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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2005How long should an RRP take?
Hello All, This is my first post, so I'll give a little background. 52 yrs old, PSA 5.79, Gleeson 4+4 and 4+3. T1c stage. I'm leaning toward surgery over radiation. I'm still undecided about traditional radical vs. da vinci. My question is a doc I am considering for traditional 'hands on' SRP made a point about the time duration of his procedure as 1 hr. Reason being the less you are under the better. Would you be suspicious of his mention on the length of surgery as an accolade of his skill? Thanks, WhiteSoxFan I would do a lot of research before choosing anything. You have some time. Read, read, read! Then make a decision. (By the way, there was a good article in Newsweek 12/12/05 on the use of the robot, not only on the prostate, but on other types of surgeries too). Get books written by the major authorities (doctors) of pca and read them. There is some truth that it takes a bit longer to set up the robot, but I would not base a decision on that alone. Also, the doctor may not have the training, nor the means (they are expensive) to use the robot. B.A. Let me simplify my question. How long does an RRP take under normal circumstances? If a doc mentions that his RRP's take an hour would you be suspicious? Thanks for the advice concerning research on Da Vanci. I suspect what he meant to convey was that he has the procedure down well enough that he CAN do it in an hour. Frankly, I'd want the surgeon to take his time, all day if necessary, to carefully dissect away the nerves that determine my future erectile function. Bill Denton RP 2/12/02 PSA >.6 Memphis I've read anywhere from 2 hours to about 4 hours or so. The robotic procedure takes a bit more time than open surgery because of the set up time involved. My robotic procedure took closer to 4 hours I am told, I obviously do not remember any of it! A lot of time was spent on the prep work. That combined with the actual surgery, you can get into the 4 hour range with the robot. Times may be coming down a bit now, although I am not sure. My particular surgeon had done about 1000+ open surgeries and 300+ robotic procedures and it still took around 4 hours or so. Also, is your Gleason a 7 or an 8? I'm a bit confused buy your posting. A Gleason 7 can be either a 3+4 or a 4+3. B.A. PS: Also, the doc did a cystoscopy before (with a flexable scope) to make sure no pc was in the bladder neck area. B.A. Or perhaps the point he was trying to make was that the open surgery is a lot shorter than robotic surgery. Hence your time under anesthesia would be much shorter with open RP. Generally speaking, shorter times on the table and shorter times under anesthesia are preferable in terms of potential complications. One other point, robotic RRP is "expected" to have similar long-term outcomes, in terms of cancer control, as does the traditional, open RP, but there is no published data to prove this assumption at this time that I am aware of...Best wishes and good health, Ron I just had my RPP done on Tuesday. Surgery took about 3 hours. Had my surgery done at Sloan Kettering . I'm 49 yrs old, my jumped 2 pts in about a year to 4.2, 4 of 12 cores were positive, Gleason 8 (3+5), mostly on right side. Firmness on DRE. Sloan is state of the art and they have access to robotics but my surgeon didn't recommend it as he wanted to be able to have better access and do what it necessary. He thought that out have that flexibility out weighted any robotic benefits. My brother who is a surgeon and a PCa survivor feels the same way (had his done at Hopkins). Dr. Eastham (GREAT MD & person) was able to spare entire left nerve and more than half of right so no grafting was done. Upon nerve stimulation Junior stood at attention. Surgeon believes everything contained. Pathology reports next week. I was up the next morning (Wednesday) sitting at 6am and did 3 laps around the floor. They took me off iv's and morphine on Thursday morning. I was doing well and they released me on Thursday afternoon. Im getting around ok. I probably over did it (walking, getting up & down etc) because I was hurting yesterday. Cathether is is pain but beats cancer. Surgeon it could be removed as early as next Thursday. That make my Christmas merrier, Sloan Kettering and my surgeon were excellent. Only thing is I wish they gave my donated blood back to me. Might of sped my recovery some. Back to robotics...... regardless of what you do make