Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

January 10, 2012

> I think most men(young and old)expect miraculous things when

> the choose the robot assisted procedure and when it doesn't

> happen it leads to more cases of depression and other

> psychological issues. I certainly can include myself in that

> group. I expected(at 52) to walk on water in a couple of weeks

> and when that didn't happen I became depressed and that caused

> psychological issues that took longer to overcome then the

> surgery.

>

....

>> Conclusion Risks of problems with continence and sexual

>> function are high after both procedures. Medicare-age men

>> should not expect fewer adverse effects following robotic

>> prostatectomy.

>>

>> http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

I seem to recall reading a study that said that men undergoing

robotic surgery were *less* happy with their outcomes than men

undergoing open surgery. It wasn't because their actual outcomes

were worse but because their expectations were higher.

Lest the surgery patients think this is primarily a surgery

problem, they need only look at the hype surrounding the various

radiation modalities. Since I've been following prostate cancer

I've seen IMRT, brachytherapy, and now proton therapy and

CyberKnife, all over sold to the public in an attempt to win

patients for the various medical practices that offer those

services.

I've also seen the problem with cryosurgery and HIFU. It is my

understanding that results with those two treatments have been

less satisfactory than with surgery or radiation, but the men who

have chosen them generally believed they were getting a more

advanced, more successful treatment that had lower side effects.

There are doctors out there who will tell the straight truth

about what to expect, but it requires some character on the part

of both doctor and patient to speak and really hear the truth.

Somebody once posted a photo of what his abdomen looked like the

day after open RP. It was swollen, with long and wide sutures

and lots of ugly purple bruises. It was mighty scary. A lot of

people criticized him for posting it, but I'm thinking he did a

service to us all.

Alan

January 11, 2012

Concerning side-effects, both my urologist and my surgeon discussed them with me when I chose surgery. The advantages to robot-assisted seem to be in less down time than with open surgery; that was one reason I embraced it. Anyway, I knew what the side-effects would be -- incontinence and sexual dysfunction -- and a month after surgery, I'm dealing with them just fine.

I didn't want to wait for the surgery, either, because at 63 I'm relatively young and in good health (well, other than the cancer), and had I done watchful waiting, who knows what my health would be or how far the cancer would have spread in five or six years?

January 13, 2012

Thanks for the heads up. I'm having the daVinci robotic surgery this coming Monday, Jan 16th. I'm 62 and chose to have the cancer removed

now, rather than later. I'm against taking large doses of medications and take a chance that it will go away. I will keep the group posted.

To: ProstateCancerSupport From: white.richard54@...Date: Tue, 10 Jan 2012 09:20:12 -0800Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

I think most men(young and old)expect miraculous things when the choose the robot assisted procedure and when it doesn't happen it leads to more cases of depression and other psychological issues. I certainly can include myself in that group. I expected(at 52) to walk on water in a couple of weeks and when that didn't happen I became depressed and that caused psychological issues that took longer to overcome then the surgery.

To: ProstateCancerSupport <ProstateCancerSupport > Sent: Tuesday, January 10, 2012 7:50 AMSubject: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men [1 Attachment]

Looks like this supports the fact that the experience of the doctor is moreimportant than the procedure he does. Wonder what the conclusion would befor men under 65? Also given the frequency of side effects should more oldermen with low risk PCa consider AS to avoid the side effects? KathyConclusion Risks of problems with continence and sexual function are highafter both procedures. Medicare-age men should not expect fewer adverseeffects following robotic prostatectomy.http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

January 14, 2012

, do your kegel exercises -- up to 100 daily, and there's good chance the incontinence will fade fairly quickly. It was no issue after four months for me. ED still remains an issue after two years, but tri-mix injections solve that problem. Injecting tri-mix sounds terrible, but to me it's a minor inconvenience. According to Dr. Mulhall at Sloan Kettering, starting on Viagra soon after the surgery will help recover sexual function. My uro didn't put me on it for at least 6 months after the surgery. Don't let your uro wait that long. I was 67 when I had my surgery two years ago.Mike Clowes To: prostatecancersupport Sent: Friday, January 13, 2012 2:23 PM Subject: RE: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

Thanks for the heads up. I'm having the daVinci robotic surgery this coming Monday, Jan 16th. I'm 62 and chose to have the cancer removed

now, rather than later. I'm against taking large doses of medications and take a chance that it will go away. I will keep the group posted.

To: ProstateCancerSupport From: white.richard54@...Date: Tue, 10 Jan 2012 09:20:12 -0800Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

I think most men(young and old)expect miraculous things when the choose the robot assisted procedure and when it doesn't happen it leads to more cases of depression and other psychological issues. I certainly can include myself in that group. I expected(at 52) to walk on water in a couple of weeks and when that didn't happen I became depressed and that caused psychological issues that took longer to overcome then the surgery.

