Re: ED after radical prostatectomy

[Guest guest]

How about a second and third opinion. With the low numbers that you have you have some time to research the solutions. Consider active surveillance too. It doesn’t matter how good the surgeon is, you will have some side effects. There is no sense going through the surgery and living with the side effects unless you really need to. From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Charlie DeSent: Wednesday, June 06, 2012 5:34 PMTo: ProstateCancerSupport Subject: ED after radical prostatectomy Just saw my urologist about a radical prostatectomy. I have one positive core at the apex of the prostate with a Gleason 3+3 and a PSA of 4. I am 61 years old and in good health with normal sexual function. The doctor stated he performs about 50 radical prostatectomy a year all using the da Vinci robot. Per the doctor, I have a 50% chance of long term ED after the surgery. Viagra will reduce the long term ED from 50% to 30%. These numbers seem low compared to the best surgeons in the country. If you have any information, please share. Charlie D.

[Guest guest]

I would get a second opinion on the tissue samples before doing anything. Also, with numbers that low I would learn more about Active Surveillance before doing any treatment. You have time for this.Jeff To: "ProstateCancerSupport " <ProstateCancerSupport > Sent: Wednesday, June 6, 2012 5:34 PM Subject: ED after radical prostatectomy

Just saw my urologist about a radical prostatectomy. I have one positive core at the apex of the prostate with a Gleason 3+3 and a PSA of 4. I am 61 years old and in good health with normal sexual function.

The doctor stated he performs about

50 radical prostatectomy a year all using the da Vinci robot. Per the doctor, I have a 50% chance of long term ED after the surgery. Viagra will reduce the long term ED from 50% to 30%.

These numbers seem low compared to the best surgeons in the country. If you have any information, please share.

Charlie D.

[Guest guest]

I'd also start looking at alternate treatments for when the time comes. I had

surgery back in Feb. 06 with good results and no regrets, (similar numbers as

you have now) but that was the gold standard at the time. Today I probably would

go with a different treatment, probably delay treatment as others are

suggesting. Seeds, beam radiation have near equal success rate it seems. By all

means though, don't be rushed into anything.

[Guest guest]

Charlie. Please get additional opinions. My husband age 46 recently had this

surgery. He had Gleason 6, psa was high over 10, one positive core biopsy. Due

to his young age the surgery was recommended. I did a ton of research.

Everything indicated that the number of surgeries a dr does is directly linked

to post surgery side affects. 50 a year is not that many. Our surgeon does 50 a

month and has done 4000 in total. My husband is doing well. All the very best

to you. Randy AM

Sent from my iPhone

[Guest guest]

Three suggestions:

1. If this was your first PSA test, you might want to know what your " PSA

doubling time " is. That's a reasonable way to measure how aggressive the cancer

is. The Gleason score is related to the PSA doubling time, I believe (high

Gleason cancers (Gleason 8-9-10) grow faster than low-Gleason (6) cancers).

So, taking another PSA reading in a few months would give useful information.

_Do not_ ride a bike, or have sex, or ejaculate, for a few days before the next

PSA test.

2. I support the " active surveillance " crowd. If you _need_ treatment, you

should get it. But if you _don't_ need treatment -- you have a cancer with a

really long doubling time -- postponing treatment is reasonable.

A good radiation oncologist using brachytherapy ( " seeds " ) can equal or better

the results of a good surgeon.

On the MSKCC website, you'll find some " nomograms " that predict whether your PCa

has grown out of the prostate capsule (they're called " Partin tables " when

printed out):

http://www.mskcc.org/cancer-care/adult/prostate/prediction-tools

3. Your doctor is probably making up his " ED success rate " , rather than

measuring it. To measure it, he'd have a third party give the IIEF

(International Index of Erectile Function) questionnaire to each patient before

surgery, and then again a year and two years after surgery. That's more

follow-up than most surgeons do, and I've never heard of one who used

third-party reporting.

You should ask him how he gets the numbers he gave you. Men lie about their ED,

and doctors lie about their results.

>

> Just saw my  urologist about a

> radical prostatectomy. I have one positive core at the apex of the

> prostate with a Gleason 3+3 and a PSA of 4. I am 61 years old and in

> good health with normal sexual function. 

>

> The doctor stated he performs about 50 radical prostatectomy a year all using

the da Vinci robot. Per the

> doctor, I have a 50% chance of long term ED after the surgery. Viagra

> will reduce the long term ED from 50% to 30%.

>

>

> These numbers seem low compared to the best surgeons in the country. If you

have any information, please share.

>

> Charlie D.

>

[Guest guest]

50 a year?That's it?Let's put things in perspective: http://www.nycrobotics.com/?gclid=CN2emu72vLACFYeo4Aod_A-1ow"To date, he has performed over 3500 robotic prostate cancer surgeries"At 50/year, that means that he's been performing robotic surgeries for...70 years. (I'm thinking: He does a lot more than 50 a year)While you're out there getting second opinions, you need to find a more experienced oncological surgeon. Don't be someone's guinea pig. Let someone we DON'T know do that. Get the best guy you can within your insurance coverage. Fifty surgeries a year is NOT that guy. I used Tewari. I think he is great. Even so, I still have mild ED

issues, 4 years out. I do not have ANY continence issues, though, and my PSA remains at zero.Your mileage will, of course, vary. But you still want to drive the best car you possibly can.Steveboothby171@...

[Guest guest]

Thanks to everyone who replied. I have a national Blue Cross Blue Shield PPO so I can see any doctor in the US who is a member. (I have never found a doctor who won't take it.) Many factors to consider. My mother died at 90 and my father at 86. Hoping to have 25 more years. Seriously concerning seeing Dr. Vipul Patel at Global Robotics Institute in Orlando, Florida. He has performed 5000+ robotic prostatectomy surgeries for prostate cancer. If you have any information about him. please share. Charlie D. To: "ProstateCancerSupport " <ProstateCancerSupport > Sent: Thursday, June 7, 2012 4:12 PM Subject: Re: ED after radical prostatectomy

50 a year?That's it?Let's put things in perspective: http://www.nycrobotics.com/?gclid=CN2emu72vLACFYeo4Aod_A-1ow"To date, he has performed over 3500 robotic prostate cancer surgeries"At 50/year, that means that he's been performing robotic surgeries for...70 years. (I'm

thinking: He does a lot more than 50 a year)While you're out there getting second opinions, you need to find a more experienced oncological surgeon. Don't be someone's guinea pig. Let someone we DON'T know do that. Get the best guy you can within your insurance coverage. Fifty surgeries a year is NOT that guy. I used Tewari. I think he is great. Even so, I still have mild ED

issues, 4 years out. I do not have ANY continence issues, though, and my PSA remains at zero.Your mileage will, of course, vary. But you still want to drive the best car you possibly can.Steveboothby171@...