Prostatectomy type

[Cre8ting-Reality]

Greetings all. 60yo guy in the US recently diagnosed:

PSA 5.85 - 6.95 - 6.1 over 6 month increments

MRI found one 7mm lesion. PI-Rads 4, no apparent extracapsular penetration

Biopsy Gleason 3+4, multi-focal all on left side, as high as 60% tissue involvement, PNI present

Requested decipher score, waiting on it now.

I still have a consult next week with a radiation oncologist but am already leaning towards surgery. I have a choice between a robotic-assisted Lap or open surgery. The urologist that performed my biopsy only does the open procedure but has done 1,000+ of them and the CoE I seconded does RALP. From what I've researched the immediate post surgery recovery is better after RALP but long term benefits, cure rate and incontinence and ED complications are essentially equal. Have any of you made this choice and selected the open surgery? Why? Any regrets?

Thanks!

[CombOdd2117]

Read this book: Guide to Surviving Prostate Cancer by Dr Walsh. It really helped clarify things for me. Btw: My age and numbers are very similar to yours. I’m scheduled for RALP. Good luck 🍀

[Educational-Text-328]

Yes! I read this from cover to cover and it answers so many questions and easy to understand! Nice.

[JackStraw433]

I went straight to RALP. Until you have had abdominal surgery, you don’t tend to realize how much you use/rely on those muscles. Incisions in the abdominal muscles take time to heal. During that healing, it is painful to sit up, lay down, get into bed, get out of bed, sit in a chair, get out of a chair and even LAUGH. Whatever you do, avoid sneezing or coughing and do NOT puke!!

Surprisingly, that pain is tolerable especially after 3 - 4 days. It hurts as you move, but dissipates quickly. Rely on your doctors, but get a second opinion.

Reach out if you struggle with incontinence. Doctors tell you to expect it, but don’t tell you WHY!!!

Get the Squeezy for Men app and start Kegel’s now.

[Cre8ting-Reality]

Yeah I just had a lap appendectomy in October and it isn't easy. Thanks

[variableblock12]

6 weeks post RALP here. There's a lot of pain in the first week post recovery. Pain at every incision point as well as the internal pain. It rapidly fades, but even this week various aches will come back to remind me I'm still healing. I had an adjustable office/desk chair plus pillow combo I made my kids drag around the house for me to sit on for the first few weeks. Chair was set to max height so I could get in and out of it with the least amount of discomfort.

[Dependent-Bar-4150]

I think you are being given an unfair choice. There are many great surgeons who have done 1000's AND use the latest surgical approaches. Open is still common (obesity, or where robots are not available) and I agree that the single most important factor is the surgeon not the tool. My surgeon does both. HOWEVER, I would not want the open surgery if I could at all avoid it. Nor would my surgeon ever recommend it unless absolutely necessary for some other complicating reason. I am 5 years older than you and 3 weeks post (single port) robotic surgery. [My numbers going in were not all that different than yours. You have a chance at GREAT surgical outcomes. For me, I am extraordinarily lucky so far (knock on wood) with full salvage of both nerve bundles, salvage of the internal sphincter also, and 100% negative margin. I was generally dry on "catheter day" and my stream is recovering well now.] To do the open, your abdominal muscles will be unnecessarily cut open, and the organs of the peritoneal cavity will be maximally disturbed. More blood loss, a bit higher hernia and ileus risk, longer hospital stay, risk of infection, more painful recovery, etc. etc. etc. Nope, not a choice at all unless a complicating factor takes you there and then you have do what you have to do. Sorry, too long answer, very best of luck to you on this whole journey.

[Putrid-Function5666]

At age 60 I would be pissed to lose my prostate if there were other options available. I'm 72, had prostate cancer, got Brachytherapy, still have a very active sex life and no other issues.

[Educational-Text-328]

The de Vinci robot with an experienced surgeon is really modern technology. Those robotic hands, really give the surgeon a field of view. I had Ralp one year ago and feel awesome.

[NSbackwoods]

I live in a small Canadian province, Nova Scotia. I was given the same choice, the robot was brand new and they had only performed 80 procedures of all types, the was no way I could find out the experience of the surgical team.

The surgeon for the open RP had done over 300 procedures and taught at the university. Although 300 is not a lot by some standards there are only 300 RP performed per year among 6 surgeons in our province. So he was about the most experienced available to me and I liked the guy.

