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How do you choose a Da Vinci surgeon?

DWL
Posts: 11
Joined: Jan 2018

I was diagnosed last November with prostate cancer and the urologist recommended robotic surgery to remove the prostate.  I got a second opinion from another urologist who recommended the same.  I'm struggling with the decision.  Any help will be appreciated.

ASAdvocate
Posts: 115
Joined: Apr 2017

Usually, prostatectomy surgeons are preferred based on the number of operations they have performed, and how many thet are currently doing per year. I have read opinions for total RP's of close to 1,000, and yearly of 150 or more. But, those are just random opinions seen on forums like these. They are not absolute, but should tell you that experience is valued by those selecting a surgeon.

 

But, you have only spoken with two urologists, and, being surgeons, they recommended surgery. Hmm???

 

In my opinion, you need to also consult with one of more radiation oncologists. Radiation is just as effective in curing prostate cancer as surgery, and may have fewer side effects. Do not let a surgeon talk about radiation, as they often are out-of-date or otherwise misinformed.

It would be helpful if you could post some of your biopsy results here. That way, replies can be better advised to match your situation.

A link to a radiation study, just to encourage your looking further into treatment options:

https://www.sciencedaily.com/releases/2016/04/160418145458.htm

 

 

DWL
Posts: 11
Joined: Jan 2018

The first urologist recommended Da Vinci surgery and gave me a book titled "Prostate & Cancer" and I read that the Da Vinci surgery has a steep learning curve and you should find a surgeon that does 3 or more every week.  He is highly recommended but only does 2 to 6 per month.  I then went to a "Cancer Center" and met with an oncologist. He referred me to a radiation oncologist and another urologist.  Of course the radiation oncologist recommended radiation (a combination of brachytherapy followed up with several weeks of daily low dose external beam radiation treatments) and the urologist recommended surgery (he does Da Vinci surgerys and HIFU's).  This surgeon has done over 2,000 surgeries and does several every week.  Neither would recommended radiation vs. surgery and left that decision to me.

My PSA was at 3.1 March, 4.7 in August, and 6.28 in December.  I had a biopsy in November with 5 of 12 cores positive, risk group intermediate T2b-T2c, and a gleason score of 4+3.  I'm 63 years old and in good health, no meds, and active sex life.

I've been to a couple support group meetings, talked to different people, and have tried some google searchs.  Different people have different opinions.  Cryotherapy, HIFU, Proton Beam, Cyber Knife, Holistic infusion treatments, etc. etc. etc.  

I'm leaning towards surgery then my neighbor calls and says don't do it - go with radiation (He's 78 with a gleason 3+3 and has been recommended to get TURP then radiation).

 

Clevelandguy
Posts: 441
Joined: Jun 2015

Hi,

As AS said it's usually the number of surgery performed with Da Vinci and should have several hundred(at least) under their belt, talk with other patients who have had surgery with them, see if you can find any ratings on web sites about their sucesses.

Also you should be comfortable with the doctor, bed side manor, ect.  You should also talk with at least one oncologist to get their viewpoint on surgery vs some form of radiation treatment.  All treatments, surgery vs radiation have side effects, some short term, some long term.

You should also have had an MRI done to map where the tumor is, so you know if it's close to the edge of your prostate or buried deep within.  Do you know what your gleason score was?  Very important in determining what treatment you should do. Agressive cancer is nothing to mess with.  Keep doing your homework..................

Dave 3+4

DWL
Posts: 11
Joined: Jan 2018

I did have an MRI.  There were two "lesions".  One was "right posterolateral peripheral zone at the mid gland.....broad zone of contact with the posterolateral prostatic capsule of approx. 1.4 cm.... The other "left lateral transitionalzone at the prostatic base...."

DWL
Posts: 11
Joined: Jan 2018

It helps me to have someone to talk to who has been there.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

With radiation, the perimeter of the treatment can be extended outside the prostate, so cancers outside the prostate can be treated. Surgery is a localized treatment, and does not treat cancers outside the prostate. With a 4+3 and five of 12 cores positive, there is a posibility that your cancer may be outside the prostate.

I wonder, if your MRI used a 3.0 magnet, that is a T3 MRI, the strongest magnet in clinical use, which can provide the best image among MRI's, so you will have the best idea of where you stand.

The amercan urological association recommends  a bone scan  for those with a gleason of 4+4=8; in your ccase with a 4+3 and five cores, you may wish to discuss a possiblity of a bone scan.

Although all treatments can have side effects, surgery can have side effects with greatest significance.

 

DWL
Posts: 11
Joined: Jan 2018

The MRI "was performed on a 3 Tesla magnet.  High-resolution T1 axial, T2 axial, T2 sagittal and T2 FSE coronal images were obtained through the prostate gland and seminal vesicles. ....."  The radiation oncologist said they would irradiate to include an area around the outside of the prostate.  The surgeon said he would remove tissues around the outside of the prostate if needed.  I think that could include neuro vascular tissues?

fishinguy
Posts: 18
Joined: Dec 2017

First, I will say, research al of your opitions.   Not just surgery, really know what's involved in them all and then decide.

