Husband diagnosed as intermediary unfavorable

Lori,

Having access to MD Anderson is outstanding as they will also have the latest technology and Surgeons involved in the latest techniques regarding prostate surgery. You will undoubtedly have already read about the DaVinci Robotic Laparoscopic Surgery that would likely be used if your husband had a Radical Prostatectomy. This surgery is still done primarily using the DaVinci Multi-port robotic system. First you want to find a surgeon using the latest DaVinci Single-port system. This is just one single incision versus three or four. This alone counts for less blood loss during surgery, a quicker healing and only one small scar. I even went home the same day of the surgery. You have also heard about I am sure nerve sparing. Their are two additional parts of the latest surgery technique, Retzius sparing and the sparing of the Puboprostatic ligament.

In a certain technique which not all Surgeon’s are trained in, the Surgeon is able to spare the puboprostatic ligament during robotic prostatectomy. In essence my Surgeon said this technique keeps the continence mechanism intact and it also helps maintain urethral length. A longer urethra allows for more control in the release of urine reducing the likelihood of incontinence and also the Puboprostatic ligament provides support to the urethra in keeping it in its position. He further does Retzius sparing of the tissue between the bladder and the prostate which further helps with continence. Another benefit of sparing the Puboprostatic ligament is the less likelihood the patient will see any reduction in their penile size that many patients report by either perception of it or a slight amount as its drawn in. 

Also having surgery at a major hospital the surgeon should as my Surgeon did, while I was in surgery have the removed prostate tissue sent to check on clear margins to the hospital pathology for staining to see whether I had the clear margins. This clearly delays the closing of the surgery and in my case my margins did come back positive which surprised the surgeon because based on the hundreds of tissue he visually has seen in surgery which he did not see anything unusual and the PET scan saying it was contained within the prostate really was a surprise. Many Surgeons do not bother with this based on the PSMA Pet saying it is all contained and at your post surgery appointment they give you the disappointing news that you have positive margin. Well my Surgeon was then able to go back in for 2 more hours delicately continuing nerve sparing and cut for more margin and at my post surgery appointment I was told the final margin was then negative. Without that additional step of my tissue going to pathology I would have been told at my post surgery appointment that unfortunately you have positive margin as many are. His later afternoon surgery got delayed by more than two hours by the surprised breeching of the capsule by my cancer, but still knowing he had the additional afternoon surgery, he was focused on me and not his afternoon surgery.

Immediately upon my catheter coming out I was continent and have minimal ED side effects 90 days out with more improvement expected. I was up walking immediately after surgery and did not even spend that night after surgery in the hospital. Within two weeks I was back to normal activities like driving and getting out and around and traveling. Although my catheter was in for 10 days that was due to a 3 day holiday period but that allowed my surgery to continue to heal. 

He also explained he operates in reverse as being upside down, but not in that sense, but from how you are approached in Surgery. Most robotic laparoscopic Radical Prostatectomies are still as I said done with a multi port DaVinci system with the robotic system placed between your legs which are up in stirrups where the Doctor operates and at least three maybe four incisions are made below your belly button. In using the Single port he places it above your head where he is standing looking down your body towards your feet and you are basically laid flat, no feet up. His one incision is above the belly button and this approach towards your prostate is how he is able to spare the ligament. This is a newer technique but worth trying to find someone well trained and experienced in it which I would imagine MD Anderson would have. This is if your husband decides to go the surgery route. I’am sure others will be able to share their positive Radiation treatments and your final decision on your treatment course will be a totality of your husband’s cancer status and recommendations from your Doctor’s. I wish your husband well.

Yes! I agree with above recommendations. Being close to MD Anderson which is a center of excellence is a big plus in your husbands favor. Keep in mind there are many factors to consider and even the best places may likely offer different choices of treatments. It can be difficult to decide.

definitely make sure there is noooo cribiform seen .ltake it from me I was 3+4 at age 56 sent it out for decipher testing came back Cribiform I chose the radiation route. I was good for about five years and then my PSA crept up all the Gleason three was gone, but the Gleason four which was cribiform was still there and I was being told that cribiform looks to be radiation resistant. I was lucky to do salvage surgery. I wish I would’ve done it the first time it was no big deal not even two hours on the table in the hospital overnight even the catheter was that bad , if you look it up, what is the gold standard for prostrate cancer that’s contains the prostrate the gold standard is surgery. The back up plan is radiation and then you even have a third option which would be the dreaded hormone treatment. Hope this helps with your decision.