Robotic or DaVinci Prostatectomy

RALP
Judge,

First off, best wishes on finding the right doc and procedure for you. I'm 12 days past a da Vinci RALP, done at Shands/UF in Gainesville by Dr. Parekattil. Looking back in hindsight, the results could not have come out more favorably for me.

I am 45 and was informed of my diagnosis on 12/23 after my biopsy. 3 positive cores, 5 more with high PIN out of 16 total taken. It was initially called a T2b, but turned out to be T2CN0M0.

My post surgery experience has been better than I could imagine. I started cutting back on the narcotics to Tylenol Ex Strength on the second day home and am using very little Tylenol now. My incisions were small and are healing well. I've experienced almost no urine leakage, I'm still wearing guards, but that's more of a psychological thing at this point. I have also started experiencing erections again using low-dose Viagra.

Dr. Parekattil and his staff at Shands are fantastic and took extremely good care of us from the initial consultations, biopsy and diagnosis to the surgery and afterwards. He gave me his cell phone number the second time we met and told me to call anytime I've had a question.

I've said all that to say this: For me, the reasons for pursuing the RALP vs traditional surgery or radiation came true in every point. I think I've been very blessed, but this is just what happened for me.

The statements that he told us and we read about da Vinci RALP were:

1) RALP tends to have a shorter recovery time. Aside from being told I couldn't drive while having a Foley cath, I was up and around almost normal within just a few days of getting home. I've been out of work for two weeks and I'm going back on a mornings-only basis this coming Monday. I have a desk job, so that makes it a little easier to get back to work, but I've felt ready for several days now.

2) RALP tends to preserve nerves for erections. This also appears to be coming true as I've had erections using Viagra for a couple of nights now, less than two weeks after surgery. I've also been able to achieve a moderate erection without the pill. Dr. Parekattil also uses an additional process called hydro-dissection to lift the nerves off the gland and it seems to have worked perfectly in my case.

3) RALP tends to preserve urinary control. This one was a big concern, but I've had no problems here either. One thing I did do differently: I read a lot of material that recommended doing Kegels to strengthen the PC muscles to help with urinary control. Most of what I read seemed to be aimed at guys who were already having problems after surgery. I decided to start doing the excercises a couple of months PRIOR to the surgery and it appears to have helped in my case. I was able to control my flow sitting on the table immediately after having the Foley pulled out this past Tuesday and have had only very small drips due to coughing or sneezing since then.

As far as how experienced should your surgeon be, I don't know that there's a hard number you can put out as a minimum, but you should be comfortable with the answers you get to questions like "how many of these have you performed?", "how frequently do you perform them?" I also asked for numbers in terms of problems occuring out of total number of surgeries and that helped to calm some nerves for me also. Both in terms of the number of procedures being high and the instances of problems being low. He and his team were very frank with us about the possibility of erectile or urinary problems occuring and stated up front that cancer removal was goal #1 and everythign else came secondary. They also went into significant detail with us about things that could be done after the fact to solve those problems if they happened.

As to the preparation for surgery, it was mostly focused on switching to clear liquid diet and cleansing the bowels the day and night before surgery. I started Kegels ahead of time, but that was the only other thing that I did.

I pray that you're comfortable with whatever you decide to pursue and that the outcomes are exactly what you want.

da vinci, etc
the comments made by the other reply to your message are excellent. da vinci is the state of the art.

i chose a young (37 yr old) surgeon who does 1 to 2 da vinci a week. he trained both here and in Germany.

i personally would want someone who has performed at least 100 surgeries.

my main problem after the op was with my bowels, which locked up due to "ileasis," which caused a lot of bloating and build up of gas. time and a prescription laxative solved the problem. it was two weeks ago today that i was cut on.

Davinci
Hi Judge,

I am 46 and was diagnosed Dec 2008 and Davinci was set upon me in early January, I was very bruised internally and was still sore two weeks after, it was my thought as a toolmaker that the Robot in question is a neat Idea, However it does not give feed back on the amount of pressure being used on its limb movements to a sufficient extent as to match that of a surgeons hand in my opinion! my operation was over six hours and I was told it would take around half of that and I was not given a reason for the extra time taken, I do believe that more experience on this davinci Robot would have proved my operation to be far better than it had been as an experience for myself, I to this day cannot get a useful erection using Viagra-Cialis-or Caviject although in fairness I have not tried the highest dose yet. and I most certainly would not have a prosthetic thingy put in! and I have met with a couple of 80+ year old's who took just about a year for full erections and I do believe that my case is quite if not exceedingly rare and the surgeon (nice chap) was quite young he should have done a few hundred more now!!!, so don't be put off but be reassured of the surgeons experience first.

BDJC said:

Focus on the doc, not so much the procedure
Judge, I'm doing a little cut and paste from a post I put up on another thread:

It is important to know that when it comes to radical prostatectomy, too much importance is placed on the procedure itself, and less on the ability of the physician that performs the procedure. If you decide to have the radical prostatectomy, don't focus as much on how the physician performs the procedure (whether he performs a traditional open radical, a laparascopic, or the DaVinci robotic radical). The most important thing is the experience and skill of the physician that performs the procedure. Why? Because the cure rates are the same from procedure to procedure. That is to say, men are not cured better via DaVinci than they are via traditional open RP. The only difference between the two is the length of stay in the hospital post-surgery and overall recovery time.

These are the first questions you should ask of any doc who wants to treat your prostate cancer:

1. How many men with prostate cancer have you personally treated?

2. Do you track all the men you've treated in a database?

3. How many of these men have PSA 0.2 ng/ml 10 years after treatment?

4. If you were to treat my particular case of prostate cancer, what is my 10-year Individual Cure Rate (ICR)?

If a physician doesn't know the answers to these questions, or just cites some medical study of which he was not a participant, then he is just guessing at how well he cures men of prostate cancer. A note on the ICR - this requires that a physician track the results of all the men he has treated. To calculate an ICR for you, a physician would compare your pre-treatment characteristics with every other man he has treated that has similar pre-treatment characterisitics, and then give you an exact percetage of all those men that achieved PSA 0.2 ng/ml 10 years after treatment.

End of cut and past section. I'd also like to add that I encourage all newly-diagnosed men to consider two procedures - surgery and a procedure called ProstRcision. Those are the only two procedures that have a long-term track record of men achieving and maintaining PSA 0.2 ng/ml. I recommend you read the Q&A section at http://www.prostrcision.com and then fill out the form on the Contact Us page to get an ICR based on the ProstRcision procedure, as well as set up a free phone evaluation with a board-certified radiation oncologist.

Two thumbs up on BDJC's post
Spot on, every point (though I know nothing about the ProstRcision thing).

If you can get a really good practitioner for method X but can only find so-so doc's for methods Y and Z, go with method X (even if good Y would be better than good X).

I was lucky: my GP sent me a list of the top doc's in the region (her opinion) for each technology (open, robotic, radiation). We went and interviewed the two surgeons and made our choice that way. Both the surgeons had done more than 2,000 prostatectomies, and either one of them would have done a fine job--the decision was really made on non-medical issues.

The whole story on our trek (so far) is on our website: http://www.sv-moira.com

Larry