sure your going to someone who has done this hundreds or thousands of times. I hope hear my experieince helps you. Good luck, good health, Merry Christmas/Happy Holidays.... ps...... One thing I really screwed up on is requesting that Santa bring me a recliner our family furniture is low and it's a challenge getting up. I am very grateful for my friends, access to excellent medical care and the fact that I caught this early. I have a friend battling pancreatic cancer so this is a walk in the park. pss.. 49 yrs old (former Chicagoian living with wife and daughter who are Cubs fans, they did cheer for ChiSox though. :) Holy CRAP!!! No RRP takes an hour. RUN, RUN, RUN AS FAST AS YOU CAN!!!!  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 Non Illegitimi Carborundum > Let me simplify my question. How long does an RRP take under normal > circumstances? If a doc mentions that his RRP's take an hour would you > be suspicious? Thanks for the advice concerning research on Da Vanci. > Let me simplify my question. How long does an RRP take under normal > circumstances? If a doc mentions that his RRP's take an hour would you > be suspicious? Thanks for the advice concerning research on Da Vanci. My RRP was done by Dr. Scardino at Sloane in NYC - I went into the operating room and came out 6 hours later. One hour?? Yikes!! I'd rather they take their time than rush through things. Sandy K. > > Let me simplify my question. How long does an RRP take under normal > > circumstances? If a doc mentions that his RRP's take an hour would you [quoted text clipped - 5 lines] > > Sandy K. 3 to 3.5 hours if the doc is careful and knows what he/she is doing. >Let me simplify my question. How long does an RRP take under normal >circumstances? If a doc mentions that his RRP's take an hour would you >be suspicious? Thanks for the advice concerning research on Da Vanci. My "conventional, hands-on" RRP (May 2005) only took an hour. Perhaps a few minutes less, because the doctor was down talking to my wife in 60 minutes. I just had my RPP done on Tuesday. Surgery took about 3 hours. Had my surgery done at Sloan Kettering . I'm 49 yrs old, my jumped 2 pts in about a year to 4.2, 4 of 12 cores were positive, Gleason 8 (3+5), mostly on right side. Firmness on DRE. Sloan is state of the art and they have access to robotics but my surgeon didn't recommend it as he wanted to be able to have better access and to do whatever is necessary. My brother who is a surgeon and a PCa survivor feels the same way (had his done at Hopkins). Dr. Eastham (GREAT MD & person) was able to spare entire left nerve and more than half of right so no grafting was done. Upon nerve stimulation Junior stood at attention. Surgeon believes everything contained. Pathology reports next week. As for recovery,,,,I was up the next morning (Wednesday) sitting at 6am and did 3 laps around the floor.. Pain was tolerable. They took me off iv's and morphine on Thursday morning. I was doing well and they released me on Thursday afternoon. Im getting around ok. I probably over did it (walking, getting up & down etc) because I was hurting yesterday. Cath is is pain but sure beats cancer. Surgeon it could be removed as early as next Thursday. That make my Christmas merrier, I''ve been getting around house ok. Climbling stairs as needed. Changing cath. Showered on my own. I cut out the Vicadin yesterday as I want to gets tmy bowels back in order (pain meds & iron supplements bind you up).. Sloan Kettering and my surgeon were excellent. Only thing is I wish they gave my donated blood back to me. Might has sped my recovery some. Back to robotics...... regardless of what you do make sure your going to someone who has done this hundreds or thousands of times. Understand outcomes. Do your research. But my local urologist and Sloan gave me the same choices "young guy" with a Gleason 8 you treat aggressively....combo (hormones, scan radiation & seeds) vs surgery. I want to know that I got it taking it out using nerve sparing made sense for me. I hope hear my experieince helps you. Good luck, good health, Merry Christmas/Happy Holidays.... ps...... One thing I really screwed up on is requesting that Santa bring me a recliner... our family room furniture is low and it's a challenge getting up. I am very grateful for my friends, access to excellent medical care and the fact that I caught this early. I have a friend battling pancreatic cancer so this is a walk in the park. pss.. 49 yrs old (former Chicagoian living with wife and daughter who are Cubs fans, they did cheer for ChiSox though. :) 8. DominicM Dec 17, 12:59 pm show options Newsgroups: alt.support.cancer.prostate From: "DominicM" <dmarr...