Is robot prostate surgery best for quality of life?

griff 1 said:

quanity
good post man, i am new here and have surgery sceduled on the 23rd of june. too much stuff to take in and read. any way now i am wondering what way to go da vinci way or open surgery. thanks griff 1

experience
Griff,
Each of us has just one primary treatment experience, and we all hope our choice was the best. I'm a DaVinci person - not because I chose that over open, but because I chose a surgeon I felt good with, and he only does DaVinci. His partners include surgery-only guys, so it was easily available.

just be sure you understand the incontinence and ED impacts, and know the experience of your surgeon. Don't let them gloss it over.

After that, we learn, we choose, and hope we are right. No second-guessing.

Kongo said:

Not too much information
Griff, I understand your frustration with all the information but frankly I think there's not enough information. Make sure you really know the pros and cons of your treatment choice. Many of the posts on this forum are from men who have difficulties after surgery (pads, erection aids, pain, etc.) but I suspect that most of the ones without complications move on. There are downsides with any treatment. One recent study I read indicated that DaVinci actually had more quality of life issues overall than open surgery but I'm sure most of the DaVinci graduates here would say that is a function of physician experience with the system. Make sure that if you choose DaVinci that you're not providing your prostate as a training experience for the surgeon. Go with someone who has done hundreds of them.

My urologist (a surgeon) recommended surgery and he only does open surgery saying that you pay a surgeon for his skill with his hands. He felt that the rapid increase in DaVinci machines is leaving too many surgeons with too little experience conducting the operations. A skilled DaVinci surgeon would probably say that their ability leads to further surgical complications than open surgery. To me it seemed like the difference between one six inch incision or six one inch incisions.

I elected to go another route and am about to begin treatment with Cyberknife radiation which is an appropriate treatment for my condition. Stage T1c, PSA now at 2.8, 1 of 12 cores positive with 15% involvement. Normal DRE and no other symptoms.

Depending on your pathology, radiation may also me an option.

If you do go the surgical route, be sure to ask about incontinence, ED, penile atrophy, pain, and so forth. Same with radiation.

Best of luck but I would urge you to get more information not less.

Griff
If you go the Da Vinci route (I did) I would say pick a surgeon that has done over 1,000 procedures...otherwise you are taking a chance at what Kongo said in becoming a training patient for the surgeon.

There are many surgeons that have done over 1,000. Here in the small midwestern town of Indianapolis I know of three surgeons that have all done over 1,000 procedures in Scott, Hollensbe and Koch.

Find experience, grill them with questions about their success rates, and then go with your gut....that goes for any procedure you are looking into. This beast is a crap shoot no matter what treatment you pick...it's possible to lift up it's ugly head years down the road.

There are some very wise people on this board who have done extensive research into the treatments. As Kongo said many who have had successful outcomes might have moved on but some don't - I am prime example of one who has not moved on..and still posts. Here's my path.

52 years old
PSA 9/09 7.25
PSA 10/09 6.125
Diagnosis confirmed Oct 27, 2009
8 Needle Biopsy = 5 clear , 3 postive
<20%, 10%, 10%
Gleason Score (3+3) 6 in all positive cores

11/09 Second Opinion on Biopsy slides from Dr. Koch
(4+3) = 7 5%
(3+4) = 7 10%
(3+4) = 7 10%

Endorectol MRI with Coil - Indicated the Palpal tumor was Organ confined

Da Vinci performed 12/29/09 - Dr. Hollensbee & Scott
Sling installed at time of Da Vinci – not sure what name of it is but not the 800 that is causing all the problems. Attached to Coopers Ligament.


Post Surgery Pathology:
Prostate size 5 x 4 x 3.5 cm Weight: 27 g
Gleason: Changed to (3+4) = 7
Primary Pattern 3, 80%
Secondary Pattern 4, 18%
Tertiary Pattern 5, 2%
Tumor Quantitation:
Greatest Dimension, Largest tumor focus: 19 mm
Additional Dimension 18 x 15 mm
Location, largest tumor focus: Right posterior quadrant
Multifocality: Yes
Greatest dimension second largest focus 10 mm
Location: second largest focus: Left Posterior quadrant
Extraprostatic extension: Yes
If yes, focal or non-focal: Nonfocal
If yes: location(s) right and left antero-lateral
Seminal vesicle invasion: No
Cancer at surgical margin: No
If no, closest distance with location: less than 1 mm, right posterior quadrant
Apex involvement: No
Bladder involvement: NO
Lymph-vascular invasion: No
Perineural invasion: Yes
Lymph nodes: 9 from right pelvic 0/9 positive
Stage: pT3a, pNo, pMX
All nerves sparred - found two additional pudendal arteries

FIRST PSA TEST 2-11-10 <0.1 NON-DETECTABLE

Virtually Pad free 2-20-10

SECOND PSA TEST 5-26-10 <0.1 NON-DETECTABLE

Notes on Recovery: Was at my desk working (from home office – sales) 6 days following my surgery. No pain to speak of (very lucky as many have some pain) I think because I took the Tramadol they gave religiously and found it to be the best drug in the world. BM’s where the trickiest part and most uncomfortable in the early stages but improved with time – follow the diet they give you!...I strayed off and the next BM helped to get me back on track – I like food very hot and spicy - don’t recommend that for at least a month following surgery. Cream soups, mushroom, celery, and chicken worked great the first week following surgery. Mashed Potatoes…Ah the first time following surgery it was heaven!...the first really solid food I ate…..you will learn to appreciate food all over again as you add back your favorites following surgery when the time is right. Take all the help from everyone around you…it might be a while you get that opportunity again to be waited on hand and foot. Liquids are a concern but some affect people differently it seems reading through the discussion board…I found anything carbonated would cause much leaking…alcohol was not good either…but I justified doing it thinking It’s my training method to work on my bladder control!...lol I love homebrewed beers too much! And am an admitted hop head.

ED path:
Early on started on Viagra 100mg pills cut into 4ths so 25mg per day dose then a full 100mg on every 7th day.
Also bought pump and used sporadically to get blood flow to member. Within about three weeks or 5 weeks from surgery (cannot remember but probably posted on CSN somewhere) had usable erections.

Currently only need ¼ pill to get usable . Day 150 am starting to get semi hard without any drug.
Recommend-Guide to Surviving Prostate Cancer-Second Edition
Dr Patrick Walsh
Recommend-The First Year Prostate Cancer-An Essential Guide for the Newly Diagnosed
Chris Lukas
Recommend-Saving Your Sex Life-A guide for Men with Prostate Cancer
Dr. John Mulhall
Prostate Cancer Meet The Proton Beam-Apatient's Experience
Fuller Jones
Recommend-You Can Beat Protate Cancer and you do nto need surgery to do it
Robert J. Marckini
Recommend-Surviving Protate Cancer without Surgery-The New Gold Standard that save your life and life style
Dr Michael J. Dattoli
Conquer Prostate Cancer
Rabbi Ed Weinsberg
Recommend-Eat to Beat Prostate Cancer Cookbook
Ricketts
Page with Free Guides to Prostate Cancer and Exercise and Nutrition
http://www.pcf.org/site/c.leJRIROrEpH/b.5814067/k.C966/Guides.htm


Comprehensive Book list on Prostate Cancer - http://www.wellnessbooks.com/bookstore/

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Randy in Indy