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Gleason 7, Psa 4 weeks ago 4.1, Robotic or Open? Please help...

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Prostate Cancer
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Posted 12/10/2009 10:17 AM (GMT 0)

Hi I was hoping some of you can give advice either from your experiences or experiences of others with similar stats.

My father was diagnosed with PC about 4 weeks ago.

12/12 biopsies came back positive, 10 (3X4) and 2 (4X3)

He has Gleason 7 and a Psa of 4.1 with one perineural invasion.

Went for Bone Scan and Ct Scan and both negative.

He is considering Robotic surgery because he is concerned about the loss of blood and the side effects of open. After reading so much statistics online it seems that open is the best way to go.  Better cure rates, more extension into the lymph nodes, etc. I am worried his choice to go robotic will be a huge mistake considering he is Gleason 7.

If anyone can help me or give me feedback, advice I would really appreciate it.

Posted 12/10/2009 2:10 PM (GMT 0)
HI LuvMyDad,

Actually, both types of surgeries have similar outcomes. There are advantages and disadvantages to either form of surgery. Usually the determination in which form of surgery to use, will be based on the experience of the surgeon (higher the better) and/or any other medical condition that would make robotic not feasible...such as a prior hernia mesh installed or if your dad is extremely overweight...just for examples.

But to answer your question...either method will not be a mistake. But you do need to factor in his age and his ability for major surgery. Also don't forget that there are other methods of treatment besides surgery that need to be considered also.

Others will chime in shortly....best of luck and welcome to Healingwell
Posted 12/10/2009 2:21 PM (GMT 0)
Well surgery might be his best option, but then if that doesnt get it all he still has other options including radiation. The good news is that the bone and ct scan came back fine. But listen to others on here whose stats might have been like your fathers. Take care and glad he has you in his life. What is his age by the way?

Michael

Posted 12/10/2009 3:56 PM (GMT 0)
I've had both kinds of surgeries and recovered from the robotic much quicker.But the doctor can tell you more.good luck to him.

Zach
Posted 12/10/2009 4:05 PM (GMT 0)
I am an open surgery guy, that was my experience. Either method has its plus/minuses. The loss of blood has been greatly minimalized over the years to where that is not a big issue. Some men are just bleeders, but that has happened with robotic surgery too, though rare.

The quality of the surgeon and the faith and trust you have in him/her should be the deciding factor. WIth open, and I will attest first hand, you will have longer hospital stay, and a longer physical recover time as a rule. I was in the hospital for 4 full days and needed every minute of it.

With open, you have one large incisions, as opposed to several smaller ones from robotic.

With either method, its important to know that it is still a major and complex surgery, and that there will be serious recovery time, which also depends a lot on the patien'ts age and general health. And there will be side effects. He will have incontinence, how bad? No way to know ahead of time. Some guys go dry instantly, others struggling a year or two later, most get dry in a few months. On the ED front,
no way to predict or calculate that ahead of time, too many variables.

WIth all your father's core's being positive (be nice to know the percentage of cancer) and being a Gleason 7 case, my bias would be towards surgery. Others will strongly disagree, but that is ok.

Good luck to him, and to you. Please keep us posted.

David in SC
Posted 12/10/2009 4:46 PM (GMT 0)
Hi, thank you LV-TX, 60 Michael, zachattack and purgatory, for your incredible feedback. It is so nice to be able to talk about this. It has seriously taken a toll on my family.
My father is 62 y/o age and in very good health otherwise.
To be honest, I dont remember exactly how much in each biopsy, I think it was about 60-70% percent on the right, and 20-40% on the left. Again, it was 12/12 positive, (my heart drops everytime I think about it or type it).

He is going in for robotic surgery on Dec. 21. I am hoping that it is all contained in the prostate. I am just scared that he maybe cutting himself short by opting for robotic over open.
(Is it true that the cancer recurrence rate is much lower for open v. robotic?)
But reading your posts it seems that having a better doctor can make all the difference. I guess from now I will just keep my fingers crossed.
I know this is a very silly question, but what could be the prognosis? People keep telling me it is more like a disease then a cancer, and usually people die with it not from it, what do you guys think?
Posted 12/10/2009 5:05 PM (GMT 0)
It's true, most men with diagnosed prostate cancer will die with it, and not directly from it. That can be encouraging for most men.

The method of surgery, robotic vs. open, will not determine how well the cancer has been rid from your father, it will depend on the skill and experience of his surgeon, and how and where the cancer is located exactly. There are no guarantees with this, and you can hope for the best results.

