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    Old 02-18-2021, 08:21 AM   #1
    musicmanone
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    Complications for RALP surgeon

    My RALP surgery is schedule for a little less than 4 weeks away. I have been told that there are two complications that he is expecting.

    1. My prostate is stuck to my rectum. He said that it will be a very delicate process to seperate them.

    2. My bladder is somewhat smaller than normal and the neck of the bladder is stretched. He said that it will be a complicated process to narrow the bladder neck and reattach it to the urethra so that it doesn't leak.

    He has also said that he expects my surgery to take at least 4 hours.

    Have any of you had either/both of these situations?

     
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    Old 02-18-2021, 01:22 PM   #2
    Terry G
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    Re: Complications for RALP surgeon

    A diagnosis of PCa on top of BPH always seems to present more complications. As a guy with a far simpler diagnosis I cant offer any suggestions beyond recommending finding the best surgical team you can. In complicated cases I think its best to seek out the very best preferably a team from one the centers of excellence. Good luck and keep us posted on your progress.
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    Old 02-19-2021, 11:33 AM   #3
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    Re: Complications for RALP surgeon

    How many RALP procedures has your guy done?
    - in total
    - in the last year
    - in the last two months

    My understanding is that the top surgeons consider themselves "experienced" once they have done a 1,000 or so. I know my guy had done over 1,500 when it was my turn and he did not consider that a big number.

    In your situation - I would want a surgeon with vast experience over many years.
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    01/06/21 0.052

     
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    musicmanone (02-19-2021)
    Old 02-19-2021, 01:21 PM   #4
    IADT3since2000
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    Re: Complications for RALP surgeon

    Hi musicmanone. You wrote:

    Quote:
    Originally Posted by musicmanone View Post
    My RALP surgery is schedule for a little less than 4 weeks away. I have been told that there are two complications that he is expecting.

    1. My prostate is stuck to my rectum. He said that it will be a very delicate process to seperate them.

    2. My bladder is somewhat smaller than normal and the neck of the bladder is stretched. He said that it will be a complicated process to narrow the bladder neck and reattach it to the urethra so that it doesn't leak.

    He has also said that he expects my surgery to take at least 4 hours.
    Did the surgeon say whether they were stuck together by cancer that had spread or by some possibly natural cause? I'm thinking an MRI should be able to determine that and thinking that you probably have already had such an MRI.

    Assuming the rectum and prostate are not stuck together by cancer, it might ??? be possible to separate the two in advance of the surgery and insert some SpaceOAR gel to keep them apart, but this is my layman's conjecture with no published research or expert opinion I've ever heard to back this up. SpaceOAR works very well when there is at least some space between the prostate and rectum. You might want to contact the company behind SpaceOAR and ask if they have heard of any experience with this issue. I've never heard of its being used to support surgery; it is used frequently now to support radiation by protecting the rectum.

    If the stuck-together issue is due to cancer that has spread into the rectum, I'm wondering if radiation might work better. The rectum would then have to be in a strong area of the radiation field, and there would likely be some long term consequences, but the way radiation works is that healthy rectal cells would be injured by the radiation but then recover while the cancerous cells would be injured, not recover and soon die. Have you consulted a radiation oncologist and given him the imaging and surgeon's caution about the two problems?

    If radiation would be suitable for the rectal issue, it makes sense to me, as a layman, that radiation instead of surgery would be much better for the bladder issue as the bladder neck/urethra connection would not be disturbed, so the size difference would not matter. Modern radiation, with supportive imaging, plus ADT as appropriate, is very effective, not like the old radiation options that were not as good as surgery for dealing with the cancer, and not like modern radiation that is so good at minimizing the likelihood of annoying, burdensome side effects that was typical years ago. Also, are you young and healthy enough for an extra long prostate cancer surgery? I'm thinking you are, as it would be, to me at least, irresponsible for a urologist to offer demanding surgery if you were not.

