Robotic Surgeons help please

[dawnsearlylight]

My husband is 64 and has prostate cancer his PSA is 11 the Gleason score is 7 has had a biopsy last year that was clear but this year showed positive 12 out of 20 also a clean bone scan.  His doctor says that his best bet is to remove the prostate and our options are the old way or the new robotic surgery. We are very concerned because the robotics are very new to our area and his doctor has never done this proceedure. He said that it will take at least a month to schedule because they have to get in a surgeon to be there to guide him if needed. Having cancer is scary enough but to have to face making a decision about being the first patient for a doctor is really scary. I understand that someone has to be the first and that this is where they learn their skills but it is not making this decision any easier.  My husband also suffers from depression and I am worried about this also being an issue as we make this decision..and the recovery after surgery. I understand that there are many issues dealing with recovery. I guess what I want to know is your feelings on being the first patient that a doctor performs on or should we go to someone who is very skilled at this. This would mean having to go to another city and dealing with the back and forth and then what happens with the relationship with the doctor here. My husband really likes his doctor but if we decide to go to another city to have this done by someone who is experienced will his current doctor still treat him locally.  So many questions and so many concerns and would appreciate any and all comments on this matter.

[skyhag]

Hi there...I am writing because I have been in your shoes.  My husband had laproscopic surgery four years ago.  We spent months exploring all the options.  Robotic prostate surgery was a new concept at that time (at least in the area where we live).  My husband had EXCELLENT results with the nerve sparing surgery performed by his dr.  Very minimal side effects (especially those that men worry most about) were experienced.  I am sorry to report, however, that he experienced recurrence three years later and is currently undergoing IMRT (a form of radiation)  

Once again, he is doing well and the prognosis is wonderful.  We give full credit to the expertise of his urologist and the close attention my husband received during follow up visits.  I strongly recommend that you seek the most experienced surgeon available. As a wife, I have been completely proactive during all of this with countless hours of research and prayer.  Sometimes, I feel that he just sits in the dr. office "waiting on his lollipop" :)  He doesn't seem to mind that I take charge...in fact, I think he appreciates me dealing with a situation that is sometimes too difficult for him to think about.  

Please feel free to contact me, through a friendship request, if you find yourself in need of a conversation with someone who's been there.  And PLEASE, do not be discouraged by my husband's recurrence.  His chance of remaining cancer free was 87% according to all the tables...he just happened to be one of the unlucky 13%.  I admire his wonderful attitude throughout this whole ordeal and strongly believe the mind can be as powerful as the medicine.  I hope your husband will be blessed with a peace of mind knowing that prostate cancer is a very treatable and curable disease.  64 years old is young by today's standards.  My husband was only 54 at the time of his diagnosis, so we know the impact of this blow.

Take care and keep everyone posted.

Kay

[dawnsearlylight]

Same here..had check one thing and was checking on my watchlist so thanks for you help. We do a good bit of traveling but hubby is always "ready to be there" when his is healthy so I imagine that we would stay for at least a week. Drive time to Atlanta would be about 5 hrs for us and I imagine that would be kind of hard. If we can just get this ball rolling I would feel much better. Thanks!

[Artdude]

Although i had written a reply to another comment, i have just now gone back to view some of my "watched list" forums.  You asked about how much time you would have to spend in the area where the operation is to be performed.  You would want to arrive the night before the day of the operation.  operation day.  You check out the next day, but you would probably stay that night in a local hotel.  I have heard of doctors wanting you to stay an extra day just because of the travel time and to avoid complications.  So minimum would be 3 nights and about 4 days.  A famous football player in Pennsylvania flew to Florida for his surgery.  He stayed the week so that the surgeon could remove the catheter.  Depending on how far you would be traveling would also affect how long you would be staying.  Your husband is going to feel better than conventional surgery, but he won't feel like traveling long distances.  We were discouraged from traveling too long.

I live north of Atlanta--about 55 minutes.  I was VERY ready to get out of our van when we arrived home.  I didn't really travel much until I went back to have my catheter removed.  So...if you are very far, you might consider a week and a day of staying near the hospital.  Most hospitals have a list of hotels that offer special rates to patients and their families.  Hope this helps.  stay in touch.  blessings.

[kazzy101]

I am thinking of you.
It so hard when your spouse is unwell, or needs guidance, it is not like looking after your kids, when you can make the decisions and know they will happen. Of course, it all changes when they get older...Take care

[dawnsearlylight]

Thanks so much both of you for this info. Of course, it is my opinion also that he needs to see some one else on this matter. I guess that right now he is still in the shock stage and is unable to move forward with any of this. In some ways I feel like he thinks if he ignores it might go away. This is so frustrating as I don't know how to help him. He won't talk with anyone about this other than myself or his doctor. So I am trying to do all the research that I can. He does know that I have posted and am seeking answers but for right now he just doesn't want to deal with it. Depression plays a major factor in this. One thing he has been asking is about the recovery after the proceedure. It seems that we will have to travel if we go to someone who is experienced in robotics and that would mean being at least 3 to 4 hours away from home. So...baring the fact there are no complications in the surgery itself how long do you think we would have to stay in the area where we have it done?? Of course the cath is a major dislike for him so I would think we would need to stay till it is removed...but how soon did you guys feel like traveling? Also where can I find this info on the research you mentioned..my husband does pay attention to info and perhaps if I can print it out for him it will get him moving on this decision thing. Maybe I am worring too much about him not moving as fast as I would like...I just feel like every day its there it has more of a chance to spread...as other than him having a clear bone scan we do not know how big the tumor is until it comes out. Also his doctor said that they don't remove any lymph nodes with the robotic surgery..so I am guessing the only way we will know if it has spread is the size of the tumor. Thanks again for responding and anything thoughts you can throw my way are helpful!!!  Bless you.

[keyzersoce]

Researchers at Memorial Sloan-Kettering Cancer Center in New York City analyzed data on more than 7,700 prostate cancer patients who had been seen by one of 72 different surgeons at four major academic medical centers. They found that when the surgeon was very experienced in doing prostatectomies, the patient had a much better prognosis. Patients whose surgeons had performed the operation only 10 times were 70 percent more likely to have their cancer return within five years of surgery than those whose surgeons had done at least 250 procedures.


I agree with Artdude. Get a second opinion from an experienced surgeon.

Good luck.

[Artdude]

I had my robotic surgery October 2007.  You do want someone experienced.  Sure--someone has to be first, but doctors can (and should) assist many times before doing the surgery on their own.  Your husband doesn't want to be the first patient.  You don't say where you live and what cities near you might be able to assist your husband in his treatment.

I have a local urologist in Gaineville who is excellent with a wonderufl reputation and who would have done a radical retropubic prostatectomy (normal open procedure).  He knew that i was interested in the robotic and when i learned that my insurance would cover the surgery, that I would seek a urologist/surgeon that could do it.  A good doctor will not have an issue with your husband seeking "more advanced care."  My doctor said that though he would like to be the one to treat me, he was more concerned that i get the treatment with which i was most comfortable.  He said this not only because he didn't do radiation or other forms of treatment besides surgery, but also because he is a true doctor committed to helping his patients become healthy again.

I would suggest a "second opinion" to discuss robotic with an experienced surgeon.  Follow up can be done with your local urologist who can (and should) forward future test results to the surgeon.  I would make the return trip(s) to have the surgeon remove the catheter and for the first few post op appointments, but once the every-three-months appointments began, elect to have those done locally with your husband's current urologist.

This phase of deciding treatment is almost as stressful as the diagnosis.  I wish you the best as you two make the decision.  If I can of further assistance, just drop me a line or visit my profile.

Blessings.