@gmail.com> - Find messages by this author Date: 17 Dec 2005 09:59:22 -0800 Local: Sat, Dec 17 2005 12:59 pm Subject: Re: How long should an RRP take? Reply | Reply to Author | Forward | Print | Individual Message | Show original | Remove | Report Abuse I just had my RPP done on Tuesday. Surgery took about 3 hours. Had my surgery done at Sloan Kettering . I'm 49 yrs old, my jumped 2 pts in about a year to 4.2, 4 of 12 cores were positive, Gleason 8 (3+5), mostly on right side. Firmness on DRE. Sloan is state of the art and they have access to robotics but my surgeon didn't recommend it as he wanted to be able to have better access and to do whatever is necessary. My brother who is a surgeon and a PCa survivor feels the same way (had his done at Hopkins). Dr. Eastham (GREAT MD & person) was able to spare entire left nerve and more than half of right so no grafting was done. Upon nerve stimulation Junior stood at attention. Surgeon believes everything contained. Pathology reports next week. As for recovery,,,,I was up the next morning (Wednesday) sitting at 6am and did 3 laps around the floor.. Pain was tolerable. They took me off iv's and morphine on Thursday morning. I was doing well and they released me on Thursday afternoon. Im getting around ok. I probably over did it (walking, getting up & down etc) because I was hurting yesterday. Cath is is pain but sure beats cancer. Surgeon it could be removed as early as next Thursday. That make my Christmas merrier, I''ve been getting around house ok. Climbling stairs as needed. Changing cath. Showered on my own. I cut out the Vicadin yesterday as I want to gets my bowels back in order (pain meds & iron supplements bind you up). Just taking Aleve for pain when needed. Sloan Kettering and my surgeon were excellent. Only thing is I wish they gave my donated blood back to me. My brother thinks that could speed my recovery some ....increase energy. . Back to robotics...... regardless of what you do make sure your going to someone who has done this hundreds or thousands of times. Understand outcomes. Do your research. But my local urologist and Sloan gave me the same choices "young guy" with a Gleason 8 you treat aggressively....combo (hormones, scan radiation & seeds) vs surgery. I want to know that I got it taking it out using nerve sparing made sense for me. I hope hear my experieince helps you. Good luck, good health, Merry Christmas/Happy Holidays.... ps...... One thing I really screwed up on is requesting that Santa bring me a recliner... our family room furniture is low and it's a challenge getting up. I am very grateful for my friends, access to excellent medical care and the fact that I caught this early. I have a friend battling pancreatic cancer so this is a walk in the park. pss.. 49 yrs old (former Chicagoian living with wife and daughter who are Cubs fans, they did cheer for ChiSox though. :) WhiteSoxFan, Sorry to hear of your misfortune. Only you can decide what is best for you. Take your time and read all you can. Most of the guys here did that, and we came to different conclusions. Most sound happy with their decisions, and you probably will be too. I had a Robotic Laparoscopic RP in February of 2004. The surgeon was Dr.Joseph Wagner. He has done hundreds of robotic procedures.I'm very pleased with him. You could look at the Hartford Hospitals website www.harthosp.org for information about the procedure. They have a video of one of the operations that you can watch on your computer, and the doctors explain everything. I went there and I am very happy with my results. The operation took about 3 hours, but seemed like seconds to me. I was able to go home 20 hours later, and back to work day 6. Now I never leak, and a most of my erection ability has returned. The worst part was waiting between the diagnosis and the surgery. I picked surgery because I think it offers the best chance of a complete cure. PSA is expected to drop to nothing. You can have the pathologist go over the whole gland, nor just tiny pieces of it. Also, I wanted to take the hit on erection and continence at the start and get it over with. If you get good results from surgery, it lasts. I wanted the robot technique because I like having the doctor be able to see as well as possible, and the post op misery is less. All the treatments have potential benefit and risks. Check them all out. My PCa stuff