    Would you mind providing some details of your case? If the rectum issue is due to stage 4 prostate cancer, then surgery would be an extremely iffy proposition in terms of the likelihood of success, with salvage radiation and supportive ADT almost certain to be needed in the near term and for most men a much better option per medical research. On the other hand, I doubt there would be many surgeons who would be willing to operate on a stage 4 patient, so I'm thinking that the "stuck together" issue is not due to cancer. Do you know if your surgeon is regarded as an expert prostate cancer surgeon? (The two earlier replies make excellent points.)

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-19-2021, 01:28 PM   #5
    musicmanone
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    Re: Complications for RALP surgeon

    The sticking issue is due to the fact that I had TURP surgery 06/15/20. All indications, including mpMRI, are that the cancer is contained in the prostate.

     
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    Old 02-19-2021, 01:55 PM   #6
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    Re: Complications for RALP surgeon

    Hi again - just saw your reply.

    Here's another point about radiation: IF the biopsy and imaging provide solid evidence that there is no cancer around the area of rectal contact, then radioactive seeds could be placed to provide zero or very low radiation in the contact area, but still deal very effectively with cancer elsewhere. Seeds could be combined with external beam radiation. Do you know what the evidence is about cancer in the neighborhood of the contact area?

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-20-2021, 02:57 PM   #7
    musicmanone
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    Re: Complications for RALP surgeon

    I've been told that seeds are not an option for me; not enough tissue there because of the TURP surgery.

     
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    Old 02-20-2021, 03:09 PM   #8
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    Re: Complications for RALP surgeon

    Quote:
    Originally Posted by musicmanone View Post
    I've been told that seeds are not an option for me; not enough tissue there because of the TURP surgery.
    That makes sense, but was it a radiation oncologist who talked to you? Radiation oncologists know radiation well, while surgeons do not (and vice versa).

    Depending on the locations of the cancer in the prostate, it might be possible to do the equivalent of "focal therapy" with radiation safely and effectively - avoiding the area adjoining the rectum but radiating the rest of the prostate. Focal therapy is an emerging approach in the US, and I haven't heard of it being done before with radiation, but, as a savvy layman, I don't see why it could not be done if there were no known cancer in the area with the rectal connection.

    If you do see a radiation oncologist, it would be much better to see one who is not connected to your urologist, and hopefully one who is very experienced with prostate cancer patients. Sometimes there are business relationships that are not in the patient's interest.

    It would help to know your key case characteristics - Gleason score, stage, PSA history with dates, any highlights of scan results or testing.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 03-02-2021, 06:36 PM   #9
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    Re: Complications for RALP surgeon

    Curious as to who is doing your surgery? Had my prostate removed October 2020 South Bend Memorial

     
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    Old 03-03-2021, 04:53 AM   #10
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    Re: Complications for RALP surgeon

    It is my understanding the prostate is stuck to everything. It has connective tissue that does not separate easily. They can not cut it loose at the urethra and simply pull it out. It has to be surgically separated from its surroundings.

    Cancer complicates it. It's sticky, like some hard boiled eggs, pulling tissue with it.

    No one can predict it is organ confined.

     
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    Old 03-03-2021, 05:15 AM   #11
    musicmanone
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    Re: Complications for RALP surgeon

    Dr. Scott Blickensderfer.

     
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    Old 03-04-2021, 04:47 AM   #12
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    Re: Complications for RALP surgeon

    I go to the same group, But a different Dr. I think they are pretty good at what they do..

     
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    Old 03-04-2021, 05:44 AM   #13
    musicmanone
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    Re: Complications for RALP surgeon

    Dr. John Hudak used to be my urologist there, but he doesn't do RALP, therefore I was moved to Dr. Blickensderfer.

     
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    Old 03-04-2021, 09:13 AM   #14
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    Re: Complications for RALP surgeon

    Hudak is my Doc..

     
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    Old 03-05-2021, 05:16 PM   #15
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    Re: Complications for RALP surgeon

    Would not radiation be less complicated.

     
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