It would likely be helpful to read what some medics have to say on the
subject.

The Prostate Cancer Research Institute's webpage at

http://prostate-cancer.org/education/education.html#local_therapy

has such information. Scroll about halfway down the page to the section
"Local Therapy", where links to papers on the various forms of
prostatectomy will be found.

Best of luck.

Regards,

Steve J

Hello Mike, it appears to me that there is a growing trend towards
Laparoscopic and Robotic Laparoscopic surgery - I read posts here from
time to time and remember only one poster here recently going for the
plain vanilla RP (I could be wrong!).  Of course ascp is a tiny
microcosm of PCa-world but I do sense this change.  Perhaps it's a
fashionable blip?  Since both LRP and RLRP are relatively new there's
not yet data mature enough to compare long-term outcomes.  Briefly,
this was my reading:
RP - nice big hole, the surgeon is more hands-on but there's more
blood.  Longer recovery time.  Substantial stats available.
LRP/RLRP one medium hole + 4 tiny 'stab' wounds, less hands-on, less
blood, shorter recovery time.  Fewer stats.
There was a post here recently claiming negative margins in approx
half of RPs compared to approx one third of LRP/RLRPs (please correct
me for errors).
The impact of your 45 day wait is incalculable and as a patient on WW
for 2.5 years my advice will be less cautious than that of others,
but, for you as a gl6, my vote on a straw poll would be to wait the 45
days if that is the procedure you want.  Of course, you must use a
surgeon who has plenty of experience and who inspires confidence.

I chose an LRP 2 months ago (UK) and was soon up and about.  Bar the
odd stress-dribble, I'm fully continent, and had an unmedicated
erection firm enough for penetrative sex (80%-ish) at 4 weeks and even
better erections now with cialis.  Of course I can't say anything
about my prognosis but, for the moment anyway, I am very happy with
the outcome.

I can only pass along that my boss chose robotic as he should only miss 2-3
weeks of work.

Good luck.

Maui wrote:

I had a laparoscopic radical prostatectomy (LRP) done at Johns Hopkins
about 8 weeks ago.  I was hospitalized for two days, and on a catheter
for about a week afterwards.  (I'm getting blood drawn for my first
post-surgery PSA today.)  I chose the laparoscopic procedure because of
minimal blood loss and shorter recovery time.

I lost only 100cc of blood during the procedure (~ 2 tbsp), and so
required no transfusion.  I was lecturing my classes two weeks after
the surgery,  I am slowly regaining continence, but have had no
erections yet.  I am patiently waiting, though my wife and I have
resumed a sex life that includes orgasms for the both of us.

If I recall correctly, my surgeon (Pavlovich at Johns Hopkins) had
learned how to use the robot, but decided that he preferred doing the
surgery without it.  Since he has over 450 LRPs under his belt, I felt
very comfortable in his hands.  Apart from what he said, I don't know
anything about the robot.

Probably the most important recommendation I could give you is to get
the very best and most experienced surgeon you can.  It seems that
there is a high variability in the success rates and side effect rates
from surgeon to surgeon.  Don't worry so much about the time frame;
remember that prostate cancer is usually very slow-growing.

Mike, whatever you decide, all the best!  You will get through it.

--charlie

Hello Mike,
   I have to be the one to have had RP.  Radical Prostatectomy.  1999.  The
Surgeon choice is important.
I was building cabinets in my garage 10 days after surgery.  I did not leak
a drop, and erections took about 1.5 years to come back.....I lost many
nerves in the surgery......I am fine, and looking back was glad to have a
professional experienced surgeon who took great care of me.  I did have
blood drawn for surgery but did not need any.  Good wishes, and choice.
John Loomis

Most people would agree that the choice of the procedure is less
important than the skill of the surgeon in performing the procedure.

