I am new to the board, and newly diagnosed with PC, so, as some of you who are further along know, actively seeking information and support.
I am currently scheduled for surgery in early March with an open surgeon and in April with a robotic surgeon. Both are highly regarded and experienced. My approach has been that the temporary advantages of robotic in some areas such as more rapid recuperation, less time with catheter, etc. would not be determining factors since the long run trumps the short.
However, the January release of the National Comprehensive Cancer Network guidelines indicate that results from either are comparable and that high volume surgeons in high volume centers have better results.
Comments on your choice would be appreciated. Also, if any of you originally scheduled with one surgeon and canceled, how did that go, and would that urologist follow you after you had surgery with someone else?

Flyfisher:

Since I had proton I can't answer your question regarding which surgery procedure is best, but think those that have had surgery might need a little more info from you in order to help out.

Major

Sparky: I have gone through the process of determining surgery is the correct option for me, just wondering what others have experienced.
As for additional information: Stage T1C, 2/4 cores at 3.0% on left, 1/7 cores at 1% on right, with total core length of 75mm and 44mm. Gleason is 6 based on 3/3. First biopsy done after a 4.1 PSA reading with 1.4 change in velocity over 14 months. Second biopsy in mid-January. PSA before second biopsy was 3.7, with Free PSA of 35%, so I was not expecting cancer. First biopsy showed atypical acinar proliferation in 1 core sample.
My treatment options are unlimited in the sense that health is good, life expectancy is 10+ years (age 64), etc. I want it out! Surgeon possibilities are one who has done 200 robotic surgeries and teaches it to other docs, and one who has done 1,000+ open surgeries. I have talked to several who have seen the first surgeon, none who have talked to the second.

The pioneer and most highly regarded robotic surgeon Dr. Bertrand Guilleneau who heads the minimally invasive prostate surgery program at Memorial Sloan Kettering Cancer Center has stated that highest proficiency surgical skill levels are reached after 1,000 procedures. I had near perfect results 5 years ago with the open procedure performed by Dr. Peter Scardino who is now chief of surgery at Sloan-Kettering. In his book "Dr.Scardino's Prostate Book", he cautions that anyone opting for the robotic procedure should select a Dr. who is not only at the highest skill level of that method but is also an expert at the open procedure in case it is necessary to revert in midstream due to un-expected developments which occur in a significant numer of cases.
I had the catheter out after 5 days, never experienced any incontinence and have recoveres full erectile function after 4 years following bi-lateral nerve sparing.My PSA is still undetectable after 51/2 years.
My brother -in-law had the robotic 5 months ago by an experienced robotic surgeon in the mid-west and he still needs to wear pads. He also waited too many years following his diagnosis (5) and the tumor grew to occupy the entire prostate gland so both nerves had to be removed to obtain clear margins.
Given your choice between a robotic surgeon who's only performed 200 procedures and an open surgeon who's done over 1,000, I'd definitely go with the more experienced open surgeon. The open procedure is still considered
the "gold standard" although robotic is getting there. Unfortunately there are still too many robotic surgeons on the learning curve to 1,000 and I wouldn't want to be one who contributes to their education.
Good Luck with whatever you decide.
Bob

The pioneer and most highly regarded robotic surgeon Dr. Bertrand Guilleneau who heads the minimally invasive prostate surgery program at Memorial Sloan Kettering Cancer Center has stated that highest proficiency surgical skill levels are reached after 1,000 procedures. I had near perfect results 5 years ago with the open procedure performed by Dr. Peter Scardino who is now chief of surgery at Sloan-Kettering. In his book "Dr.Scardino's Prostate Book", he cautions that anyone opting for the robotic procedure should select a Dr. who is not only at the highest skill level of that method but is also an expert at the open procedure in case it is necessary to revert in midstream due to un-expected developments which occur in a significant numer of cases.
I had the catheter out after 5 days, never experienced any incontinence and have recoveres full erectile function after 4 years following bi-lateral nerve sparing.My PSA is still undetectable after 51/2 years.
My brother -in-law had the robotic 5 months ago by an experienced robotic surgeon in the mid-west and he still needs to wear pads. He also waited too many years following his diagnosis (5) and the tumor grew to occupy the entire prostate gland so both nerves had to be removed to obtain clear margins.
Given your choice between a robotic surgeon who's only performed 200 procedures and an open surgeon who's done over 1,000, I'd definitely go with the more experienced open surgeon. The open procedure is still considered
the "gold standard" although robotic is getting there. Unfortunately there are still too many robotic surgeons on the learning curve to 1,000 and I wouldn't want to be one who contributes to their education.
Good Luck with whatever you decide.
Bob

I find your reply to be quite interesting. After having talked with numerous people who have had prostate surgery, the CEO of the largest private hospital in the country, the person most associated with the advent of the open prostatectomy, etc., it is clear that the labels "best," "most distinguished," etc. are dependent on the person with whom you are speaking. For example, research indicates that there is a learning curve for robotics, but certainly does not state 1,000 is necessarily the number, though it is easy to see why one of a handful of people performing that number might use it as a standard!
My conclusion is that though there are certainly relationships between experience and outcome, that beyond a certain point the issue of the "best" is determined by the result obtained by the individual. Factors such as stage, previous sexual health, attitude, etc. are difficult to factor into stark statements such as number performed, rate of incontinence, impotence, or other side effects.
Thanks for the responses!

Great Information! I have a queston on the terminology used here. Is Robotics and Laparoscopy PC surgery one in the same or are they different? I just googled both and came up with different procedures. I thought that robotics was a newer version of laparoscopy and that MDs may not have the best experience since the technology is new. Maybe I'm wrong on this, please advise. I found an experienced MD in my area who trained with Dr. Guilleneau in Paris. Anyone know the background of laparoscopic PC surgery?
The MD I found has done the 1000 cases so I feel he is the man. I found that it was more difficult to find an MD who had as many cases in laparoscopic surgery than in the Walsh open surgery.

I had robotic surgery last June. It's all about the doctor. One doctor I went to wanted to do regular surgery and even remove one nerve. I saw a second doctor who had switched to robotic approx 3 years prior. He had done in excess of 600 robotic surgeries at that time and was teaching to other doctors. He is an outstanding doctor, not only was the surgery perfect but his care afterwards was amazing. I don't think 1000 surgeries is a must when selecting a doctor. The best doctor will do the best because thats how they perform their jobs. I would recommend the robotic with the best doctor you can find. Let me know if you have any other questions.

There is a difference between the robotic and laparoscopic. Though both are laparoscopic as opposed to open surgery, all laparoscopic surgery is not robotic. Some call the robotic surgery Da Vinci surgery.
As I have researched the surgical treatments for PC, it has become clear that the urologists in my area are very competitive. My doc, who does open surgery, "fired" me when I decided to switch to the robot assisted surgery. He said he did not want the responsibility of cleaning up after another surgeon if something went wrong, but when discussing treatment options prior to my decision for surgery, he had referred to the robotic surgery as a "gimmick." I have no doubt that my previous surgeon who does open surgery is excellent, but have determined that there is no "best" surgeon, just the one who is best for us. In that sense, "best" may be defined retrospectively, based on our outcome.