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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.
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.
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.