RP involves al onger recovery time in general, but not greatly so.   I
had a RP in 2000, was pretty much able to do normal tasks, except for
pads, by the time the catheter came out two weeks after surgery.  I was
continent a month after the catheter came out and regained erections
some 18 months following surgery, despite my age 67 at the time of
surgery.    I've been PSA free since then.     My surgeon seems to do
pretty well with the RP technique he has developed.  A friend recently
had RP with the same surgeon, and so far the results are promising.
Apparently, our surgeon has decided to remove the catheter a week after
surgery rather than two weeks after, as in my case.  I would still
highly recommend him to anyone considering prostate surgery.

Maui wrote:

Hi Mike...Here is a collection of articles relevant to your question.
Good luck with whatever technique you choose!..Best wishes and good
health, ron
---------------------------------------------------------------------------?--------------------------------------------------

This is from Medscape's review of the 2005 AUA meeting
http://www.medscape.com/viewarticle/507264?src=mp
"The positive surgical margin rate continues to be higher with
laparoscopic and robotic prostatectomy compared with the open
approach.[54,69,70] It is unclear how this will translate into
disease-free and overall survival, since the laparoscopic and robotic
experience is still immature. Nonetheless, it is cause for concern."

At the same meeting, Dr. Guillonneau, one of the originators of the
lap-procedure for RP said (in his abstract), "eradicating positive
margins at the distal prostatic apex remains a challenge."

Robotic-Assisted Laparoscopic Prostatectomy: Do Minimally Invasive
Approaches Offer Significant Advantages?
Joseph A. Smith Jr and S. Duke Herrell
Journal of Clinical Oncology (JCO),Nov. 10, 2005
"Separating hype from reality is sometimes difficult with many medical
procedures and this is particularly applicable to RALP. Patients who
appropriately research treatment options so that they can participate
in their own medical decisions may have difficulty interpreting
marketing efforts by hospitals and physicians. The lack of randomized
trials or even balanced prospective studies limits the ability to
analyze comparative results of RALP versus open surgical approaches."

On the subject of "the improved visual field vs. loss of tactile
feedback" discussion, here is a piece from one of Walsh's papers...
J Urol. 2005 Feb;173(2):446-9; Radical retropubic prostatectomy. How
often do experienced surgeons have positive surgical margins when there
is extraprostatic extension in the region of the neurovascular bundle?
Hernandez DJ, Epstein JI, Trock BJ, Tsuzuki T, Carter HB, Walsh PC.
"Visual and tactile assessment during open surgery by an experienced
surgeon provides valuable information on when and where it is safe to
preserve the neurovascular bundle in patients with EPE in the region of
the NVB. Surgical approaches in which tactile sensation is muted or
absent, laparoscopic and robotic, need to undergo a similar evaluation
to determine whether magnification of the operative field is sufficient
to overcome the lack of haptic feedback and ability to palpate the
tissue"

and finally, Dr. Catalona's view on the subject...
http://www.drcatalona.com
Question:  I have been hearing a lot of good things about DaVinci
Robotics for removing the prostate.  I know that you do not practice
the procedure, but what would you say about its benefits for preserving
potency and continence?  And which patients should consider it as a
treatment alternative?

Answer:    In my opinion, the robotic prostatectomy (often called the
DaVinci prostatectomy) is not as effective as the traditional open
prostatectomy for simultaneously accomplishing complete removal of
cancer and preserving potency.

One of the reasons is that the robot lacks the "human touch" and it is
not possible to appreciate how the prostate gland feels and how readily
it separates from the nerves and other surrounding tissues. The robot
does not handle the prostate gland as gently as the human hand, and not
infrequently the robot punctures the capsule of the prostate, leading
to positive surgical margins.

Another limitation is that with the robotic prostatectomy, the prostate
is removed by burning it out with electrocautery or a so-called
harmonic scalpel that cuts by heat, and if the heat is too near the
nerves, it irreversibly damages them. Also, if the burning is too close
to the prostate gland, it risks cutting into the prostate, resulting in
positive surgical margins and possibly leaving cancer behind.

Advocates of robotic surgery say that there is less bleeding and
greater magnification with robotic surgery. However, excellent
magnification and visualization can be provided with open surgery, and
with an experienced surgeon, few patients require blood transfusions
from another person.