To: ProstateCancerSupport <ProstateCancerSupport > Sent: Tuesday, January 10, 2012 7:50 AMSubject: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men [1 Attachment]

Looks like this supports the fact that the experience of the doctor is moreimportant than the procedure he does. Wonder what the conclusion would befor men under 65? Also given the frequency of side effects should more oldermen with low risk PCa consider AS to avoid the side effects? KathyConclusion Risks of problems with continence and sexual function are highafter both procedures. Medicare-age men should not expect fewer adverseeffects following robotic prostatectomy.http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

January 15, 2012

My husband is also a month out of surgery. He's been taking Viagra, but it's not helping much. He's been looking into the injections, but he's wondering how long after surgery to try them.Sent from my iPad

, do your kegel exercises -- up to 100 daily, and there's good chance the incontinence will fade fairly quickly. It was no issue after four months for me. ED still remains an issue after two years, but tri-mix injections solve that problem. Injecting tri-mix sounds terrible, but to me it's a minor inconvenience. According to Dr. Mulhall at Sloan Kettering, starting on Viagra soon after the surgery will help recover sexual function. My uro didn't put me on it for at least 6 months after the surgery. Don't let your uro wait that long. I was 67 when I had my surgery two years ago.Mike Clowes To: prostatecancersupport Sent: Friday, January 13, 2012 2:23 PM Subject: RE: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

Thanks for the heads up. I'm having the daVinci robotic surgery this coming Monday, Jan 16th. I'm 62 and chose to have the cancer removed

now, rather than later. I'm against taking large doses of medications and take a chance that it will go away. I will keep the group posted.

To: ProstateCancerSupport From: white.richard54@...Date: Tue, 10 Jan 2012 09:20:12 -0800Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

I think most men(young and old)expect miraculous things when the choose the robot assisted procedure and when it doesn't happen it leads to more cases of depression and other psychological issues. I certainly can include myself in that group. I expected(at 52) to walk on water in a couple of weeks and when that didn't happen I became depressed and that caused psychological issues that took longer to overcome then the surgery.

To: ProstateCancerSupport <ProstateCancerSupport > Sent: Tuesday, January 10, 2012 7:50 AMSubject: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men [1 Attachment]

Looks like this supports the fact that the experience of the doctor is moreimportant than the procedure he does. Wonder what the conclusion would befor men under 65? Also given the frequency of side effects should more oldermen with low risk PCa consider AS to avoid the side effects? KathyConclusion Risks of problems with continence and sexual function are highafter both procedures. Medicare-age men should not expect fewer adverseeffects following robotic prostatectomy.http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

January 15, 2012

Thanks for the tips Mike. It sounds like the next few months will be a pain in the ass. Do you know if testosterone (sp?) would

help with the ED. My surgeon told me I would have a problem with ED for up to a year and a half, possibly. He mentioned taking

viagra and the injections. I was too stunned at the time to ask about testosterone. He also told me that there may be some

permanent shrinkage. I'll see about him prescribing some viagra.

To: ProstateCancerSupport From: mjc_316@...Date: Sat, 14 Jan 2012 18:54:33 -0800Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

, do your kegel exercises -- up to 100 daily, and there's good chance the incontinence will fade fairly quickly. It was no issue after four months for me. ED still remains an issue after two years, but tri-mix injections solve that problem. Injecting tri-mix sounds terrible, but to me it's a minor inconvenience. According to Dr. Mulhall at Sloan Kettering, starting on Viagra soon after the surgery will help recover sexual function. My uro didn't put me on it for at least 6 months after the surgery. Don't let your uro wait that long. I was 67 when I had my surgery two years ago.

Mike Clowes

To: prostatecancersupport Sent: Friday, January 13, 2012 2:23 PMSubject: RE: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

Thanks for the heads up. I'm having the daVinci robotic surgery this coming Monday, Jan 16th. I'm 62 and chose to have the cancer removednow, rather than later. I'm against taking large doses of medications and take a chance that it will go away. I will keep the group posted.

To: ProstateCancerSupport From: white.richard54@...Date: Tue, 10 Jan 2012 09:20:12 -0800Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

I think most men(young and old)expect miraculous things when the choose the robot assisted procedure and when it doesn't happen it leads to more cases of depression and other psychological issues. I certainly can include myself in that group. I expected(at 52) to walk on water in a couple of weeks and when that didn't happen I became depressed and that caused psychological issues that took longer to overcome then the surgery.

