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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2006

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robotic prostectomy/east coast

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Ed  Kratz - 16 Feb 2006 10:56 GMT
While I'm hoping for the best while working with variation in my PSA, and
hoping it's resolved, I'm considering my options.
(A PSA of 5.4 in October after a year ago being 1.6.  Re-test in November
1.9, then repeat in January 2.5. Scheduled for another re-test
in two weeks.  Negative DRE by internist, and URO.)

Just wondering if anyone had opinions or experience , pro or con with
robotic prostectomy.
I'm in Philadelphia, but willing to travel.
Believe I've heard good things about Dr. Tewari,  and about a Dr. Lee (I
think) recently moved to U of Penn in Philadelphia.

Any comments would be appreciated.

Thanks,
Ed
From Bob - 16 Feb 2006 11:51 GMT
No personal experience, but their are 2 issues, the prostate must be
small, and you must not be over weight, also read that the procedure
takes 6  (six)  hours. Cancer must also be confined  (early stages),
and not spread beyond capsule.
Good luck
KenA - 17 Feb 2006 02:42 GMT
My RLRP (with no complications) took 4 hours - start to finish. Discharged 28 hours
after start of surgery.
KenA
======
> No personal experience, but their are 2 issues, the prostate must be
> small, and you must not be over weight, also read that the procedure
> takes 6  (six)  hours. Cancer must also be confined  (early stages),
> and not spread beyond capsule.
> Good luck
Leonard Evens - 16 Feb 2006 15:06 GMT
Ed Kratz wrote:
> While I'm hoping for the best while working with variation in my PSA, and
> hoping it's resolved, I'm considering my options.
> (A PSA of 5.4 in October after a year ago being 1.6.  Re-test in November
> 1.9, then repeat in January 2.5. Scheduled for another re-test
> in two weeks.  Negative DRE by internist, and URO.)

I'm not sure why you assume you have prostate cancer?  Have you had a
biopsy yet?   Depending on your age, your PSA history is quite
consistent with a bout of prostatitis.   If your doctors want to avoid a
biopsy,  it might be worthwhile doing a fee PSA test.

In any case, a biopsy stands a good chance of settling the matter.

> Just wondering if anyone had opinions or experience , pro or con with
> robotic prostectomy.
[quoted text clipped - 6 lines]
> Thanks,
> Ed
Ed  Kratz - 16 Feb 2006 23:24 GMT
Leonard,
Thanks for the comments.   I will see what happens in the next PSA.
If it's still at 2.5 URO and internist agree biopsy is next.
Thanks for your comments.
Ed
> Ed Kratz wrote:
>> While I'm hoping for the best while working with variation in my PSA, and
[quoted text clipped - 20 lines]
>> Thanks,
>> Ed
Scott Brody - 17 Feb 2006 08:02 GMT
Assuming that a Biopsy confirms that you have PC you can check out
the web site for Intuitive Surgical Instruments... the manufacturer of
the daVinci equipment...

http://www.intuitivesurgical.com/products/davinci_surgicalsystem/

I am sure that the procedure is done near you... remember you will
only be in the hospital for 1-2 days (max), but you will have a
catheter for 5-6 days... so, you will have to be near your MD for that
time... after the catheter is removed you could see any MD for your
follow up visits... but it is best to see your surgeon...
The key in selecting the surgeon is to find someone who has done
the procedure 200+ times... they get faster at it with "practice"

I had mine last March... 2.5 hrs long... 3-4 tablespoons of blood
loss... virtually zero pain.... only minor discomfort... home in my
own bed 30 hours post op.... catheter removed 5 days later...
incontinecy over mid August... and potency is coming back...
Need I say more!

Since my surgery I have been a major advocate of men's health care...
and a very active support person... feel free to call me for whatever
additional information or support that you require...

Check out these sites:

http://www.davinciprostatectomy.com/video.html

Actual webcast of an RRLP
http://www.stronghealth.com/services/urology/webcast.cfm

http://www.prostatecancerfoundation.org/site/c.itIWK2OSG/b.46638/k.865C/Prostate
_Cancer_Treatments.htm#top


>While I'm hoping for the best while working with variation in my PSA, and
>hoping it's resolved, I'm considering my options.
[quoted text clipped - 12 lines]
>Thanks,
>Ed
Ed  Kratz - 17 Feb 2006 10:43 GMT
Scott,
Thanks. I'll check out the links.
Ed

> Assuming that a Biopsy confirms that you have PC you can check out
> the web site for Intuitive Surgical Instruments... the manufacturer of
[quoted text clipped - 45 lines]
>>Thanks,
>>Ed
Alan Meyer - 20 Feb 2006 17:12 GMT
> ...
> Actual webcast of an RRLP
> http://www.stronghealth.com/services/urology/webcast.cfm
> ...