With robotic surgery, it is more difficult to suture and apply
hemostatic clips and it is more difficult to perform a lymph node
dissection.

Enthusiasts of the robotic procedure claim it is "less invasive" and
has a quicker recovery time. But actually it is more invasive because
the surgeon has to go through the peritoneal cavity to get to the
prostate (a more invasive approach associated for
greater risk for injury to the bowel, major blood vessels, and the
ureters and a greater risk for later intestinal obstruction from
adhesions).  Usually 6 one-inch incisions are made for robotic surgery,
while for open surgery, one 4 to 5 inch incision is made
that does not enter into the peritoneal cavity. With the smaller
incision now frequently used for open surgery, there is no material
difference in the recovery time and return to normal activity. .  .

The complications with robotic prostatectomy are more serious than with
open prostatectomy and they lead to more postoperative emergency room
visits, more
re-hospitalizations, and more re-operations.

I believe that with the robotic or laparoscopic prostatectomy, the
patient and the surgeon have to make more of a stark choice between
removing all of the cancer or preserving the nerves to maintain
potency.  I believe that there is a greater likelihood
of accomplishing both objects with the increased access provided by the
open approach.

Most importantly, however, the robotic prostatectomy  has no track
record in terms of long-term cancer  control.  If small amounts of
cancer are left behind,  it may not become apparent for years.

Patients sometimes tell me that they know someone who underwent a
robotic prostatectomy a few months ago and seems to be doing fine.
However, the final outcome of the operation may not become apparent for
up to 10 years. Thus, long-term cancer cure rates are needed before one
can truly evaluate the effectiveness of the
operation.

In sum, I do not believe the robotic prostatectomy is as safe a cancer
operation as open radical prostatectomy, and I do not believe that
nerve sparing can be as readily or safely accomplished.  For patients,
the most important outcomes of radical prostatectomy are: Is he cured
of his cancer?  Is he continent?  Can he have erections sufficient for
intercourse?

These questions have  been well documented for open rostatectomy.  The
jury is still out with laparoscopic/robotic prostatectomy.

The most important factor is the surgeon and not the technique.

LFC

I'm quite sure you were often told here that you need to research this
disease, it's treatments, and their consequences.  Not knowing that RRP was
one of several surgery options, including RPP, LRP and RLRP, shows that you
have done very litt...  no... make that no research.  So, you want to make a
decision that will have effects for the rest of your life based on your
physicians opinion and attendant vagaries and our opinion?

Okay by me.  Get the robot.  It's the best thing going for a 55-year-old
with a T1c and Gleason 6.

But, I'd sure feel better if you'd read at least one book to find out why.

Welcome to the club.  I'm sure things feel overwhelming for you now,
but they will get better.  I just wanted to tell you that my
sister-in-law lives in Kauai (with her handsome 2 Hawaiian boys).
Well, she just sent me a photo calendar for the new year and I wish the
year were 1000 mos. in the year because those photos were just out of
this world!  She has a garden full of orchids and all sorts of tropical
flowers, birds of paradise or whatever.  Anyway, it's spectacular.

Now to your question.

I AM NOT A DOCTOR AND AM NOT GIVING YOU MEDICAL ADVICE.  HAVE BEEN
INVOLVED WITH PCA FOR 18 MOS, OTHERS HAVE FOR A MUCH LONGER TIME.  THIS
IS JUST ONE LAYPERSON'S OPINION TO TAKE WITH A GRAIN OF SALT.

First of all, there doesn't seem to be any immediate urgency for you to
make a decision so you should wait until you're absolutely sure of the
right thing to do! Of course, only a doctor can tell you this for sure.

My husband was diagnosed in Aug. 05 and had RLRP (robotic) surgery in
10/05.  We live in NYC and so we have a pretty broad choice of docs and
hospitals.  However, now, 14 mos. later, I believe we made all of the
wrong decisions so maybe you could learn from our mistakes.

