any feedback on robotic surgery

[dumbme819]

I am a 55 year old male with prostate cancer.  psa of 3.5, gleason of 6 (3+3) and yes I understand that 30% or so of gleason 6s are really gleason 7s.  Paranernal (sp ?) invasion indicated.  3 of 8 cores positive.  I am looking at the robotic surgery and considering one of two doctors,  both with good reputations.  

anyway, I am very worried about loss of sexual function after the sugery.  has anyone had the robotic sugery and what is the feedback.  what has exericence been with radiation seeds and with this new spangled thing called cyberknife.  

I an confused on what the best method is and who the best person is to do it.

thank you in advance for whoever response.

[tluvlee]

I spoke with my dads surgeon who indicated that the primary focus is the cancer removal not restoring sexual function, however he did indicate that the robotic magnifies everything so that there is a greater chance that no nerves are damaged whereas with the open option you have a harder time seeing things that well.  

As far as the seeds, my mom said that the seeds are an option with a 1 or 2 but anything greater they arent as effective.  You may want to confirm this with your doctor.  My dad was a 4.4 so that was not an option for him, I asked.  As far as radiation afterwards, my fathers doctor told us that they think they removed all of the cancer, but they have to wait for the pathology results to be completely sure.  If there is any left they will likely use radiation and chemo to get rid of it.  

As far as the 50% who have somewhat normal function.  I was always told that you would hear more from a dissatisfied customer than a satisfied one.  Instead of assuming that they dont exist, assume that they are out wielding Viagara and having really good sex again and too busy to post on message boards. :-)

If you want to read further I can tell you what my dad is going thru right now.  If not, you may stop here.  

My father is 3 days post op from the robotic surgery.  He was in surgery and under anesthesia from 9am til about 6:30 pm.  He is in a lot of pain.  He is having a hard time urinating and a lot of pain when he does.  Urine is leaking as well as going into his incision drain bulb instead of his foley bag since he has a catheter. Everything they do seems to cause a great deal of pain.  Because they have to reconstruct the urethra and because he has a catheter, he feels like he cant pass his urine.  He wants to get up to do it.  The pain has him somewhat incoherent and delusional. He doesnt understand why he cant get up to pee. We insisted last night that they do something about the pain because it was beginning to effect his blood pressure.  From what I am told it is normal to have a lot of pain immediately after surgery.  They did an ultrasound today to make sure there were no obstructions.  We will talk with the doctor tonight about the results.  This wont be a cake walk but the most important thing is removal of the cancer.  You dont want it to progress, at 58 you are young and we were told that your chances for having sexual function restored are better the younger you are, because most men are older when diagnosed, thats why the numbers seem so bleek. But my dads doctor did say that the benefit of the robotic surgery was that there is not as much nerve damage which decreases the chances for erectile problems. My friends husband had his prostate removed at age 39 or 40 and regained all function without aid(blue pills).  You dont want to wait til you're older to deal with it.  My father is 69 and just had the surgery, and my grandfather was 72 when he was diagnosed.  My grandfather chose not to treat his at all and later died at 87 because by then it had spread to his lungs.  I hope this helps.  I dont want to scare anyone but I wish someone had been this frank with my dad about what to expect.  

[keyzersoce]

My friend gathered all his files and consulted with a medical oncologist, whose only job is to look over the facts and give his opinion on how to proceed based on that info and the patient's wishes.

I would advise you to also seek out a medical oncologist who may help you decide.

Good luck.

[dumbme819]

thank each of you that responded.  I have talked to several doctors and the best I can see to get is fiven my age and progression of cancer there is a 50% chance of something that resembles a normal function (but normal is not defined), a 30% chance of something with a "ton of viagra" and a 20% change of being disfunctional.  However, everyone I have talked to that has has the robotic surgery has indicated that they fall in either the 20% or 30% group so I am wondering if the 50% group even exists.

In any event I am also wondering if anyone has concluded that an alternative to surgery is better given my circumstances and progression of the cancer and if there are better alternatives, what alternatives those may be.  It is frustrating dealing with the doctors who are all so "litigation worried" or "I only know the procedure that I do" that you can't get a straight answer from them.

its like making a decision with only half the facts, I guess I should just be happy that my cancer was found a earily as it apparently was, but I just can't make a decision on what to do.  I just remember someone's comment "chose wisely as you only get one chance for treatment here"  that has driven me into the inablility to make a decision

thank you all that respond.  
signed dazed and confused (a little comic relief by a stressed out person)

[nycwaldo]

I'm not a doctor, but I think some loss of sexual function is typical after any type of prostate surgery -- but these days, especially with pills like Viagra, some of that loss may be mitigated, with the right treatment regimen.

One thing to consider when choosing a surgeon is, does he have any colleagues who specialize in sexual dysfunction? In other words, can he refer you to a urologist who has a lot of experience in treating erectile dysfunction?

Depending on where you live, if you are near a major medical center, you may be able to find someone with a lot of experience in this area. I would suggest trying to find someone who has a track record of scientific publications about erectile dysfunction. Try a web search using the doctor's name and the words "erectile dysfunction".

Good luck to you!