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LuckyGuy's avatar

Does anyone have an opinion about having prostate surgery with a young surgeon using a DaVinci machine vs. an old school surgeon with lots of experience but known for opening the patient up from front to back?

Asked by LuckyGuy (34935points) May 26th, 2009

This is probably not the right place to discuss this but I am making myself physically ill researching on the internet while I wait for my appointment.
I just turned 55 and had blood work done as part of my routine physical. Everything was great except my PSA (my first ever) was 17.5. My doc put me on antibiotics for 2 weeks and retested. The results just came back and my PSA is 21.8! He said I need to see a specialist. I have been researching this and realize that this number is not good. I have absolutely no symptoms and feel fine except for the urge to puke when I read about this issue.
Do I go old school or do I go with the new technology? Does the new machine give tactile feedback to the surgeon? Does accurate robot surgery outweigh the advantage of hand feel? Does the use of new technology balance out the fact that the surgeon has not done hundreds of surgeries?
Is this situation as bad as I think it is?...

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24 Answers

Simone_De_Beauvoir's avatar

I wish you luck
my initial reaction is to go with the young doc

LuckyGuy's avatar

I can look up all kinds of information and get reviews about electronics or hand tools. Why can’t I find information about doctors and their success rates? I want to see Patient reviews, performance…..This is a hell of a lot more important than buying a post hole digger – and I can find hundreds of reviews on that!
Something is wrong with this picture.

Simone_De_Beauvoir's avatar

@worriedguy cause as a helpless, dumb patient (supposedly) you don’t get such info as the medical world looms above you with their superior knowledge – sorry about that, it sucks

SirBailey's avatar

My friend, if it were me, I’d have NO problem deciding. Go with the young doctor and the new technology. You can’t say the young doctor hasn’t performed the procedure much. You have no idea how many patients the young doctor did. He wouldn’t be allowed to do it if he wasn’t any good. He is NOT some medical student. The robot procedure is quick.

You have the right to ask the young doctor how many procedures he’s actually done (but then, what answer would satisfy you?) You should also ask him what the benefits are with the new procedure. That WILL persuade you.

Are you actually thinking about being opened from front to back? Seriously?

LuckyGuy's avatar

I was told that the experienced doctor with all kinds of knowledge and experience is called “The Sanguinator” because of his larger incisions so he can get in there and work freely.
The DaVinci machine seems like a good idea except maybe it really is important to feel the nerves. One slip and I won’t be able to play the piano again…
I’m getting sick to my stomach thinking about this. (Personally I like the idea of the newer technology.)

casheroo's avatar

@worriedguy First off, I know how nerve wracking a decision like this can be. When I had to decide on a certain surgery, I was a mess. The “what ifs” can make life miserable. I chose to have a surgery that could potentionally ruin the way I lived, and never have a healthy, normal lifestyle ever again. But, I chose a doctor, got the statistics and facts from him.
I went home and debated it over and over. My surgeon did it the way that I had asked him too, since there was an “old school” way of doing it, but with my own research, I learned it had a higher failure rate. So, when I asked him for the newer way, he said that was the only way he did it.

I’ve heard of the DaVinci machine, and have heard nothing but great things. Technology has come a long long way. I’d go with the machine.

LuckyGuy's avatar

OK, I’m going with the younger doc with the DaVinci machine.
My appointment is for June 4. Then there will be a biopsy to follow.
It is going to be a tough couple of weeks waiting.
From what I read, I already know the answer… 21.8 is not good…

wildpotato's avatar

“Why can’t I find information about doctors and their success rates? I want to see Patient reviews, performance…”

I worked as a Patient Services Coordinator for a specialist, and part of my job was to make connections between patients like you and past patients of the doctor I worked for. The system was, after a patient is in a course of treatment or has completed treatment, we asked them to give their permission to be contacted by us in the future to arrange ‘info sessions”. Our new patients liked it because they knew these people are open to talking to you, and want to be helpful, not like we in the medical world with our looming superior knowledge :oP

Each of the docs you mention ought to have someone who holds the same or similar position (we also go by “Referrals Coordinator” and a few other monikers), who should be able to direct you to people who have the information you need. Some offices don’t have a program set up like mine did, but you can still speak to the Coordinator, explain that you heard that this was sometimes done, and very sweetly ask him or her to take some time out of his or her extraordinarily busy schedule to call some past patients and ask if they can contact you or if you can contact them. It might take a day or two to set up, because my office required signed waivers – but this was easy if the person on the other end is faxable.

Good luck, and comment me if you have more questions!

jbfletcherfan's avatar

I will obviously never be put in this position, but if it WERE me, I’d definately go with the young doctor. The new way of doing things may seem like something out of Star Trek, but it HAS been tried & proven to be successful, obviously. You don’t want to be cut open like a fish, my dear. Your healing time will be greatly reduced if you go this new route.

For example: I had a complete hysterectomy 5 years ago. It was all done through 3 tiny incisions in my belly. What a breeze! I was back to work full time in 2 weeks! Think what it would have been if they’d have done it the old school way!! There’s no comparison!