Hope this helps. His surgery will be coming up soon, if it were me, I would have waited till after Christmas, but perhaps the surgeon you want to use has a tight schedule.

Your dad will need you on his recovery side after surgery. When he gets his post surgical pathology report, you will both know a whole lot more, then you do presently.

He should do well.

David in SC
Posted 12/10/2009 7:00 PM (GMT 0)
I can't add anything more than what David said above. Just wishing your father a speedy recovery. At his age and health, he should recover very easily. It will take a week or so to obtain the pathology report after the surgery, so learn as much as you can between now and then. He is very fortunate to have a very caring daughter by his side.

We are here to help in anyway we can.
Posted Yesterday 2:28 AM (GMT 0)
Hello Luv my dad.

I had open surgery 2.5 years ago. I went into the Hospital on a Wednesday morning for surgery and was discharaged on Friday about noon. I had 24 staples from my belly button down to Jr. I had very little blood loss and no blood added. I was up and walking the afternoon after surgery. I cannot see my surgery scar now. Fatigue was present for afew months so was the leakage. I took no pain meds after the IV ran out, and no bladder spasms either. I could not believe how painless this procedure was. My PSA's have all been less than zero and after this amount of time the whole thing seems like a blur. This was my experience with all of this. If I could suggest something is to find the most experienced surgeon you can find at a very good hospital. Good luck to you and let us know about your journey.

Mika
Posted Yesterday 3:04 AM (GMT 0)
Hi LMD,

I'm saying the same thing as the other guys: Both robotic and open are good procedures with high success rates. So you don't have to fret over choosing one over the other. Before my surgery, I talked to an open surgeon and a robotic surgeon, and they were very complimentary of each other. So I wound up with robotic, done on December 8 last year. I healed up well, and even helped my teenagers with their Christmas shopping, although I wasn't feeling up to traveling or having people over. It's highly likely that your father will be home for Christmas (which I know may not matter if you don't celebrate Christmas), may not be feeling great yet but maybe in good spirits for having gotten it over with.

In my case, the surgeons I was considering were both excellent, but I chose the hospital with better nursing care.

Best to you and your father,

DJ
Posted Yesterday 8:34 PM (GMT 0)
HI LMD- I LMD TOO,

Had Robotic, very pleased I did, great recovery, great results, very pleased with outcome, Tell Dad not to worry too much.  He will do just fine.......................Cheers Kev.

Posted 12/14/2009 12:15 AM (GMT 0)
He's scheduled for Robotic so that is the right choice.
You can help by helping around the house: do laundry, arrange to have the driveway plowed (if you have snow where you live), buy some Incontinence pads now.
Introduce him to this site, if you can. He will find a lot of info here.
Good luck,
Jeff
Posted 12/14/2009 12:49 AM (GMT 0)
I just had a second opinion from a Uro who admits he himself doesn't do robotic but called it vastly superior, 3D imaging etc.
Posted 12/14/2009 12:51 AM (GMT 0)
Hi LuvMyDad,

I had my robotic RP on Oct 29, 2009. It was not a hard decision to go with the RP because of the long term benefits, but the decision between open and robotic was more difficult. After talking to Doctors at the Mayo Clinic and here in St Paul, MN I decided on the robotic. To me the benefit of having what the surgeon was looking at was blown up by 10 times and he didn't have all the blood to obstruct his view out weighed the benefit of the "feel" benefit in open surgery. The most important factor in both methods is the experience of the surgeon. A rule of thumb is that he should have done the surgery at least 200 times. With robotic I had no pain, was out of the hospital the next day. The incontinence was a problem for the first 4 weeks, but now am down to one pad a day with none for the nights. I feel great..went out for my daily 5 mile walk today. That is good for a 70 year old guy. Give your dad a lot of support. My dear wife has been with me every minute i needed her.

Good Luck
Dick
Posted 12/14/2009 5:17 AM (GMT 0)
LuvMyDad,  Your Dad is lucky to have you as a daughter.  I had open surgery and was home the 2nd day.  My Dr. told me before surgery I did not need to bank blood that I would not need additional blood.  He was right.  I have freinds that had Robotic Surgery and have done juswt as well.  I think the 2 surgery choices are a toss up.  Both have their advantages for are very close with results. 

Best of luck to you dad. Do keep us informed and as others have said "show him this web location.  He my be very interested in the comments.

Jeff T

Cajun Country

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