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Posted 6/14/2010 3:59 PM (GMT 0)
I thought I would just share a bit for anyone who is just starting out on the PCa 'Journey' (i'm kinda tired of hearing that, but it is accurate)

Six months after being diagnosed I am still a bit unsettled about treatment.  Aside from learning about the different treatments, I learned something else about this process.  Your feelings about various treatment options change over time.  I feel like I had settled on an approach 3 different times, only to get additional information on the treatment that made me rethink.  This includes acceptance into a clinical trial.  So while I have spent the last 6 months trying to come up with a great way to avoid having this surgery, I am now looking seriously at the surgery option.  I am not against the other options, they just may not be right for my circumstances, so I pass no judgements.

I am meeting with Dr. Scardino at MSKCC next week to discuss open RP.  I know the recovery time is much greater, but since he is only doing open, I'd like to hear the reasons why.  Sometimes a doctor will look at a patient and decide they have physical characterstics that supports one approach better than the other.

After this I plan to meet perhaps with Dr. Eastham or one of the other surgeons at MSKCC to discuss laproscopic/DaVinci.

I haven't had a PSA test in a while as I've also been on the Kidney Stone 'Journey' for several months, which disqualifies you from getting an accurate PSA.  Jeez...  That journey totally sucked.  Hope to see what's going on in that deparment next month.

My MRI a few months ago showed a very tiny tumor completely contained, so while I have time, I still feel like gettin the show on the road.

I wish you all well!

 

Posted 6/14/2010 4:40 PM (GMT 0)
Bassguy,
I can't speak in terms of the type of surgery you're going to have at MSKCC, because mine was different; however, I can't say enough about the care and attention I received during my stay after surgery. I will tell you one thing, they are serious about getting you up and walking on a regular basis and using the spirometer (sp?). I was a "good boy" and did what I was told, but I shared a room with an older gentleman, about 75, and he did not. The nurses and doctors were after him daily about walking and using the spirometer. Also, anytime I hit the buzzer, I received an immediate call back or nurse visit.
Wigs
Posted 6/14/2010 5:02 PM (GMT 0)
Bassguy,

Good luck on your treatment selection.

I can only tell you about my experience (DaVinci surgery) and like most men here I always wondered if I was making the right decision. open surgery vs robotic vs brachytherapy (seeds).

I am 13 days post op and am actually elated at how well things went with the DaVinci surgery.

My surgeon had about a 1000 DaVinci surgeries, plus I got three personal recommendations, so it might not have been just the DaVinci method, but the skill and experience of the surgeon.

This may just be me, but I could not imagine having to wear that catheter longer than the week I had to. For that reason alone I am glad I chose DaVinci (besides all the other reasons). From what I understand, open surgery patients usually wear the catheter 10-14 days. I felt that the catheter really held me back in getting back into the swing of things--others will probably chime in and for them the catheter was no big deal at all.

Another big benefit for me with the surgery that was not mentioned by either of the two surgeons I consulted with was that now I can urinate like I was 18 again. Prior to surgery I had intermittent problems starting my urine stream, a weak stream and sometimes an urge to urinate even when my bladder was empty. Those symptoms have disappeared, I hope for ever. My point is, curing my urination problems were an added bonus with surgery that I didn't even know would happen. I am surprised I have never seen this listed as a benefit of surgery.

Dan
Posted 6/14/2010 5:46 PM (GMT 0)
Bass,

I had open surgery, and had no regrets about it. At the time of my surgery, robotic was too new in my area, and I didn't want to be one of the "learning curve" patients. As it were, they discovered that I had an unusually deep and narrow prostate bed, even if I had chosen robotic, it would have been aborted. As far as bleeding, that's not much of an issue anymore with a good open surgeon, they bank 3 units for me, and never needed a drop, even though my surgery drug on due to complications. The one incision isn't that big anymore in length, compared to the old days. Ten days after surgery, the staples came out, and the actual incision wasn't a big issue either. As far as magnification, my surgeon assured me that they use the latest technology in the operating room, even with open surgery, and he has high tech magnifying glasses on as well as a large screen in front of him to see things close up. The real advantage in my opinion, is that the surgeon actually has his real human fingers in you, and with live tactile feel, my surgeon still feels its better than any kind of simulated touch between the surgeon and the "fingers" on the robot. That part I am sure varies greatly from surgeon to surgeon. Yes, a bit more hopspital time, but I have seen robotic guys here need 2 days in the hospital, and some open guys ready to go home after 2 days. In my case, I needed all 4 days due to complications.

