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young dx how to choose what is right treatment

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Posted 2/3/2007 5:33 AM (GMT 0)
47 year old, PSA 4.1 (2.5 in may), gleason 6 on both sides.  Leaning toward radical, but looking for opinions on lapro and or other options.  willing to travel.

47 y/o male

PSA 4.1

Gleason 6 on both sides

Dx on 1/29/07

20% of Biopsy cores

Posted 2/3/2007 8:10 AM (GMT 0)
I recommend robotic prostatectomy. Surgeon can perform the surgery at greater magnifcation than open and work more precisely. Smaller scars and less recovery time ard big pluses, as well. I felt it gave me the best change of having negative margins coming out of surgery. Survival was of utmost importance, and erection capabilities are a distant second (as well as continence)

Having said that, everyone's journey is personal..
Posted 2/3/2007 1:22 PM (GMT 0)

Kziz,

A comment regarding Da Vinci robotic vs. open--I have heard that the blood loss with an open is often significant enough that the surgeon is performing at least part of the surgery by "feel" because the surgical field is obscured by blood. With the da vinci there is far less blood loss, the field of surgery is far more visible, with 15x magnification, 5 to 1 translation of motion, allowing for very very precise movements, and the arms of the robot never, ever get tired.  I was amazed at the tremendous power and huge size of the hands of my urologist, but now that I better understand the physical challenges of an open surgery, I can see that his strength comes from 30 years of extremely strenuous exercise (the surgeries). All that effort can carry with it the risk of fatigue on the part of the surgical team. With da vinci this is far less.  I guess video games can serve as training for some fields! 

Markus


Posted 2/3/2007 3:34 PM (GMT 0)
Short and quick DaVinci so many advantges over open radical. You will become your own expert start researching. Make sure your doctor is a young dude that has no fear of compters and video games. I sure wouldn't want anybody my age of 57 doing the robot dance in my body. Diagnosed 8/10/06 PSA 4.3 5 of 12 cancer Gleason 7 Davinci Surgery 10/12/06 wonderful recovery
Posted 2/3/2007 3:59 PM (GMT 0)
Well, this voting sounds overwelming twards tha DVinci, I didn't even know about DaVinci back when I had my radical! I guess it was fairly new then. I word about open which is always mentioned in this debate is the surgin can feel things wlth his hands that can't always be seen such as the texture of the prostate which may indicate pre cancerous tissues and the feel of other parts around the prostate. By no means am I suggesting one over the other, I'm just giving a opinion which wasn't brought up yet. No matter which way you pick Kziz, it will be the right one for you! Just make absolutly sure you are comfortable with the surgin you pick. I think anyone here will tell you that this is way more important the the type of surger or other method you pick I'm almost glad I didn't have to pick back when mine was done! Good luck!!
Your friend,
Pete
Posted 2/3/2007 4:06 PM (GMT 0)
Hello kziz,

Early diagnosed PCa contained within the prostate capsule; low Gleason score; seems like a perfect match for an experienced daVinci surgeon to perform a flawless procedure. The key to any successful operation is the experience and skill of the surgeon. The very best of luck in you research.
Posted 2/3/2007 4:23 PM (GMT 0)
Hi kziz,

I had the "open" surgery and am very happy I did. Everything worked fine and I had very little pain. The recovery has been no problem either compared to some previous surgeries I have had. The catheter was in for 6 days and I could hold my pee as soon as it came out. My only incontinence has been some small leaks now and then. The doc saved both nerve bundles and my potency is coming back slowly.

Just thought I would throw in another viewpoint. Do your own research. Pick the treatment option that you feel is best for you then find the best doc you can to perform it. Make your decision then don't look back. The only things we can bring to the OR are a healthy body and a good attitude. Be a cheerleader for the medical team....

