Bob,

You can ask Dr. Weinberg about the laproscopic procedure as he does know
about it. My brother was considering the same thing, but Weinberg says that
some 10% (roughly) of Laproscopic procedures turn into traditional
procedures for a number of different reasons. His primary concern has been
the inability to actually *feel* the prostate and the surrounding tissue.
This can adversely affect the results of the surgery (cancer has a different
feel from that of normal tissue).

On a less important note, the procedure tends to take longer (about twice as
long). In his book, Walsh also reports that some patients experience
shoulder pain from the CO2 that is used to inflate the patient. From a
recovery and pain issue, I found that there was no pain, and I seemed to
heal quickly -- the staples were removed in a week.

Ed

Bob:

I guess I'm sort of in the same position as you.  Diagnosed 6 weeks ago
(age-57, T1c, Gleason 6 (3+3), PSA-12.3).  Since then,  I've visited 2
urologists, a radiation oncologist, and a robotic surgeon.  I found the
Robo-doc through someone on this group, who was very pleased with his results.
After reading a bunch of books, meeting all the docs, running the printer out
of ink twice (web searching), I decided on the Robo-doc and surgery is
scheduled for late next month.

For me, the deciding factors were the precision that robotic surgery is capable
of and recovery time.  For this doc: average hospital time - overnight; average
blood loss 150cc (!); average catheter time - 1 week.  For more info, check out
their web site (www.uant.com) and do a 'Google" for the "Da Vinci Surgical
System", for info on the robot they use.

Obviously (since I haven't had the procedure yet), all my info is hearsay and
stuff I've read, or been told by the doc.  Hopefully, I'll be abe to give a
positive first-hand account in another month.  Meanwhile, it's enough to point
you in a direction do look for more information.

Good luck.

Chuck Flanagan

Hi, Bob.....
I had LRP in November of 2002.  It was the right choice for me.  I had never
had major surgery before, and it was an easy recovery.  There are always
pros and cons to different procedures.  Some doctors say they like to *feel*
the tissue during surgery..... but doctors who do LRP use magnification
instruments that allow them to actually *see* things in great detail... and
in an almost bloodless field, since there is very little blood loss with
LRP.
A good site just for information about LRP is www.krongrad-urology.com .  If
I had it to do over, I'd go LRP.... but that was me.  Each of us is
different, and there's really no *right and wrong* answer.  You need to
decide what is best for you... and what you are most comfortable with.

I'll be happy to answer any questions you might have.  I remember well what
it was like at that time when I was trying to decide on a treatment.  I was
51 at the time of surgery.

Take care.....
MikeH
domiha@hotmail.com

I had asked about LRP and was basically discouraged from it for 2 reasons.
First, the procedures takes longer and that generally means that you will be
under anesthesia longer than with RRP.  Second, the difference in the amount
of time for recovery is not that great (as opposed to gall bladder removal).
Additionally, my doctor, the head of urology at Memorial Sloane Kettering in
NYC, felt that there was only one or two people worldwide who were extremely
competent in the procedure.  I guess the last statement is very subjective.
However, since I had decided to put my trust in him, I thought it wise to
take his advice.

Sandy K.
Age 47
2/04 PSA 4.9
3/5/04 biopsy 9 of 10 cores positive
Gleason 6, Staging T2b
6/17/04 - RRP
Waiting patiently to have cath removed on MOnday...

 My own personal opinion is that I prefer RP. I like the idea of my surgeon
seeing all. I don't like the idea of laying on the table for up to 7 hours
under anesthetic. That said.... I'm sure that either way will be fine. Good
luck!

I'll only qualify something I've already related.  At 49, you have almost no
choice but surgery.  However, you do have a choice between RRP, LRP and
Robotic LRP.  It seems to me there was once a concern about nerve-sparing
with LRP.  But, I think that has been surpassed with Robotic LRP.  But, to
be honest, I cannot any long recall where, or if, I've read that.....
Damned Lupron!  Guess I'll have to go back and re-read some resources.

