Open vs Robotic RP

My Dr does both. He explained that both have advantages. With Robotic, obviously everything is magnified where the surgeon can see things very clearly. Also recovery time is suppose to be quicker.
With open, he said it's an advantage sometimes where he can actually feel an area if he needs to. I chose robotic and although my recovery time was not quite as I expected, I don't regret my choice. I hope this helps, lots of info out there. Good luck!

Ultra, welcome to the forum. I hate to see guys your age show up.
It sounds like you have a good handle on things, and have made up your mind on surgery. Others will advise you to investigate Brachytherapy (seeds), both LDR and HDR, possibly SBRT / Cyberfknife, etc. I was advised to do so, just to be complete, even though i had surgery in my head. I did so, and still went for surgery. I would say that investingating these other treatment modalities is a good idea, if you haven't already, just so you know going in, that youve looked at everything and done your due dilligence, and have confidence going in, that you've done the right thing. With that said, I would do surgery if i was in your shoes. I actually was in your shoes, except i am 23 years older.

To your question - i think what is more important than robotic vs open, is who the surgeon is, how many surgeries has he done, what is his record on positive margins, continence, and ED, and JUST AS IMPORTANT, do you have a high degree of trust in him. When you've found the right guy, based on those criteria, do whatever procedure he does.
Recovery is supposed to be much quicker with Robotic, AND less blood loss (minimal). As kwoo mentioned above, proponents of open feel they have the advantage of feeling the tissue and it gives them a better idea of how wide to cut to get negative margins. The proponents of robotic say that the high level of magnification that the robot gives them on the video console more than makes up for the loss of tactile feel.
So there you have it, there is no one answer, like almost all things related to PC.

One piece of advice, and yes, I am biased ....
If you are going to NY to see Samadi, make it your business to also meet with Dr Ash Tewari, at Mount Sinai. And if you aren't "Doctored out", perhaps James Eastham at MSKCC, who i have not met but have heard great things about. And if you do investigate Brachy, try to get in to see Dr Zelefsky also at MSKCC, who others here have said is one of the best at that procedure.

My procedure was done by Dr Tewari, and i am extremely pleased. I was fully continent at 5 weeks, and have experienced pretty much no ED. And have just had my 6 month PSA and it is undetectable. Of course, every situation is different and i believe, pathology being equal, most of this stuff related to side effects, is 75% the surgeon, 25% good luck.

Dr Tewari is Chief of Urology at Mt Sinai, where Samadi was before he went to Lenox Hill. Tewari is on the same level as Samadi, with over 6000 surgeries, and is a world recognized expert, has published many studies, and in my opinion is more of a scientist than Samadi.
They are i think, on a par, as far as surgical skill, but i think if you see them both , you will recognize two very different personalities. I wont say more.

Good luck on your journey, and stick around you will get plenty of education, guidance and support here, if you feel you need it.

Bummer you have to be here at such an early age. I'm very sorry about that, but with your diagnosis you have every reason to think you'll do well. And there's a certain calmness in your post that I think will serve you well.

I'm one of those guys that Prat mentioned will tell you to investigate alternatives to surgery. Pretty much any treatment will cure you so I'd be thinking mainly in terms of what the likely side effects are the psychological pros and cons of each treatment are. Of course, if you're set on surgery that's fine and I'm glad to hear you're doing your due diligence on robotic versus open and assessing who to perform the procedure.. But if you only talk to the surgical superstars, you'll only get surgical recommendations.

Most important keep learning and I really hope do well. Good luck and keep us posted!

thanks for all of the replies; the support on this forum is remarkable. what gets me about open vs robotic is that in Chicago we have one of the most experienced and successful surgeons in Dr. Catalona but all the literature (some of which is marketing) provides me pause to evaluate other options.
Basically my mind is thinking, Dr. Catalona is in my backyard effectively so why go through all the logistical issues of traveling somewhere to have the surgery. Doesn't make logical sense and it's somewhat confusing honestly.