Jim
Posted 2/3/2007 4:34 PM (GMT 0)
kziz   &   loved ones,                    A    “Special”   Warm Welcome   to   You!   I know we can “all” make Your Journey smoother just by being here for you!   This is truly a great forum!!! ~ You have joined! You are now part our forum family ~ a group of wonderful individuals who are so willing to share their journey with you!     It helps “all of us” ~ to help you ~ if we know where you are on your path. So ~ Please stay with us and take our hand when you need it!   Keep posting.... OKAY!!   KNOWLEDGE IS POWER... and POWER conquers fear YOU MAKE THE DECISIONS… YOU HAVE OPTIONS… ~ and ~ Your decision will be the right decision for you!!!   We invite you to visit our personal thread listed in our Signature below… Our thoughts and prayers will be with you as you continue your search for answers…   In Friendship ~ Lee & Buddy   “God Bless You”   It's a little prayer   ~   "God Bless You" ...but it means so much each day, It means may angels guard you and guide you on your way.     (Direct Link ~ just click on the title below and a new window will open!   Reminder … click on the REFRESH icon once you get there) Helpful Hints for New Members... Hope this helps you! :) Updated 02-05-2007
Posted 2/3/2007 5:16 PM (GMT 0)
Hi again Kziz,

I also had open surgery. Several reasons I picked open over robotic:

1: As explained in an earlier posting on this thread, the open surgery supposedly gives the surgeon a better more open view of everything. This can be particularly important if the cancer is near the edges and the doctor needs to check carefully to make sure that it hasn't spread and that he/she can get all negative margins. With your Gleason 6, you are mid grade but you mentioned that your husband has cancer on both sides which I think increases the odds of the cancer having penetrated the capsule. I am not trying to scare you about that. You just want to consider all the possibilities that could occur. Being prepared is better than being surprised.

2: The robotic method is fairly new and lots of docs who are doing it have not done a huge number. You don't want a doc who is still in the "learning" stage. You can overcome this problem though by making sure that you seek out a doc who has done hundreds and hundreds of robot assist surgeries. Unless you live in / near a very big city this might require you to travel for your surgery.

I will say that given all the stuff that I have read on this site, if it weren't for my high Gleason score, I would now be a lot more inclined to consider the robot procedure.

Good luck,

Ben
Posted 2/3/2007 6:08 PM (GMT 0)
Kziz,

I had a Da Vinci but my surgeon had done over 2,000 open RRP's and had done over 800 Da Vinci's when I hooked up with him. I asked him about the comparison and besides the less pain, blood loss and quicker recovery he said that the three dimensional view that he gets with the camera and the closeness of that view gives him a lot better surgery field to work in. When I went back for my six week follow up I I asked him about what his university based urology clinic was getting for comparable complication rates between open and robotic. He said that they were not ready to publish anything yet but that the results show that the robotic is getting better results. In saying that you have to understand that there is not a large difference but the Da Vinci is evolving to become the gold standard. It is not the right surgery for advanced PC and even my surgeon says that he has to evaluate paitients to see if they are candidates for the Da Vinci.

Tamu
Posted 2/3/2007 10:24 PM (GMT 0)
Da Vinci not available in Oklahoma. Does anyone have information or knowledge regarding MD Anderson in Houston? THis is where we are leaning right now, however have not ruled out John Hopkins, City of Hope, or even Mayo.
Posted 2/3/2007 10:39 PM (GMT 0)
KZIZ....Not True.....There are two Urologist that use the Divinci in Oklahoma City. One is out of the OU Med Center (name is Wong)?. The other is in Midwest City (name is Law?). The only machine I know of is in Midwest City.
I decided to go with my Urologist in Norman and have the open RRP. I just felt good with My Dr. and being able to stay here in Norman. I could have wished for a little better outcome with the bladder control. But I don't think it had anything to do with my Dr. Some people just have more trouble than others.
My Dr answered all my question regarding the differance of the open vs the Robotic. He even said he would support me if I wanted to go to one of the "Big" centers such as Mayo or Hopklins for surgery and to him for my follow up. He said this decision was all about me and not about him. I really respected him being so open!
Make the decision that is right for YOU. The go for it!!!!
Good Luck...... KW
Posted 2/3/2007 11:11 PM (GMT 0)
KW, Our dr did say that a dr in MWC had just bought a devise, but said if we went to him we would be rehersal for others. He said the urology board in OK has yet to approve the procedure. Thank you for the dr's names, we will check into them.
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