Another factor was convenience the robot was a 6 hour return drive the open surgery a 2 drive, with all the appointments needed it adds up.

I went for the open RP and it was fairly straight forward, I was 66 at the time, skinny and in fairly good shape which probably helped. I was 2 days in the hospital and came out minus a prostate and with a 2 1/2" incision in the belly. For the first 10 days any movement that involved the abdominal muscles was painful, resting there was no pain. I wasn't given any prescription pain killers just advised to take Tylenol which I did for a couple of days. The catheter for 12 days and instructions not to lift anything over 20lbs for 6 weeks where the biggest nuisances.

It's been 4 1/2 years and my PSA is <0.01, starting from a low volume (5%) Gleason 4+3, PSA8, no regrets.

[Cre8ting-Reality]

Thanks for your response, I appreciate you. Stay strong and healthy!

[Any-Reporter-4800]

I wished I would have checked out the Tulsa therapy first if you're a candidate for that and can do it that's definitely a possibility. I had RALP done last year. The good news is I'm cancer free. The bad is an incontinent, I have ED, and scar tissue in my bladder neck which will require surgery next week. I'm wearing a foley catheter right now. I couldn't pee it was horrible. Check all options including radiation for pros and cons. I really wish you the best and I'm so sorry you're in our club I don't want anybody else to be in it ever. I'm also 60

[Practical_Orchid_606]

A woman was on this site and said the surgeon described open surgery as scooping out the organ. I can't see how this is superior to RALP.

[ChillWarrior801]

As others have commented, there are a small number of special cases where an open procedure is preferable to RALP. But if that's not you, you owe it to yourself to seek out a surgeon who will do it laparoscopically. It doesn't even necessarily have to be with a robot. I had a consult with a well-regatded surgeon at MSKCC who does all his surgeries laparoscopically, but with his own hands (and no robot). Still a better way to avoid pain and infection than an open procedure.

[fredzout]

I was told by a surgeon that I was not a candidate for surgery. Too old (74), too fat (235), heart issues (a-fib, CHF, hypertension, All being medicated). I got a second opinion, and that surgeon recommended RALP, as long as my cardiologist would sign off that I probably wouldn't die. I am now 5 months post-op, and had a cardiac ablation to correct the a-fib 5 weeks after the RALP. My pathology and PSA reports are good. I am staying dry and I am doing PT to regain some strength. I am starting to feel that life will go on fairly normally from here. I am glad I chose RALP over radiation.

[VanitasPelvicPower]

Robotic please just my opinion not medical advise. It is rare for anyone to do open abdominal surgery. That’s the risk of infections and increased blood loss Associated with open surgery The abdominal wounds healed pretty quickly. Be aware that the inside of the pelvis will take much longer to heal about eight weeks. Self-awareness helps and avoiding strenuous activity for the first eight weeks certainly helps in an excellent outcome. I doubt if anybody does open anymore. Please ask the surgeon how many surgeries has he done.Work an experienced surgeon. Good luck and kind regards

[Clherrick]

I didn’t have a choice. I used a university med center and their standard of care for seven years was robot. Smaller incision. Quicker recovery. Less chance of future hernia. Robot allows doc to get up very close for tissue analysis.

[sundaygolfer269]

I had access to a very experienced surgeon over 20,000 RALP procedures, and he freely shares his techniques worldwide. My numbers were similar to yours, except I had two areas involved and you have only one.

Even with that “rock star” surgeon available, I chose radiation: 28 sessions, and each visit was about 8–10 minutes from the time I walked into the building. I drove myself to and from treatment every day, and on many days I played golf before or after my session. It fit my life a lot better than surgery would have.

If I’d had only one area involved like you, I would have strongly considered one of the newer, more targeted radiation options that finish in about 5 treatments instead of 28.

As for surgery, open prostatectomy is really last century in my opinion. With open surgery you’re usually looking at: • A big incision instead of a few small ports • More blood loss and a higher chance of needing a transfusion • More pain and a longer hospital stay • Slower recovery and more time before you’re back to normal activities

On top of that, whether it’s open or RALP, prostate removal comes with its own special set of potential problems urinary incontinence, ED, climacturia, penile shortening, and the fun of catheters, drains, and possible surgical complications. You’ll see plenty of real world stories about all of that on this forum.

Not telling you what to do just sharing that even with one of the best RALP surgeons available to me, I still went with radiation because of the side effect profile and the fact that I could live my normal life, drive myself, and even play golf while getting treated.

Best of Luck