Laparoscopic or open surgery? - G8 (5+3)
I apologise for opening a new thread, and if it's against the rules feel free to merge with the old; but I feel the concerns in the other have been kindly and thoroughly addressed and the most recent dilemma now requires a more direct discussion.
Previous thread: http://csn.cancer.org/node/303384#comment-1545753
Father in-law with PC, 62 years old, into 2nd month of HT, based in China. Gleason 8 (5+3), prostate size fairly normal (slight enlargement), PSA 24 prior to HT (currently unknown). MRI suggests cancer contained within the gland, but by no means a guarantee. Doctor's stage appraisal: T2c - T3a.
The current dilemma:
China doesn't have advanced enough radiotherapy to trust it as a primary option. Therefore we have decided to use it as a backup to surgery. The surgery has been decided on based on the staging ambiguity (T2c - T3a). In the event the PC is contained within the gland then the surgery will hopefully excise all of it. If not, then surgery still offers the ability to cut away anything outside the perimeter, with radiotherapy as a backup. We are aware of and have taken into account all the side effects of surgery.
At the moment we have two options on the table:
1: A highly experienced expert surgeon in Shanghai who favours open surgery to deal with PC.
2: A highly experienced Beijing surgeon and professor who is an expert in Laparoscopic surgery (and teaches other hospitals and doctors around the country about how to perform this method).
Note: Robot surgery is not an option here.
The problem is, on Chinese PC support groups similar to this one, 90% of people suggest open surgery as the better option for G8 patients. This is partly due to a Chinese belief that open surgery is cleaner and easier for the doctor to "catch all", whereas the obstacle of working through holes via Laparoscopic is less efficient.
These are people who have dealt with PC themselves or within their families before, so their recommendations aren't given lightly - but they have a very strong lean toward open surgery. That said, not all people here do open surgery, and many on the group have had Laparoscopic and are doing well.
Money is an issue for anyone facing disease in China. Going to Shanghai for open surgery is hugely expensive, whereas the Beijing surgeon will actually come to us to perform Laparoscopic surgery. It's a saving of approx 60%.
We're not factoring in money as a method of deciding, but if it's true that the difference between Laparoscopic and open surgery methods is genuinely negligible, then it would become an important factor. From everything we've read from western studies, Laparoscopic is actually favoured over open surgery these days, and there is no evidence to suggest it's less efficient. This is conflicting with the Chinese consensus and giving us a headache!
We're aware recovery time with Laparoscopic is much better than with open too, and in the event we opt for this, we would have money left over to consider things like radiation salvage treatment etc. There's also been some suggestion that open is potentially dangerous to people over 60 due to trauma. Potentially life shortening?
So I'm really (really!) interested in your thoughts and advice on this! Literally the only thing swaying us on open surgery is the mass belief and recommendation of Chinese people with PC experience that open is more efficient, and more necessary for a Gleason 8 patient.
Based on your understanding and experiences with G8 or above, open and laparoscopic surgeries, do you feel there are any advantages or disadvantages of note here?
Thank you again for your support and advice.
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