.

As you probably know, surgical volume is associated with improved patient outcomes, and fewer complications (http://www.mskcc.org/mskcc/html/95740.cfm) so it’s really important that the surgeon you choose has a lot of experience.

It’s great that you’re networking and researching treatment options because it will help you make intelligent, well informed decisions. Best of luck.

-Esther

bdhilton
Posts: 752
Joined: Jan 2010

Thank you for the good article plus from a great hospital group. Scary thought that only 2 percent of surgeons nationally have enough experience to perform an RP with good results...and I am sure most of us agree that experience along with excellent stats are what is going to give you the best results if you qualify to have surgery..

Best to all-B

dav5942
Posts: 16
Joined: Feb 2010

Update-Want to thank everyone for the great info!

We decided to go with DaVinci. Drove our RV to Austin, TX done on 3/29 9am, walking at 2pm back to RV the next day. Had Catherter out today, so far no problems. Results of lab were no margins and pretty much confirmed the early info. Will see what happens in 8 weeks with PSA tests. Will spend the summer RVing out West and return to Florida in the fall(doc said no ATVing for 8 weeks-so we will just watch).

But for now feel like I did three months ago before I found out about PC.

Best of luck to everyone and thanks again!!!! Dave

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

Dave,

I had my surgery in Austin last Oct. I didn't drive as far as you did, only from the Ft. Worth area.

I assume you used Randy Fagin? He is considered a daVinci "Superstar" and a good reason to drive to Austin for the procedure. If so you may be interested to know he recently accepted a position with Intuitive Surgical (daVinci robot manufacturer) as Senior Medical Advisor - Training. He will stay with the Urology Team but cut back his workload a little. He was very early in use of the robot and is in the top 7 in the world for daVinci experience with a little over 2000 procedures. He is a little difficult to reach by phone but very responsive via email.

Good luck on your recovery and RVing!

VB

dav5942
Posts: 16
Joined: Feb 2010

VB,

Thanks, yup had Dr. Fagin. We could have done it in Orlando with Dr. Patel, but was planning on heading West anyways so just tried to keep life as normal(would not be normal without the RV for us). So far no leaks!

ralph.townsend1's picture
ralph.townsend1
Posts: 350
Joined: Feb 2012

According to an on-line report in the Financial Times published late last night, “The FDA has received an increase in reports of problems associated with [Intuitive's da Vinci robotic surgical technology] and said it is trying to weigh the risks and benefits of using robotic surgery rather than conventional surgery.”

The “New” Prostate Cancer InfoLink is somewhat puzzled by this increase in reports of problems, since the technology has been available for more than a decade. However, the da Vinci robot is now being used far more widely than just in prostate cancer, and it is possible that inappropriate application of the technology is some surgical settings may be an issue.

The Financial Times article quotes an FDA spokesperson as follows:

Since it is difficult to know why the reports have increased, FDA has elected to talk with some surgeons to help in determining if the rise in reports may be a true reflection of problems, or may simply be an increase in reports because of other contributing factors.

The “New” Prostate Cancer InfoLink wishes to be very clear for patients that we do not consider this development to be a reason to cancel or delay (or even not consider the option of) a robot-assisted laparoscopic radical prostaectomy carried out by a skilled surgeon who is used to and experienced with this technology.

Urologic surgeons now have significant experience with the application of this technology in the treatment of prostate cancer. As with any form of technology, it takes time to learn to use it well, and some surgeons are just less competent than others. While are not aware of any underlying problem with the technology itself, we shall certainly continue to monitor this situation with great care.

Additional comment as of 8:55 am today: Apparently variations on this story are also now available on the Bloomberg.com and The Wall Street Journal web sites. (Access to the latter site requires a subscription). Bloomberg has apparently gained access to the questionnaire sent to selected surgeons by the FDA

ob66
Posts: 214
Joined: Apr 2010

Ralph, I am a financial based person so your use of references in the Financial Times, Bloomberg.com, and The Wall Street Journal tweek my interest. But these are not exactly that a medical professional, like myself, would go for medical authority or medical advice. Would be like will AAPL be up or down tomorrow.

Ralph, you have resided here long enough. Get some medical sources to make your point or counterpoint whatever it may be. 

If you think I am off base, look at the two paragraphs starting after the Financial Times quotes: DISCLAIMERS. Just like with stock recommendations. This is my body, not my portfolio. Please come back with some medical verification, not economic fluff. "Please recognize sarcasm".

ralph.townsend1's picture
ralph.townsend1
Posts: 350
Joined: Feb 2012

Just putting Information out there, your right!

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