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Hi HR 20 months ago I had nerve sparring prostatectomy and have no incontinence and ED is about 70% and getting better. My surgeon found that the cancer spread to the fatty tissue outside the prostate. He removed this cancer. I don't know if robotic can see what is around the gland. My recovery was tough for 2 weeks which surgeon attributed to getting the cancer that was outside the gland. I think the big plus for robotic is an easier recovery. I would try to find out if outcomes are the same. The most important thing is to get a skilled surgeon for whatever procedure you pick. I have heard bad stories with both and it seemed attributed to lack of skill and experience. I would also talk to a radiation oncologist before making a decision. If you have specific questions regarding my surgery feel free to ask. Bruce
IMO, your Urologist is on the ball and offers you sound medical advice. With so many unreliable Urologists out there, you should consider yourself lucky to have him.
Those hospitals that have invested millions in the robotic assisted RP equipment will tell you that it is superior to open surgery and there will likely even be studies cited to back that claim up. (After all, what would you expect them to say with that kind of money invested in the equipment). The reality, however, is that studies have shown that open surgery performed by one of the top surgeons in the country yields more favorable results. If you research this, I am confident that you will find this to be true.
The KEY phrase above is "performed by one of the top surgeons" and,in that light, Dr. H. Ballentine Carter is one of the top RP surgeons in the country at arguably the best prostate cancer hospital in the USA. You would literally be in good hands.
HR, here are a couple of other excellent Open RP surgeons on the east coast. Dr. John Libertino @ Lahey Clinic in Burlington, MA and DR. Jerome Richie @ Dana Farber Cancer Center in Boston.
These doctors, along with Dr. Carter, have all received the Castle Connolly America's Top Doctors for Cancer Award in 2011. If you go to the vitals.com website, you can check the three of them out. You will see that Dr. Libertino gets the highest patient rating and he will be my choice when it comes time to have the surgery. For what it is worth, I have already sat with him and came away very impressed. We did not talk about open vs. robotic surgery much, but I do remember him saying that being able to feel the prostate in your hand is a distinct advantage. (To be fair, you would expect him to promote Open RP, but it also made sense to me).
Lastly, I agree with Bruce that if, in the end, you decide on robotic RP, it is equally important to seek out one of the top surgeons that perform this procedure.
I'm now leaning more toward the open surgery at Johns Hopkins and following my docs advice..Dr. Ballantine has performed something like 3000 surgeries...
I had it in March of 2006 and have recovered fully (my story is on yana, search for Fagin, my urologist). No ED, no incontinence.
Robotic has become much more prevalent, just be sure your surgeon has done at least 2k successful prostatectomies, with excellent nerve sparing results. Unfortunately Randy Fagin no longer operates. So, I have no one to recommend.
Benefits of robotic:
1. Much less invasive - 5 small incisions, no real muscle cuts
2. Seldom requires transfusions
3. Much better optics, IMHO much more likely to be nerve sparring
4. Much easier and shorter recovery time
Couple a good robotics surgeon with a good pelvic floor rehab physical therapist and your likelihood of success are excellent, assuming your staging is correct .
ThiUSIA my opinion, others will vary... As a wonderful oncologist told me, the best decision you can make, regarding your treatment, is the one with which you are most comfortable.
I would choose Radical ( which I had ) if the Radical Procedure surgeon was a very top one vs a lesser experienced robotic surgeon. However, I would likely go Robotic if I had a fortunate choice of a very top surgeon in each discipline. There was no Robotic available locally when I had mine done so it was an easy choice - once I decided to have it out that is.
