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Robotic vs traditional laproscoptic RP

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Prostate Cancer
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Posted 3/29/2018 12:01 PM (GMT 0)
I have recently been diagnosed with PC. I am convinced that surgery is the right choice for my case. I think I hav faith in my urologist at MGH and I am scheduled for laparoscopic prostectomy on 4/18/18. MGH does robotic also but my urologist, who has about 12 years experience and 450 prostectomies, says he prefers laparoscopic and holding the instruments himself. I read a lot about the benefits of robotic surgery and wonder what the real differences are in cancer control and side effects versus laproscopic without the robotic control.
64 years old
DX 2/21/18
PSA 11.54
3 positive cores
Gleason 6, 7 & 8
No symptoms
Posted 3/29/2018 12:43 PM (GMT 0)
Welcome Boston221- sory you need to be here.

You are fortunate as MGH is a great hospital.

450 prostectomies is sort of light as over 1,000 would be preferable.

The skill of the surgeon is more important than robotic or laparoscopic.

Have you considered radiation?

Go Red Sox!!

Bobby Mac
Posted 3/29/2018 12:59 PM (GMT 0)
Good Luck Boston,

At A minimum I would recommend a second surgical consult.

I'm a surgery guy doing well at 9 years out. However I no longer recommend surgery to family and friends. At age 60 with all the new data on radiation therapy I would go that pathway. Diagnosed today with my same pathology I would jump into radiation tomorrow.

Read my post in this thread....

https://www.healingwell.com/community/default.aspx?f=35&m=3993054&g=3993844#m3993844

You may have already consulted with radiology... if not it is a must do.

If you choose surgery the guy that did my surgery is at Brigham he is now the chief of the division of urology. I would highly recommend him. (Adam Kibel, MD) He operated on my brother and I and we are doing about as good as it gets.

Again My Best To You

Hero
Posted 3/29/2018 1:00 PM (GMT 0)
Thanks. That is all good to know. I briefly consider radiation but the oncologist felt that if I went with radiation I woudl also need hormones therapy for 28-36 months. I would much rather not do that for so long.
Posted 3/29/2018 1:15 PM (GMT 0)
Understood, Good Luck!
Hero
Posted 3/29/2018 1:32 PM (GMT 0)
Welcome Boston 221 - I'm on the North Shore

There is a wealth of knowledge and information on this board - and folks with way more knowledge than me will weigh in here. There are a couple of themes when someone new shows up:

1) send your biopsy slides to Epstein at Johns Hopkins for a second opinion - they are the best in the business, and only read PCa slides - you Gleason score may change for the better, or for the worse, which may influence your decisions

2) I agree with Bobby Mac - 450 prostatectomies is light - I went to Lahey Burlington and the two top surgeons there Dr. Canes and Dr. Moinzadeh each had 2500+ prostatectomies to date. Dr Kibel is also held in great esteem around here. Hero is also right - the skill of the surgeon outweighs the numbers.

3) you mention that you met with an oncologist - was it a radiation oncologist or a medical oncologist? Current thinking on hormone therapy seems to be twofold - either six months or 18 months unless there is something else going on. By all means meet with a radiation oncologist, probably two of them. Get someone who specializes in SBRT, and the more traditional IMRT. They tend to specialize in one or the other, and like a urologist specializing in surgery can't really give you an informed opinion about the other treatment options.

Good luck, and keep us informed.

Rob
Posted 3/29/2018 2:10 PM (GMT 0)
Boston 221, I'm only gonna speak from my own personal experience I'm sure there will be lots of guys coming on with lots of good ideas and advice we have some very knowledgeable guys on here! Ok let me start if you were just diagnosed having surgery already in April is way to early. You need to be own advocate and get a good team in place look at all your options and then proceed. You have time to do more research PCA is slow growing although right now I know how you feel you want it out and gone and get on with life. PCA is now part of the rest of your life even if you do have the prostate removed and you get fortunate to catch it all. There will always be PSA tests and the anxiety that come along with them. I would suggest you read the SRT and ADT thread and see some of the experiences that guys have had. I'm not gonna give any opinion on types of surgery all I can say when they start messing around in there with the nerves and bladder I certainly would want a surgeon who has done more than 450 you will be dealing with the side effects of surgery the rest of your life. With that being said check out all your options there are so many different treatments available all with different side effects which should be a big consideration in your decision. And as the guys have said I would send out my slides for another opinion. Also make sure you read the thread on the top of the forum page for guys that have just been diagnosed. Wishing the best for you in whatever treatment you decide on!

Larry
Posted 3/29/2018 2:41 PM (GMT 0)
Welcome.

I'm a surgery veteran, and I am pleased with my choice. As others have said, choose the most experienced surgeon you can find. This is a complicated surgery, and you want a person who has seen and done it all.

I could have done more research on radiation therapy. I biased myself a bit towards surgery, and I don't have regrets. However, I have subsequently learned more about the types of radiation that would have benefited me.

Since I had my surgery in late 2016, I've read a great deal about SBRT, and the possibility it could become the gold standard of treatment for many men.

Bottom line is take your time, look at both surgery and radiation, ask questions, search the web, use this forum since there are some knowledgeable members here.

Good luck.
Posted 3/29/2018 6:29 PM (GMT 0)
My surgeon has done thousands of LPR and his hospital got a da Vinci robot a few months ago. He did not even offer me RALP and I was glad he did not. Experience is a key factor.
Posted 3/29/2018 8:32 PM (GMT 0)
No studies have found a difference in oncological outcomes between open, laparoscopic or robotic surgery. Perioperative complications favor robotic, but they usually aren't a big deal.

/www.ncbi.nlm.nih.gov/pmc/articles/PMC2859140/

The more important question is how experienced the surgeon is in the technique he uses. Here are some questions to ask:

/pcnrv.blogspot.com/2017/12/questions-to-ask-and-not-ask-on-first.html
Posted 3/29/2018 9:14 PM (GMT 0)
Boston, I agree with you that an argument in favor of surgery over radiation is the years of androgen deprivation therapy (ADT) that comes with radiation and Gleason 8. ADT must be the "Achilles heel" of radiation treatment regarding quality-of-life!
In selecting a surgeon I looked at the surgeons documented results. To find one with low amount of positive margins and best results regarding ED and continence. I am not from US so I don't know if such information is available for you?
Posted 3/30/2018 12:42 AM (GMT 0)
In open surgery, i am told the surgeon, if experienced can feel the cancerous material sticking to his tools. In rarp it takes more experience to notice the stickiness of the material because there is no feel. I have no idea if this is true. My surgeon explained it to me after he cut wide and took all my nerves.
Posted 3/30/2018 1:15 AM (GMT 0)
Its all about the experience period...whatever the treatment...the biggest threat to getting the "right "treater is "loyalty" er...ah... misplaced i.e....I'm gonna leave it at that...
Posted 3/30/2018 1:18 AM (GMT 0)
A minor caveat to experience...the Capt of the Titanic had 30 years of experience ...working against him...hey nobody said it would be easy...
Posted 3/30/2018 1:22 AM (GMT 0)
Boston,

With brachy boost, you shouldn't need any ADT with it, especially if your Gleason score is 8 and you had only 3 positive cores.

/pcnrv.blogspot.com/2017/12/is-adt-still-needed-for-high-risk.html
Posted 3/30/2018 1:33 AM (GMT 0)
old beek...You are correct sir...
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