An open surgery is not the way it use to be even 20 years ago. The incision is much smaller, and as mentioned, bleeding is rarely an issue. As far as which is better for ED and incontinence issue? I don't think there is an accurate way of judging that. Just from our pool of men here at HW, the results are all over the page.

Glad you are taking your time deciding. That's the most important part. With your stats, you have that luxury, and don't let any doctor or practice push you into something you don't want to do.

To be honest, you still sound like you would be a good candidate for "seeding". When I first was dx. with PC, that was my choice, but my stats quickly ruled it out as a choice.

Please keep us posted.

David in SC
Posted 6/14/2010 6:04 PM (GMT 0)
You will hear pros and cons between robotic surgery and open surgery and the best advise I can give...is throw all that out the window and ignore the promoted benefits of one over the other. I had robotic and spent as much time in the hospital afterwards as the open guys. Spent 5 days and had two units of blood...was on the table for 5 1/2 hours...but that was me. So don't be persuaded by the proposed benefits of robotic over surgery because it may not apply in your case as was mine. Just find a good hospital and a good surgeon and go the route you feel most confortable with and you will be fine with either method.

I also agree with David...and really look into the seed therapy as another choice.
Posted 6/14/2010 6:21 PM (GMT 0)
I can identify. I went from first leaning towards surgery to brachytherapy to finally choosing a very successful clinical trial of TFT with cryosurgery. That said whatever you settle on be sure of it. In fact take a week off after so then to further reflect on it before committing to a specific treatment. Once you do, don't look back. Now as far as what type of surgery go by your doctor and what he is most familiar with. I'll say one thing as a layman in my time here it does seem to me that there are less and shorter incontinence problems with open surgery over robotic generally. I know the recovery time may be a little longer but I would rather have that than longer incontinence problems. Of course take my advice there as you wish remembering I've had no problems at all with my different treatment method. So whattheF do I really know? Good luck and congratulations in taking your time to decide.
Posted 6/14/2010 6:47 PM (GMT 0)

Dear Bassguy:

As others have said, congratulations on taking your time to make a decision.  Being an educated patient is a great thing, IMHO.

One additional thought...Dr Scardino has been quite outspoken of late re the benefits of active surveillance for early state PCa patients.  See his presentation on this in this link: http://www.urotoday.com/media/presentations/auany2009/scardino_restaging_low_risk_prostate_cancer_10_27_2009/player.html

Anyway, he does not address age in this presentation but you might want to talk with him about AS during your visit.

Tudpock (Jim)

Posted 6/14/2010 6:49 PM (GMT 0)

Somebody said...
the best advise I can give...is throw all that out the window and ignore the promoted benefits of one over the other

No disagreement here--that is pretty much what I did when I decided on who was going to operate on me--I primarily decided on the surgeon and not the method

1) I had two friends who had prostate removal and they both had the same surgeon and were very satisfied
2) I asked my Uro who he would recommend and one of the names was the surgeon who operated on my two friends.
3) Through web searches I confirmed the guy who was recommended was highly experienced.
4) I had a consultation with this surgeon and felt good that he was my man.

And his method was Da Vinci. If he was an open surgeon I probably would have had him do it anyways.

Dan
Posted 6/14/2010 7:30 PM (GMT 0)
For what its worth, I feel the differences between open and robot are exaggerated. I had the open and was out within 48 vs 24-36hrs for Robby.As far as recovery goes, to me, it is not the number of incisions vs. the size of incisions, though this is the determinent, for hospital stay, but what has gone on below these incisions. You are recovering from all the cuts, stiching, fooling around, whatevah they do inside the pelvic area. As my surgeon explained to me, when I complained about continual penile pain on urination, He said that its pretty much of a mess in there and the pain has to go somewhere. I'm 8 mos out and other than ED, which is improving, I'm back! My choice for open was strictly for the surgeons feel. Having said that, my only disappointment with my surgeon and not that much either, was he had a protocol of not sparing a nerve if that side had a high volume. Said It likes to go to those nerves. I trust him on that point, hence only one side was spared. As I rethink this as I type, I suppose an argument could be made, that Robby's hands may not make as much of a mess as human hands. I noticed my surgeons hands though and he had what I consider perfect surgeon hands, small,slender and delicate. OK, I'll stop!!
Posted 6/14/2010 9:25 PM (GMT 0)

Sounds like I may have had the same surgeon as logoslidat, depending on what "W" stands for.  Also open procedure, also continent from the time the catheter came out.  I think the surgeon is the #1 factor in continence. Only difference is that I was a bit less far along and kept the nerves and ED is going away. I agree that the incision is a trivial issue, what matters is erectile function and urinary continence. I think the surgeon determines that, not the presence or absence of robots in the room.

