Prostate Cancer - Looking for people who have had the Da Vinci Surgery with Dr. Vipul Patel
Good day. After a PSA investigations, I have discovered that I have prostate cancer. I have made the following investigations:
- Fusion Biopsy in Milan, the result was 7 (positive)
- A PET Colina Test which could not reveal the areas of the disease, only a bit in the adenopathy area of the pelvis.
I am 52 years old and I would like to minimize any complications whilst preventing any impotence and incontinence. After personal research, I have discovered that Dr. Vipul Patel seems to be the go-to surgeon for the robotic surgery with Da Vinci, which is supposed to be minimally invasive and nerve-sparring which sounds exactly like what I need.
If there are people out there that have had this surgery and would be up to give me advice to point me in the right direction, I would be grateful. Thanks.
Comments
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Nerve sparing surgery
In my case, nerve sparring surgery was meaningless.
It left me 100 % with ED which I never recovered to the point of any functionality.
Was 51 y/o at time of surgery and with no other medical problems, very healthy with no signs of ED before RP and also physically very fit.
MK
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Minimally Invasive
I would not call this surgery minimally invasive. I am assuming you have a Radiologist Onocologist.
What do they say? You need to be asking a lot more questions. Side effects from surgery pretty much urethra shortening;incontinence; erectile dsyfunction. Below is my surgical procedure.
They basically have to go through your core to get to the gland; seminal vesicles, and lymph nodes.
The patient was taken to the operating room where he was placed under general
anesthesia in the supine position. He was then placed in low lithotomy position,
prepped and draped in the usual manner for a robotically-assisted radical prostatectomy.
The abdomen was entered through a periumbilical incision and a double balloon 12 mm port was placed here. The abdomen was insufflated. The other five port sites were marked off and placed under direct laparoscopic vision.
The robot was docked and the procedure was begun from the console.We began the procedure by releasing large bowel adhesions on the left side of the
abdomen. This was done with cold sharp dissection. The space of Retzius was then
developed by dividing the median umbilical ligaments bilaterally as well as the
urachus. Both vas were divided as they entered through the internal ring. Once the
space of Retzius was fully developed, the endopelvic fascia was opened close to the
prostate. The dorsal vein complex was suture ligated with 0 Vicryl over the base
of the gland and then divided with the bipolar cautery over the bladder neck.A bilateral pelvic lymph node dissection was then done (obturator and hypogastric)
including deep pelvic nodes on the left side. All longitudinal lymphatics were
clipped or sealed.Bladder neck was dissected out anatomically and divided. We went wide anteriorly and
obtained a negative frozen section here.Seminal vesicles and vas deferens were then identified, mobilized, dissected up and
elevated. Denonvilliers fascia was then opened posteriorly and I dissected between
the layers of Denonvilliers fascia all the way to the apex. The vascular pedicles
to the prostate were taken with the ENSEAL device and large clips as we got close tothe neurovascular bundles. The bundles were well preserved bilaterally. Small
metal clips were used as we worked under the posterior aspect of the prostate. An
element of high lateral release was done, but I was not aggressive about getting tooclose to this capsule. I specifically went wide at the left apex to avoid capsular
incision. As I dissected along to the apex I noted excellent neurovascular bundle
sparing bilaterally.The dorsal vein complex was then isolated and taken with the ENSEAL device. The DVC
was oversewn with a V-lock suture. The urethra was divided with cold sharp
dissection. The prostate was put into a specimen bag.The anastomosis was then done in a two layer fashion using a Rocco suture to
approximate the urethra posteriorly. This was a single horizontal mattress.Continuous 3-0 Monocryl was then used employing a Quill suture to achieve a
watertight anastomosis. The bladder neck was tapered with 2-0 Vicryl. The
anastomosis was sealed with Eviseal and stented with an 18-French Foley catheter. ABlake drain was placed in the abdomen through the fourth arm port. This was
secured with silk.Marcaine was used to block all port sites.The right-sided 15 mm port was closed at the fascial level with 2-0 Vicryl. The
prostate was removed in its bag through the umbilical port. The umbilical port site
was closed with continuous #1 PDS in the fascia. All skin incisions were closed with Monocryl and Dermabond.The patient was awakened and taken to the recovery room in good condition. Estimated blood loss for the case was 100 mL. Sponge and needle counts were correct x 2. .
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Not like having a tooth out
Hi there,
This is not trivial surgery.
About 95% will recover something close to complete continence after one year, the rest will leak somewhere between lightly and badly enough to need further surgical intervention.
For men in their fifties recovering the ability to have an erection is about 60%, older men do a lot worse.
Some men can have OK orgasms after the event, some others just have non events.
It can be a good answer to a difficult situation but it is not without it's problems and downsides.