That is some video.  Makes me glad I'm a computer programmer
and not a surgeon.

   Alan
Buck - 17 Feb 2006 08:47 GMT
It would be a good idea to consult with the best experts available on
diagnosis as well as treatment. A test of free PSA would seem to be in
order before a biopsy. Should you have cancer and you meet the criteria
for robotic surgery, in my opinion it's the way to go. I've never heard
of the surgery taking six hours. Mine was done in considerably less
time. There is less bleeding and greater precision. The recovery was
quick and easy. Although there are other factors, the skill of the
surgeon is an important factor that impacts incontinence and potency. I
have had no problem with incontinence and after four months am starting
to recover potency. I'm sure there have to be qualified surgeons with
substantial robotic experience in the Philadelphia area. If not, you
are probably within two hours of Johns Hopkins, which is rated as the
number one urology hospital in the nation. I traveled about an hour and
a half to my surgeon and it wasn't that big of a deal. The result is
far better than I could have obtained locally. Good luck!
Ed  Kratz - 17 Feb 2006 10:44 GMT
Buck,
Thanks for your comments.
Johns Hopkins is a place I'd consider.
Ed
> It would be a good idea to consult with the best experts available on
> diagnosis as well as treatment. A test of free PSA would seem to be in
[quoted text clipped - 11 lines]
> a half to my surgeon and it wasn't that big of a deal. The result is
> far better than I could have obtained locally. Good luck!
JerryW - 18 Feb 2006 02:08 GMT
Ed,

If the Dr. Lee you refer to is the same Dr. Lee who had such an excellent
reputation with the DaVinci RLRP recently in Arlington, TX before leaving
here, I know at least one of his patients personally who recommends him very
highly. As I said, Dr. Lee was considered "one of the best" with this
equipment and procedure in this area. If you wind up with PCa, and it
certainly does not sound like a certainty at this point, and you have an
interest in RLRP as a treatment, you would do well to check out Dr. Lee.
Signature

JerryW

Please respond to group; email address is not valid

2/11/04 PSA 2.6, Suspicious DRE (age 62)
2/23/04 Biopsy: Gleason 3+4=7, T2a, left lobe
5/18/04 RRP, Path: Gleason 4+3=7, T2c, both lobes
7/13/04 PSA <0.1
10/12/04 PSA <0.1
1/18/05 PSA <0.1
4/26/05 PSA <0.1
10/13/05 PSA <0.1

> While I'm hoping for the best while working with variation in my PSA, and
> hoping it's resolved, I'm considering my options.
[quoted text clipped - 12 lines]
> Thanks,
> Ed
Steve Kramer - 18 Feb 2006 11:41 GMT
Ed,

After your PSA went from 1.6 to 5.4, I would have been concerned about (not
convinced of) prostate cancer with a doubling rate of less than one year.
Now, with two subsequent PSAs of less of 1.9 and 2.5, I'm almost moved to
say that prostate cancer is least likely.

There are a few things that can cause a prostate to produce an elevated PSA,
including infection.  Did you take Cipro or some other strong antibiotic
after the 5.4 reading?  If so, you may be cured.

There are many things, including sexual intercourse and DRE, that can
elevate PSA from 1.9 to over 2.0.

You may have a perfectly normal prostate that at one time caught a virus or
infection.

Signature

PSA 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

> While I'm hoping for the best while working with variation in my PSA, and
> hoping it's resolved, I'm considering my options.
[quoted text clipped - 12 lines]
> Thanks,
> Ed
Ed  Kratz - 18 Feb 2006 12:34 GMT
Steve,
Thanks for your comments.
 After the 5.4 reading, I took levaquin for two weeks.
I did see a URO after the 1.9 reading.
 He did a DRE and recommended I get one more PSA, and if it was in the
neighborhood of 2-2.3 just get PSA's every six months.
When the repeat was 2.5, my internist thought he'd try a 4 week round of
Levaquin, wait two weeks, then repeat the PSA test, and test urine.
 I'll be going in for that the week after next.
And I'll be avoiding exerecise, etc. for a few days before the second PSA.
   He won't do a DRE, since I had a DRE in November with him, and December
with the URO.
 I'm cautiously optomistic, but I tend to be a worrier, and feel it's good
to hope for the best, but to be semi-prepared for the worst so one is ready
to deal with bad news.
Thanks for your comments.

Ed

> Ed,
>
[quoted text clipped - 29 lines]
>> Thanks,
>> Ed
 
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