is: age 50 PSA 4.5 Bx showed High Grade PIN 5 months later PSA 5.6 repeat Bx 1/12 cores <1mm gleason 3+3=6 stage T1c RLRP 2-11-04 at age 50 Favorable path, 5 small foci of 3+3, organ contained Post op PSAs <0.1 Steve U > Hello All, > > This is my first post. As a White Sox fan, or in general? :-) > 52 yrs old, > PSA 5.79, Gleeson 4+4 and 4+3. T1c stage. I'm leaning toward surgery [quoted text clipped - 3 lines] > Reason being the less you are under the better. Would you be suspicious > of his mention on the length of surgery as an accolade of his skill? At 52, you are just crossing over into the age range where your options are completely open. However, a vast majority of 52-yr-olds get surgery for various reasons -- if they can. That Gleason 8 might be a small problem, though the T1c and 5.79 are moderating data. I think I would continue to lean toward surgery. HOWEVER, you should research this decision to the extreme. There may never be a bigger decision in your life and your doctor is not in a position to make it for you. Read prostate cancer books by Walsh and Strum; check out www.phoenix5.org; and research the Internet. And, above all, when you have questions, bring them to us and/or your doctor. I can't speak for your doctor, but we will be thrilled to provide our opinions. Finally, don't settle on a doctor, yet. The one who just diagnosed you may be a good diagnostician (or may have missed the bastard's obvious signals over the last couple of years). However, that does not make him or anyone he recommends a good or poor surgeon. You want a good surgeon; one with a lot of nerve-sparing experience. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 Non Illegitimi Carborundum Nice group!!! Thanks for all your support and advice and vents are important too. The pathology for the biopsies that came back positive were 4+4=8 ( I still don't know what's the difference between the first number and the second number in the gleason score and the significance being in the first position vs the second position. Why is a 4+3 different from a 3+4?) and the other positive biopsy taken was a 4+3=7. BTW I had an interesting conversation with a Radiologist doc that chose surgery. Till later, WhiteSoxFan (go Bears!) The x + x being the first x is the predominant or most found cancer cells in the prostate and aggressiveness of the cancer cells ranging from mild (1) to poorly differentiated (5). Thus a person with a Gleason 3+4 would be a Gleason sum of 7, but the cancer cells that were found to be the majority in the prostate would be a Gleason 3. (Hope I made some sense). B.A. > Nice group!!! Thanks for all your support and advice and vents are > important too. The pathology for the biopsies that came back positive > were 4+4=8 ( I still don't know what's the difference between the first > number and the second number in the gleason score and the significance > being in the first position vs the second position. Why is a 4+3 > different from a 3+4?) and the other positive biopsy taken was a 4+3=7. The Gleason Score is a combination of two ratings. Each rating is on a scale from 1 to 5. The better the differentiation, the lower the number. An evaluator looks at the samples and rates them 1 to 5. He then selects the most prevelant sample and the second most prevalent sample. Those two combined are the Gleason score. No one gets a 1+1=2. The lowest I've seen here is a 2+3=5. Most of the people (43%) have a Gleason of 6. 38% have a Gleason 7. Those who have 3+4=7 greatly outnumber those at 4+3=7. Both types have an amount of 3 cancer and an amount of 4 cancer. However, the 4+3=7 Gleasons have more 4 cancer than 3 cancer. Neither is good. 4+3 is the worse of the two. 5+5=10 is the worst of all. > WhiteSoxFan (go Bears!) Nice explanation of the Gleason score, Steve. I never really did understand mine but I now realise it was actually quite good (1+5=6) even though the consultant wasn't very positive about it - probably because my PSA was pretty high at the time (24). The chart he consulted only had total Gleason (i.e. 6) on one axis and PSA on the other and took no account of the individual components. I've always felt more positive about my prognosis than the Docs, maybe that is way they've always erred the other way - to keep me down to earth. But I prefer a PMA...