I am 3 months post op . Had LRP @ Johns Hopkins. Did all my due diligence
like yourself. I feel about 99%. Would definetly make the same choice.
Very little pain, 2 nights in hospital, 1 week cath, we spent ten days in
the Baltimore area and returned home.My numbers were very similar to your
3+3, no staging. After surgery all margins were neg. Spent 2 hours in
surgery. No shoulder pain from co2. My procedure was non DiVinci, 3
incisions about 1/4 long.

I have the highest regards for the entire staff at Hopkins. Dr. Christian
Pavlovich performed surgery. My three month followup is due 8Jul04. I only
expect good things.

Good luck to you. Again recovery time was an issue with me and mine wass
about 31/2 weeks before I was back to about 90%.

Jack A.

Hi Robert,
First let me add my sympathies to you for meeting the qualifications to join
our little group.  The hazing ritual is a little hard to take but once you
get over that you will find us a pretty civil lot.

Seriously, I do realize how tough it is at 49 to learn that you have this
disease.  I was 51 and thought that was too damn young to be thinking about
this old man's form of cancer.

We have this discussion every couple of months about LRP Vs. RRP.  I just
checked through Google at:
http://groups.google.com/groups?hl=en&lr=&ie=UTF-8&group=alt.support.cancer.prostate
and found there are 37,000 messages archived there under this news group.
Way too many to check.  Information overload - but your might want to dig
through some of it.

In the last couple of years I've learned a couple of things:
1) People want their own life or death decisions validated by seeing other
people make the same decision in the same circumstances, so they (knowingly
or subconsciously) slant their responses to lead you toward their particular
bias.
2) Folks tend to "drive a stake into the ground", as we say in my line of
work, and don't update their facts as new information comes in.

Frankly, I've seen similar attitudes displayed here toward cryosurgery and
PRP.  If I didn't choose it, it can't be as good as the (old) gold standard
RRP.  Recent experience with cryo (and brachy) have shown them to be viable
alternatives.  There is even a schism between advocates of the robotic
camera, manual LRP approach and the robotic manipulator LRP with each of us
taking sides.

Perhaps I should state my bias before going further.  I had LRP (robotic
camera, manual manipulators) in October of 2001.

Does LRP take longer than RRP?  Yes, a little.  Typically LRP, nowadays,
takes on the order of 3 - 3.5 hours (NOT 7 hours as in the early days).  Is
that significant?  Of course, the less time the better, but this is not a
big factor for an otherwise healthy 49 year old.

Which surgical approach offers the surgeon better view of the prostate?
Undoubtedly LRP.  The field of view is magnified 10 - 12 times larger with
LRP and the surgeon works in a near bloodless field compared to RRP.

Recovery is faster with LRP.  There is less pain.  There is much less blood
loss.  Catheter is in for a shorter period.  THEORETICALLY, LRP should
result in better continence and potency due to the greater precision of the
excision and superior imaging of the surgical field (the jury is still out
on whether these better outcomes will prove true).

The ONLY shortcoming of LRP Vs. RRP I will concede is the lack of long term
data for LRP, but to use that as an argument for not considering LRP is just
"CATCH-22".  We have no data so you shouldn't do it but if you don't do it
we will have no data.

OK, I'll come off my high horse now.  Read, question, research, talk to your
physicians but try not to get too get too turned off any of the many options
available to you by any single opinion (including mine!)

All the best to you.

Joe

Hey Bob,
Last guy was right the stuff we know is better than new stuff they say.Yes
think for yourself and learn.I had RP and somethings;had bonescan and lots of
tests first;Am less than 0.1 twicw in 9 monthes;that beats antthing else.Know a
guy had LRP and his robot died in the middle-yeah died as in go in the closet
and get the old one and reprogram and now he has 8 holes instead of four.But
what the hell my surgeon could'a died too though he 's too mean probobly.Anyway
God Bless and Take Care.