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Posted 5/17/2008 5:39 PM (GMT 0)
Hi all-

Just found this site this morning and will do the keyword search to explore further - but would like to get started with some fundamental questions.

I went through the typical process of confirming and diagnosing prostate cancer: PSA blood test (9.95), biopsy (1/8 >Gleason 7 (3/4), ultrasound (at time of biopsy) and Catscan.  The CT indicated cancer limited to Prostate.

So am now researching the three primary options for this diagnosis: radical prostectomy (open and robotic (da vinci)) and radiation. Perhaps I am 15% into studying this thing but I am leaning toward robotic. I realize there are many factors that lead to the descision: patient health, appropriate diagnosis, and experience of the medical professionals.     

All things being equal>> is there good statistical reference material that shows the positive and negitive impacts of these procedures based on the characteristics of the profile outlined above?

My limited studies indicate the selection of a well qualified and experienced physician is critical to the minimization nerve and related organ damage. I plan to use my network to help locate the best physician for the procedure I choose but what approaches have you found to select/confirm physician choices? How does one get unbiased statistical information on experience and results?

Thanks for your feedback and look forward to contributing to this site as we move forward.

 

Posted 5/17/2008 6:25 PM (GMT 0)
Welcome, I chose surgery because of my age and small volume of disease, plus I just wanted it out. I felt the advantages of having everything out, examined to determine extent of disease, lymph node involvement and such made surgery my best hope. That said, you have to make the ultimate decision based on your age, needs, resources, and long term outlook. Research as much as you need to, review the Hans and Partin tables, and perhaps a 2nd or 3rd opinion. BTW, with surgery, I also knew that I could have salvage radiation if a recurrence happens in the future. Good Luck, read the posts here, it is a wonderful site.

Randy

PS I chose a surgeon based on the number of procedures logged, success rates with ED and Incontinence, and the facility he used. The surgeons experience is key, this is a complicated and delicate procedure.
Posted 5/17/2008 6:37 PM (GMT 0)

I am going to make an assumption and that often gets one in trouble.  I am assuming your from Oregon. 

I don't know what research you have done but here are two sites I would recommend if you have not seen them.

 http://www.prostate-cancer.com/index.html- discusses differnt options - Does not discuss Proton Radiation so try  http://www.proton-therapy.org/

Remember you are your own  best advocate.

Richard & Debbie yeah tongue yeah

Posted 5/17/2008 7:21 PM (GMT 0)
To answer your question - you'll have to ask the doctor(s) and trust their honesty.

-Les
Posted 5/17/2008 10:21 PM (GMT 0)
I am 73, just had Da Vinti May 5th. I am very pleased. I am wet as a drownded rat and guess that will go on for a while, otherwise very happy. I think my sergeon thought 70 was about the limit on age but I insisted. I feel more comfortable with getting that thing out if possible. I had no intention of surgery when I was diognosed but, soon changed my mind. I like to ask God for guidance on such matters.
Posted 5/17/2008 10:25 PM (GMT 0)
Ace

You chose the best guidance counselor I can think of.

Richard yeah tongue yeah

Posted 5/17/2008 10:53 PM (GMT 0)
Hey Ace,

I ran into lots of info about 70 being the cutoff for surgery too. I was 72 and had an open prostatectomy with no post surgical problems. It show two things: lots of PCa info is wrong and we have to take our treatment into our own hands.

Good luck...

Jim
Posted 5/17/2008 11:14 PM (GMT 0)
I am almost three weeks post robotic surgery and like Ace very wet but I am thrilled to have the cancer removed. I researched my Dr via friends and web and choose a Dr that gets all the tough referrals in my area. I interviewed the Dr and almost immediately trusted him. He is active in writing research papers and willingly shared the number of robotic surgeries he performed and the results. He also does open surgery as well as robotic. I also interviewed another surgeon who wanted to do open surgery (only does open surgery) and was outspoken about the pro's of open surgery - guess I felt that since he did not do robotic I was getting only one side.
As I read this site it appears (gang correct me if I am wrong) a lot of the success of the surgery has to do with many factors. I've read accounts of men with both sides of nerves spared and having trouble with incontinence and ED and other men with only one side spared doing well with no continence issues or ED. I am sure the Dr plays an important role as does attitude, patience, good support system, and prayer.
Good luck as you make your decision and please let everyone know what you decide and how things go.
Oh - BYW - any good Oregon Pinots you can recommend?
Posted 5/18/2008 12:04 AM (GMT 0)

It is a very difficult decision, but one that only you can make.

