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Old 09-26-2010, 11:55 PM   #1
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Athermal Intrafascial Robotic Prostatectomy

Do any of you know about this method of surgery? I'm wondering whether this surgery is performed on patients with high-risk prostate cancer.

My husband's PSA was 32 at last check, 10/10 cores positive for cancer (60% on the right lobe and 20% on the left) and a Gleason score of 7 (3+4) (20% =4)

I believe the surgery he has booked on October 13th is open. I wish I felt like we had more time. I just don't think, in Irv's case, that we can fool around with this.

I'm really anxious to get some responses on this.

Rhonda

 
Old 09-27-2010, 02:44 PM   #2
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Re: Athermal Intrafascial Robotic Prostatectomy

Hi Rhonda,

You and your husband have given the options a good look, and if you are getting comfortable with Dr. Klotz's surgery, it may be a good thing to stop looking. I can paint a somewhat sunnier picture for radiation than you may be seeing at the moment, but you have already had opinions from professional medical folks, and that deserves weight. I'll add comments about the radiation.


[QUOTE=srhonda61;4334754]...

Both doctors, the urologist (Dr. Klotz) and the radiation oncologist suggested surgery as the absolute best option for Irv. The reason the oncologist gave was, although studies have shown that radiation and surgery have similar results for long term success, the studies have been performed mostly on men who are quite a bit older than Irv. Therefore, the results for even longer term success for somebody who is as young as Irv just don't exist.

[COLOR="darkgreen"]I believe that last sentence is likely true. The other side of the issue is that we now have some fairly long-term and impressive results from radiation studies, especially those involving a combination of IMRT and seeds for higher risk men.

Here's a series I've been following and which has just been updated in this report:

J Oncol. 2010;2010. pii: 471375. Epub 2010 Aug 18.
Long-term outcomes for patients with prostate cancer having intermediate and high-risk disease, treated with combination external beam irradiation and brachytherapy.
Dattoli M, Wallner K, True L, Bostwick D, Cash J, Sorace R.
Dattoli Cancer Center & Brachytherapy Research Institute, 2803 Fruitville Rd., Sarasota, FL 34237-5367, USA.

Abstract
... Methods. 321 consecutive intermediate and high-risk disease patients were treated between 1/92 and 2/97 by one author (M. Dattoli) and stratified by NCCN guidelines. 157 had intermediate-risk; 164 had high-risk disease. All were treated using the combination EBRT/brachytherapy ± hormones. ... Nonfailing patients followup was median 10.5 years. Results. Overall actuarial freedom from biochemical progression at 16 years [that's the total length of the series to the cut-off point, with the average follow-up being 10.5 years] was 82% (89% intermediate, 74% high-risk) ... Conclusion. This study helps to strengthen the rationale for brachytherapy-based regimens as being both durable and desirable treatment options for such patients. ...


That's very impressive work, especially considering that the patients were treated in the 1990s, and there have been substantial strides forward in treatment since then! By the way, PubMed gives us a link to the complete paper. It appears this is an update to an eye-catching version published a few years earlier.

This is just one of the series that demonstrates strong and long-term success numbers for brachytherapy and combination brachytherapy/external beam. While "long-term" is relative, with an average of a little over ten years in this case, this is about as good as it gets for many surgery series too. Moreover, surgery success rates tend to continue falling gradually as the years tick by, even at the ten and fifteen year points. In sharp contrast, radiation results tend to fall gradually for the first few years, and then they virtually flat line - maintaining high levels of success. That's one of the reasons why I'm impressed with the prospects of radiation for younger patients.

However, it's important to remember that results in less-expert institutions may not be as good.


Quote:
One of the first things that Dr. Klotz said to Irv before he received the results of his bone scan and ct scan was, if your cancer hasn't spread and we can remove your prostate then the cancer will be treatable and curable.

Of course we don't know yet if Irv's cancer is curable until the pathology report is done on the prostate and we see if any cancer has been left inside. However, I guess that he still believes that removing the prostate gives Irv the best chance of being cured.
I think that such belief is important.

Quote:
I'm ok with the idea for surgery for him, especially after having spoken with past patients who have gone through it. I just got a little lost in the surgical options, mostly because Irv has been talking about robotic surgery and then, finding out about the AIR prostatectomy threw me over the edge a little.

I think I need to go back to feeling lucky that Dr. Klotz is the one who will be performing the surgery. With the surgery date only two weeks and a bit away, I think it's time to settle down and accept the decision we've made.

What do you think?

Regards, Rhonda
I wish you peace and success.

Take care,

Jim

 
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Old 09-27-2010, 08:58 PM   #3
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Re: Athermal Intrafascial Robotic Prostatectomy

Jim, if the prostate is taken out and there is still some cancer, then radiation, and perhaps hormone therapy will have to be done anyway. But, I would think that (and I believe I've read) that radiation therapy after a prostatectomy wouldn't be as powerful in comparison to if the cancerous prostate was still there.

So, with that being said, wouldn't the results of radiation and hormone therapy have the same good results AFTER surgery? In that case, the only downfall would be the side effects of the surgery....but it can also be viewed as an extra measure in the right direction...to rid the body of the cancer.

Who knows...Maybe we'll get lucky and the surgeon will be able to save the nerve bundles on the left side and Irv will be able to get back his erection. There's always hope.....and his age may be to his benefit.

 
Old 09-28-2010, 05:33 AM   #4
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Re: Athermal Intrafascial Robotic Prostatectomy

Hi Rhonda,

I'm glad you are getting more comfortable with this.


Quote:
Originally Posted by srhonda61 View Post
Jim, if the prostate is taken out and there is still some cancer, then radiation, and perhaps hormone therapy will have to be done anyway. But, I would think that (and I believe I've read) that radiation therapy after a prostatectomy wouldn't be as powerful in comparison to if the cancerous prostate was still there.
That's true.

Quote:
So, with that being said, wouldn't the results of radiation and hormone therapy have the same good results AFTER surgery?
They would.

Quote:
In that case, the only downfall would be the side effects of the surgery....but it can also be viewed as an extra measure in the right direction...to rid the body of the cancer.
That's so on both counts.

Quote:
Who knows...Maybe we'll get lucky and the surgeon will be able to save the nerve bundles on the left side and Irv will be able to get back his erection. There's always hope.....and his age may be to his benefit.
I think he has a good shot at complete success, but I'm glad you are prepared in case your husband needs to do more.

Take care,

Jim

 
Old 09-28-2010, 08:13 AM   #5
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Re: Athermal Intrafascial Robotic Prostatectomy

Thanks, Jim, for your last response and your positive attitude.

As for being prepared, one can be prepared on a cognitive level but, the reality is, until we actually have to go through it, we can't really know what to expect in terms of what the experience is really going to feel like during the process.

So, that being said, I may seem confident now that our decision is made, but what is coming up ahead is very scary and I know that my tear ducts are probably going to be in good use over the upcoming future, starting with the moment Irv says goodbye as he is taken in for surgery.

However, like every other challenge we've faced in life, we'll get through this one too.

Rhonda

 
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