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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2006pca tumor detected in the seminal vessels with open rp as opposed to robotic rlp
i had a discussion with a 58 yr old acquaintence who just had his catheder removed after open RP. he indicated that the surgeon said that he was lucky to have chosen the open surgery since he was able to feel the tumor in his seminal vessels whereas it would not have been detected during a robotic rlp. he went into the surgery with a gleason 7 and a T2 with 8 cancerous core samples and one that was 65%. is that a convincing reason to choose open rp over robotic rlp? i have scheduled robotic rlp for oct 31 based on several factors. the one that is prominent in my mind is the accuracy with the X10 magnification. of course, the quality of the surgeon is most impt, but everything else being equal, what is more critical, the accuracy or the tactile? the answer might be skewd in my case since my gleason is 6, T1c, 3 samples with cancer and with less than 10% per core. it's probably contained but i hear they usually find more during the surgery. gary correction it is seminal vesicles not vessels gary gary.mille...@comcast.net wrote: > i had a discussion with a 58 yr old acquaintence who just had his > catheder removed after open RP. he indicated that the surgeon said [quoted text clipped - 14 lines] > > gary my origional question raises another question: what if, during robotic rlp, the biopsy reveals the pca has got out of the prostate? how is the pca outside the prostate detected if it is not easibly visible, which might be why the surgeon above said that my acquaintence was lucky to have chosen the open tactile approach? gary > correction > it is seminal vesicles not vessels [quoted text clipped - 19 lines] > > > > gary I had robotic and the seminal vesicles were also removed. I believe this is routine. So I think your concern is moot. There is no biopsy during surgery. There is a total gland analysis by the pathology lab. A postive margin would indicate it may have gotten out of the capsule. And with 10x magnification, why would it not be visible with robotic? I don't think any anecdotal evidence can be a convincing reason to make any one choice over another. >my origional question raises another question: >what if, during robotic rlp, the biopsy reveals the pca has got out of [quoted text clipped - 27 lines] >> > >> > gary > my origional question raises another question: > what if, during robotic rlp, the biopsy reveals the pca has got out of > the prostate? > how is the pca outside the prostate detected if it is not easibly > visible, which might be why the surgeon above said that my acquaintence > was lucky to have chosen the open tactile approach? I had open surgery. I had cancer outside the prostate. It was not discovered until a year later. Doctors generally cannot tell there is cancer outside the prostate until after the post-op biopsy regardless of the method of surgery.  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, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum > my origional question raises another question: > what if, during robotic rlp, the biopsy reveals the pca has got out of [quoted text clipped - 27 lines] > > > > > > gary >i had a discussion with a 58 yr old acquaintence who just had his > catheder removed after open RP. he indicated that the surgeon said [quoted text clipped - 3 lines] > he went into the surgery with a gleason 7 and a T2 with 8 cancerous > core samples and one that was 65%. He had a Gleason 7 and a T2. With 8 hits, he probably had a T2b. You are Gleason 6 and T1c. Of the hundreds of people who have reported their numbers over the years, about 44.3% have come here with a Gleason 6 or lower. Only about a third of those had a T1 Stage. Those are damned good numbers. You also had a fairly low PSA. You learned these numbers so that you could make an informed decision about YOUR cancer. I recommend you stay your course unless and until you have evidence that subrogates one of YOUR criteria. Furthermore, and you should talk to your doctor about this, I am almost certain that the seminal vesicals are coming out with the prostate making the "feeling" of them during surgery moot. 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, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum thank you for answering my origional question. stateing my question in another way: is the 10X visibility adequate to be able to detect tumors in other tissue locations that are typically examined by the open surgeon by feel if deemed necessary? gary > >i had a discussion with a 58 yr old acquaintence who just had his > > catheder removed after open RP. he indicated that the surgeon said [quoted text clipped - 30 lines] > Casodex added daily 07/06 > Non Illegitimi Carborundum is there a reasonable chance that the robotic rlp might not detect pca outside the prostate that the open rp would detect? i am asking this question in response to the open rp surgeons comment that my acquaintence was lucky to have selected open rp implying that the tumor might not have been detected during a robotic rlp. is it possible the surgeon was just doing some marketing? gary > thank you for answering my origional question. > stateing my question in another way: [quoted text clipped - 37 lines] > > Casodex added daily 07/06 > > Non Illegitimi Carborundum ... > i am asking this question in response to the open rp surgeons comment > that my acquaintence was lucky to have selected open rp implying that > the tumor might not have been detected during a robotic rlp. > is it possible the surgeon was just doing some marketing? ... I'm inclined to think that the best answers to this question can only come from surgeons with considerable experience in both techniques. If your friend's surgeon has done a lot of open surgeries and no or very few robotic surgeries, I'm not sure how qualified he is to know what can be done robotically, and vice versa for robotics only surgeons. [Of course having said that, I'll add that he's a lot more qualified than I am to have an opinion on this :^)] Alan > is there a reasonable chance that the robotic rlp might not detect pca > outside the prostate that the open rp would detect? > i am asking this question in response to the open rp surgeons comment > that my acquaintence was lucky to have selected open rp implying that > the tumor might not have been detected during a robotic rlp. > is it possible the surgeon was just doing some marketing? You're getting perilously close to that which I should not comment on -- nor should you consider me an expert. It is my opinion that both RRP and RLRP have little chance at detecting cancer unless it is grossly outside the prostate. 