No one here is trying to tell you what to do. The end decision is totally yours. But it just makes sense to go the easiest way here. I wish you all the luck in the world. Keep us posted, okay?

Buttonstc's avatar

This may sound a little odd but one of the questions you want to ask him is about his video gaming experiences. As much as it is fashionable to decry young folks obsessions with them they actually did studies of Surgeons using the new robotic systems and those with the most video gaming experience had higher success rates.

If you think about it it kinda makes sense.

jbfletcherfan's avatar

@Buttonstc This is true. I’ve heard this, too.

LuckyGuy's avatar

Buttonstc Should I be happy or worried if he tells me he reached the 24th level in D&D?
Thanks everyone for your input. My decision is made. You really helped.
I’ll let you know what happens. Now, If I could just get rid of this sick feeling in my stomach.

wildpotato's avatar

@worriedguy Heh, D&D is not a videogame. But the fact that he played it does likely mean that he had plenty of time to devote to studying rather than partying…

Buttonstc's avatar

Having never played the game I’m going to go out on a limb and assume that 24th level is a desirable achievement for this game..

The basic rule of thumb is, the more gaming skill the better as it’s the same skillset as required for precision with the robotic controls.

Buttonstc's avatar

@wild potato Well that shows how much I know about individual games ha ha. Sudoku is more my speed. :)

BCarlyle's avatar

http://www.roswellpark.org/Patient_Care/Specialized_Services/Robotic_Surgery_at_Roswell_Park/WhatIsRoboticSurgery

Here is a link to a cancer center in the area that I live. The site discusses some of the issues relating to robotic surgery. I had the opportunity to hear a lecture from a urologist that does robotic surgery. He raved about the future of surgery and all of the potential that it offered… obviously as a robotic surgeon he is a bit biased, but I have heard other surgeons talk about how robotic surgery is ideally suited for procedures in very confined spaces- as in prostate surgery. I’m not an expert by any stretch of the imagination, but it seems like robotic surgery has shown good outcomes in for this procedure as compared to traditional surgical methods.

LuckyGuy's avatar

I selected the younger doc and the robotic surgery. I’m glad I did. My PSA has been “zero” ever since.

Buttonstc's avatar

That’s wonderful to hear: I’m glad it went well for you.

If you don’t mind, I have a question, but if you prefer to answer by pm, thats fine since it’s kinda personal.

My landlord had his prostate surgically removed a number of years ago with standard surgery which left him with all types of side effects, the most annoying of which is incontinence (presumably from the severed nerves).

I don’t know if it’s because the surgeon was a complete butcher or just because standard surgery in such a confined space has that result.

Have you had any side effects which have persisted over the years? Since you opted for the newer hi tech procedure, I was just curious.

But if my Q is too nosey for something this personal, feel free to decline.

PS Did you find out how much video gaming experience he had :) ?

LuckyGuy's avatar

@Buttonstc I’ll give you some general, well published statistics and will pm you for specific info.
Understand that every man’s case is different. It depends upon the size of the prostate, how far the cancer has spread, what needed to be removed, the patient’s age, and general health, etc.

The two main side effects are Incontinence and ED.
All of these numbers are estimates but are reasonably good approximations:

Incontinence: After prostate surgery ⅔ of the men will be continent at 3 months. Of the remaining ⅓, ⅔ of them will be continent at one year. That means about 1 in 10 will be incontinent after 1 year. Of those, 80% will be fixed surgically.
ED: At 3 months 30% are back to “normal”. At one year 50% are back to normal. Of the remaining there are options to help: pills, devices, injections, implants.
Of the guys I know who had total ED and had implants every one of them says it is better than when they were a teenager.

I never asked about his gaming. I would not have liked the answer either way. If he lit up and said: “Dude! Totally! I’m a 10th Dan Black Belt in WOW!” I would have thought maybe he should be studying more.
Or if he said “Whats gaming? Is that like online poker?” I would have not liked that answer either.
We limited our conversations to prostates.

Buttonstc's avatar

Fair enough. I guess that is sort of an oddball Q to be asking an

M.D. about his video gaming experience. I just found the results of those studies I referenced to be so interesting, especially since so many are so critical of youngsters time spent video gaming. Who knew that it would end up becoming such a valuable skill for surgeons performing robotic surgery?

And if I ever eventually go for knee surgery with the robotic option, I’m just the type who would ask :) especially if interviewing several potential choices of surgeons.

LuckyGuy's avatar

In case anyone is still following this question I figured I’d give an update.

It has been 5 years since the surgery and my PSA is still <0.01. That means the chances of me having a biochemical recurrence in my lifetime are now nearly zero. There is virtually zero chance it will be prostate cancer that kills me.

Whew! It looks like I dodged that bullet.

BCarlyle's avatar

Glad to hear that you have done well after surgery. You definitely made the right choice with robotic surgery for prostatectomy. 85% of prostatectomies across the country are now done robotically.

LuckyGuy's avatar

@BCarlyle Thank you for the blast from the past. Robotic surgery has certainly taken over since I posed this question.
I’m at almost at 6 years and my PSA is still near zero. Great!

Dutchess_III's avatar

I’m so glad the way this all turned out!

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