To answer your question, I had a wonderful urologist.   Worked with him for years watching my PSA rise, and a couple of biopsy's along the way.  Once diagnosed, he did recommned surgery.  He is  asurgeon as well, but performed only open surgery.   I wanted to research robotic as well.   He gave me the names of who he felt were the best robotic surgeon he knew of at his clinic, the University of Minnesota, the Twin Cites area, and the Mayo clinic.  I was hesitant to ask him at first, for fear of offending him.   His response was great.   He said "You are the star of this show and any decison you make you'll have to live with the rest of your life.  I'll help you any way I can".  So I met with two surgeons that each had done more than 3500 of these surgeries.   I ended up going to the Mayo in Rochester MN for my surgery and couldn't be happier with my results.   I was also offed a chance to join a study at Mayo, which swung my decision.   I have two sons and figured if I can help with a bit of research to assist them down the road, it was the least I could do.

I was diagnosed as 4+3, but after pathology regraded to a 3+4.

contento
Posts: 76
Joined: Jul 2017

You got good advice above. I chose a surgeon that also had done  hundreds of procedures.  However I went a bit further than that and I chose a surgeon that had also done his residency using robotics . This gave me a little more comfort that he learned from someone very skilled in the art and presumably knows how to teach that art . Most surgeons who use robotics learned after they became open surgeons and had to learn robotics from another surgeon on the fly.

Also most surgeons practice in more than one hospital. Ask him which hospital he feels most comfortable in. He most likely will have a preference.

Hope this helps -- contento

fishinguy
Posts: 18
Joined: Dec 2017

contento made an excelent point.   The surgeon is part of a team.   The team who worked with me knew what the surgeon wanted.   There was a comment by one of the assisting team about my three apppendectomy scars, he said the surgeon wanted all the arms insterted at specific angles, but he didn't think they'd be a problem.   The point being, the surgeons team knew exactly he wanted.  So if the surgeon practices at different hospitals, ask the surgeon if he has worked longer with one team than another.

DWL
Posts: 11
Joined: Jan 2018

Somehow while talking to the DaVinci surgeon we did talk about his team.  He said that he won't work without his nurse who has a "hand" inside.  It is a teaching hospital so he is assisted by a 5th year minimum resident.  He only works at the one hospital.  Thanks. 

DWL
Posts: 11
Joined: Jan 2018

I checked into CK but was told by the Doc that it wasn't good for me either due to the size of my prostate (42mL) or size and locations of lesions.  So I'm ruling out some options by process of elimination.  Someone else recommended cryotherapy because it worked for him (he said that sex is not happening but is OK with that). Now I'm looking into HIFU and have a consultation scheduled tomorrow with a local urologist who does both DaVinci and HIFU.  The radiologist's nurse has called twice asking if I've made a decision.  Leaning towards DaVinci but still undecided.  Thanks to all on these message boards.

Old Salt
Posts: 720
Joined: Aug 2014

With 5 of 12 cores positive, I don't think that HIFU is a good option. There are likely to be even more cancerous spots that would need treatment at some point. Just remember that a biopsy only samples a minute amount of the prostate ('needle in a haystack' is a good analogy).

DWL
Posts: 11
Joined: Jan 2018

due to the fact that I have two tumors.  One on the left and one on the right.  Thanks.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

There are various machines that deliver SBRT, CK is one of them.

My friend had successful SBRT treatment with a prostate size greater than 42ml, so I do not understand why you were told that treatment was not possible. Was this a radiation oncologist that specializes in SBRT?

DWL
Posts: 11
Joined: Jan 2018

I'll try another group.  Thanks.

DWL
Posts: 11
Joined: Jan 2018

I'll let you know what they say.  I like the sounds of CK from my understanding they place "locating beacons" in your prostate to more accurately guide and focus the radiation beam.

Clevelandguy
Posts: 441
Joined: Jun 2015

Hi DWL,

Sounds like you are doing the right thing, keep gathering info on the various options and then pick one that's best for you and your family.  Good luck!

Dave 3+4

Steve1961
Posts: 231
Joined: Dec 2017

another thing I am confused about .what exactly causes lesions anyway . I would think trauma but I guess not .i am having a t3 mri soon I guess that will tell me  . I sure hope that DRE s Dont cause lesionscause I had a few lately the last one kinda hurt lol but it was clean anyway just wondering thanks

DWL
Posts: 11
Joined: Jan 2018

others called them lumps, tumors, or cancer.  I'm not a doc and don't know correct terminology - just repeat what i've been told and seen.

Steve1961
Posts: 231
Joined: Dec 2017

thanks I will ask I actually thought lesions were actually small cuts or tears in the prostrate  That make s sense 

hopeful and opt...
Posts: 2224
Joined: Apr 2009

tumor that may or may not be cancerous. The radiologist may rank these tumors on a pi-rad scale of one to five; five having the greatest cbance of being cancerous. The MRI does not diagnose,only a biopsy can diagnose.

ASAdvocate
Posts: 115
Joined: Apr 2017

A lesion is anything not normally there. It is a very broad term, and may include tooth infections, skin eruptions, cysts, tumors, etc.  The word itself does not signify danger, just something different to be aware of.

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