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My husband (58 years old) was diagnosed last week with PC. 1 core biopsy out of 12 came back positive. Davince Prostatectomy has been recommended. Our question is this: How important is the number of robotic surgeries a Physician has done? I have scoured the internet and have not found this topic discussed anywhere. Can anyone help with these statistics?
Hi Lavonna
Please take some time to peruse this website as well as read A Strange Place (available on the main page). This will give you an idea of the available treatment options for your husband.It is important not to rush into things.
Whatever treatment you choose it is absolutely essential to ensure your specialist is highly experienced in his proceedure. This is the most important thing you need to do and is key to a successful outcome.
I have read here of Da Vinci surgeons who have done hundreds if not more than a thousand ops. If you do decide on this route you need to ask about the surgeons track record including rates of continence recovery and ED recovery
Way too early to make a decision on treatment options; you need to do a lot more research. According to a new study the side effects of robotic surgery are way understated. Using a standard of incontinence of no pads, no leaks, only 28% of surgery patients achieved this standard in 2 years.
For a low core, low psa, gleason 6, Active survelience may be the best option as 70% of these cancers never progress and the 30% that do when treated have the exact same cure rate as if treated mmediately.
Thank you for the replies! We are afraid to take the "watchful waiting" approach. what if we wait and he has mets later? that would leave us wondering if we should have taken care of it earlier?!? It seems to be a road of many gambles!! I wish it was more "cut and dried"!! We cannot seem to find a right or wrong answer, it just does not seem "black or white". There are soooo many scenerios!!
I started this website precisely because I wanted newly diagnosed men and their wives, partners, family to be able to talk to people who had already been through the ordeal of diagnosis, choice of treatment and treatment itself, so you’re in a good place. I’d like to answer your specific questions:
1. You ask How important is the number of robotic surgeries a Physician has done? I cannot emphasize enough how absolutely important it is to find an experienced surgeon with a good track record. Thee is no doubt at all in my mind that much of the damage done to men who have surgery is because the surgeon was inexperienced in what is a very complex procedure. In a study published this month it was reported that 80% of all procedures in the US are carried out by doctors who do less than 10 procedures a year and that more than 25% of procedures are carried out by doctors who only do one procedure a year. You simply do not want one of those surgeons operating on your husband. If you go to the RESOURCES page and scroll down, you will see the names of two men who claim to keep information on the best surgeons. It is also important to establish what would be done if the Da Vinci robot failed for any reason during the procedure. This is not reported as a frequent event, but the point is that many of the Da Vinci surgeons admit they have lost their skills at manual surgery and it is therefore important to know that there is an equally qualified standby surgeon.
2. You say It seems to be a road of many gambles!! I wish it was more "cut and dried"!! We cannot seem to find a right or wrong answer, it just does not seem "black or white". There are soooo many scenerios!! You’ve hit the nail right on the head and already discovered what many people have taken a good deal longer to find – that the entire prostate cancer business is made up of uncertainty. As Aubrey Pilgrim, a long time survivor before he passed on from an unrelated illness used to say The Golden Rule Pf Prostate Cancer Is That There Are No Rules With that in mind it is important to seek the best and most varied advice you can, using the answers to these QUESTIONS as a guide. It is also worth reading Dr Strum’s views - ASSESS STATUS BEFORE DETERMINING STRATEGY
3. Finally you say We are afraid to take the "watchful waiting" approach. what if we wait and he has mets later? that would leave us wondering if we should have taken care of it earlier?!? That is perfectly understandable view because you have not yet had a chance to understand some of the key issues. It is well worth reading the piece by Dr Jonathan Oppenheimer on his BLOG where he says, amongst other wise advice For the vast majority of men with a recent diagnosis of prostate cancer the most important question is not what treatment is needed, but whether any treatment at all is required. Active surveillance is the logical choice for most men (and the families that love them) to make.