First, let me make an important point: Scientists have earlier
discovered  that the velocity (or doubling rate) of the psa level may
be predictive of whether a given person will get Pca.  Now,
cutting-edge research (see article posted by Curtis on 12/30) seems to
indicate that the doubling rate in the period before the surgery (say
10 mos.) is predictive of the OUTCOME, i.e., whether the ca will
metastasize, etc.  This is a brand-new and exciting finding.  Now, I am
not a doctor and keep in mind that I'm not giving you medical advice,
but what stands out in your stats is the increase in your PSA velocity
in the 6 mos.  So that would be a cause for concern and I would bring
up this issue with a very competent doctor if I were you.

Here are the numbers you submitted:

10/01 PSA 4.7  Biopsy Negative
3/02   PSA 5.1  Biopsy Negative
8/02   PSA 6.9
3/03   PSA 9.1  Biopsy Negative
9/03   PSA 8.1
3/04   PSA 6.3
9/04   PSA 5.8
11/05  PSA 6.0
5/06   PSA 6.6
11/06  PSA 13.8  Biopsy Positive  G6, T1c, 55 yrsMike

Now, your PSA has more than doubled in six months, and I would be very
concerned about this.  Also, I'm no expert, but as others have pointed
out, there is something odd about your high PSA level; it just doesn't
seem to accord with your other scores.  So I think you need a very
smart doctor to figure this all out.  (And maybe do add'l diagnostic
tests.)

Now, I have come to believe the most important choice is the treatment,
then the doctor and then the hospital. In that order.  For anybody with
anything less than a non-suspicious, localized cancer I would suggest a
variety of treatments.  But even though your Gleason score is not high,
you have some other factors that might make your ca worse than the doc
thought originally.

There is no way to actually know what's in your prostate and what type
of cancer you have until you send the cancerous tissue to the pathology
lab after treatment to be analyzed.  The pre-op Gleason score is just
an educated guess.  So my concern is that what happened to my husband
may happen to you: you may find out after your rp that the ca was worse
than they had thought and they might even upgrade your Gleason score.
Understand that if your ca does turn out to be worse than they thought
(as it does in maybe 30% of cases, acc. to Scardino) , it's too late to
make a decision change.  So you don't want to do something you will
regret later.

My husband went into surgery with a Gleason 3+4=7, a PSA of 9.56 and I
believe a staging of t1c (not sure).  In any case, he had what would be
termed an intermediate-grade cancer.  However, after the surgery it was
determined that the ca was worse than they had thought, and his G score
was upgraded to a 4+3.  Now this may not sound like a big deal to you
but for us it is monumental!  That's because the evidence seems to
indicate that in the long run, the 3+4 tends to remain localized while
the 4+3 tends to metastasize.  Big difference.  Now it feels like we
have a (mushroom?) cloud hanging over us.

Now I have come to believe firmly that if you have a cancer with a G of
7 or more you should have open surgery (RRP) and if we had it to do
over again, that's what we would have done. (Although reasonable people
diagree.) That's because the biggest? doctor in the country, Partin of
Johns Hopkins, seem to think so. I read, **in a post from a pt, that
although Dr. Partin is competent in various surgeries (including
robotic) he will ONLY do OPEN surgery on a patient with a G7 or less.
Now, I don't know much about Dr. P, but I do understand that he is head
of the Urology department at what is considered the best urology
hospital in the country.  That's enough for me.

Then there's Dr. Guionneau with whom I'd had had some experience with.
I had read about him in Peter Scardino's "Prostate Book" (must-buy!)
and I thought him to be the most qualified doctor availlable to operate
on my husband.  I believe he invented the LRP and he is head of
Minimally Invasive Surgery at the Urology Dept of NY Hospital. So he
does know how to do robotic surgery as well as laparascopic.  Now, I
have been told that he prefers LRP, but maybe it's because he has more
experience with it.  In any case, he has stated publicly that he cannot
say that the rate of negative surgical margins (whether there's cancer
left at the edges of the prostate after RP which can predict long-term
outcome) for robotic surgery is equal to that of RRP (or LRP).  This is
because there are no long-term studies available that compare the two
methods.  He is basically saying he would err on the side of caution.