(Positive Mental Attitude, better spell it out given our last conversation 8^). I've recently found out that I only had a very small proportion of cancerous cells so the probability of containment is looking better and better, despite those cells being rated a 5. This group is great. Two things to make me feel better and I've only been here a couple of days 8^). I should have joined long ago. >> Nice group!!! Thanks for all your support and advice and vents are >> important too. The pathology for the biopsies that came back positive [quoted text clipped - 18 lines] > >> WhiteSoxFan (go Bears!) tim wrote...snip... > Nice explanation of the Gleason score, Steve. I never really did understand > mine but I now realise it was actually quite good (1+5=6) even though the > consultant wasn't very positive about it - probably because my PSA was > pretty high at the time (24). Hi Tim...I think in another thread you said your PCa was found during biopsy. A Gleason score of 1 is very rare and usually reserved for PCa tumors from the central zone found during a TURP (a procedure to remove prostatic tissue around the urethra). Even in this case 2's are much more common than 1's; in fact, I don't think I've ever seen a 1 reported. A 1+5 is an even stranger mix. Since you've already had treatment, this may be water over the bridge, but you may want to have your biopsy slides sent out to an expert PCa pathologist for re-reading. A list of such experts can be found at http://diagnosis.prostate-help.org/pcgleas.htm Actually, such information might prove useful down the road, should secondary treatment ever be required...Best wishes and good health, Ron > Hi Tim...I think in another thread you said your PCa was found during > biopsy. A Gleason score of 1 is very rare and usually reserved for PCa Yes, it was a biopsy. > tumors from the central zone found during a TURP (a procedure to remove > prostatic tissue around the urethra). Even in this case 2's are much > more common than 1's; in fact, I don't think I've ever seen a 1 > reported. A 1+5 is an even stranger mix. Since you've already had > treatment, this may be water over the bridge, but you may want to have The consultant I had was pretty vague and I guess I wasn't in quite the best frame of mind to remember details so I could have got it wrong. > your biopsy slides sent out to an expert PCa pathologist for > re-reading. A list of such experts can be found at > > http://diagnosis.prostate-help.org/pcgleas.htm This is a good reference - I'll be reading it through in more detail. I'm in the UK, though, so the experts list is not necessarily relevant. UK vs. USA might explain some difference in policy in the grading too, though its more likely I just mis-remembered. From that page there is a reference to grading tiny foci by just doubling the primary grade so it may just be that I really had 3+3=6 to give me the total I remember and I made the rest up based on my then incorrect understanding to fit the observation that most of the samples were "clear". Actually, the more I think about it the more I think this is it. As you say this is "water under the bridge" so I will check it out but I'll wait until my next check-up. I'd be a lot more worried if my pathology results hadn't been so good (margins etc. clear, less than 1% of the removed cells cancerous). Thanks for the info. > Nice explanation of the Gleason score, Steve. I never really did > understand mine but I now realise it was actually quite good (1+5=6) even > though the consultant wasn't very positive about it - This is a Big Red Flag that something was screwy in the analysis of the biopsy samples themselves, or in recording/reporting the results of the analysis. 1: Gleason Grades of 1 & 2 are *almost* *never* issued as a policy of both Epstein and Bostwick, two of the biggest names in PC biopsy work. I will wager you a dozen donuts that the number '1' was NOT in the report as it came from the pathologists work. (I have not queried ALL the Big Names in PCA biopsy analysis, but I have both of these on record that 1 & 2 are never seen except from tissue samples taken in a TURP (roto-rooter for BHP), and as TURPs are at best rarely done anymore, 1 & 2 will almost never be issued anymore) 2: Gleason grades number "how different from normal" the various tissues are. The least differentiated (most similar to normal healthy tissue) would get a 1, the most highly differentiated (closer in appearance to martian brain tissue than human prostate tissue) would get a 5. The odds are a million to one against you being the 1-in-a-million that had Gleason grade 5 cells in the biopsy tissue, but no grade 4, or 3, or 2, but lots of grade 1. Urgent suggestion: get a second opinion on the biopsy. Have it re-read by