PROSTATE SURGERY,,,ROBOTIC OR HANDS ON?????

I had 4 of 8 cores positive and Gleason 7. I had surgery through the DaVinci robot 5 and a half years ago. My PSA was near 20. I have been in remission since. I think what's more important than the technique is the experience of the doctor. If your doctor has done 150 surgeries a year then he is likely experienced with many complications with the disease procedure. If he has 120 procedures in the last ten years ~ not so much. Doctor experience over procedure will always be a nice trump card. BTW my surgeon was 220 miles from my doorstep. I had little pain but some numbness for a few weeks in my left leg. My urinary continence is not an issue and my sexual functionality is normal several years after the fact. My doc has a couple thousand procedures under his...or his patients belt...

I have a few questions for you to consider...

How long ago was the biopsy? If recently then I suggest you slow the bus down and get more educated. There are other options available that might be better choices.

What is your PSA doubling time? A slow disease is a good disease to monitor for a while.

Take your time and make very good and sure that you fully understand the available options. I know you like your urologist, but I would talk to a radiation oncologist too. One that does not work with your urologist will eliminate conflict of interest.

Lastly ~ stay positive...I know this one helps...

Tony

Hotrod -- Welcome to Healing Well. Sorry you have reason to be here, but I’m glad you found our forum. I’ve gotten a lot of great information and encouragement from the people here on a patient to patient basis. They are very knowledgeable and caring.

Please don’t rush into a decision. You will get through this. PCa is usually a slow growing cancer, so you have time to educate yourself and make informed decisions. An excellent book to start with is “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer.”

Getting that diagnosis is really tough, we’ve all experienced it so we know what you’re going through. When you hear, “you have Cancer”, it knocks you out. Initially you are in shock and feel despair. But you pull yourself up, and seek information and educate yourself about PCa and start making decisions.

I would encourage you to get a second and maybe a third opinion. Consider talking with a radiation oncologist and a medical oncologist. Consider going to a major cancer center; many offer multi-discipline programs where you can schedule appointments with more than one specialist in one day. Travel if you need to. I traveled 1,300+ miles for treatment, and I did not find it to be a problem other than the additional expense. Also my local uro was completely willing to take over the follow up.

I fully agree with Tony. In doing my research on PCa, what stood out to me as the most important factor in your outcome is the amount of experience and skill of the doctor doing your procedure (whatever procedure you choose). As for surgery, a radical prostatectomy (open or robotic) is a very complex operation, one of the most difficult surgeries in medicine. There are definitive studies that demonstrate better outcomes if your surgeon has done 250+ procedures. In my opinion, you want someone who’s done over 700 of that particular procedure (open or robotic) and you want someone who does at least 3 per week. There are no do-overs. Ask what your surgeon’s numbers are. If he’s won’t say or is evasive – find someone else.

For what it’s worth, my surgeon told me he was a big time skeptic of the robotic procedure. He got so fed up with all the hype that he decided to learn the robot with the intention of de-bunking all the propaganda. However, after learning the procedure and becoming proficient; much to his surprise, he came to the conclusion that the robotic procedure is better (in his opinion). He believes the better vision realized using the robot trumps the tactile advantage that the open procedure has.

When you go to doctor consults take someone with you, take notes, and be sure to have a list of questions. You might also consider recording the conversation (with the doctor’s permission) as you can’t write down everything. I wish I had done this. Get copies of all lab work, bone scans, whatever you have done, and keep it in a folder.

Best of luck to you and keep us posted -- Tigerfan

Hotrod, welcome to HW.  Sorry you have to be here but glad you found us.

If you do ultimtely choose surgery I would echo the thought to choose a doctor with experience...over 250 procedures seems to the the inflection point for better cure rates.

However, as others have said, you are really sticking your head in the sand if you do not consider options other than surgery.  Ruling out other options after talking with one urologist is like ruling out a Chevrolet before going to the Toyota shop.  You only get one shot at this so you want to make sure you get it right and have no regrets.  The best way for that to happen is to get yourself educated by reading books such as the ones by Walsh, Strum and Scholz and -- especially -- talking to radiation and/or medical oncologists who may provide another perspective.

Finally, if you will post a signature with more specific stats such as Gleason score, % of each core with cancer, etc. it will help others respond to your posts.

Good luck.

Jim

Hotrod,

Welcome to HealingWell. You've received some very good advice already, so I'll just add a few thoughts:

* I think there's probably slightly more discomfort from open surgery, and it might take an extra few days to recover, but a year after surgery that won't matter to you one bit. Pick a surgeon you trust and let him do it his way.

