Third Choice

My husband had a template biopsy in March and had Da Vinci surgery 3 weeks later so not sure why he said that? Maybe it depends on the surgeon, after this keyhole surgery he is making a good recovery. Maybe others here had a template biopsy and also Da Vinci, would be interesting to hear others thoughts?

Trish

some good advice already

do you think your consultant is saying no robotic or keyhole surgery because he can't offer or do that in his hospital? Under the NHS Choices scheme You can choose where to have your treatment so if there is a Da Vinci machine in a nearby health authority you should be able to go there. Your Consultant should be able to refer you. He may have a really good explanation for his statement though, so I would be inclined to ask him to explain his reasons to you and ask him why he feels robotic or keyhole is not a viable option so that you can consider things.

You are right in saying that surgery is rare after RT.

Was Brachytherapy discussed or mentioned as an option.? You have not said what your PSA was at diagnosis, it needs to be quite low for Brachy to be offered I think. Hopefully Sandra (Johsan) or one of the Brachy people will post for you too.

xx

Mo

Edited to delete a sentence repeated in error.

Edited by member 30 Jul 2015 at 06:28  | Reason: Not specified

Thanks for the reply Chris. At the moment there is no robot surgery available in Scotland although one unit is due to open in Aberdeen fairly soon.

Paul

Hi Paul,

Interesting what you say about long term side effects - I'll keep that in mind.

I hadn't really intended going outwith my own area but it's something that's worth considering in view of the information I've been receiving on this forum.

Thanks

Paul

My hubby had a choice of several treatment routes; surgery, radiotherapy with hormones or hormones / radiotherapy followed by brachytherapy - after much consideration he has opted for the brachytherapy and is due to start his radiotherapy on 1st September.

If you click on my avatar you will be able to see his history, make sure you fully consider all options before you decide.

Wishing you well on your journey

Maureen

This link is a bit old but may help

http://www.dailymail.co.uk/health/article-1325743/Who-best-surgeons-treating-prostate-cancer.html

Roy

Paul,

Don't be embarrassed to ask the hospital or the surgeon's PA about your prospective surgeon's experience and successful outcomes. Some have for example a better record on preserving nerve bundles and erections of patients but such so called nerve sparing is not always possible if all the cancer is to be removed.

It drives me round the twist all the current bigging up of keyhole & robotic surgery. My husband chose to have open RP, there is no data to suggest that keyhole gets better results and based (anecdotally) on members here, it seems more likely to go wrong.

Are you sure that the doctor said you couldn't have keyhole because of the template biopsy? I think that prostate cancer laid at the front is harder to remove cleanly so maybe the surgeon believes open surgery gives him the best chance of getting it all.

In case you are wondering, one of the reasons that open surgery was John's best option was because he had scar tissue from an appendectomy. In addition, there was a suspect lymph node and at our hospital, lymph nodes are not removed in keyhole, only through open surgery. Another factor was that the surgeon (it would have been the same guy whichever method John chose) advised that in his view it was the best option in John's particular circumstance ... Perhaps naive of me but when the specialist who can do both types told us one is better than the other, we trusted that he knew his stuff.

Consultants have a god-like aura tbh . Its easy to sit and feel like a 12 year old when they are talking to you . I was only given the one option . Even though I knew about robotic surgery from this website , I didn't think of going elsewhere in the country . Maybe I should have . I didn't think of asking if he could do it "open " instead of keyhole . Get what I mean ?? Most people are so uninformed and just do as they are told . Prostate Cancer UK assured me my area was excellent for treatment and that the consultant team were highly qualified. Best of luck with your choice Paul
Chris

Just saying, Lyn, while I respect your views and bow to your far greater knowledge about the whole issue of PCa than I possess, your post does answer your queries and doubts about surgical option choices, does it not?  

And I take the view that we, any of us here, whether we have experienced a surgical option or know someone who has, should not direct any one to a particular course of action, unless of course we are God and "know" what is best? 

Chances are that in John's case open surgery "hands in guts" was selected as he had scar tissue from other procedures?  As you say.

Knowing that this the case as you mention it, that changes, limits, things, options wise, surely? 

If he had not had "other scar tissue" then his surgeon may have chosen differently, may he/her?

Evidently the surgeon looked at the scar tissue and decided that Da Vinci was not the best option?  Reasonable. 

For my situation the surgeon who could only offer open surgery, offered, "open surgery".  

Until I was made ware of the robot I would have gone with that open surgery option.

Chance conversation with an acquaintance put the Robot in my radar.

Knowing then what I know now changed everything, thank goodness.  

Only when I was made aware of the differences between Open and Robotic was I able to make an informed decision.

Fast forward 2 years 5 months, and I have no regrets.

Finding the right option for "you", the bloke with the troublesome Prostate, is crucial.

So in a nutshell if anyone had the same scar tissue John had, and the same issues John had, and the same staging John had, and that will probably only be found at pathology he may be best with "hands in" surgery.

FWIW My first option surgeon who could only offer "hands in", and who I liked, trusted and would have gone with, later said to me that if he could have offered me the Robot, he would have offered it, but that his NHS trust did not have one.  He, the one who offered "hands in" later came, on his day off to see the Robot do me at Reading. 