As for the original post, having surgery in the late 40's with a small, low grade tumor is a tough call. There is a long life expectancy for the prostate cancer to grow but that would be awful young for ED if that was the outcome.  I might op for trying to watch it for a year or two.

Posted 6/14/2010 9:42 PM (GMT 0)
Bassguy,
I'm glad to have decided on a plan of action. Because of my high Gleason, I had a choice between surgery and IMRT. I chose Robotic surgery simply because we have one of the best where I live. I haven't regretted that decision. Good luck to you. See you on the other side.
Posted 6/15/2010 1:45 AM (GMT 0)
Dr Bruce Dalkin University of Washington, Seattle , Wa., He worked for and on me. 4.5 hour surgery. unilateral left side spare. Basically built a firewall around the excized prostate. disected 29 lymph nodes,9 on the left and 20 on the right. all cancer free. I know, it has other pathways but nodes are primary route.
Posted 6/15/2010 1:51 AM (GMT 0)
Thanks everyone for your feedback.   My stats indeed make me feel like a period of AS might be realistic.  However, I've yet to connect with a medical professional who would support it.  That may just be the cards I am drawing from the deck.  One of the reasons I am specifically seeing Dr. Scardino is his published views on watching these things for a bit before jumping in.   He may not believe that applies in my case, being 50, but I'll see when I talk with him next week.  If he feels that I am a candidiate for something else, I'm hopeful he would recommend exploring it.  So far I've not seen much in the way of cross-discipline support.   No one has ever said, maybe you should go see Dr. X and talk to him about X.   Practitioners are pretty much stovepiped due to commercial concerns.   If you've got a big machine that goes buzz, zap, or snip, it has to be paid for. .. and I completely understand that.  That's the reality of the world we live in.  You just have to be prepared to navigate it and not be tripped up by it.

Thanks again guys for your support.

Posted 6/15/2010 2:18 AM (GMT 0)
Bass,

Whether you call it AS, or just plain old fashioned due dillegence, you are doing well in your approach to the whole thing. I feel confident when you have crossed all the "t's" and dotted all the i's, you will be comfortable with your final decision when the time comes.

I think you are doing great.

David in SC
Posted 6/23/2010 8:15 PM (GMT 0)

Bass,

I'm a "graduate" if you will,  of the MSKCC laproscopic procedure and our medical histories seem very similar.

E-mail me directly at [email protected] if you want to chat specifics.

This is the link to my very first post with more info.

https://www.healingwell.com/community/?f=35&m=1684312&g=1684312#m1684312

The care I got at MSKCC was top notch and I'm undetectable psa now for 7 months.

Good luck to you,

Mike

Posted 6/23/2010 10:56 PM (GMT 0)
I'll chime in.  I had open RP.  Was out of the hospital the next day.  Went back to work 3 days after the cath. came out.  Everyone is different.  I have never taken a long time to recover from anything.  Except having cancer....


Posted 6/25/2010 12:48 PM (GMT 0)
Bass, my husband had the robotic surgery slightly over two years ago. He is a self-confessed baby when it comes to pain and just didn't like the idea of being cut open in the traditional way. His recovery was unremarkable and there was practically no pain. His biggest complaint was the catheter - man, did he hate that thing! Once it was out, he breathed a huge sigh of relief.

The surgery took slightly more than 5 hours. Before going into the OR, the surgeon asked me for my cell phone number and promised to have someone from the OR call me to let me know how John was doing. The Dr. told me to go have a nice dinner since it would be a while (which I did, with my SIL and good friend who were keeping me company). An OR nurse called me a few hours later to tell me that everything was proceeding smoothly and that John was doing very well under anesthesia. The surgery was over about 9:00 pm, and I was allowed to see John in the recovery area for about 10 minutes. Fortunately the nurse prepared me for how swollen John's face was - he looked like a pumpkin!! This was because of the inverted position patients are in for this type of surgery. I also wasn't prepared for the amount of blood in the urine bag - that was horrible to see. But, John was one happy camper (wished I could've had some of the drugs they gave him!) and he came out of the anesthesia briefly when he heard my voice.
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