We did evaluate brachy, cryo, etc. but given my age and the fact I really don't want any of the longer term potential complications with radiation, my wife and I decided on surgery.
The brachy surgeon recommended using seeds which both my wife and I were suprised at; we thought he would provide the same feedback as the surgeons taking all factors and demographics into account.

Do now the decision is basically go with Dr. Catalona or go with an equally experience robotic surgeon (Tiwari, Samadi, or Patel)...

Confusing to say the least and mentally I just want to get the PC removed.

thanks for listening...

What I heard about Dr Patel in Celebration (Orlando) is that he isn't at the controls of the machine for the entire procedure. I had RARP in Houston (MD Anderson) with Dr. Davis at the console for the entire operation. He has over 2,000 da Vinci procedures now.

ultra497 said...

We did evaluate brachy, cryo, etc. but given my age and the fact I really don't want any of the longer term potential complications with radiation, my wife and I decided on surgery.
The brachy surgeon recommended using seeds which both my wife and I were suprised at; we thought he would provide the same feedback as the surgeons taking all factors and demographics into account.

Hello Ultra and welcome. You have received the pluses and minuses of open vs. robotic so I won't add to that.

I will say that there are very few long term potential complications with Brachy other than sexual side effects which are, on average, considerably less than with surgery. In fact a recent study by MSKCC showed the 10 year rate of secondary cancers with brachytherapy to be the same as for patients who had surgery -- both extremely low. Since you are in Chicago, you might want to consult with Dr. Brian Moran at the Chicago Prostate Center. He is one of the best brachtherapists in the world, has treated many patients who frequent our site and will give it to you straight.

Prato said that if he was you (and he was), he would most certainly choose surgery. I'll just add that if I was you (and I was but older) I would most certainly choose LDR Brachy, HDR Brachy or SBRT. All of those provide the same cure rates as surgery but with a lesser chance of the onerous side effects of incontinence or sexual dysfunction. My thinking, contrary to some, is that younger men have a longer time with which to suffer from those SE's hence the logic to try to minimize them.

However, if you guys are set on surgery then I wish you the absolute best and encourage you to choose a highly experienced surgeon because they tend to deliver better results. However, I just want to also encourage you to make sure you have done your due diligence in getting educated before making this important decision. Read noted oncologist Dr. Schultz', "Invasion of the Prostate Snatchers" if you want to know why.

Jim

My only additional thought for you is that there are great, and near-great surgeons and teams all over. To get top-notch treatment you don't have to go to the two or three rock stars. What I found, out here in the midwest, is that (for example) one of the top PC robotic surgeons in the world is in Nashville at Vanderbilt (Dr. Smith). I got great treatment (trifecta at about 8 weeks, no ED drugs required) at Barnes-Jewish hospital in St. Louis and the Washington University team.

While I think it's important to know how many treatments an individual surgeon (or brachytherapist for that matter) has done and their personal success rate, I also think it's important to know something about the team and the facility backing up that lead expert. If you're at a national top 10 center, then you're going to be in good hands. Personally, the morning after surgery, the most important person on my treatment team was the guy who brought breakfast, and apologized profusely when the only thing I could have was cream of wheat. He promised..and delivered...a much better lunch.

Welcome aboard 497!

I had my surgery by Dr. Patel on Celebration, FL. In fact I am on my way there this coming Thursday for a 3 year follow up. They said I can come back whenever I want and it always feels like home when I go there.

No one can claim to have more experience in the world than Dr. Patel, over 8,000 surgeries and counting.

In answer to John_TX who said Patel is not at the controls all the time, this is true. He has a "TEAM" that preps the patient but he is behind the controls for every surgery where it counts, removing your prostate.

He is a very humble man, always having the "TEAM" take credit for his success. I like that in a surgeon. He is not God nor does he act like it.

He likes his patients to stay close by if you have longer than a 2 hour drive away until after the catheter is removed. We stayed in a hotel just across the street from the hospital. It had full kitchen so you could have your meals in the comfort of your room. And the hospital is 10 minutes from Disney World if you would like to go to the park, just hop on a shuttle from your hotel. If you don't want to go, your family can.

Good luck with your choice, we are here for you for any other questions.

Bill from Florida