Laparoscopic or open surgery? - G8 (5+3)

Pathfinder,

I am unaware of any "rules" regarding beginning new threads.

Your post here today appears IDENTICAL to one you submitted on July 22 ("Need Your Advice on Surgery Types").  The issues you share regarding oncological services in China, and the types of surgical delivery available are identical also.  And the financial issues: Identical.

Of course it is also OK to resubmit an identical set of questions, I just found it odd.  Do recall that you got numerous replies to your July 22 enquirey ?

max

Here's a link to a recently posted article that refers to an Australian study:

https://prostatecancerinfolink.net/2016/07/27/ralp-vs-orp-data-from-a-randomized-phase-iii-clinical-trial/

Good luck!!

Timon

Pathfinder,

In medicine, and especially cancer treatment, there are no "definitive differences."  There are studies, statistical analyses, the opinions of experts.  If you are waiting on "definitive" or irrefuatble reasons to choose one form of surgery over the other, it will never happen.

Both are sound, established ways of doing RPt. Both have high curative rates.  Several responders have recommended using the more established surgeon.  I agree with them.

Beyond that, there is not much to say.   Cancer treatments have no guarantees. They do not come with a warranty.  If treatment fails, no one gets their money back.  But this is true of life in all areas.

In the history of philosophy there is a story from around 1350 AD, entitled Buridan's ****  (it also goes by the name of The Philosophical Donkey).

There are slightly differning versions of this, but the one I was taught relates that a wise donkey was tied equal distances between two piles of hay. They are identical, both are fresh, healthful. The donkey always chooses carefully, and looks back and forth, back and forth. He cannot decide which is best; he agonizes over the decision.

Eventually, he starves to death, unable to decide.  Either pile would have kept him alive and well.

max

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Pathfinder said:

"In many cases a PC patient in China will stay with whatever hospital they were in when the PC was discovered, never question anything at all, and end up having whatever surgery is offered in the exact same hospital without being aware of the risks or severity of their condition. 

It's only the proactive children who tend to get online and start making discoveries and reaching out to others for guidance in decision making."

Actually, the situation is much the same in the US.  The burden of finding out about the available therapies for PCa is entirely up to the patient (or his family).  Not very much help is given by the treating urologists and only the most proactive patients (or families) will discover much of what you have learned from us here.   And, often men simply decide to choose whatever therapies that are recommended to them by their doctors without doing any further research on their own.

Here's my story which is an example of the kinds of struggles PCa patients in the US also have to endure to get the treatment they want:

I was with Kaiser in Northern CA and was given only 2 choices for treatment -- surgery (open or laproscopic) or brachytherapy -- when my PCa was discovered by biopsy in Jan 2010.  I immediately got online to do research on PCa and the 2 treatments offered to me and I did NOT like what I read.  Further research over the following 3 months revealed other alternatives that I considered better -- particularly CyberKnife, which I eventually chose.  However, I then had to find a site that offered CK treatment for PCA.  Fortunately, it was offered at UCSF in San Francisco where I lived. 

Then, I had to figure out how to pay for it.  I was enrolled in a group health plan that offered only a few providers other than Kaiser.  Fortunately, Blue Shield was one of the other providers  and just recently in the fall of 2015 changed their policy on CyberKnife -- deciding that it was then no longer an "experimental" treatment and from then on eligible for medical reimbursement.  Having discovered this, I then had to make the change in my medical group coverage during what's called "open enrollment" (which only occurs once a year) to change from Kaiser to Blue Shield so that I could switch from Kaiser to Blue Shield to get CK treatment at UCSF.  Fortunately, the open enrollment period was in April and became effective in July.  So, I was then able to get CK treatment at UCSF in September 2010. 

It was a struggle but it was the best decision I could have made.  The treatment was a complete success and I have experienced no side effects what so ever - no ED or incontinence or any other complications.  I recently passed the 5 year "cure" threshold and my PSA level continues to drop after a worrisome delay and bounce.  So, I am a very healthy and happy cancer survivor.

I wish your father-in-law the same good fortune,

Pathfinder said: "We also have a Cyberknife clinic on our doorstep, but have heard mixed things about it. Would you mind me asking what your gleason/PSA was when you had CK surgery?"

I was rated Gleason 6 with a PSA of less than 10 when I was diagnoses w/PCa, which is "ideal" (if there is such a thing) for CK treatment, because the cancer caught early and was still confined to the prostate. 

CK has been used for patients w/Gleason 6 because there is confidence that the cancer is confined to the prostate.   CK and any other method of radiation can be used for men rated at Gleason 7 or 8 but there has to be a high degree of confidence that the prostate is confined to the prostate capsule and/or to a specifically identified location.

When my PSA was erratic and bounced about 3 years after treatment, I received an MRSI (magnetic resonance spectrographic imaging) scan that detected the location of choline (which is a marker for cancer) using a Tesla magnetic coil inserted in my rectum.  This scan revealed that there was NO cancer remaining in my prostate or anywhere near by.  The same test can be used to determine the existenence and exact location of prostate cancer and its spread locally.  If you still want to opt for CK, I'd suggest you get this (or any similiarly effective) scan to determine whether or not CK would be effective in treating the existant cancer.

BTW, for those men who undergo laparoscopic surgery and later find that they require follow-up radiation treatment, CK is seldom used.  Instead, IMRT or IGRT are used to treat the prostate bed and adjoining areas because the object is not to deliver the radiation to a precise area (as CK does) but to a larger area where cancer may or may not be present.  It's kind of a water hose approach - spay and hope for the best -- because they really don't know exactly where the cancer is located.   With open surgery, there would be less (if not any) doubt about the location of any cancer that has spread.