Best wishes,
Georges0 -
If I were you
If I were you, at your age, I would go and see a Radiologist Onocologist and see what they say. Also, you need to know if in their opinion is the cancer contained locally to the prostate? I am 68; Gleason 4+3=7; RARP 3/20/2018. I am fully continent; I am about 75% recovered from ED isuues. My PSA at this time is undetectable. My decision was based on what the doctors told me (Radiologist and Surgeon). I elected surgery based on their recommendation. In retrospect, surgery is permanent. You probably need to be a little more forthcoming in the data you are providing (history of PSA; Gleason; DRE results, any other health issues). The final decision comes down to you. If you are leaning towards the surgery or RT; HT you need to make sure you get in the best shape that you can possibly be in.
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Other that that can you putlighterwood67 said:Minimally Invasive
I would not call this surgery minimally invasive. I am assuming you have a Radiologist Onocologist.
What do they say? You need to be asking a lot more questions. Side effects from surgery pretty much urethra shortening;incontinence; erectile dsyfunction. Below is my surgical procedure.
They basically have to go through your core to get to the gland; seminal vesicles, and lymph nodes.
The patient was taken to the operating room where he was placed under general
anesthesia in the supine position. He was then placed in low lithotomy position,
prepped and draped in the usual manner for a robotically-assisted radical prostatectomy.
The abdomen was entered through a periumbilical incision and a double balloon 12 mm port was placed here. The abdomen was insufflated. The other five port sites were marked off and placed under direct laparoscopic vision.
The robot was docked and the procedure was begun from the console.We began the procedure by releasing large bowel adhesions on the left side of the
abdomen. This was done with cold sharp dissection. The space of Retzius was then
developed by dividing the median umbilical ligaments bilaterally as well as the
urachus. Both vas were divided as they entered through the internal ring. Once the
space of Retzius was fully developed, the endopelvic fascia was opened close to the
prostate. The dorsal vein complex was suture ligated with 0 Vicryl over the base
of the gland and then divided with the bipolar cautery over the bladder neck.A bilateral pelvic lymph node dissection was then done (obturator and hypogastric)
including deep pelvic nodes on the left side. All longitudinal lymphatics were
clipped or sealed.Bladder neck was dissected out anatomically and divided. We went wide anteriorly and
obtained a negative frozen section here.Seminal vesicles and vas deferens were then identified, mobilized, dissected up and
elevated. Denonvilliers fascia was then opened posteriorly and I dissected between
the layers of Denonvilliers fascia all the way to the apex. The vascular pedicles
to the prostate were taken with the ENSEAL device and large clips as we got close tothe neurovascular bundles. The bundles were well preserved bilaterally. Small
metal clips were used as we worked under the posterior aspect of the prostate. An
element of high lateral release was done, but I was not aggressive about getting tooclose to this capsule. I specifically went wide at the left apex to avoid capsular
incision. As I dissected along to the apex I noted excellent neurovascular bundle
sparing bilaterally.The dorsal vein complex was then isolated and taken with the ENSEAL device. The DVC
was oversewn with a V-lock suture. The urethra was divided with cold sharp
dissection. The prostate was put into a specimen bag.The anastomosis was then done in a two layer fashion using a Rocco suture to
approximate the urethra posteriorly. This was a single horizontal mattress.Continuous 3-0 Monocryl was then used employing a Quill suture to achieve a
watertight anastomosis. The bladder neck was tapered with 2-0 Vicryl. The
anastomosis was sealed with Eviseal and stented with an 18-French Foley catheter. ABlake drain was placed in the abdomen through the fourth arm port. This was
secured with silk.Marcaine was used to block all port sites.The right-sided 15 mm port was closed at the fascial level with 2-0 Vicryl. The
prostate was removed in its bag through the umbilical port. The umbilical port site
was closed with continuous #1 PDS in the fascia. All skin incisions were closed with Monocryl and Dermabond.The patient was awakened and taken to the recovery room in good condition. Estimated blood loss for the case was 100 mL. Sponge and needle counts were correct x 2. .
Other that that can you put that in a way it can be understood. But I do agree with you that there is nothing minimally invasive about this operation.
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I just had this surgery three
I just had this surgery three months ago and it was apiece of cakesix small incienses over night in the hospital two weeks of recover at home then back to work.I had the surgery because I had agleason score of 9 and my doctor said that I tried radiation and it didnot work that it would be very very hard to remove the prostate then the doctors found a tumor on my kidney so if it has to come this will be the only type of operation I would ever consider
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Thank you for all your
Thank you for all your responses and for your wishes. I would like to apologize for mistyping my age, it's actually 48. The last PSA score was 9.46, the Gleason score was 3+4. There is no cancer growth outside of the prostate as far as the doctors could tell, the biopsy has been given. I also have a few ganglions outside of the prostate which should, supposedly, be removed as they say. In the DRE examination, nothing was seen or felt.