another lab. This is a common normal thing. My first lab (U.S. Labs in California) graded me 4+3=7; the second (Bostwick) graded me 3+4=7. This will require you calling the lab that did the first biopsy, and get a release form (Yeah, HIPA!) to send the block and slides (not just slides) to the second opinion lab. Execute the release form (Yeah, HIPA!) with the second opinion lab to get their report as well. > probably because my PSA was pretty high at the time (24). This is not high, but not near any records. > The chart he consulted only had total Gleason (i.e. 6) on one axis and > PSA on the other and took no account of the individual components. This is a bold brain-fart on somebody's part. Get the name of the lab and the phone number to them, and call them directly. Get them to fax you the release form (Yeah, HIPA!) and fax it back: you want a copy of the pathologists report showing dominant and secondary Gleason grades. > I've recently found out that I only had a very small proportion of > cancerous cells so the probability of containment is looking better and > better, despite those cells being rated a 5. The only thing past 5 is them developing their own identity, breaking out of your abdomen like an Alien, and joining the May Day Parade. Grade 5 is close to immune to treatment, and, the younger you are the more active == dangerous this (probably) is. > This group is great. Two things to make me feel better and I've only > been here a couple of days 8^). I should have joined long ago. *sigh* if you had this "long ago" you're in a heap of trouble now! I have not written to pull a Stephen King/Edgar Allen Poe on you... rather, this is untrustworthy news (1+5) and it is horrible news (5). Please get things re-examined. >>> Nice group!!! Thanks for all your support and advice and vents are >>> important too. The pathology for the biopsies that came back positive [quoted text clipped - 17 lines] >> However, the 4+3=7 Gleasons have more 4 cancer than 3 cancer. Neither >> is good. 4+3 is the worse of the two. 5+5=10 is the worst of all. anything with '5' in it is properly thought of as 'seriously bad news'. > This is a Big Red Flag that something was screwy in the analysis of the > biopsy samples themselves, or in recording/reporting the results of the > analysis. I replied to an earlier post that I suspect I got mixed up with my imperfect understanding of the Gleason score, the fact that nearly all the samples were "clear" and that the total was 6. I think my real score was 3+3 obtained by doubling the primary grade of a small focus. > This is a bold brain-fart on somebody's part. Get the name of the lab and Me, I think. > The only thing past 5 is them developing their own identity, breaking out > of your abdomen like an Alien, and joining the May Day Parade. I like the image (in an uncomfortable feeling way) 8^). > *sigh* if you had this "long ago" you're in a heap of trouble now! I've had a radical prostatectomy since with v. good pathology results so I don't *think* I am in trouble (except for getting my Gleason score wrong). Very few cancerous cells found and none in the margins etc. > I have not written to pull a Stephen King/Edgar Allen Poe on you... > rather, this is untrustworthy news (1+5) and it is horrible news (5). No, I appreciate the warning but I think the untrustworthy part is correct (with me being the untrustworthy one). I misinterpreted some things when I didn't understand the significance of the individual components in the score and not realising that my total of 6 could have been a 3+3 if the focus was localised. I got the "1" from the consultant telling me that the majority of the biopsies were clear and the 5 by subtracting that from the total but the reality is that I only *knew* the total score and that it was confined to one sample. I really, really appreciate your concern so I'm sorry that I got confused and gave incorrect info. Cheers Tim > I think my real score was > 3+3 obtained by doubling the primary grade of a small focus. Hmmm... reasonable explanation. > I've had a radical prostatectomy since with v. good pathology results so I > don't *think* I am in trouble (except for getting my Gleason score wrong). > Very few cancerous cells found and none in the margins etc. HOPEHopehopehope and then a little hope! >> I have not written to pull a Stephen King/Edgar Allen Poe on you... >> rather, this is untrustworthy news (1+5) and it is horrible news (5). [quoted text clipped - 10 lines] > I really, really appreciate your concern so I'm sorry that I got confused > and gave incorrect info. Well, I'm glad I can put the Alarm Siren away! My hopes now are that 1: This bastard got the message and won't show up in your body ever again! Not after the way you treated it the first time! *humph*! (sound of offended cancer sulking down the street) 2: Incontinence is at worst temporary, and full control of hydraulics is achieved. 