In my case, because the PCa wasn't very aggressive and considering my age, I chose surgery. Initially, I was opting towards radiation, but after doing lots of research, my personal view was that I wanted this "thing" out! ("if my prostate doesn't love me anymore, then I don't want it around") nono

I opted for robotic because of the short-term advantages (less down time, less blood loss, etc.) Plus, I was fortunate to be in an area that provides top-notch hospitals and surgeons, so I was able to consider (and interview) different surgeons.

Bottom line:  do your research, talk to different healthcare providers, and make the decision that is best for you!

Good luck in your decision.

Phillysub 

Posted 5/18/2008 1:16 AM (GMT 0)
In my case I opted for robotic surgery. Initial diagnosis was nothing on DRE, lower end PSA, nothing visible on CT or bone scan. Biopsy said no perineural involvement is evident. Radiologist agreed that that surgery may be best option which could be followed by radiation if later required as radiation followed by later surgery was a very inadvisable option because of scar tissue. O.K. Surgery selected then and I decided on robotic mainly on the quicker recovery time. Nerve sparing is dependent on involvement of the nerve pathways with the cancer which I believe cannot be seen pre surgery. In my case perineural involvement on both sides was determined during surgery so no nerve saving was possible. According to my surgeon, who does both open and robotic, where the robotic comes into its own is with excision of the prostate. According to him, with the cameras and smaller instruments of the robot he can more clearly see the back and back upper rear parts of the prostate as he cuts. If contemplating surgery with a surgeon who does both, I would ask which he prefers to do and more importantly, why he prefers that method.
Posted 5/18/2008 2:12 AM (GMT 0)
Just wondering how the "counselor" mentioned several times above recommends a particular practitioner.

-Les
Posted 5/18/2008 2:28 AM (GMT 0)
Hi. After reading the other posts you have a lot of good advise. Study all the options and choose a treatment by a Dr with a lot of experience. Make your choice and don't look back. As for me I had open surgery on a Wednesday morning, got out of the hospital just after noon that friday. No pain meds after leaving the hospital and no blood during the surgery or after. Everyone heals at a different rate. The same goes for ED and continence. Good luck to you and let us know how your journey is going. By the way Les, went toa cruise in today but no Atomic Orange Corvettes.

Mika
Posted 5/18/2008 2:40 AM (GMT 0)
Mika-

I figure on my way out everyone will know it's me.

-Les
Posted 5/18/2008 3:16 PM (GMT 0)
Hi Pinot

welcome to a great  site  and wonderful forum .....you are ;lucky to find it before your choices are made ... i wish i did it is a great knowledge base!!!

in my case i did not know much or was aware of researching   pre surgery...i was monitored for about 2 years by my Urologist , which was mostly experienced with open RP, and due to my age and health i chose an open procedure.

I did consult with a rdiologist that was honest  enough to recommand me a surgery again due to my age , health and good chances of recovery since i also had Organ confined cancer i chose open surgery.

At the time i had a choice of doing the DaVincie with my Surgen Partner , but being i trusted my surgen i chose the open procedure, however if i would change anything today it would be  researching the DaVinci more and leaning to it  for faster recovery, however i will still chose a removal of that thing OUT of my body and start a clean slate.

All procedure will have side effects to some extend , some longer term , and some shorter term , in my case i also wanted to leave the radiation option open JUST IN CASE!!! and did not want to take the chance that my nerves or other organs will be detirioating maybe few years  down the road IF the radiation is of a stronger dose ...hjowever i hear alot with success  story with other procedures as well

you must do your research, and recovery is slow BUT   as you said 80% of success is  up  to the experiences your surgen have...i am 11 months out , was dry from the  day i took my Cathtar out , ED is a longer process  but  significant improvement is showing in last couple of months as i had a nerve sparing operation...it  does take between 6 to 24 months to get back to potency  in MOST cases ...some lucky ones can gain it back in 10 weeks sometimes...

Good LUCK!!  and keep us posted .... DO YOUR RESEARCH!!   and make the choice that ONLY   fits   YOUR NEEDS !!!

GB :-) :-)

Posted 5/18/2008 3:52 PM (GMT 0)
I opted for radical vs robotic because I was so comfortable with my local doctor. the decision for me turned out to be the right one even though my surgery was a failed attempt due to lymph node involvement. I know many people opt to travel great distance for surgery, but I believe the relationship you have with your physician is important assuming it is a good one. In many cases the physician will refer you to someone who does robotic surgery. Let us know what you choose.

