Who does the cutting

Samsungtech1 said:

Souvenr
Dave,
Normally your presiding doctor willdo the op. just ask him. Donot worry about offending him. Better to know beforehand. Just for refresh what was your gleason, and PSA? Is it contained? If you were in the desert then you are young. IMHO I would seriously consider cyberknife. Even if it is agressive, if you are young, I believe that from what I have learned on this site that RPP is a bad decision. Mine was too severe for input here,but if you read the posts uphere not many who had cyberknife suffer from incontinence, or ED.

Is your doc a Urologist? If so get an Opinion from a radiation oncologist. You only get one shot. You have to get it right. Dr. Can just sat it had spread to nerves, etc. how would youknow?

Hopefully you sharpened the knife before you gave it to him. Confidence in your sharpening ability should get you through this.

Good luck,

Mike

Doc
Mike,
Brief history:
Age 62
Diagnosed in 1999 - single focus of adenocarcinoma, too few cells to Gleason, PSA was 8.2
1999 - 2012 - five negative biopsies, only found PIN, PSA bouncing all around, never < 7
Last biopsy in Sept, PSA 7, 2 cores positive, one with 5%, one with 50%, both Gleason 7 (3+2)
My doc is urologist and oncologist as well as a surgeon. He is head of the Urology Oncology department at the VA Hospital.

I considered every possible treatment and had a heck of a time making up my mind. I created a table and compared Surgery vs Radiation, Open vs Robotic/Laparoscopic, Internal vs External (radiation), High Dose Rate vs Low Dose Rate (Brachy). In the table I listed all the benefits of that method and had a column that listed the benefits importance (to me). Open surgery was clearly the winner. Granted the importance was very subjective but it was only a decision aid for my surgery.

Thanks for your comments!!!!

David

Swingshiftworker said:

Interesting . . .
It's interesting how people will make different decisions given basically the same data.

I and others here with pretty similar stats opted for various forms of radiation instead of surgery because of the greater risk of ED and incontinence, as well as other potential consequences, following surgery.

You chose the opposite. Actually, you chose open surgery which is even more risky (or at least more traumatic on the body) than robotic. However, there are those that think that open better enables the surgeon to properly dissect the prostate and "see" any cancerous tissue that may adjoin the prostate that is not as apparent when robotic surgery is used, which I'm guessing is at least one reason you chose open over robotic.

I got the impression that you had already made your mind up about having surgery done in the 1st post, which is why I didn't give you my "dangers" of surgery and the CyperKnife and other radiation options "pitch" -- the one I give to early stage PCa candidates who are asking for info before making a choice. You are obviously not in that camp.

I respect your right to make whatever decision that makes the most sense to you and I hope the choice you've made is successful.

Yep
Mike,
The tactile sense is one reason I wanted open vs robptic. Another reason is a surgeon has to learn to do it the old fashion way first and then they learn robotics. My thought is the old fashion way is his "first language" so to speak and probably what he knows best. Two reasons surgery won was the mode definitive method of determining failure, i.e., if your PSA >.02 you're screwed and you know it. The other reason was you have a more concrete answer of the extent of the cancer after surgery with margin analysis and clinical staging. I am more worried about incontinence than impotence - I pee more often than I have sex (unfortunately). There is a fairly good solution to incontinence if I have that. Some of the reason I shied away from radiation was they all listed rectal problems as a possibility - more so than in surgery. Also I have read from multiple sources that any side effects with radiation tend to get worse over time whereas they tend to get better with time after surgery. If it was just me to be concerned with I would never have decided to have treatment but I had to consider other people in the equation - wife.

Thanks again for the discussion. I have tried to talk to a few people and finally wrote a note that is lying on my desk at work. It says "No one really gives a sh*t. Don't waste your breath". I have since quit talking to anyone about it unless absolutely necessary (to schedule leave, etc.).

Thanks again.

David

VascodaGama said:

Not one doctor but a Team
David Surgeries are not done by one doctor alone. The main surgeon will be the one “cutting” if you request for that. Just ask about the team and about their experience.

In my case, I inquired before surgery and had to sign an agreement relieving the principal doctor (my urologist) from any wrong doings. His name was described in the agreement as the surgeon.
The team that performed my surgery was introduced to me before the operation and was composed by 5 specialists with my urologist (surgeon) in command of the cutting. The youngest doctor (probably a pupil) was in charge of the stitching and another one was in charge of vital signs. The second surgeon in command did nothing but assisted in the operation the whole time. Someone was in charge of “vacuum” the area in detail.
After RP the same team used to visit my room everyday for checking. The second in command was a ED specialist and later become my adviser.
Additionally the team had two professional anaesthesiologists, a physician and a nurse, and the usually required number of helpers (nurses). I was informed of the above by the yong doctor.


I think that you can trust what is agreed before the "cutting".

Hope for the best.

VGama

Thanks
VG,
Thanks. I realize there are lots of folks involved but I am mainly concerned with the cuting and stitching. You can bet I will have a discussion about this before the operaation!

Thanks again. Best of luck to you!!!

David

Swingshiftworker said:

Just Ask
If it's a "teaching" hospital, all you can do is ask who is actually going to perform the surgery and, if you don't like it, ask for a change or, if they refuse, go elsewhere if possible.

Talked to the Doc
Thank you all for you responses. I have been talking to my doc (via e-mail) and he explained tat he would be the attending physician and aother senior resident would be assisting. He also encouraged me to consider radiation. I was impressed that a surgeon would suggest considering radiation. He is a very honest person in my opinion. I have an appointment with him on January 10 and I am going to discuss staying on active surveilance for a while. We'll see what he says.

Thanks again for all your comments.

Have a great holiday!!!

David