3: Erectile functions are undiminished. > Well, I'm glad I can put the Alarm Siren away! My hopes now are that Phew, me too! 8^). > 1: This bastard got the message and won't show up in your body ever > again! Not after the way you treated it the first time! *humph*! > (sound of offended cancer sulking down the street) Check, so far. > 2: Incontinence is at worst temporary, Continence is adequate, if not *quite* complete. So I'm putting a check in this box, too. > 3: Erectile functions are undiminished. I'm working on this one. I'm working my way through the available drugs to find the right balance between side effects and function. Viagra and Levitra give me vile headaches ("Not tonight, I'm going to have a headache tomorrow") so I'm experimenting (under GP supervision, of course) with Cialis ATM. Some promising results but not yet complete success. Cheers Tim >> 3: Erectile functions are undiminished. > [quoted text clipped - 6 lines] > Cheers > Tim Hmmmmm...... Screw the head-ache, c'mere m'love! If the head-ache is from the vaso-dialation effect of the viagra/levitra/cialis, then try a vaso-constrictor right afterwords: Mt Dew/Pepsi/No-Doz/askyerMDfor sumtin! >> find the right balance between side effects and function. Viagra and >> Levitra give me vile headaches ("Not tonight, I'm going to have a >> headache >> tomorrow") so I'm experimenting (under GP supervision, of course) with >> Cialis ATM. Some promising results but not yet complete success. > Hmmmmm...... Screw the head-ache, c'mere m'love! LOL. But you don't know how bad the headaches were! Like the worst hangover for the whole of the following day, plus the drugs weren't really working that well (no matter how long it's been I can't do much with an erection that lasts 10 seconds 8^). > If the head-ache is from the vaso-dialation effect of the > viagra/levitra/cialis, then try a vaso-constrictor right afterwords: Mt > Dew/Pepsi/No-Doz/askyerMDfor sumtin! So far I getting results as good, if not better, from the Cialis, and with no side-effects. But I'll bear that in mind as there is a possibility I may go back to the Levitra again - it's the only one which has allowed for any "spontaneous activity". OTOH, the Cialis provides more sustainability and is still working the next day or two - a definite plus given NHS only allows for 1-2 tablets a week 8^). Of course, once I find something that works I won't necessarily stick with the NHS 8^) - though a couple of Cialis a week may be enough once I get the dose right...free erections from the NHS for the rest of my life, now that's something I thought I'd never type 8^). Cheers Tim I'm not gonna start a thread about the holidays...but I'll use this post to thank everyone for their help in a very tough year and to wish everyone the very best. It struck me that the last few threads show the phenomenal "coming-together" power that this group aways shows. OK...NOW... I'm about 9 months (actually EXACTLY 9 months today) out of the open RRP surgery. I'm 57 and...my doc likes using Cialis starting one month after surgery to help increase blood flow. I've been using it almost every other day with a pump and manual stimulation and though I have orgasms and increased size (which is better than a turtlehead)...no spontaneous erections yet. Though guys here have said that sometimes...they just return 'all of a sudden.' It's also been mentioned by the guys here that Cialis is 'weaker' than the other 2 drugs. But...as Tim mentions...the 36 hour usage period helps at the start. When...