Newly Diagnosed - Open or Robotic Surgery and Who ?

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Thanks Bluebird - I appreciate your support and input. I am approaching this journey knowing you all are out there to help. Another Rite of Passage in Life.

             

Hi Cpb,

I'm glad to hear that you decided to go with surgery. From my research, the best doc that do open are Dr. Scardino in NY and Dr. Catalona in Chicago. One of the best robotic docs is Dr. Tewari in NY. You can't go wrong with any of them.

Best of luck to you. May you have a quick and speedy recovery.

AEG

Thanks AEG - I appreciate your response. I should have posted my topic correctly. I meant open or Robotic. I would prefer Robotic if I am proper candidate for it. My Urologist says I am but that assumes Pathology- Gleason 6 (3+3) coupled with low PSA 2.7 with T2a is correct. What about Samadi or Guillonneau also in NY for Robotics ?  Thanks again.

CPB

CPB,

It sounds like you're a good candidate for robotic esp if the PC is confined to the prostate. This is only my opinion. I've heard the names Samadi and Guillonneau for Robotics, they probably are some of the top ones in NY but I would probably go with Tewari. From my research, Dr. Tewari is excellent for robotics. Perhaps you can consult with him and decide for yourself.


I found some videos / interviews of Dr. Tewari, I hope you can watch/hear them on your computer. If you can't, you can go to a local library to watch them:

Please keep us posted.

Links:

http://www.brightcove.com/title.jsp?title=307719464&channel=301783375
http://www.brightcove.com/title.jsp?title=307739154&channel=301783375
http://www.youtube.com/watch?v=cswcGoxVZi4
http://www.youtube.com/watch?v=0malkSW6PtY
http://video.aol.com/video-detail/id/1799718909
http://video.google.com/videoplay?docid=2622472122799081510
http://pl.youtube.com/watch?v=3c0SlMvlTGw&mode=related&search=


Best of luck to you.

AEG

Transrectal MRI will give you a decent idea, although not 100% accurate. Best way I know how.

There are probably other tests out there, let's see what the other members have to say about this.

A.

cpb,

There is no "for sure" when you are dealing with prostate cancer. What you have to do is collect all of the information that you can and then use it to determine your choice of treatment. Your staging indicates that the DRE was abnormal. There are numerous prediction tools that have been developed to use statistics to help provide information. I plugged in your information in the one developed by Memorial Sloan Kettering. The calculator came back with an organ confined prediction of 88%. It also predicted a 1% chance of seminal vessel and lymph node involvement. Once again this is just a tool so use as information not as a hard and fast outcome. All this indicates a very early detection with a Gleason that is the most normal for prostate cancer.

I chose the robotic for the less surgical trauma and because I believe that the improved field of view for the surgeon gives the best chance for regaining continence and a successful nerve sparing. There are several surgeons within a reasonable distance of you that have done hundreds of robotics. My surgeon is at Vanderbilt University and was only two hours from my home but I would have gone any distance to find a surgeon that had done hundreds of robotic surgeries. You can go to www.davinciprostatectomy.com and get to the web site of the manufacturer of the robot. They have a list of surgeons and hospitals that are doing the robotic surgery.

Stay with us as you go through your journey. This forum has become a band of brothers and sisters.

Tamu

Thanks Tamu - My Doctor used the Sloan Kettering Calculation as well - he thinks I am a good candidate for Laproscopic procedure. Will continue research.

cpb,

I faced the same choice this year. For me, the more I researched it, the less it became a choice and I was convinced that robotic was the way for me to go.

There are more and more experienced da vinci surgeons around. I decided to focus on the most experienced I could find, which boiled down to two who are up above 1500 procedures. Dr. Mani Menon, at Henry Ford, in Detroit may be above 2000 procedures. His claimed recovery statistics are impressive. I chose Dr. Vipul Patel, at James Cancer center in Columbus, Ohio. I think he is now over 1700 surgeries. He impressed me with his confidence, openness about the skills and qualifications of other surgeons and, well, he is just a great communicator. And, very importantly, his clinic runs like a swiss watch. I mean, it isn't just him, it is his entire support staff. Until I went through this I didn't realize how many different people would be involved in the whole thing.

BTW, pardon my ignorance, but there may well be other 1500+ surgeons who I am simply aware of. I hear good things from the guys who have been treated at City of Hope in California but don't recall the specifics.

Tewari and Menon worked together and I know Tewari is very highly regarded, a total pro. There is a guy at Johns Hopkins (can't recall his name now, he is asian) who is somewhere over, I think 800 procedures and very well respected.

I think you'll find that, as others have said, the choice of type of surgery is less important than the skills of the surgeon. Scardino at Sloan-Kettering is second to none.

God bless you in your decision making. BTW, have you heard about a recent study that seems to classify prostate cancer into two distinct forms? The classification is by dna and there is one which apparently is very agressive and the other one is very slow growing and less dangerous. Don't have the citation handy, but wish the study had been completed before I had to make my decision...

Good luck, my friend.

Hi Cpb,

52 years old, PSA of 3.1, Pre-op Gleason of 6 and post-op of 7 and clea margins(all confined).

I too chose Dr. Patel at Ohio State and though originally from Ohio I live in NC so I made a rather lengthy trip-but it was worth it. Dr. Patel has supposedly done as many as anyone else and has taught many other surgeons. My surgery was at approx. 3:30 on a Monday and I was released at noon the following day-very little blood loss. It is now one month later and I use about one pad per day with daily improvement. There are many factors effecting a successful outcome including your age and health, are there good nerve bundles found, and of course, the quality of the surgeon. I felt that Patel offered the best potential based on the number of surgeries he has performed and on discussions with him. One thing I did find a little concerning was the lack of real good follow up.  I think this was in part, to me being out of state and not following up with Dr. Patel. The important thing here is to ensure you have a local urologist that will be willing to follow up for on-going therapy(potency) and follow up tests

best of luck

bzup

I went with robotic by Dr. Dasari out of Centennial in Nashville.  I have had absoulutely no adverse issues other than a PSA that bounces between .03 and .05 at the 22 month point.  The one thing I wish I had checked on is whether the surgeon has the pathology report done while the robotic equipment is still in place.  I would have gone with that option if I had checked it out better becasue I did have some adverse path findings that may have prompted the surgeon to go back in and do a little more carving if he had immediate access to the Path report.  The key with robotic is to find someone that has done over 200 to 300 procedures, I would not consider it with less experience than that.

Good luck!

hi cpb

i just posted this reply in answer to another question similar to yours:

Dr. Tewari at NY-Presbyterian Hospital (Cornell) in New York City is considered one of the top robotic surgeons in the US. I believe that he has performed over 2000 prostate robotic surgeries. He was a pioneer with Dr. Menon in robotic surgery at the Henry Ford Hospital in Detroit. Dr. Tewari was hired to head up the prostate robotic surgery team at NY Presbyterian when it was established a few years ago. If I had elected robotic surgery, I would have selected him. I consulted with him, but decided that the proton therapy was best for me at my age. Get the best robotic surgeon you can find even if you have to travel. Best of luck!

You asked the following question: What about Samadi or Guillonneau also in NY for Robotics ?

Dr. Samadi transferred from NY-Presbyterian (Columbia) in the past year to Mt. Sinai to head up their robotic surgery. From my research I believe that he has a very good reputation. Dr. Guillonneau with MSK has been considered top notch in laparoscopic surgery, but I was not aware that he now performs robotic surgery. Dr. Scardino at MSK only performs open prostate surgery, but is considered superior if one wants open surgery. I believe that MSK has been slow in transitioning to robotic surgery, if they now perform it there.

Dave