* It's the experience of the surgeon that matters, not the technique. This is a technically difficult surgery, and the consequences of ineptness are nothing to sneeze at. Make sure you ask your surgeon how many prostatectomies he's done. You want somebody who has done at least a couple hundred. Several hundred is better.

* The advice you've received about taking your time and educating yourself is the best advice you'll ever get on anything. If I have one regret about my whole experience, it's that I didn't consider all my options seriously enough. Don't write off radiation on the basis of a conversation with a surgeon. Talk to a radiation doc about IMRT and brachytherapy, and don't be afraid to ask how many of these procedures the doc has done. It's a critical question, and you want somebody VERY experienced.

* While you're gathering opinions, talk to a general oncologist who specializes in prostate cancer. He won't have the bias of a surgeon or a radiation doc, and you'll get a very valuable perspective. One of the questions on your list should be whether you need to be treated at all. If you're a candidate for active surveillance (watchful waiting), you may be better off postponing treatment altogether. Keep an open mind.

Good luck with your choice, but make sure it's a very well-informed choice. And please let us know what you decide and how you make out. You've got a very treatable cancer. Whatever treatment you decide on, chances are excellent that you'll be fine.

Best,

Jonathan

My husband is actually going through IMRT, but before we made our final decision, we interviewed quite a few surgeons, from three different hospitals. While we originally leaned towards robotic, should my husband have chosen surgery, we would have gone with an excellent surgeon from Duke who conducts open surgery. That's because of several reasons: he was the most impressive of all the surgeons and we would have felt good in his hands, and he only does open. What I'm echoing here is that we believe, as others have said in this thread, it's the experience and skill of the doctor that counts more than the method.

Greetings All And THANK YOU for all the replies:

Some of you asked about my Gleason scores. Well, here is what I took off the pathology report. Maybe someone can decode it for me?

Diagnosis:

A. Prostate right, core needle biopsies:

Adenocarcinoma, Gleason grade 4 + 3 = 7, involving 20% of biopsy material.


B. Prostate Left, core needle biopsies:

Adenocarcinoma, Gleason Grade 3 + 4 + score 7, involving 10% of biopsy material.

Hope these reading give you an idea of what's going on?

Thanks again so very much. Look forward to your replies.

HorRod58

I'll agree with most of what has been said, with one exception in my case - I was in the hospital for four nights after DaVinci. The idea that the length of stay is automatically shorter is based on statistics.

Hi Hotrod,

I have to agree that the experience of the surgeon is what is most important when deciding which type of surgery to go with. The main conclusion I have reached after reading this forum is you probably will have a quicker recovery period with robotic.

My URO offered me a choice of surgeries. If I wanted robotic, he would have to send me somewhere else. Having done over 1,000 open surgeries, I was impressed with him and opted for open. I had surgery on Nov 5, 2011 at Kaiser Permanente in San Diego. They tried to kick me out on the evening of the 7th, but I couldn't find a ride home, so I was discharged around noon on the 8th.

One side effect is after my URO sewed me up, I noticed I had a new stomach "pooch" above the incision and now and had to go up a size in underwear although I weighted the same (6' 210#). The "pooch" was sore for several weeks, but now is fine. For awhile I had second thoughts about open surgery, especially after wearing the catheter for 17 days versus perhaps half that time with robotic.

Now, 10 months later, I'm doing fine, incontinence & ED a manageable nuisance, but still in the "Zero club."
Life is good

Everyone here has given great info. I echo their input. Take sometime to get educated about your options and do what you feel is best for you. Once you make your decision, don't look back. Eat right, exercise, loose weight if you need to. I compare it to preparing for a heavy weight fight, because it is.

I choose DaVinci and I am happy with my choice. When my wife and I met with my uro to discuss treatment, we had already decided on DaVinci but didn't have a clue as to who to see.
She asked my uro, "if it were you, who would you use?" He didn't hesitate to say Dr. Vipul Patel. He has performed over 5,500 robotic surgeries, more than anyone in the world. He was located 100 miles away. He was also on my insurance plan.

After meeting with Dr. Patel we set the date for 4 weeks later.

We rented a hotel room across the street from the hospital. They even gave us a better rate because of the surgery. We checked into the hotel the day before surgery, I got out of the hospital the morning after surgery, and we stayed in the motel 6 days until the catheter was removed. The cath is the most unpleasant thing about either open or robotic so it will be removed quicker with robotic. My surgery was on a Tuesday, I had to wait until the following Monday to have the cath removed. If I had the surgery on a Monday, he would have probably had it removed that Friday.