(I prefer that over 'if') some erections begin...I'll try the Viagra and Levitra for better results. I had samples of both...didn't have bad effects...but they didn't help. But it was early on...so I'll go with Cialis until I see some activity...and then try the others again and see what's what. Steve U. is our expert on injections...and they are ALWAYS a possibility...down the road a bit. :-) Some guys have their erections coming back early...some late...we'll see. Again, the best to all, Ron B. Chicago I had the RRP at Northwestern last August. It took about three hours. My Gleason was 3 + 3 and the grade was T2a. I had a follow-up PSA last week and the results were less than 0.1. My urologist told me to see him again in 6 months. > Nice group!!! Thanks for all your support and advice and vents are > important too. The pathology for the biopsies that came back positive [quoted text clipped - 9 lines] > > WhiteSoxFan (go Bears!) That's great, Thomas. It's gotta be good do hear that magical phrase, "I don't need to see you for six months." SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 Non Illegitimi Carborundum >I had the RRP at Northwestern last August. It took about three hours. My >Gleason was 3 + 3 and the grade was T2a. I had a follow-up PSA last week [quoted text clipped - 14 lines] >> >> WhiteSoxFan (go Bears!) My robotic surgery is scheduled for 12/27. When discussing this with the appointment desk, they said when my surgeon first stated doing robotics, it took 4-5 hours. They said he has become so proficient/skilled/experienced that his average robotic is now about 3-4 hours. I'll let you know at the end of the month.... HTH, Ken > Hello All, > [quoted text clipped - 9 lines] > > WhiteSoxFan > ... My question is a doc I am considering for traditional 'hands on' > SRP made a point about the time duration of his procedure as 1 hr. > Reason being the less you are under the better. Would you be suspicious > of his mention on the length of surgery as an accolade of his skill? I'm not a doctor, but my understanding is that, indeed, less time under a general anaesthetic is better than more time. There is less likelihood of complications and side effects from anaesthesia, though problems with anaesthesia are probably not the main dangers during the operation. I think it bears on the decision but may not be the main consideration in choosing which procedure to have. Success rate may be the most imortant issue, rates of complications next, and recovery time third. In theory, the outcome of RRP and LRP should be identical. In both cases they remove the prostate. The question is, can the surgeon get all of the tissue at risk equally well with each procedure, and spare all of the tissue that should be spared with each procedure. The answer is, it probabably depends more on the skill of the surgeon than on the specific procedure. But that's just my surmise. As for the one hour claim, that seems very low to me. I had radiation, not surgery, and can't speak from personal experience, but I thought that RRP patients were typically spending 3 hours or so under anaesthesia and LRP (robotic) patients were closer to double that. I find the one hour claim a little disturbing. If it's true, then perhaps this guy is very fast - maybe too fast and not sufficiently careful and accurate. If it's false, then the guy is potentially a liar and may not be trustworthy in other areas either. Or maybe he just meant that the actual removal of the prostate is one hour and the prep, going in, coming out and sewing up are not included. But if so, he's still making an, at best, misleading statement. Or maybe I'm all wrong and it can be done well in an hour. I'm no surgeon. Who am I to know? I suggest getting a second opinion from another surgeon. Ask him how long it takes and how long you're under anaesthesia, and what he thinks about the relative merits of RRP and LRP. Alan Having just returned home about 3 hours ago from a daVinci RRP, mine took 4 hours. In and out of the hospital in 29 hours. The guy before me took a little longer as my surgeon also fixed his hernia "while he was in there"... Truly amazing there's so little pain. My catheter has been the most annoying part of post-op. Ken BTW, both nerves were able to be spared.. Yippee! Get the biopsy report and cath comes out in 7 days... WSF, If you have questions, let know. =============================== > Hello All, > [quoted text clipped - 9 lines] > > WhiteSoxFan Yup. Been hearing (reading) the same thing from surgery patients for almost four years now... "surgery went great, want to strangle the guy who invented the catheter." Glad to hear things are going well for you. Looking forward to the post biopsy report. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05 PSA .07 .05 .06 .05 .08 Non Illegitimi Carborundum > Having just returned home about 3 hours ago from a daVinci RRP, mine took > 4 hours. In and out of the hospital in 29 hours. The guy before me took a [quoted text clipped - 22 lines] >> >> WhiteSoxFan KenA, Welcome home. Enjoy the "vacation" from usual responsibilities. SteveU |
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