The point is that a diagnosis like your husband’s will almost certainly, on further investigation, turn out to be that of an indolent disease. If this is the case, then current views are that it takes 15 – 20 years for a tumour to reach the size that it can be diagnosed and a further 15 – 20 years to become life threatening. Against that time scale it is important to realise that the indolent version of the disease doesn’t suddenly leap from the gland and become a metastasised disease. There are some versions that are that aggressive, but it seems very unlikely that your husband has this aggressive variety.
Just one other point. Many men have said that they would be unable to deal with the uncertainty of the continual watching of the PSA levels which are a part of an Active Surveillance program. The article above mentions this, but does not fully make clear that every man who has been diagnosed with prostate cancer will be watching his PSA – or any test that takes it’s place – for the rest of his life, since none of the current therapies guarantees a cure.
Hope this helps – but keep on asking questions until you find answers that suot you and your husband.
The 1st biopsy showed some "atypical" cells. It was done in Wichita, Ks. It was then sent to a lab in California. I know at least 2 pathologists have looked at it. Gleason (3+3)6. His PIN-4. I have not done very well deciphering that number yet? "Also favoring the diagnosisof cancer is that stain for racemase is positive". Again, THANK YOU guys SOOO much for the communication!!! It means a lot to me to get different perspectives!
With a biopsy result like that you really must think very hard before taking any drastic, and life changing steps. I think it would be in your interests to seek the opinion of a recognised expert in the field - see RECOGNISED EXPERT PATHOLOGISTS
If you can find a doctor who will discuss Active Surveillance with you intelligently, and not simply dismiss it, you should give the idea full consideration. I don't know if you have come across the name of Donna Pogliano? She was a PCa activist and co-author of one best books on PCa - A Primer on Prostate Cancer. The Empowered Patients Guide.. Although she is no longer active in the PCa field, some of her words of wisdom linger - this is what she had to say to a man with a similar diagnosis to your husdband's:
From what I'm reading here, you're thinking of undergoing local treatment for one silly millimeter of prostate cancer?
If what you posted about your situation is correctly stated, this is what is meant by "insignificant disease". When they talk about prostate cancer being overdiagnosed and overtreated, they're talking about YOU!
The medical profession may have lured you into the medical mill with a positive biopsy, but you DO still have the option of removing yourself from the treadmill of diagnosis-by-biopsy followed by immediate-local-treatment. I'm sure that either a surgeon or a radiation oncologist would be delighted to treat you because if they only treated patients with your extent of disease their stats would be lookin' REALLY GOOD!
Lavonna, I was my surgeon's 48th DaVinci patient. He left half of my prostate behind forcing me to undergo a full course of radiation treatment with hormone therapy. Choose the surgeon wisely.
OK here is an update. My husband simply did not want to do the active surveliance. Dr A.J. Farha in Wichita, Kansas did a Davinci Prostatectomy on January 18,2010. He was very fortunate through this entire process. The most pain he experienced was the evening of the surgery, on a scale of 1-10 he said his was a 3. The following 2 days it was a 1 and no pain from then on. However the most important thing is that he was DRY the first night after the catheter was removed and had VERY minor leakage during the day for 11 days following. So 3 weeks after sugery he has no continence issues. They had him start taking Cialis (20mg) twice a week beginning the day they removed the catheter. Still early to tell but it appears that is going to come back also to whatever "normal" will be. Everyone has to make their own decisions and live with whatever they decide. My husband has not for a moment regretted his decision. Fortunately for him it was all very uneventful and he feels blessed to be cancer free at this moment. We have truly appreciated this website. What wonderful people you all are!!! We wish you all the best. I would welcome sharing information with anyone that it might benefit.
Lavonna and Ken Huston
Glad to hear that all has gone well, Lavonna. As we discussed here, there are no 'wrong' or 'right' decisions. You and Ken chose what suited you best and I'm sure you'll go from strength to strength.
Of course, if you want to share information with anyone that it might benefit, the way to do it is to JOIN US and then keep udating your story over the years. It is clear from a POLL that I ran on site that the most important issue for the majority of men who visit the site is the long term outcomes of the various treatments. It is people like you and Ken who can give them this information and that is why I try to persuade men who have been good enough to share their story to continue with brief annual reports.
There are now more than 850 stories on the site, some going back 15 years.
