Confused

I thought I had just about made my mind up about the treatment to pursue until I read the Q@A's of Dr Catalona provided by a link in one of the posts today.  He obviously is not sold on laproscopic surgery whether robotic-assisted or not.  He provides a good argument with his background of 5,000+ open surgerys and references a study that tends to support his conclusions that, all things considered, open surgery is the preferred method.  I did notice, however, the study he referenced was from 2003-2005 comparing open vs laproscopic.  How on earth has everyone made up their minds which way to go when it's suspect-if not obvious- each doctor thinks their procedure is the best.  I hope to get my stats/info entered tomorrow.  dx2-16-10. Gleason 3+4, 1 adenocarcinoma, 2 PIN, high grade, appointment with Dr Shah, a diVinci surgeon, in Atlanta 22 March.  This forum and everyone on it is a Godsend!  I sure would appreciate hearing from you who have been there done that-either procedure!

John in NC (Chatuge)

Chatuge
I believe the most important thing is to pick the surgeon and let him perform the procedure with which he is most proficient.
I will be having robotic surgery with Dr Joseph Smith at Vanderbilt Medical Center on April 7. I too considered all options.
Once I decided on surgery, I considered both open and robotic for several weeks. I had 4 surgeon interviews.
In the end I chose Dr Smith. He is the only surgeon that I interviewed that had done a great number of both open and robotic. He had done over 2000 open surgeries before switching to robotic some years ago. He has since done over 3000 robotic and stated he is convinced that robotic is superior with the caveat that the surgeon is the most important part of the equation.
Good Luck

Rick

John:

From everything I have studied on the subject, it is the experience level of the surgeon that makes the difference.  Many of the studies that showed da vinci as inferior included docs with inferior experience as well.  While there are no long term studies with da vinci,  my opinion is that it is just as good (maybe better) with the caveat that you want a surgeon with 250+ procedures.

Having said that, I don't see from your post here that you have explored other options.  Irrespective of the fact that most men on this forum have chosen surgery, it is a big deal.  Just look at all of the posts about ED, incontinence, strictures, shorter penises, ejaculating urine, depression, etc. if you don't believe me.  You are not doing yourself any favors if you don't discuss options with a radiation oncologist to look at less invasive options.  Just MHO.

Tudpock

If you have crummy or no insurance - the one night versus 3 or 4 nights in the hospital could be part of the consideration.

John in NC: when my husband was choosing his treatment two years ago, we too were confused. It seemed like every time we were completely comfortable with the treatment choice, we'd read or hear something that caused us to question our decision.

My husband wanted surgery - he considered radiation but discarded it early on in his decision making. Our surgeon had been doing robotic surgery for years and while he does both open and robotic, felt that robotic was best in my husband's case. Our surgeon prefers robotic over open because of the excellent visual clarity. The camera allowed him to view the entire prostate from all sides before starting to cut. Since one of the two positive cores from the biopsy was very close to the edge of the prostate, he was concerned about cutting too close to that edge which might have resulted in a positive margin. In our case, the robot gave the surgeon an advantage in that he was able to view the area and plan how and where he was going to cut.

As others have said, I too believe that picking the surgeon based on their skill and success rate is more important than the surgical technique. Incontinence and ED are side effects of surgery, regardless of whether robotic or not.

John,

I think that is a valid question and you got some good responses to your thread. I would ask Dr. Shah if he has also done open surgery. One other option that you might consider, at least as a consult, in Gainesville, Ga they started doinf Robotic last year. Dr. Wu and Dr. Ornstein had both done thousands of open and are now doing Robotic. It might be helpful to also talk to Dr. Ornstein to get his opinion about which surgery would be helpful given your stats. Not sure if I spelled their names correctly but they are now with NE Ga Medical Center. You are in the drivers seat my friend.

Michael