To: ProstateCancerSupport <ProstateCancerSupport > Sent: Tuesday, January 10, 2012 7:50 AMSubject: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men [1 Attachment]

Looks like this supports the fact that the experience of the doctor is moreimportant than the procedure he does. Wonder what the conclusion would befor men under 65? Also given the frequency of side effects should more oldermen with low risk PCa consider AS to avoid the side effects? KathyConclusion Risks of problems with continence and sexual function are highafter both procedures. Medicare-age men should not expect fewer adverseeffects following robotic prostatectomy.http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

January 15, 2012

ï»¿

I was badly bruised after surgery.

It was a few months before I used the Caverjet injections, the tablets didn't work for me

Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men [1 Attachment]

Looks like this supports the fact that the experience of the doctor is moreimportant than the procedure he does. Wonder what the conclusion would befor men under 65? Also given the frequency of side effects should more oldermen with low risk PCa consider AS to avoid the side effects? KathyConclusion Risks of problems with continence and sexual function are highafter both procedures. Medicare-age men should not expect fewer adverseeffects following robotic prostatectomy.http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

January 15, 2012

Best of luck ,,,I wish you all the best and I will keep you in my thoughts and prayers tomorrow.

Sheila

To: prostatecancersupport Sent: Friday, January 13, 2012 11:23:42 AMSubject: RE: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

Thanks for the heads up. I'm having the daVinci robotic surgery this coming Monday, Jan 16th. I'm 62 and chose to have the cancer removednow, rather than later. I'm against taking large doses of medications and take a chance that it will go away. I will keep the group posted.

To: ProstateCancerSupport From: white.richard54@...Date: Tue, 10 Jan 2012 09:20:12 -0800Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

I think most men(young and old)expect miraculous things when the choose the robot assisted procedure and when it doesn't happen it leads to more cases of depression and other psychological issues. I certainly can include myself in that group. I expected(at 52) to walk on water in a couple of weeks and when that didn't happen I became depressed and that caused psychological issues that took longer to overcome then the surgery.

To: ProstateCancerSupport <ProstateCancerSupport > Sent: Tuesday, January 10, 2012 7:50 AMSubject: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men [1 Attachment]

Looks like this supports the fact that the experience of the doctor is moreimportant than the procedure he does. Wonder what the conclusion would befor men under 65? Also given the frequency of side effects should more oldermen with low risk PCa consider AS to avoid the side effects? KathyConclusion Risks of problems with continence and sexual function are highafter both procedures. Medicare-age men should not expect fewer adverseeffects following robotic prostatectomy.http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

January 15, 2012

> ... Do you know if testosterone (sp?) would help with the ED.

> My surgeon told me I would have a problem with ED for up to a

> year and a half, possibly. He mentioned taking viagra and the

> injections. ...

I'm not a doctor and have no special expertise in this area, but

I'd be surprised if testosterone helped. As I understand it, the

problem has to do with surgical damage to the nerves and blood

vessels involved in erections. Recovery requires healing - which

also requires attempts to use what you've got - just as recovery

from muscular injury requires both healing and exercise.

In addition, the standard theories about prostate cancer hold

that testosterone promotes prostate cancer growth. I think it

might be dangerous to get testosterone supplements at this time.

Even if your surgery removed all of the cancerous tissue in the

prostate it is likely that there are still cancer cells

circulating in your blood stream and settled in bones or organs.

In most patients, these circulating cells will die off over time,

but I don't think you want to do anything that might promote

their continued ability to live and replicate.

There are some things you can do. One is to continue practicing

Kegel exercises. These are thought to help recovery. Another

possibility is to take one of the Viagra/Levitra/Cialis drugs.

The study that showed these help was paid for by the

pharmaceutical industry, so I'm not certain that it was 100%

objective. But there are people who argue that low doses of

these drugs, taken on a regular basis, can help recovery.

Finally, and perhaps most importantly, you need to keep trying

to have sex. Most men are still capable of enjoying sexual

stimulation and achieving orgasms even without erections. I

think that, if you are flexible and inventive, you and your wife

or partner can still have a very satisfying sex life now and also

contribute to recovery of function that will help more in the

future.

I have often read about men who take up to two years to recover

sexual function. Some men never recover. But if you haven't

recovered in a few months, don't give up. It takes time. And in

the meantime, don't give up on sex.

Good luck with it.

Alan

January 15, 2012

Thank you for the advice. I think I'll forget about the testosterone and try the viagra. I appreciate you taking

time to write.

