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Posted 04 Nov 2020 at 12:01

So almost two weeks into this and still only spoken to one person despite chasing for further consultations. I have a chat today about HIFU anytime now which should be interesting.

Since my initial research I've started to lean more towards prostate removal purely because it seems the HIFU approach isn't seen as a radical surgery and has limited data to show long term results. I have seen a lot of cases where further surgery was needed in the 3 to 5 year timeframe.

As far as prostate surgery is concerned, it seems there are a few options around and some in this group have had both. It's difficult to know what would be best isn't it! I'm interested in RARP due to the reduced risk of urinary issues afterwards but I don't know whether I'm a candidate nor which hospitals have a lot of experience in this. At 50 I have two main goals... staying alive and trying to maintain the best life post treatment as I have many working years ahead and want to enjoy them.

Every day that passes I worry that what is going on will be getting worse, even if it's slowly. But being a 4+3 intermediate I don't want this hanging around longer than it needs to be!

Posted 04 Nov 2020 at 15:17
The different types of RP are:

- open surgery

- laparoscopic / keyhole RP

- robot assisted RP

- retzius sparing RP

In terms of outcomes, you couldn't slip a hair between them; it is more about your lifestyle & recovery needs.

Open surgery still has the edge in terms of outcomes - % progression free at 5 and 10 years, positive margins, continence and ED are all slightly better after open surgery.

Keyhole & robot assisted have the edge in terms of the amount of time needed as an in patient and recovery / return to work / return to driving, etc.

Open RP is a much shorter time under anaesthetic; keyhole is a longer operation but the risk of blood loss is lower.

People with heart conditions may not be suitable for keyhole surgery as you are tipped head down on the operating table for a number of hours.

Retzius sparing RP has great data on continence recovery but not so great for ED.

If deciding between robotic and old fashioned keyhole, the most imporant thing is the experience of the surgeon.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 04 Nov 2020 at 16:05

I went open RP as my surgeon preferred it as he felt it gave the best outcomes and very pleased (so far)

Incision must have been about 8" long but very neat 

My advice would be get the best surgeon you can (based on stats/recommendations/options) regardless of specific technique

Posted 04 Nov 2020 at 16:27
Absolutely Mike! We paid for J to go to a specific surgeon, one of the so called 'Golden five' at the time - even though he was one of the leading lights in RARP, he advised that open surgery would be best for J, partly a) because of the scar tissue from his appendectomy and how that might impede nerve sparing and b) in our area at the time, lymph nodes were not removed in keyhole RP. I understand that in may areas, a few nodes are removed routinely now during RARP but it is worth asking the question.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 04 Nov 2020 at 18:48

Hi Chris

Just a note to say the Prof Whocannotbenamedhere also pioneered many of the techniques used in laparoscopic urological surgery. I’d still be tempted to consult with him as a sounding board for your next steps as he is well positioned for all aspects of surgery. For me it was the best thing I ever did.

No lymph nodes were removed in my case as all clear on the scans and real time pathology (NeuroSAFE) showed no spread  or seminal vesicle involvement plus good margins.

I’ve been very fortunate with my outcome in terms of ED, continence and so far my PSA is undetectable.


Edited by member 04 Nov 2020 at 20:41  | Reason: Not specified

Posted 04 Nov 2020 at 22:36

Hi,    I was diagnosed 4+3, near the edge, in Oct/Nov 4 years ago.  One of my concerns was how Christmas and winter peaks might effect when my operation was done.   Now there are other problems with Covid.   I asked about alternatives and was offered Robotic at another hospital but I remained single focus (i.e. get it out) and went with the flow.  My op was  Friday 16th December which I was told was an additional fitted in, as I'd been told it would be mid Jan.

I'd bear in mind whether you want to get it done quickly or ponder alternatives and discuss them with the performing specialist before making a conclusion.

All the best, Peter



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