Atb

dave

who by the way regrets rien 

atb

dave

Edited by member 07 Aug 2015 at 07:11  | Reason: Not specified

Far too much detail for my bead Lyn.

All too deep for me.

The issue is relatively simple for me, free and informed choice.

Prompting anyone to a choice is maybe not ideal?

Ideally everyone should have all the information.

Getting their head around it and choosing what is best for then is the optimum aim.

Nice to see you back.

dave

Finally met with the surgeon and the radiographer last week. 

According to the surgeon, he wouldn't recommend keyhole because I had a template biopsy which set off a severe infection in the prostate. As a result the prostate would be quite 'sticky' and difficult to remove with keyhole. The options, he said, are open surgery or radiotherapy.

The radiographer, however, while he would be willing to treat me with radiotherapy, felt that there was risk of fairly serious bowel and urinary side effects with the treatment.  This was due to the fact that I had been on tamsulosin for a long period of time (15 years) and in the last 4 months I had undergone 2 colonoscopies and had a large number of polyps removed from my bowel.

We took the weekend to discuss the options but realistically there is really only one option. I phoned the surgeon on Monday and asked to be placed on the list for open surgery. In a way it was a relief to more or less have the decision made for me.

I have been given a date (October 21st.) for the surgery.

I would like to thank everyone who took the time to offer advice and information on the forum  -  it is much appreciated.

I'll post an update after the op.

Paul

It's been a lively few weeks:  Due to a cancellation I was offered surgery 2 week earlier (on Oct. 7th). It seems to have gone well but I had a bad reaction to the morphine which caused me to see thousands of ants climbing the walls (among other weird things).

I was discharged a week later (14th Oct. complete with staples and catheter). Wedding anniversary.

Three days later the community nurse arrived to remove the staples but, having done so, a section of the wound re-opened, limiting my mobility and requiring daily nurse visits since then.

Several days later - urine infection - antibiotics prescribed.

Tomorrow  -  big day. To finally have the catheter removed and, hopefully hear the pathologist's report on the prostate. Fingers crossed that all problem cells have been dealt with.

Will post again when I know more.

Paul

It was indeed a bizarre experience Sandra - not just the ants. My room had a vinyl floor with a mottled effect and, in the ever changing patterns I could make out soldiers from different countries and centuries marching, digging trenches etc., along with a variety of animals.

A doctor from psychological services visited me and asked if I thought they were real. I replied 'no'.  he asked me why I didn't think they were real and I replied 'because I touched them'.  I later told the night nurse that I didn't think that was the right answer. He agreed but laughingly suggested that I'd get more one-to-one care in 'psych'.

Fortunately I 'escaped' soon after.

Paul

Oct. 27th    -   no beds available.  To phone again tomorrow.

Oct.28th     - admitted for overnight stay.  Catheter removed

Oct. 29th    -  Discharged without seeing consultant.  Will have to await for word of follow up outpatients appt. to find out if all cancer cells have been removed.

Keeping my fingers crossed.

Paul

Hi Paul,just wondered how you were going on"",what is a template biopsy,i had a normal one(i think)&it laid me low for about a month afterwards.im post De Vinci 10 days&go for catheter out tomorrow.I was told would get some results in 6 weeks,ive to have a blood test 1week prior then see consultant.Please keep me aware of your progress&good luck.

Best Wishes.

Polarbear 2.

Hi Polarbear 2

I had an ordinary trus biopsy which detected no cancer.  However an MRI scan indicated that there might be something worth further investigation and I was sent for a template biopsy. This is done under general anaesthetic and involves taking more samples than the trus biopsy. This detected the cancer.

I'm progressing steadily just now  -  the infection has lifted and the wound is slowly healing. I'm experiencing a bit of incontinence but I suppose that's to be expected.

You'll be glad to get rid of the catheter - I know I was - it felt like a big step in the recovery process. I hope all goes well for you in the next few weeks and that you get a good result at your next appointment.

{Paul

I was sent home the next day, after passing the requisite amount of urine and a check on the wound.

I like the fact that the surgeon phoned you after a couple of weeks to update you on the results - seems like a sensible policy. Hope that the results were satisfactory.

All the best with your recovery.

Paul

I'm just over 4weeks out from surgery now and progressing well,if slowly.My recovery has been held back a bit because the wound opened when the staples were removed. However,going in the right direction now.

LiKe you I was offered various treatment options. I was inclining towards radiotherapy but finally opted for open surgery when the radiographer indicated that I might suffer more side effects with this treatment due to the large number of polyps that had been previously removed from my bowel.

So far this seems to have worked for me, although I've still to see the surgeon for a debrief.

Good luck with your final choice of treatment,Sandy. Side effects can be dealt with and all the treatments should have similar results -the removal of the cancer. As one of the nurses pointed out to me, the fact that you have a choice is a good sign and augurs well for a successful outcome.

Let me know how things are going.

Best wishes

Paul

Had a meeting with the surgeon 2 weeks back.  The surgery was 'difficult' due to the size and condition of the prostate but otherwise everything went according to plan. However, it's possible that some cancer cells might have broken out of the gland and I will have to be monitored every 3 months.

If that turns out to be the case then a course of radiography might be called for. That, however, should do the trick so, overall, I'm fairly positive about the outcome.

In the meantime my very best wishes to all who took part in this conversation.