peace and love
Dale
Posted 5/18/2008 4:49 PM (GMT 0)
 Hi ~ OregonPinot and Loved Ones,   W elcome     to…    ~ HealingWell ~   and   A    “ Special ”    Warm Welcome   to   You !   Knowledge gives us POWER….   POWER takes away the fear.   ~      ~      ~      ~      ~      ~      ~      ~      ~      ~      ~      ~      ~     Click   on   link   below for important information that will help you ~ help us!!     >>   Welcome New Members ~ to HealingWell   The information (link) listed above is to help you get around the forum!    v        This is a journey best traveled with friends.  Welcome ~ New Friend from all the members here... on HealingWell.com   v       IdahoSurvivor ~   Moderator for Prostate Cancer Forum http://farm2.static.flickr.com/1160/1313099593_9f819e3ff8.jpg   v       TC-LasVegas ~   Moderator for Prostate Cancer Forum   v       bluebird ~   Moderator for Prostate Cancer Forum http://i206.photobucket.com/albums/bb179/mamabluebird1955/mamabluebirdWelcome.jpg
Posted 5/18/2008 4:54 PM (GMT 0)
Hello OregonPinot,
This decision will need to be yours. But I think by finding a reputable radiaologist or surgeon you will fare well. Welcome to the best place on the web for patient to patient interaction. No matter your choice, you will find someone to share your experience with. As for me, it was surgery by daVinci robot, then hormone therapy, then radiation. The surgery was useful in that it told us that we needed to add additional therapies quickly. I have had success and I am in remission at this time. Good luck in your decision. And stay with us. We have a great group of supporters (all kinds).

Tony
Posted 5/18/2008 5:28 PM (GMT 0)

Greetings, OregonPinot.  Welcome to the forum - I have found it to be a great group of men and women who are very open to sharing their experiences for the benefit of others. 

In my case, the Urologist I had seen had treated me several months before my diagnosis for a kidney stone.  I had gone to him based on the recommendation of my son who is an RN and had experience with many docs from his time working in the ER of a major hospital here in our city. 

My urologist did the biopsies (12 shots) and gave me the diagnosis of prostate cancer.  His specialty is ED and reversing vasectomies - he does not do prostate surgery so I considered him to be an impartial advisor.  Whatever option I chose I would have to go to someone else.  When we went in for the diagnosis (Christmas Eve 2007) he sat us down and said if you were 70 I would be going over lots of options for treatment.  At your age of 55 there is really only one option and that is surgery.  He touched on all the others, but I had a lot of faith in him and thus we spent most of our time on surgery.  He referred me to the surgeon he said he would go to if he needed this treatment and I did not regret it.  I found the surgeon to be great - spent lots of time with us and explained everything.  Also, he was very experienced and had done this procedure thousands of times.  He did say that while he did the open surgery he had great expectations for the DaVinci and it was the wave of the future.  However, he said he liked to be able to see everything and be able to have a good look around while he was in there. 

I have been very pleased with the results of my surgery.  My PSA is zero and I have had very little problems with incontinence or ED.  You have to find the right treatment for you.  What is right for me may not be right for you. 

We will be praying for you and your family as you choose the right treatment for you and then as you and your medical providers carry it out.  Best wishes.  David

Posted 5/19/2008 7:04 PM (GMT 0)
Thanks all for your comments, I really appreciate them – but that’s not to imply that I am not looking for additional comments – I have a few questions about some of the responses and answers to a couple questions. Lungman/Randy:   You wrote:  " I chose a surgeon based on the number of procedures logged, success rates with ED and Incontinence, and the facility he used." My question: concerning rating the surgeon, what baseline did you use concerning statistics in rating physicians and facilities?   How many did you look at? What’s your impression of the quality of the statistics provided?     Surgeon (artifical statistics below for example only): 1000 procedures ED at 6 months 80%, ED at 12 months 40% Incontinence at 1 year 30%   Facility: 2nd generation Di Vinci ? ?       Smilingoldcoot:   Yes,         from Springfield/Eugene Oregon     Mac User: Same question as I wrote to Randy aka Lungman, above.   Good Pinot? Presume you mean Noir. I can’t recommend any gris.   Yes, lots. Many small boutiques without good distribution. Those that do have the ability to order from your local wine merchant (or you can order directly) include:   Riversedge Winery (Umqua region) and Witness Tree Vineyard and Christom (both Eola Hills region) and soon my own but not yet recommended (McKenzie River   Winery). Both Christom and Witness have great Chardonnays as well. Bon appetite!        
Posted 5/19/2008 8:35 PM (GMT 0)
I did not look at hard statistics. Probably should have but didnt. I did decide to use a teaching / research hospital (KU Med Center) I figured that if my Dr taught robotic surgery to Med students he probably knows what he is doing. When I interviewed my Dr (by the way his last name is Thrasher - interesting name for a surgeon ) I asked him how many robotic surgeries he has performed and how many men regained control of continence and how many regained erectile function - he had his statistics and was very willing to share. He also gave me copies of research papers he authored. I never felt like I was being sold - his confidence along with the numbers he shared made me feel good about him. I was not aware of National averages so really did not have any way to grade my Dr's statistics - again, probably should have.
I also have a friend who had robotic surgery from Dr Thrasher and my friend has regained continence and erectile function. So knowing someone who walked the same path that I was headed was influential.
Please let me know if you have any more questions. I read the site daily and GREATLY appreciate the responses.
Posted 5/19/2008 11:24 PM (GMT 0)