I had called Dr. G's office to try to set up an appt, but they said he
only takes g6 or under. Not only did I feel upset that the best surgeon
around takes only the easiest cases (doesn't he ever want a challenge?)
but I was concerned that maybe he thought people with a G7 or over
would not fare that well -- or might not even benefit from the
treatment.  There ARE other possible reasons, like the fact that some
top doctors "cherry-pick" the patients with the best outcomes so it
makes their stats look good.  But I don't know.

[Accidentally deleted material on Catalona; see ron's post]

Now, the downside of open surgery is that there is a somewhat longer
recovery time and a greater loss of blood, potentially.  But if you are
in good health and can handle it, I would not let that prevent me from
choosing RRP.  A lot of men have posted here that their experiences
with RRP were not that bad.

The most important concern for you in choosing a treatment is the
outcome: whether it will cure the cancer.  Everything else is secondary
and many men don't get bad side effects or there are many different
ways of dealing with them.  So, I would forget about convenience,
absence from work, a big scar or a potential blood transfusion.  If
your case is anything but a low-grade cancer, G6 or less, Psa less than
10, your risk is increased (and especially if this business about PSA
velocity before treatment turns out to be true.)

So, you must discuss this with your DOCTOR(S) and listen to their
advice and make a decision based on the best long-term outcome for you.

Understand that most people who have been operated on by fine doctors
with the robot will probably will have good long-term outcomes.
However, keep in mind that just because something is high-tech does NOT
necessarily mean it's better.  Now I hear something called a Cyberknife
advertised on the radio, and people are getting excited about it
because it uses a robot to deliver radiation.  I don't know anything
about it, but a discussion in another group seemed to imply that it was
either experimental or not better than the current treatments (I don't
know).

Now, the pros and cons of open v. minim. invasive surgery are reviewed
in some of the articles I will give you, so you could read that for
yourself.  I do believe that Dr. Patrick Walsh, probably (one of) the
best pca doctors around (get his book, don't know the name of it) has
said that the visual advantage of the robotic does not outweigh the
advantage of the "tactile feedback" you get from RRP.  Especially, with
a very experienced surgeon, they can look at the cancerous tissue and
sometimes know from experience what they are dealing with.  The best
ones have been doing this for 40 years.

Now, about actually finding a surgeon:  The first thing I would do is
read Don Cooley's website, prostate-help.org, because he has the most
frank discussion of what doctors and the medical profession are REALLY
like.  That doesn't mean that they're bad, but they are often not what
they seem.  I know this because I have learned this the hard way.

When you look for a doctor, in other words, you can't just accept what
the doctor tells you, the statistics he gives you or the research
studies he cites.  Take it from me!!   That's why you don't have to be
paranoid but you do have to be an educated consumer.  Read the section
on what to do before you are diagnosed on Don's website.

For example you may hear even from the most highly recommended (or
rated) doctors that they have done x amt. of surgeries but in reality
they may have just assisted and you don't know what "assisted" even
means.  I mean, they could have brought the doc his lunch.  Another
example, a doctor says "I learned the robotic surgery technique from
Dr. Menon."  But that could mean that they both attended a weekend
conference on the matter.

My husband's surgeon, for example, told us he had done around 1,000
robotic surgeries and had been doing them for x number of years but
when I mentioned it to another doctor in his "league" he told me in an
off-record conversation, that that just COULDN'T be possible.  I think
he said the number was more like 200.  But I have to mention that this
second doctor is a competitor of the first doctor and so I consider his
opinion biased but I believe there is probably some truth to it.
Patients don't know how to really evaluate very technical information
about a doc's background.   And I'll just tell you, for the record,
that my husband and I are both very well-educated people, reasonably
intelligent, but as far as this process was concerned it didn't make
one bit of a difference.  So this applies to everybody no matter how
smart you think you are.