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, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum The question you ask regarding the advantage of tactile sense vs. magnified image has been asked and much debated before and there has never been a definitive answer. There are advantages and disadvantages to both. Of course doctors who do only one method will be biased and patients who have had treatment are biased as well. As was mentioned earlier, the whole business about the seminal vesicle tumor and how lucky the patient was is nonsense. Also, as for finding tumors in adjacent tissues, if there is an independent tumor in surrounding tissues the cancer has spread and the whole question is moot. What we're concerned about as surgery patients is has a tumor from within the prostate grown into surrounding tissues and has some of it been left behind. Doctors do their best to remove the entire prostate and as much surrounding tissue as they can without compromising important adjacent tissues such as rectum, bladder, and the sphincter at the bottom which is supposed to keep us dry. I suppose larger tumors can be felt and/or seen but the vast majority of patients who later get a recurrence have much smaller things, usually microscopic, which no doctor can detect. That's why we all continue to get PSA tests after our surgeries which were deemed "successful" and even after a few doctors boldly claim us "cured". Dave Perry > thank you for answering my origional question. > stateing my question in another way: [quoted text clipped - 37 lines] > > Casodex added daily 07/06 > > Non Illegitimi Carborundum " if there is an independent tumor in surrounding tissues the cancer has spread and the whole question is moot." Dave, I think the exception to that observation is that if the surgeon gets in and finds obvious involvement of lymph nodes, etc., implicating non-local disease, it might be best for the Pt for him to take a few samples for the pathology and then get the hell out. Unless debulking is warranted, I'd rather not suffer the SEs of RP if local Tx is useless. As or the magnification w/ LRP, if it is so helpful why isn't it used even in open RPs? Who says that the camera can't be inserted into the open field if it gives a better view? As to the query at hand, it is my understanding, as others have pointed out, that the seminal vesicles (and vas deferens and representative local nodes) are always removed along w/ the prostate. Thus, even if the surgeon correctly feels during the procedure that the seminal vesicles are involved, it is superfluous info. Bill Denton RP 2/12/02 PSA .96 Memphis > even if > the surgeon correctly feels during the procedure that the seminal > vesicles are involved, it is superfluous info. Not if it helps make more accurate staging diagnosis, which in turn helps determine the necessity and nature of further treatment. I.P. "I.P. Freely wrote: > Bill wrote: > > even if > > the surgeon correctly feels during the procedure that the seminal > > vesicles are involved, it is superfluous info. > > Not if it helps make more accurate staging diagnosis, which in turn > helps determine the necessity and nature of further treatment." Gee, I.P., look at what I said. The seminal vesicles are going to be removed and sent to pathology, which is a helluva lot more accurate than the most sensitive surgeon's sight and feel. So, what difference does the surgeon's preliminary "gut feel" make? None. It is, thus, indeed superfluous. Bill Denton RP 2/12/02 PSA .96 Memphis > Gee, I.P., look at what I said. The seminal vesicles are going to be > removed and sent to pathology, which is a helluva lot more accurate > than the most sensitive surgeon's sight and feel. So, what difference > does the surgeon's preliminary "gut feel" make? None. It is, thus, > indeed superfluous. Gee, sensitive, aren't we? Your sentence ending in "that the seminal vesicles are involved, it is superfluous info" came across to me, and I must assume some others, as saying the INFORMATION, not the method of determining it, is superfluous because the vesicles go anyway. I was trying to clarify the message, not shoot the messenger. I.P. A number of reasons for the lack of camera in open surgery. First of all, there's no room. The doc can barely get his fingers in there and to have a camera jostling around with the image flying every which way would be useless. Secondly, it's a bloody mess down there and there's not a whole lot for the camera to see except the doc's fingers and the blood. Thirdly, in the laparoscopic procedures, the cavity is pumped with gas to open the area up so the camera has room to look around. This gas under some pressure is also what tends to keep the blood vessels constricted somewhat so there is less blood loss and a better field to view. Dave Perry > " if there is an independent tumor in surrounding tissues the cancer > has spread and the whole question is moot." [quoted text clipped - 20 lines] > PSA .96 > Memphis > thank you for answering my origional question. > stateing my question in another way: > is the 10X visibility adequate to be able to detect tumors in other > tissue locations that are typically examined by the open surgeon by > feel if deemed necessary? > gary Open: The doc makes 5" incision from below the navel to above the pubic bone. He cuts his way through the muscle and lining, pushes away intestines and organs, and pumps out fluids until he can see the walnut-sized prostate eight or nine inches deep in the 5" hole. With both hands, he holds the tissue and slices and sews. The prostate comes out and goes to the lab. Lap: The doc pokes in with lights and cameras and 10X magnification. If any cancerous tissue is going to be seen, it's going to be seen with the help of amplified light and magnification. 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, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 Non Illegitimi Carborundum |
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