I am researching continously, however it is a bit difficult to approximate my chances of success since many posts are more than 10 years old and I thought there would be some medical advancements done since that period that would increase my chances of keeping the impotence and incontinence away.
@dthehill, could you tell me what doctor you had and how you are doing recovery-wise? Thank you.
@georges calvez, thank you for more general details about this surgery, I am truly hoping for the best and that's why after hearing about this doctor I thought my best chances would be with him
@lighterwood67, no major health issues otherwise, I am trying to keep myself physically fit as well.
If not for Vipul Patel, is there anybody that can recommend me good clinics for this issue in Europe?
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PC Containedinfallibleremission said:Thank you for all your
Thank you for all your responses and for your wishes. I would like to apologize for mistyping my age, it's actually 48. The last PSA score was 9.46, the Gleason score was 3+4. There is no cancer growth outside of the prostate as far as the doctors could tell, the biopsy has been given. I also have a few ganglions outside of the prostate which should, supposedly, be removed as they say. In the DRE examination, nothing was seen or felt.
I am researching continously, however it is a bit difficult to approximate my chances of success since many posts are more than 10 years old and I thought there would be some medical advancements done since that period that would increase my chances of keeping the impotence and incontinence away.
@dthehill, could you tell me what doctor you had and how you are doing recovery-wise? Thank you.
@georges calvez, thank you for more general details about this surgery, I am truly hoping for the best and that's why after hearing about this doctor I thought my best chances would be with him
@lighterwood67, no major health issues otherwise, I am trying to keep myself physically fit as well.
If not for Vipul Patel, is there anybody that can recommend me good clinics for this issue in Europe?
My doctors told me that my best option at the time was to remove the prostate, if the cancer is local and contained to the prostate. If the cancer was not contained they would not have removed the prostate. In fact, the surgeon biopsied a section of concern during my surgery to ensure to him that the cancer had not escaped. The biopsy came back negative, so he proceeded with the surgery. My understanding was if the cancer has escaped the prostate, no need to remove the prostate. I was quoted a 10% incontinence rate and a 33% chance of permanent erectile dysfunction. I am 20 years older than you. Like a lot of the folks on this site the worse part was the catheter. I agree. I am pretty much 100 % continent. However, my wife and I have just started doing partner yoga. In some positions, I feel like I could lose continence, but when I feel down there I am dry. The ED portion is a work in progress. I have not recovered totally from this. I still have some pain in the lower surgery area (not constant, just sometimes). Other than that I feel fine; I am very active. As far as making a decision, I have read on this site where people have analyzed until they paralyze. The main thing is do your homework; it is your decision; know what the data is telling you. As far as I am concerned, this site has a lot of information. We are the results of what our medical technology has to launch against this cancer. And believe me, we are speaking from experience. So best of luck to you on your journey.
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Robotic surgery
Hi,
I‘m not a pro surgery guy pushing that procedure but I had robotic Prostate removal almost 5 yrs. ago and would do it again. I have regained my erectile powers and still have a drip or two of leakage every now & then. I sleep very well at night knowing my cancerous prostate was removed, hopefully my cancer won’t return. Other people have done external beam radiation with great results also so it’s up to you. For whatever procedure you choose pick the best doctors and state of the art facilities you can find. If you do choose robotic surgery you will have urine leakage and ED for a while but hopefully it will improve and reduce over months & possibly a couple of years. For whatever reasons some men recover better than others, just hope your in the better category. Radiation side effects can also swing from almost nothing to severe . I don't know of anyone who has not had some kind of “damage” from any of the common treatments so do your homework and be at peace with yourself when the procedure is done. It’s not an easy decision but if you educate yourself you should reach a point and say, OK I’ve researched this and this is what I want to do. Good luck on your decision.
Dave 3+4
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This is an old thread so my
This is an old thread so my post may be moot, but I’m a proponent of doing a lot of research before deciding on prostate cancer treatment. First, do you really need treatment right now? What’s your Gleason score? If it’s a six you need to seriously consider active surveillance. The side effects of a prostatectomy are no joke. Have you considered radiation options, including brachytherapy? I’m not saying that’s what you should choose, but if you haven’t looked into it you haven’t done your homework. Prostate cancer is usually a very slow moving cancer. You probably have plenty of time to research this.
That said, Dr. Patel is a well known rock star surgeon. Just don’t rush into anything. Check out Healingwell.com. It’s a great source of support and information. Good luck and good health.
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Had DaVinci nearly 2 years
Had DaVinci nearly 2 years ago in Mass. at Lahey Hospital. In the words of the surgeon "the horse hasn't left the barn yet but he was sticking his head out and looking around". Prostate and surrounding tissue removed. I still have some very light stress incontinence and am loosing some gut which is making that go away. No erections (yet) but orgasms as good a before but dry. More than one way to skin a cat.Bottom line is that I have had to make a few adjustments but they are well worth it. Still alive and still showing undetectible PSA. It's no picnic , for sure, but beats the alternative.
