Prostate Cancer - Looking for people who have had the Da Vinci Surgery with Dr. Vipul Patel

Some further info concerning your DX would be helpful. PSA level, GS score, DRE results.
To say that you want no incontinence or impotence tells me you need to really do some serious research. We all wanted that outcome no matter the TX we chose.

Do yourself a good service and read the first two posts on this board that are well designed for the newcomer to this PCa world. Then spend a lot of time researching each and every TX option.

At your age you will have a long time to deal with the SE's of TX so chose wisely based on thorough knowledge.

I am not a surgery guy but have heard many good reports of Dr. Patel. I am sure that he would not guarantee any outcome from his treatments. Nor would any other Dr. not matter what their specialty.

Spend some time here reading the stories posted, spend some time reading the clinical studies and then spend some time getting, truly, in touch with yourself. Only then is it time to make a decision. Above all things make the decision that you can live with no matter the outcome of the TX because the outcome is always a "crap shoot".

May you be well.

Roger

Dr. Patel did my surgery in January. If surgery is your choice, I would recommend him.

That being said, there are always going to be side effects from any treatment. My current SE's are documented most recently on a thread entitled "3 Months Post RALP".

Patel has performed well over 10,000 surgeries. Experience really does make a difference. What you are looking for is a successful triad outcome: cancer removal, nerve sparing and continence. In my case, I would say that surgery was a success, though I am still rehabbing and will be for some time. This is normal. So be as prepared as possible when making a decision. It will change you forever. How much, is the question.

Post Edited (Depov) : 5/8/2019 11:33:19 AM (GMT-6)

Add in Swedish, Virginia Mason and the University of Washington, Seatlle.

Good comments all.
I imagine that you will be disappointed reading these comments, but the fact is that there is no guarantee of a totally successful DaVinci surgery from the patient's viewpoint. From the surgeon's viewpoint, a surgery is successful when the prostate has been removed and the patient has recovered. His/her time frame is a few weeks at most. But the patient may have significant side effects that last for months or sometimes even years, even when the surgeon is highly skilled.

Thank you for all your responses and for your wishes. I would like to apologize for mistyping my age, it's actually 48. The last PSA score was 9.46, the Gleason score was 3+4. There is no cancer growth outside of the prostate as far as the doctors could tell, the biopsy has been given. I also have a few ganglions outside of the prostate which should, supposedly, be removed as they say. In the DRE examination, nothing was seen or felt.

I am researching continously, however it is a bit difficult to approximate my chances of success since many posts are more than 10 years old and I thought there would be some medical advancements done since that period that would increase my chances of keeping the impotence and incontinence away.

@halbert could you recommend some prostate experts in Europe? I live in Europe and I visited Italy because it's said that they have good medical institutions for this issue.

I've also sent e-mails to Hopkins, Cleveland and Mayo Clinic for, possibly, more thorough examinations to get the best advice on-site.

And I had RALP surgery six months ago and the first couple of days home were awful with significant swelling and nasty gas pains in upper back. On the other hand, I only took one pain pill the first night as the discomfort was not really pain in the conventional sense. I found the process a little more taxing than advertised and it definitely is major surgery in a complicated area that is all interconnected. On the other hand, incontinence was not an issue for me so go figure. There is nothing a doctor can say or do that will determine how the surgery will go for a specific person. That is just your roll of dice at the time. Same with with every treatment or procedure in our PCa world.

DVQ,

Dr Patel did my RALP in 2017. I have only good things to say about him, his office, and Florida Hospital Celebration. One caveat: Florida Hospital has now been swallowed up by AdventHealth. I don't know whether they still offer the same high level of patient care/customer service as before, but Depov had surgery with Patel just a few months ago and sounds quite satisfied.

If you'd like specifics, contact me privately by email (click on my forum name and it'll take you to my public info page).

Nevertheless, I agree wholeheartedly with those forum members who have recommended consulting at centers of excellence -- Johns Hopkins, MSK, Dana Farber, Emory-Winship, to name a few on the East Coast--to explore all your options, not only surgery, and get a fuller picture of the pluses and minuses of each. Take your time.

If you decide to stick with surgery, it's important that you feel comfortable with the surgeon and his care team (PAs, nurses, office staff), so please shop around. Every center of excellence has a surgeon with plenty of experience on the DaVinci. Patel's office is very busy and comes across to some as an impersonal assembly line. That wasn't my experience at all, but certainly you'd have more personal interaction with a surgeon with a smaller set of current patients.

whatever you decide - I feel you need to move quickly. At PSA hovering around 10 - you are getting into high risk zone irrespective of gleason and other findings.

As per the given responses, and Saipan's help, it seems the best course of action is to visit a good medical center for this issue to get the best advice (regarding as well if I'm fit for RT and if that would have better results in my specific case).

I know I'm getting ahead of myself, but what is the treatment like post-surgery regarding hormones? Since testosterone can increase the risk of PCa, it seems the standard treatment in case the PSA levels increase is ADT. Is it generally something that happens? And whether if it's possible that the testosterone levels can be let free in case the PSA levels stay normal, hormonal therapy for the remainder of the life doesn't seem tempting, but I guess it can't be avoided in some cases (hopefully it can be in mine).

Now that you have received "MANY" good and valid comments I will add my personal experience view.
My PSA was lower than yours, highest test was 6.47, but my GS was considered unfavorable low risk at 4+3. Granted is was barely more 4 than 3 but still it was.
I was treated with SBRT at Swedish in Seattle,Wa. The center there was not a "touchy feely" feel good place. They were very professional, they did everything right for who I am. I don't need to have my hand held so Swedish Radiosurgey Center was a good fit. I have the sense that other people, who need more support, would get it there. I really felt that TX at Swedish with Dr. Meier was/is tailored to the individual.
There are a number of world class SBRT centers in the States. Some shy away from treating the GS7 guys and some don't. The data is beginning to become impressive on the TX outcomes for the intermediate and unfavorable intermediate PCa guys treated with SBRT.

I give you this personal info not to try and sway you towards SBRT but just to show you that you do have choices.

I have experienced no significant difference in Erectile function and only slightly worse urinary issues since TX. I had some issues with urination pre TX due to a very large prostate. Those issues pre and post TX never included incontinence. So I must say " To pee or not to pee it is my choice".

Study and then with wisdom make your choice.
Roger

Welcome back - Why does the surgical clinic recommend hormone (ADT), and radiation treatments (RT)? Did you have a 6 week PSA test done that was high? The 3 month PSA is most important so you need to wait for that value. Do you have the actual prostate surgery biopsy results to provide? Any change in Gleason score? Any positive margin or lymph node issues to report? There must be a reason for this recommendation.

Normally they should not be talking seriously about any further treatment until 3 months after surgery based on the prostate pathology results and PSA at that time. My RO recommended that I do adjuvant radiation, ART, with a PSA <0.10 without hormone therapy since the latest studies do not indicate any difference if radiation is done early after surgery with PSA <0.10.

There is no way to avoid hormone therapy if the PCa is no longer contained in prostate area or if your PSA never reaches "undetectable" 3 mos after surgery that I have heard of. I think I would wait for your 3 month PSA results and doctor followup visit before you get too far in considering all the options. Good luck.

Buddy Blank said...
Explore all options before you decide. Once it's cut out there's no going back.

that ship done sailed, buddy