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Open surgery implications

Posted 13 Nov 2017 at 21:32
Having been diagnosed with localised PC can anyone give me their experience of open surgery
Recovery post op and chances of getting all clear after that PC had not returned
Can't find stats for the latter
Posted 13 Nov 2017 at 22:19

All else being equal, the stats for all treatments are virtually identical whether that is open RP, keyhole or robotic RP, external beam radiotherapy or brachytherapy. The main indicator for your long term outcome depends more on your diagnosis and staging than anything else. If you ask your specialist nurse or urologist, they may already have put your stats into a nomogram to calculate your likely outcomes - John was informed at his diagnosis appointment (and it was also included in the diagnosis letter to his GP) the % chance of recurrence for each treatment available to him.

There are only very small differences between the different types of surgery, according to recent data:
- chance of incontinence and / or ED is slightly higher with robotic
- chance of positive margin is slightly higher with robotic
- 5 years without salvage treatment and 10 years without recurrence are almost identical
- risk of serious blood loss is higher with open
- keyhole & robotic usually need a much shorter stay in hospital than open
- open surgery is usually quicker and so less general anaesthetic is needed
- robotic & keyhole are usually quicker for getting back to work and being able to drive again
- robotic & keyhole may not be suitable for men with heart conditions (you are tipped head down for a substantial time which may put strain on the heart) or that have had abdominal surgery in the past (if the scar tissue is in the way)

John had open RP. He was in hospital for 5 days and off work for 12 weeks mainly because his car insurers (a company car) would not cover him to drive before then; although a 12 week sick note was standard issue at our hospital he felt he could have gone back at around 10 - 11 weeks. He was working from home from about 9 weeks I think.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
Posted 13 Nov 2017 at 22:46
Thank you
I have had heart surgery so open surgery or HIFU offered
Still deciding with Gleason and Psa both at 7
Concerned about risk of blood loss
Surgeon still it was rare
So don't know if his response was realistic and can anyone else share their experiences
Posted 14 Nov 2017 at 01:46

The decision on what to go with has to be yours. You do not give your staging but both Surgery and HIFU work best if your cancer is confined to the Prostate capsule - suggest you discuss with surgeon. A friend of mine had 'open' surgery and he did need a blood transfusion during his op which otherwise went ahead without problem. So it can happen but by no means necessarily so. A lot more is known about surgery, potential adverse side effects and long term outcomes.

HIFU, is still regarded as experimental in the UK because there is less known about long term outcomes. Within the NHS It is usually given as part of a trial. It has more often been used as a salvage treatment for failed radiotherapy in the UK rather than as a primary treatment which is the reason why I had it. In need HIFU can be repeated. With HIFU outcomes have been found to be better if the tumours are small and confined to one side of the Prostate.

Different men can respond in different ways and to varying degrees to all treatments but generally men who have HIFU recover from the procedure far more quickly than with open surgery. I was walking round London a couple of hours after the procedure. In fact I found it easier to walk or stand rather than sit down. The catheter was in for a week post op and it was much more comfortable after is was removed. I reckon there was about a teaspoonful of blood in my urine the first time I had a pee after the catheter was removed and thereafter it was as though I had not had the procedure in all respects, although previous HT/RT had caused ED so I can't comment on this aspect. However, some men experience a blockage that requires further catheterizing and/or other side effects which a Google search will show. So I was one of the lucky ones.

I recommend that you download or get a copy of the "Tookit" from the publications section of this charity. This details a lot about PCa and treatments.

Wish you well and do let us know how you get on.

Posted 14 Nov 2017 at 18:37
Thanks Barry
Ironically Daily Mail running an article from the US which does not recommend surgery but goes for surveillance !
Posted 15 Nov 2017 at 00:06

Daily Mail is good inasmuch as it often brings PCa to the fore (I am a regular reader), but it does tend to generalize and sensationalize so what it suggests may well not be best for an individual. What a man needs is the thoughts of those offering the treatment options open to him and to consider these together with procedures and potential side effects and then to make his decision.

It is widely acknowledged that there is 'overtreatment' in the NHS so many men suffer varying side effects of treatment that they might never need or not at such an early stage. However, notwithstanding this, some men want early treatment because it might develop severely and they want to preempt this possibility at an early stage.

It's a very personal decision.

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