I had LRP 3yrs and 3mons. ago. Undetectable so far. only side effect is
small penis (half the original size). One nerve bundle saved. Works almost
as well as before except erections don't last as long probably due to small
size and less sensitivity. Took almost three years to get it somewhat back
to normal operation. Also, Im 65 and not as good a shape as before.

Because LRP has only been around in the States for about five or six years
and RLRP for about three years, there hasn't been much credible followup on
either procedure. I believe RLRP is much superior to LRP and should replace
LRP in the future as more institutions can afford to make the switch.

Open RP is the gold standard for now until more long term followup is
acguired. Not all LRP's go according to plan. Everyone is different and
every surgeon is different. You will never know what your particular
outcome will be until it's over. Mine was a difficult one. I was under for
10 1/2 hrs. and lost 5 pts. of blood.

Ron S.

Hi David S.:

Glad to hear from you directly.  I do read all your posts and keep up
with items regarding the AMS 800, the sling, etc. which have the
attention of all us leakers.  Both my uros say I'm not a good candidate
for the AMS device since I leak about a pad/day and I could be well
under a pad/day if I regularly went to the can every two hours or so.
As it is, I can rarely tell if I ought to go except when I first get up
in the morning so I still leak throughout the day.  I've investigated
the sling a bit but I won't do it unless I can get pretty good odds of
being dry almost all the time.  Otherwise, I'll stay as I am.

Sorry about the weight gain.  I actually lost about 7-8 pounds after
getting a labrador puppy.  Before the dog, I would go out every day and
get a full lunch.  With the dog, I stayed home to watch/manage the
beast and only had a simple lunch or no lunch at all.  Lost weight
without really trying.  Now that the dog can take care of herself more
or less, I've started back on the lunches again so I expect the pounds
to creep back up.

By the way, the dog is cute as can be if you can call something with
four legs, 55 pounds and still growing, cute.  But what a pain in the
butt she can be.  She drags everything she can find from firewood to
live snails into the house as a new plaything.  Nothing better than
stepping on a half chewed, half alive snail in your barefeet.  We made
the mistake of giving her a plastic plant pot left over from a nursery
run to play with.  Now she thinks every pot is fair game, especially
the ones in use.  Great fun chasing her around the yard with a pot in
her mouth and dirt and plant flying every which way.   She can do all
the commands she's supposed to know but as soon as she's within
eye/earshot of other dogs/people, all training goes out the window with
all kinds of jumping, yelping, and carrying on in a very undignified
manner.  We've asked the trainers if she'll ever outgrow it and they
smile and say, "I think I heard of one labrador once that did."  Just
chasing her around the yard ought to keep the weight down.

Take care,
Dave Perry

If you would consider going to Canada or Mexico or Europe, you might want
to look at HIFU (High Intensity Focused Ultrsound). It looks very
promising and could put surgery and radiation out of business in the near
future. I've been corresponding with a person from Great Britain that may
have early localized cancer that is considering the treatment. It's worth
checking out this link;
http://www.prostate-cancer.org/education/novelthr/Chinn_TransrectalHIFU.html.

Ron S.

I would ask them what they mean by "fully evaluate the extent of the
cancer". I was under the impression that they cannot SEE cancer cells.
Several surgeons told me that, because of my numbers, I was a candidate
for "wide excision". I took that to mean they were going to cut my
nerves. One surgeon said he would stop the surgery and send the gland
to the lab. If the margins were positive, then he would keep cutting.
This did not make me feel like there was any "advantage of surgery".
So, to keep my nerves and have a broader area of treatment, I have
chosen SI+IMRT.

John

I would ask them what they mean by "fully evaluate the extent of the
cancer". I was under the impression that they cannot SEE cancer cells.
Several surgeons told me that, because of my numbers, I was a candidate
for "wide excision". I took that to mean they were going to cut my
nerves. One surgeon said he would stop the surgery and send the gland
to the lab. If the margins were positive, then he would keep cutting.
This did not make me feel like there was any "advantage of surgery".
So, to keep my nerves and have a broader area of treatment, I have
chosen SI+IMRT.

John

RB--

I don't have the answer but I commend you on doing your homework.  My
fantasy is that if they open you up they can find out more and do more
but I don't know if that's true...i remember my husb's robotic surgeon
saying that he was a skilled oncologist and that in the course of the
surgery he could remove the tissue, examine it, see what was going on
and do what was nec.  I can only say that based on the fact that they
found more ca than they expected when they opened up Jon I just kind of
wish that they would have continued cutting and cutting away...I
wouldn't have cared if they had left him without innards.  The only
thing that matters to me is his life.

I have to say I have a certain comfort level with them opening you up
and staring the beast in the face. I just don't know if they can find
out as much with imaging techniques.

I think the recommendation of open surgeons is partly psychological for
me.  I find it comforting to deal with older doctors.  They have a
better bedside manner and I can't say I mind when they call me
"sweetheart" or "dear".  It feels really nice when you're upset.  I
also think that older doctors are more likely to say and do what they
think bec. their reputation is either made or not -- it's too late to
do much good or damage.  And they are less likely to practice defensive
medicine.

Forex, my husband went to see Dr. M., a "famous" ED specialist who is
in his late 60's.  He told J. that (contrary to what he'd been told by
2 other docs) he didn't need to take Vitamin V, that it was "a gift to
the drug companies," that he didn't need a diagnostic ultrasound and
that what he had been told about the benefits of nerve sparing was
exaggerated.  I'm not sure that he is right but it is extremely unusual
to hear this kind of candor from a doctor. And  Dr. M. is the head of
the uro dept at a major teaching hospital here so he probably does know
something.

I think the main reason I wish we had seen some of the open surgeons is
that some of them are the "grey eminences" of the prostate business,
some legends in their own time (e.g. dr. kirschenbaum, guiliani's
doctor).  My fantasy is that maybe these oldsters would have evaluated
J's tests differently or ordered more tests or whatever or "excised"
more of the ca.  For me this is a recurrent fantasy -- i don't know if
the outcome would have been any different. But it would be comforting
for me to know that we had interviewed some of  these old hands.  So
just don't leave yourself thinking about what might have been.

Of course old hands are less agile so there are downsides as well.

Please don't rely on me for any scientific data; you seem
well--qualified to research this on your own.  I know I came across a
quote recently from dr. guilloneau, inventor of lap pca, having to do
with long-term comparisons of positive margins from minimally invasive
v. open surg.  It's worth checking out.

I think you are wise to investigate a broad range of options.  It makes
me roll my eyes now  to think that J. and I, with I don't know how many
yrs. of education between us, basically walked into one doctor's office
and said, "I do."  And the recomm. of this doc. came from another doc
we had seen only twice.  (My long-term internist who i trust with
anything recommended that we see one dr. dillon, an open surgeon, but
he has his prejudices too).  It's a better idea to go on a couple of
dates before making your decision but don't overdo it.

There is no question the benefits of minim. invasive surgery are
legion.  I allowed myself a little sarcasm in discussing my husband's
one-year QOL after RLRP but the truth is the patient hasn't complained
once. He's a satisfied customer. But don't by seduced by technobabble
either.  The newest toy isn't always the best.  Review all the options
available.

I wish you the best and thank you for allowing me to qualify my
"treatment recommendations."

Leah