To: ProstateCancerSupport From: ameyer2@...Date: Sun, 15 Jan 2012 16:34:47 -0800Subject: RE: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

> ... Do you know if testosterone (sp?) would help with the ED.> My surgeon told me I would have a problem with ED for up to a> year and a half, possibly. He mentioned taking viagra and the> injections. ...I'm not a doctor and have no special expertise in this area, butI'd be surprised if testosterone helped. As I understand it, theproblem has to do with surgical damage to the nerves and bloodvessels involved in erections. Recovery requires healing - whichalso requires attempts to use what you've got - just as recoveryfrom muscular injury requires both healing and exercise.In addition, the standard theories about prostate cancer holdthat testosterone promotes prostate cancer growth. I think itmight be dangerous to get testosterone supplements at this time.Even if your surgery removed all of the cancerous tissue in theprostate it is likely that there are still cancer cellscirculating in your blood stream and settled in bones or organs.In most patients, these circulating cells will die off over time,but I don't think you want to do anything that might promotetheir continued ability to live and replicate.There are some things you can do. One is to continue practicingKegel exercises. These are thought to help recovery. Anotherpossibility is to take one of the Viagra/Levitra/Cialis drugs.The study that showed these help was paid for by thepharmaceutical industry, so I'm not certain that it was 100%objective. But there are people who argue that low doses ofthese drugs, taken on a regular basis, can help recovery.Finally, and perhaps most importantly, you need to keep tryingto have sex. Most men are still capable of enjoying sexualstimulation and achieving orgasms even without erections. Ithink that, if you are flexible and inventive, you and your wifeor partner can still have a very satisfying sex life now and alsocontribute to recovery of function that will help more in thefuture.I have often read about men who take up to two years to recoversexual function. Some men never recover. But if you haven'trecovered in a few months, don't give up. It takes time. And inthe meantime, don't give up on sex.Good luck with it.Alan

January 15, 2012

Thank you...I appreciate that.

To: ProstateCancerSupport From: shedorman@...Date: Sun, 15 Jan 2012 23:43:16 +0000Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

Best of luck ,,,I wish you all the best and I will keep you in my thoughts and prayers tomorrow.

Sheila

To: prostatecancersupport Sent: Friday, January 13, 2012 11:23:42 AMSubject: RE: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

Thanks for the heads up. I'm having the daVinci robotic surgery this coming Monday, Jan 16th. I'm 62 and chose to have the cancer removednow, rather than later. I'm against taking large doses of medications and take a chance that it will go away. I will keep the group posted.

To: ProstateCancerSupport From: white.richard54@...Date: Tue, 10 Jan 2012 09:20:12 -0800Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men

I think most men(young and old)expect miraculous things when the choose the robot assisted procedure and when it doesn't happen it leads to more cases of depression and other psychological issues. I certainly can include myself in that group. I expected(at 52) to walk on water in a couple of weeks and when that didn't happen I became depressed and that caused psychological issues that took longer to overcome then the surgery.

To: ProstateCancerSupport <ProstateCancerSupport > Sent: Tuesday, January 10, 2012 7:50 AMSubject: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men [1 Attachment]

Looks like this supports the fact that the experience of the doctor is moreimportant than the procedure he does. Wonder what the conclusion would befor men under 65? Also given the frequency of side effects should more oldermen with low risk PCa consider AS to avoid the side effects? KathyConclusion Risks of problems with continence and sexual function are highafter both procedures. Medicare-age men should not expect fewer adverseeffects following robotic prostatectomy.http://jco.ascopubs.org/content/early/2012/01/03/JCO.2011.36.8621

January 16, 2012

Take a look at:

.. . . " Saving Your Sex Life; A Guide to Men with Prostate Cancer "

by Dr. Mulhall.

It has better information on injections than I've seen elsewhere, and includes

full penile rehab schedules.

There's also good information on the USTOO website.

It takes a while for muscles and connective tissue to heal after surgery.

Orgasms can be painful for a while -- but a painful orgasm is better than none.

>

> > , do your kegel exercises -- up to 100 daily, and there's good chance

the incontinence will fade fairly quickly. It was no issue after four months for

me. ED still remains an issue after two years, but tri-mix injections solve that

problem. Injecting tri-mix sounds terrible, but to me it's a minor

inconvenience. According to Dr. Mulhall at Sloan Kettering, starting on

Viagra soon after the surgery will help recover sexual function. My uro didn't

put me on it for at least 6 months after the surgery. Don't let your uro wait

that long. I was 67 when I had my surgery two years ago.

> > Mike Clowes

> >

> . . . . [further posts removed]

January 16, 2012

Suzi, as Chuck and others have suggested, it's far too soon for your husband to give up on Viagra. Repair can take months, or even years,but he has started in timely fashion. That should help with the recovery. As Chuck suggested, check out Dr. Mullhall's video lecture and his book, and good luck. Mike To: "ProstateCancerSupport " <ProstateCancerSupport > Sent: Sunday, January 15, 2012 1:17 PM Subject: Re: Adverse Effects of Robotic-Assisted Laparoscopic Versus Open Retropubic Radical Prostatectomy Among a Nationwide Random Sample of Medicare-Age Men