Dr Catalona's position on LRP and Robotic RRP

I’ve read Dr Catalon’s position regarding Robotic RRP and LRP in his latest Quest issue. I’m was alarmed by what he had to say. Dr Catalona referenced three studies (Sloan Kettering, Harvard and Duke). The Harvard study (2003-2005) he stated that men undergoing minimally invasive vs open radical had 3 times the odds of requiring salvage therapy within 6 month. He stated that his concern was that the gland is not all removed during surgery or that the gland is cut during the laparoscopic procedure. He also stated that men were 40% more likely to develop scar tissue that would negatively impact continence. He stated that the Sloan Kettering study found similar results to the Harvard study. He also stated that in the Duke study, patients who underwent robotic were more than 4 times more likely to regret their decision. He stated this might be because expectations were higher for the “innovative” procedure.

He ended his position by stating that the jury is still our regarding these two new procedures, but stated that so far the much of the important evidence is not encouraging.

I read it too, and the bottom line for me is experience of the surgeon. I believe that there are a number of surgeons out there jumping on the bandwagon (heck, I have driven by a medical building with a billboard on it advertising nerve-sparing robotic procedures) and that there are not enough patients to go around for all of them to acquire sufficient experience. And not all 3 of those articles supported his position. I don't remember which one, but one showed essentially equivalency.

I'm going DaVinci, but my criteria was that the surgeon had performed more than 150 such procedures. I turned down one (50 procedures) and selected a Univ of Wash professorial type (we'll see, won't we) who does 1-2 a week and is north of 350 procedures.

You know Steve...this was the exact reason I didn't want the "assembly line" type surgeon. I didn't want to be #3 on surgery day or even #2. So I chose a surgeon that only does one on the day of surgery....mine

LV,

I agree with you 100%. On the day of my surgery, November 14th, my operation was the only one scheduled by my dr/surgeon. The surgeon that assisted him in my open RP, did, however, do a robotic in the morning window.

David in SC

Having read this and having the robotic surgery, doesnt make me fell that great especially from a long term perspective...I did have a very experienced surgeon...

SHU93
I was actually hesitant to post about this article but felt it was necessary. I was pretty shocked to read it myself.

This is a most interesting conversation. There are several simple thoughts that go through my mind relative to the whole discussion of surgery / experience / which is best / etc.. I have always wondered who the person or persons would be who was the first patient, or even among the first 100 of those doing surgery of any kind. Who would say I want to be first? I have always wondered how the person gets started as everyone I have ever heard discuss this has surgery from someone at least fairly experienced. My point is not all of us can be on the experienced end. Relative to this the first surgeries are included in statistics the same as those at the experienced end. As far as DiVinci robotics goes - I watched (as it was videod) my surgeon do a surgery and talk through it from beginning to end via DVD. I know anything is possible, but what I saw looked very routine. If a surgeon has done more than a thousand of these doing basically the same thing every time it is done and especially if this is all those surgeons do, and they are conscientious, it is hard to see how extreme mistakes could be made. Ultimately though, I suppose we would not know. The same would be true with radiation - if they missed the target, or did not have the intensity set appropriately etc..

My urologist, who is a senior citizen, and has been practicing for many years and has done many open surgeries in the past told me the difference between robotic and open was just the opposite of what the article indicated. He says that any surgeon can have a bad day, but the DiVinci method lessens that possibility by magnifying and controlling surgeon movements to a finer detail. It is also less bloody so the surgeon can better view the area. The only thing I have heard is a detriment is the robotic surgeon does not have the sensation of feeling.

I suppose these kinds of discussions will be going on and on with no absolute resolution - ultimately it is a matter of confidence in the method of cure, or if surgery also the surgeon. All of us have to make the choice we make and then live with it. I do think it is interesting that by far the majority of people on this forum defend or support whatever method they chose and believe it is the best avenue. There are a few exceptions that wish they had done something different, but most do not.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008

RB, our local hospital just got their DaVinci 2 months ago. I wondered then who and what number of guys would be getting it done here, and how much experience the surgeons would have starting out. Tonights 6 o'clock news showed it setup at the local mall and letting people try it out using rubber bands, gravel and such.

Before my decision was made, my doctor/surgeon basically made the same points as in the article here in contention. He was not opposed to the Robotic surgery approach, he just felt
that there were good reasons to do it open, which included the tactile feel issues, unforseen complications, etc. he said after my
surgery, that had it been done robotic first, they would have had to aborted it quickly an convert it to an open, based on a very complicated
situation he found in my pelvic bed. I am not smart enough or experienced enough to be able to argue the ohter side, it seems
like many men here, have done very well by robotic.

David in SC