I had 2 sisters who had breast cancer. I asked their opinion. They both said "get the cancer out!"

I am glad I did.

Good luck with your decision. Keep us posted on your progress.

Bill

First, let me say a BIG THANK YOU to everyone of you kind folks that took time to respond to my post. You insights have truly been very helpful in guiding me towards my treatment. As suggested, I will take a bit of time to make the final call but right now, after speaking with my family, (Wife, Son & Daughter) whom were all at my consult with my urologist, I am leaning to have the surgery done by someone I know well and trust, my current urologist. He has done many hundred prostate surgery's and I feel he will do an excellent job.

It's kinda funny, but today I was out by myself doing some fishing and a lot of thinking. When I was young I thought that getting out of the stinking jungles of Vietnam alive was a big fight. Fortunately and through the grace of God I survived that part of my life. Well, here I am many years later in what seems like the biggest fight of my life, Prostate Cancer. But like I said in my original post, I will kick this Cancers Ass!!!

In closing, please accept my very heartfelt thanks for all your posts. I will keep you all updated as to how things go in the near future and hopefully many years down the road. I believe it was Samster who said in his post: "I believe in Jesus Christ and so after making what I thought was the best decision I placed it in His hands. I am very pleased with my outcome." Well, I also believe in Jesus Christ and with his help, my urologists skills and all you wonderful folks prayers,,,,I WILL SURVIVE, CANCER FREE!!!!

THANK YOU ALL AGAIN AND MAY GOD BLESS EACH AND EVERY ONE OF YOU.

Sincerely: Hotrod58

hotrod58 said...
Greetings All:

First, thanks for this site. 65 year old male here, just told by urologist this last Monday I have prostate cancer. He said out of 4 samples from each side, 8 total, 2 on each side came back with a medium-low Gleason score, PSA 7.7. He assured me it is very curable where it is now. He explained options and I ruled radiation out after talking with him about the results. Looking to do surgery and prostate removal but am more confused than ever. I asked about Robotic De Vinchi Surgery and if there were any benefits and he told me that when a surgeon does it directly, he can feel more around the area whereas the robotic operator does not have that feel. Also, you need an experienced robotic operator that has done many surgeries using the robot, not just a few. I asked about him not being able to see as well due to blood and being able to spare nerves, he stated that is not a big problem with the use of proper suction. As far as the post surgical pain?, my urologist stated the pain will be the same for both with no pain advantage for either one. Every ad I see for robotic surgery is like a used car salesman giving a pitch. RE: We can do it better, come here for your surgery!!!

I have faith in my urologist as he has treated me for other minor things over the years. In all fairness to him he did not try to "Sell" me on him doing it and understands it is totally my choice. I respect his honesty. Can you folks that have had surgeries done both by Robotic and also conventional please share your thoughts and experiences with me?? As I mentioned, I am opting for prostate removal, but an so very confused as to what procedure to use. My closest Robot is unit is in at the University of Wisconsin Madison Hospitals & Clinics, a top-notch place about 100 miles away. Was wondering is traveling for followups might be a pain?, (no pun intended).

In closing, THANKS again for being here. When I found out the results of my biopsy, it was like getting kicked in the head. Now, I am resolved to Kicking this cancers ass!!!

Regards, God Bless and Good Health,,,,HotRod58

The experience of the surgeon is more important than the procedure itself. The same is true with other forms of treatment, you want someone who is really good and experienced with their trade.

We have people here who have had wonderful results with open and with robotic. It's a personal choice, I definitely wanted robotic for many reasons. Driving back to the office after a week wasn't an issue at all. Driving home 24 hours after surgery was a little bit of an issue in that every NYC pothole felt like a jab to the gut. But that feeling last a day or two really.

having a great relationship and trust in our urologist is great. I did too but decided against using him in the end. I was given the advice that this was a one time thing, and that I may never see my surgeon again after the surgery (not the case in my situation) but that I should find the best I could possibly find to do it. Of coure your urologist could also be one of the best. Just saying that taking the emotion out of it can help in deciding who to use.

Good luck whatever choices you make.

I had robotic and would have been home the next day except the anesthesia created some complications for me. I ended up with a five day stay. The docs tell me no difference in outcomes with either surgery, it's just the recovery time that's shorter with robotic. Anesthesia is really tricky stuff regardless of the surgery.