When choosing a doctor your concern should be getting the best doctor,
NOT proximity.  So if we were doing it over, if I thought it was worth
it, I wouldn't hesitate to hop over to Baltimore to be treated by the
doctors there.  (JH has the highest-ranked urology dept of any
hospital).  Maybe it would involve some sacrifice or expense, but I
would make it my business to do it if my life were at stake.

You mentioned that you had made up your mind to use your local doctor
and while I don't know him if just sounds to me on the surface to be a
TERRIBLE idea.  Others have told you this, too.  Especially, if the
robot hasn't even arrived yet.  I must tell you, this is really scary.

Now, there are many ways to find out who are the most highly rated
doctors in their field.  I've got two books with such info, but I
already looked, and Hawaii is not listed.  I can't say for sure but
probably the closest "center or excellence" in urology, or top
hospital, is in LA.

Now, I'm sure your urologist has recommended some doctors to you
already, but because of issues of cronyism, I would not rely solely on
that.

Top doctors usually work at top hospitals.  I have previously submitted
a post which ranked hospitals in the US by their Urology depts (based
on rankings from us news)) and you could pull that up.  Once you have a
list of  the best hospitals you might get an idea who the best doctors
are.  Offhand, I can tell you that the top 3 uro depts in the country
are Johns Hopkins, the Cleveland Clinic and the Mayo Clinic.  Then in
the top 10 I think theres UCLA, NY Hospital, Col. Presb, Sloan
Kettering and maybe MD Anderson.  But I am reciting this from memory so
look this up.

You can also get information about doctors by reading websites and
newsgroups such as this one.  But you have to factor in how reliable
the info is.  A lot of newsgroups have mostly "anecdotal" info and
anyway, the participants are not a representative sample of the whole.
Websites can be a good source as well, but then you need to know what
the best websites are.  I will try to list some that I would trust.

These are:

prostate-help.org (Cooley's site) for good patient-to-patient info and
"straight talk".  Also good forums and NO advt'g of any kind.  And a
lot of material.  *** However, this is my impression from having spent
only a few hr. on that site.  I wonder, e.g.,  why he included Dr.
Myers in his list of "artists" (only bec. his website,
prostateforum.com is like a supermarket. The kitchen sink is also for
sale).  Other than that he may well be perfect.

prostatecancerfoundation.org - this is the foundation started by Milken
and it is by far the richest prostate cancer charity around.  That
means that they have the money to hire a lot of highly-talented people
who work full-time on pca research.  I imagine the info would be very
up-to-date.  The cite has some sponsors (cos. that donate money) which
can affect the objectivity of the info you get, but this site has NO
advt'g from any healthcare-related cos.  Also it has a few good
downloadable books, such as a 40-page one on Nutrition.

Fightprostatecancer.org - nicely laid out and organized info.
Corporate sponsorship from only a few drug cos.

pcaw.com - Prostate Cancer Education Council?  The website is run by a
non-profit corp. in spite of the "com" ending.  They just "rent" space
from the Prostate Cancer Awareness Week folks.

Ustoo.com, Ustoo.org - a good resouce for people-to-people contact like
support groups and online resources.

(Look at Honesty on the Net foundation, hon.ch.org -- they give their
approval to medical websitest that meet certain minimal requirements
and I believe they might have some guidelines for evaluating
healthcare-related sites.)

Websites to Avoid

PCRI or prostate-cancer.org.

In my experience this is the most frequently cited pca website (maybe
90%) in the forums I've been in.  This is the website of Dr. Stephen
Strum, who many consider to be a good doctor but virtually all agree
he's an "outlier", i.e., not mainstream.  However, regardless of his
vices or virtues, this website is one of the worst I've seen -- it
flunks just about every category.  But I am cutting out most of the
info to be brief (and in order not to get killed).

