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Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

56 years old, recently diagnosed 9/2/2015 with prostate cancer.

Looking for any feedback regarding treatment and doctors, specifically robotic radical prostatectomy (or open)

Anyone with recent prostate cancer experience with Northern California Kaiser locations, Stanford or UCSF would be appreciated also.


My biopsy ...

STAGE: T1c
Gleason Score: 3+4=7
PSA 4.4 08/10/2015
NUMBER OF CORES INVOLVED/TOTAL NUMBER OF CORES: 2 of 14.
TOTAL CARCINOMA LENGTH: 10 mm.
TOTAL TISSUE LENGTH: 192 mm.
PERCENT OF SAMPLED TISSUE WITH CARCINOMA: 5 %
F) PROSTATE, LEFT BASE, NEEDLE BIOPSY
-- ADENOCARCINOMA, GLEASON GRADE 3+4 = 7
-- ADENOCARCINOMA INVOLVES 2 OF 2 CORES AND 10 MM OF 30 MM
TOTAL SPECIMEN LENGTH (33%)
-- NO PERINEURAL INVASION IDENTIFIED

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

Jronne,

Not familiar with Kaiser docs but Peter Carrol at UCF is probably the best on the west coast.

You might want to consider Focal Laser Ablation. You can avoid the urinary and sexual side effects of a RP. If you have a recurrence you still have all of your options open including a RP. Also this procedure requires a MRI which will tell the Doc's if you have any hidden high risk tumors.

Fred

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

You might consider Active Surveillance. Some places are putting men on AS even with the GS 3+4 if all other factors point to a low risk case like yours.

I did get a robotic prostatectomy from a surgeon who had done about 300 already and it went very well. I did end up with recurrence but I went in knowing that would probably happen.

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

Jronne:


Don Oberlin said…

Bruce:

Just to make sure you have touched all the bases please consider getting yourself a copy of Bob Marckini's book : "You Can Beat Prostate Cancer..." His chapter on the advantages and disadvantages of several methods of treating PCa is usually of particular interest to the recently diagnosed. This book is readily available, an easy read and well worth its modest price. Although this book is nearly ten years old at this point much, if not most, of the information remains relevant.

Best wishes Don O.

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

Hi jronne,
Do you happen to have any previous PSA readings and dates as well?

For the most part your stats would make you as reasonable candidate for active surveillance even with the GS 3+4 providing you adhere to regular testing.

best wishes
john

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

Hi John, Let me tell you about my experience. Five years ago at age 54 I had a PSA of 5.6 or so. After the biopsy, I decided to have a radical prostatectomy on the robotic Da Vinci machine. The procedure was easy until I got the results back that I had positive margins meaning the cancer extended beyond the cut. The doctor did not want me to go for a second opinion of having adjuvant radiation but after several months I went anyway. The Oncologist looking at my results discover that the problem was that when the surgery was done to remove my prostate, the doctor missed a small piece of the prostate inside me and that had some cancer. After that news I went ahead and received the radiation (which was also easy). 4.5 years later my PSA is at 0.00 (all 4.5 years at every 6 months). After reading up a little on the Da Vinci, I saw that the Da Vinci had a little bit of a history with this problem of not getting 100% of the prostate. In 4.5 years I am sure things have gotten better. It appears that sometimes the prostate is close to another organ (bladder I think) and it is hard to cut the prostate out cleanly. Interesting enough I was watching an old House TV show (the one with the craze doctor) and in the episode another Doctor wanted House to operate on him and made the comment “unless you have it in your hand, it does not count”. I now know what he means. Do not let my story sway you one way or another. But if I was doing it again I would ask the risks of what I described above. Good luck. I will check back on this site in a week or so. I am going on vacation tomorrow. Mike Gastonia NC

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

Hi Mike,
Sad to read about your positive margins with Da Vinci, but very heartening to read that your salvage radiation has gone well.

Mike for the most part the success of the DaVinci procedure is dependent on the relative experience of the surgeon with the procedure. For the most part surgeons using robotic technique are generous in their tissue resection. The reason for that is while the robotic technique is precise, there is no ability for a surgeon to feel tissue as is the case with an open RP. Skilled surgeons employ the feel of tissue greatly in open procedures.

Now regarding positive margins, sadly no prostatic surgery, be it open or laparoscopic, has a guarantee of no positive margins. In addition to the difficulty of undertaking an RP, it is a very challenging operation, clear delineation between organ tissues can sometimes be difficult, even more so post EBRT, that is why so few are done.

I think, were I considering an RP, I would opt for the open procedure with a very skilled surgeon. I am old school and tend to go with what I know work's.

I did a paper a while back analysing the various treatment choices that YANA members had undertaken as primary treatment for PCa. To my surprise Robotic Da Vinci method far out numbered open RP, and for the most part outcomes were good. Perhaps the only caveat being, that almost all in the members in the analysis were of US origin. I would be very surprised if those figures would be replicated in an Australian study. The paper is available on this site should you wish to have a read.

When I was diagnosed, I was 57 at the time (now 65), I was faced with the same conundrum. I opted for EBRT on the basis that I still wanted to be potent and continent, my other issue was that I was on the fringe of High Risk with a GS 7 (4+3). The stats at that time in Australia indicated equal outcomes with RP V EBRT. In hindsight, I think I made the right choice, almost eight years later my PSA's are still between 0.13 and 0.17. I kept my potency and continency. Plus my Rad Onco was an old colleague and a good friend. "I will look after you" he said, and he did.

So in summary, there are no right options for everyone. The best we can do, is to do our research, select the medical expertise most appropriate in our subjective judgement, and the most import factor, cross our fingers and hope for a good outcome.

I trust my waffle make's some sense.

best wishes
john

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

Gosh John: That research you compiled for us sounds extremely interesting! I attempted to access it at least once previously without success. Please advise me (us) once more how to access this information.
Regards Don O.

Re: Newly diagnosed, looking strongly at robotic radical prostatsectomy, not locked in yet

Hi Don,
You can find it on the resources page (link below). Scroll down to "What other men do" 3rd paragraph. It is available as a PDF file.

http://www.yananow.org/resources.shtml


best wishes
john

Deja VU?

Mike after posting, the penny dropped. I think I was just preaching to an old PCa warrior? Am I correct in assuming you are the same Mike from back when? If so, you had a heap of Terry's guidance et al. Would you change anything with the benefit of hindsight.


john

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