This forum is for the discussion of anything to do with Prostate Cancer. There are only four rules:
No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
No harvesting e-mail addresses for Spam;
No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making
Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.
Since this is an International Forum, please specify your location in your post.
Thank you for your input. I met with the surgeon who aborted my surgery last week (Dr David Lee). He explained that he ran into a situation where my colon was 'wedged' between my rectum and bladder. He tried, very carefully, for 45 minutes to slowly cut through the scar tissue, but finally decided it was too risky. I asked him why he didn't proceed with an open procedure right then. He said "My expertise is robotic. I haven't done an open since med school (15 years ago)." So he has referred me to his boss, Alan Wein, Chief of Urology at the University of Pennsylvania. He said Dr. Wein is an expert in open prostatectomy, and will be able to help me with no problem. I have an appointment on Monday (11/24) and will let you know how that goes.
Yes, I informed him about the appendectomy. Having done over 2000 robotic prostatectomies, he didn't envision any problem. He was totally surprised to see the amount of adhesions he ran into. When I met with him following the surgery, he said "Are you sure you didn't have any other abdominal surgery"? Of course, my answer was no.
On this question of adhesions and scar tissue caused by previous surgery. The uro I am seeing now to monitor the prostate tissue left behind after my Da Vinci, says that if he does a biopsy on me in the event of my PSA trending up, he will do a template biopsy, trans perineal. (Using a similar template to the ones they use in brachytherapy, I think).
I am told that the reason for this is that with such a small amount of prostate, there is a risk of "welding" it to the colon if they go through the rectum for a conventional biopsy. If it becomes fused or welded to other tissue, then, if they have to HIFU (or radiate) the remnant, they can't avoid hitting other tissue they would rather leave alone. Somebody out there correct me if I have this wrong.
I'm not a doctor, but the more I think of what happened to me (and Paul A), the more I think all guys - especially newly diagnosed - should make a thorough NUISANCE of themselves by quizzing the medics about (a) whether to operate and (b) if the medic is gung ho about operating, just how many unforseen problems did he encounter in his career and what was the outcome. How good will he and the robot be with scar tissue if there is any there.
See I'm now told that even a biopsy through the rectum IN MY CASE (not necessarily anyone else's)could cause problems for HIFU or radiation. So I think we now have to ask not only should we have the surgery but if we go for that, should it be Da Vinci?
The problem is that even if there is a good reason for doing open surgery (e.g. scar tissue from previous operations or simply the robot breaking down mid procedure), there are going to be fewer and fewer surgeons capable of doing it. Charlie's guy and mine were at the peak of their careers and yet both said that open wasn't their skill anymore.
I had my Da Vinci surgery 8 weeks ago. I was concerned about the Robot stopping and asked my Dr. about the possibility of open surgery. He told me that one of the other urologists from his practice group was going to be present during the operation. The other surgeon had 18 years experience with open surgery and if something went wrong with the Da Vinci, they would not stop, but go ahead with the open surgery. Fortunately for me, everything went well. I thought it was standard proceedure to be ready for the open in case of problems. I also know that my surgeon said that he has never had a problem with the Da Vinci proceedure in over 130 surgeries.
Thanks to all for you comments over the past several weeks. Here is an update. I had an appointment on Nov 24 with Dr. Alan Wein, Chief of Urology at Univ of Penn Hosp. He ordered a series of MRI studies to determine the extent of adhesions. I had a follow up appointment with him today. He informed me that the MRI report indicated that I had a large presence of fatty tissue (lipomatosis) in the region of my bladder and prostate. He said he could still perform the open surgery, but that the fatty tissue would likely cause more bleeding than normal. Nonetheless, he recommended that I see a radiation oncologist before I decide on the surgery. That appointment is tomorrow. Stay tuned.
It is not unusual for Robotic surgery to convert to open. I had an excellent surgeon (performed the most LARPs in Nebraska)who ran into complications. I had a double fracture of the pelvis in '94. He said trying to get to the prostate and lymph nodes was similar to pouring molasses on a newspaper, then trying to separate the pages. I was in surgery for almost 4 hours and in the hospital for 5 days. The tumor had attached itself to the rectum wall. I'm sorry you have to go back in to surgery. This is major surgery and you can't just bounce back from it.