1.  Objectivity. Very biased (of 18 members of their medical advisory
board, not one is a surgeon).

2.   Independence.

One aspect of this has to do with who sponsors the site, if there are
any.  Now some respectable foundations do have sponsors (even drug
cos.) but it's a matter of degree and how they are presented and how
much influence they have on the content.

a.  PCRI has around 24 drug-co. sponsors.  This is a much higher number
than any of the other sites I've seen.  (Cf. pca coalition: 7).

b.  When you do a content search on a subject (such as one I did in the
"PCRI Reports" section), you might pull up an article with a giant logo
of a co. on it.  It's one thing if it's discreet, but it isn't.

c.  The site provides you with (clickable) links to all of their
sponsors.  So, for example, I was looking up something on robotic
surgery and eventually arrived at the site of the Da Vinci Co. -- the
company that actually makes the robotic equipment.  Is that where you
want to get objective info from?

d.  This is not specifically related to the website but it concerns
conflicts of interest.
Example:   Just yesterday I was reading an article by Dr. Strum posted
on the p2p mailing list for which he is the "House physician".  He had
evaluated a patient's medical data and was rendering an opinion.  He
told the patient that he should order some nutritional supplements or
vitamins, but ONLY from LEF.  Well, LEF is the sponsor of the PCRI
newsletter (one of 2 "designated sponsors").  Dr. Strum is also on the
Board of LEF, a (pseudo-) nonprofit organization which also happens to
market the doc's products.

There's more, but I don't want to exhaust myself.

I do want to say that it's too bad Dr. Strum conducts himself in a less
than respectable manner, because there are many people who feel he has
something to contribute to this subject. Maybe more than a little.  If
he is not mainstream, maybe he will turn out to be right, one day.

2. Apparently Dr. Strum's book is liked by everybody who has read it.
It appears to be easy to read, has a lot of pictures and maybe the
information in it is good, too.  I plan to order a copy.

3.  A knowledgeable person and pca patient said to me: "Strum takes his
case directly to the people," when I asked what this person thought of
him.  This may account for the fact that he has not published that many
articles (there are some).

4.  There are some very impressive doctors on Dr. Strum's medical
advisory board.

4.  The fattest content section of this website is about diagnostic
tools and I believe some take his opinion on this  very seriously.

The bottom line is, I can't comment on Strum the man or the substance
of his work because i don't know anything about those issues.  But the
way he presents himself stinks, in my opinion.
.
Good Luck and here are some cites

Leah

**PSA Velocity and Outcome

***Curtis' post of 12/30 on psa velocity.

Report to the Nation on Prostate Cancer 2004
Chapter 1: Detection, Diagnosis, and Prognosis of Prostate Cancer CME
Authors: H. Ballentine Carter, MD; Angelo DeMarzo, MD, PhD; Hans Lilja,
MD, PhD

Emerging Predictors for Prognosis
Two more recent developments in the area of prognosis are poised to
greatly improve outcome predictions in patients with localized prostate
cancer: measured changes in PSA (ie, velocity and doubling time) and
artificial neural networks

**Open surg v. Robotic

**Ron's (not Ron B's posting in answer to your questions of today which
contains the articles which cite Guilloneau and Catalona).

NOTE: The following info is from a posting by a participant in an ML.
I can't verify it although I believe I have heard the complaints about
Manon (on the cooley site).

"Dr. Alan Partin, who is now the "Urologist-in-chief of the Johns
Hopkins hospitals",has done all three kinds of RPs: open RRP, LRP, and
RLRP.He will do an RLRP if a patient requests it_and_ if the case
appears to be clearly early-stage.If it is not clearly early-stage, Dr.
Partin will refuse to use the robot and will only do an open RRP.Very
few if any other surgeons make this distinction"

"Except for a few experts such as Guillonneau and Abbou, the day of the
(nonrobotic) LRP is probably over.Dr. Mani Menon has published
comparison of RLRPs done by himto RRPs done by six of his resident
surgeons,who all together haven't done nearly as many RPsas has Menon.
In my opinion this makes Menon'sconclusions meaningless.If anyone ever
talks to Menon, you might ask himwhy he didn't compare his RLRP results
to his own RRP results, which were very good." (From .John Chandler of
PPML).