Decisions in Operating Room

Bill_in_Portland

Ive decided to go with RP using Davinci as most conservative route. Surgeon is well skilled, using Davinci a couple times a week since 2004. My question, are there decisions the surgeon makes in operating room or is the surgical plan strictly based on biopsy and staging preop? My biopsy showed Gleason score 4+3 in 2 out of 12, 3+4 in 2 out of 12, and one 3+3 in 1 out of 12. Perineural invasion not identified in all 5 but Partin Tables had 35% extraprostatic extension, 7% seminal vesicle involvement, and 3% lymph node involvement.

Max Former Hodgkins Stage 3

Protocols

Bill,

I know there is relief in making the treatment choice, regardless of which is decided upon.  At some point the general has to make the call and send the troops in....

Like 95% here, I have no medical training, but have read a lot, and spoken with my own surgeon and prospective Radiation Oncologist.  DaVinci obviously involves removal of the gland, with as much nerve-sparing as possible; the surgeon will be able to tell you how successful the nerve sparing was, or was not.  It virtually always also involves removal of the seminal vesicles. There is never a good reason to leave them in. Get a guarantee from your surgeon that they will be removed.

The gland should be analyzed by a pathologist after removal, but before the surgeon closes.  This will give the surgeon a sense of how much farther he should go, either in shaving margins, or farming (removing) lymph nodes.  The available pre-op results (Gleason, PSAs, PSA vector, bone scan (if performed), MRI or other imaging (if performed) give a fair idea of what will be encountered, but guarantee nothing.  Any decent surgeon will have flexibility and adjust as necessary should he discover something suspicious. 

Ask him what you asked us. And besides the seminal vesicles point, also ask him sppecifically how many nodes he plans to remove, and what would cause him to take more.   This may not be a lot of advice, but I have read testimonials here from men who said in DaVinci the vesicles were not taken.  The questions are free.

max

Will Doran

I Agree 100%

Bill,

I'm sorry you have to be making these desisions.  

 I agree 100% with everything Max said.  As Max said 95% of us are not doctors and can only make suggestions from what we have experienced.

In my case, I was in surgery for 5 1/2 hours.  Some of that was becasue of a birth defect (Prostate was adhered to my bladder)  and some was from trying to work through the mesh from an abdominal hernia repair.  They had to put an incision in my bladder to get the prostate removed.  Also when it was decided to remove the seminal vesicles and the lymph nodes in my groin area they had trouble finding the lymph nodes because of my muscle development in my thighs.  I was a hard core road cyclist.  They got to the lymph nodes in the right side, and then had the robot do a mirror image and went straight to the nodes in the left side.  Good thing they did remove the  nodes, because there was a very small spot in one lymph node in the right side.  That spot was so small that it hadn't shown up in my MRI's (with contrast imaging).  So, ask how much other work will be done as the surgery progresses.  

Make sure you understand completely what follow up treatments you might need.  I was a PSA of 69 when diagnosed, with a gleason of 3+4-7. I had no symptoms prior to diagnosis.   Post surgery pathology showed 40% involvment of prostate.  We were thinking it was more.  I was then given Lupron and was on that for 2 years and had 8 weeks of radiation to the prostate cavity area.  This was to clean up anything that might have been missed.  At this point I am 4 years post diagnosis and my PSA had stayed at <0.010.  I've been off the Lupron for 18 + months at this point and my PSA has come up a tiny bit.  But it's still below 1.0.  I have to have blood work done tomorrow (9/5) to check my PSA and a bunch of other stuff.  If the PSA has come up more, then we will decided what is next.  Last time I was to my Doctor, he was talking that we could do either intermitent Lupron or some other medication in pill form to bring my testosterone down some.   They had my Testosterone down to 17 at it's lowest.  Now it is back up to "normal" for me.  I'm feeling great, and hope my PSA has settled in below 1.  That is what my doctor said happens many times.  But if not, then back to the "Land of Hot Flashes".

As with all of this our cases are all different.  Make sure and ask what your limitations are post surgery for your recovery.  Do as you doctor suggests.  Prior to your surgery, you might want to start working on Kegels to help with bladder control post surgery.  You can not do kegels when you have a catheter.  You will have a catheter for a period post surgery.  The time for that will depend on you doctor.  I got mine taken out 2 days before Christmas 2013.  Great Christmas Present.  

Hang In There

Best wishes, and know you can ask anything here.  We'll answer as much as we can, according to what we have experienced.

Love, Peace and God Bless

Will