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Great news
Hi Jeffman,
Good luck on many more undetectables. Keep up the positive attitude I do believe it helps in the healing.
Dave 3+4
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I return to this forum, post
I return to this forum, post-robotic prostatectomy. My recovery is going well, with incontinence being fixed and impotence getting better and better.
The clinic where I had my surgery done recommended radiation therapy with hormone therapy (androgen deprivation) concurrently. Is there anyone that has followed any alternative methods to the ones stated above? Hormonal therapy brings a lot of side effects by itself and it isn't desirable, so I am looking for any methods or medications that don't involve it while managing to keep the PSA levels down. Thank you.
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Great post dtheHilldthehill said:I just had this surgery three
I just had this surgery three months ago and it was apiece of cakesix small incienses over night in the hospital two weeks of recover at home then back to work.I had the surgery because I had agleason score of 9 and my doctor said that I tried radiation and it didnot work that it would be very very hard to remove the prostate then the doctors found a tumor on my kidney so if it has to come this will be the only type of operation I would ever consider
now these are the threads one that is choosing surgery should hear ..THE NORM ...not the horror stories ...I don’t think anyone needs to hear a blow by blow description of every little thing that was done during surgery .that just my thoughts . For most people it is easy and a piece of cake I’m sure .just remember only .5% of men that have treatment post here and that 70% or more never have a reoccurance.i put it like this .i an bitter and upset I didn’t do surgery ..that’s my fault ..if I had the chance again I would do surgery in a second ...do we know how many cancers leave people a mess ..disfigured .cant talk .cant eat .are going to die ...prostate cancer is cancer yes but when caught early has over a 70% chance of no reoccurance.my sister in law a 2 time breast cancer survivor .losr her breast’s the second time around and damn neat died she had 2 rounds of radiation and 2 rounds of chemo ...she as painful heartburn painfull neuropathy no breasts scars and take 20 pills a day and is healthy and happy .and us men are worried about a hardon and maybe leaking a bit .seems like a small price to pay for beating cancer ...sure things can happen BUT THATS NOT THE USUAL WE NEED TO TALK MORE ABOUT THE USUAL THINGS THAT HAPPEN ..sorry but this forum did spook me when I was trying to decide .lets face it I bet a lot of men that post here are worried and probab are a bit anxious otherwise they wouldn’t post they would just go to drs and do as they say ..if I did that I wouldn’t be in the spot I’m i now ..like I said just my thoughts ..
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Sounds goodinfallibleremission said:I return to this forum, post
I return to this forum, post-robotic prostatectomy. My recovery is going well, with incontinence being fixed and impotence getting better and better.
The clinic where I had my surgery done recommended radiation therapy with hormone therapy (androgen deprivation) concurrently. Is there anyone that has followed any alternative methods to the ones stated above? Hormonal therapy brings a lot of side effects by itself and it isn't desirable, so I am looking for any methods or medications that don't involve it while managing to keep the PSA levels down. Thank you.
Sounds like you are on the mend. Do have a question: Are you saying you just had a RARP (robot assisted radical prostatectomy and now you are going to RT (radiation therapy) and ADT? Anyway good luck on your journey.
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Maybegk2469 said:Other that that can you put
Other that that can you put that in a way it can be understood. But I do agree with you that there is nothing minimally invasive about this operation.
Six incisions, then basically have to go through your bofy (front to back) to get to the prostate; seminal vesicles, and lymph nodes. This is about as simple as I can put it. Hope this help.
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Perineal prostatectomy
Hi there,
This is a prostatectomy going in via the perineum, the area between the anus and the back of the scrotum but it is instructive in how a prostatectomy is performed and what is removed or not.
There are pictures, lots of them, so not for the squeamish!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3921814/
There is also a good discussion of the various techniques.
Best wishes,
Georges0 -
ADTinfallibleremission said:I return to this forum, post
I return to this forum, post-robotic prostatectomy. My recovery is going well, with incontinence being fixed and impotence getting better and better.
The clinic where I had my surgery done recommended radiation therapy with hormone therapy (androgen deprivation) concurrently. Is there anyone that has followed any alternative methods to the ones stated above? Hormonal therapy brings a lot of side effects by itself and it isn't desirable, so I am looking for any methods or medications that don't involve it while managing to keep the PSA levels down. Thank you.
As if for now I don't know any alternative method, but its good you said NO to Androgen Deprivation Therapy (ADT). As a recent study shows people on ADT were 20 percent more likely to suffer from Dementia and 14 percent increased risk of Alzheimer’s disease.
0
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