Mac User said...
I did not look at hard statistics. Probably should have but didnt. I did decide to use a teaching / research hospital (KU Med Center) I figured that if my Dr taught robotic surgery to Med students he probably knows what he is doing. When I interviewed my Dr (by the way his last name is Thrasher - interesting name for a surgeon ) I asked him how many robotic surgeries he has performed and how many men regained control of continence and how many regained erectile function - he had his statistics and was very willing to share. He also gave me copies of research papers he authored. I never felt like I was being sold - his confidence along with the numbers he shared made me feel good about him. I was not aware of National averages so really did not have any way to grade my Dr's statistics - again, probably should have.
I also have a friend who had robotic surgery from Dr Thrasher and my friend has regained continence and erectile function. So knowing someone who walked the same path that I was headed was influential.
Please let me know if you have any more questions. I read the site daily and GREATLY appreciate the responses.

Hi Mac User,

Welcome to the other side as they say,

i hope your journey will be an easy  and succesful one.

It  would be useful if you shared your Surgeon statistics in side effects , it might be helful for some to make choices.

Also how long it took your friend to regain his Potency ?  which is the longer battle of the 2.

I did not have a robotic procedure , i had an open RP , and like you i trusted my Uro/Surgeon as he was more experienced with the open, i did not even asked for any statistics at the time, however as you can see below i am 11 months out and just starting to gain potency  and some usable erections with help of meds, but i still have a road ahead to concoure.

Please  keep posting your progress as it will be used as another statistic for others.

Thanks again

GB :-)

Posted 5/19/2008 11:30 PM (GMT 0)
I'm new here but have been reading threads for the past ten days. My husband who is 53 was just diagnosed with prostate cancer PSA 1.7 and Gleason 6 however we are awaiting a second opinion on the pathology report from John Hopkins. We have an appointment with a robotic surgeon and a radiology oncologist to decide course of treatment. I'm curious as to why people feel at his age there's only one option, and that's surgery. I've also been intouch with people from the Dana Farber Institue and Brachytherapy was highly recommended for someone my husbands age. His urologist, that does surgery also recommends Brachytherapy and said if it were him that's they way he would go. My husband knows someone that had the seeds done 15 yrs ago at the age of 43 and he's still going strong with no problems. I understand some people just want it out but to say it's the only way to go for someone that age just isn't so.
Posted 5/20/2008 12:25 AM (GMT 0)
I want to go back to my Dr to get the stats. He told them to me 4 weeks ago (and since then I've had surgery) and I dont want to mis-represent them or just post what I remember. I have a question for him anyway so I'll just add this to my list of questions. Hold on and I'll post a new topic once I am sure the numbers are correct.
Posted 5/20/2008 1:27 PM (GMT 0)
My urologist also told me that surgery vs. brachytherapy have the same long term success, I opted for surgery as a personal preference, mentally I just wanted the cancer out, I don't think I could deal with knowing I had a malignant tumor in me on a day in day out basis. Both of my parents passed away with cancer. I may well have a reoccurence in the future, but feel that I can opt for radiation at that point if necessary.

Randy
Posted 5/20/2008 2:05 PM (GMT 0)

Lungman said...
My urologist also told me that surgery vs. brachytherapy have the same long term success, I opted for surgery as a personal preference, mentally I just wanted the cancer out, I don't think I could deal with knowing I had a malignant tumor in me on a day in day out basis. Both of my parents passed away with cancer. I may well have a reoccurence in the future, but feel that I can opt for radiation at that point if necessary.

Randy

Hi Randy ,

i am sure  you  will do Fine  you are still early in the  process , and  you    young and helth i  am sure .

It   is  a personal choice , i opted  for the open RP as well, if i had to  do it over again with all  the knoweldge i aquired  by now  iwould only  change  the procedure to DaVinci maybe  just for the  mere reason of faster recovery.

Your nerves been spared  as  well as mine  and i feel improvements    as well   11 months out now.

I might  ask my  uro  to prescribe  Injections to speed up the recovery  process.

How  the Bi Mix  been  working for you ??

Keep us posted ...

Good Luck !!

GB :-) :-)

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