Surgeon appointment for Robotic Prostatectomy: Questions to ask?

Posted by oskarpr @oskarpr, May 16 9:03am

Tomorrow I will have an appointment with a surgeon for possible robotic surgery (prostatectomy).
59yrs old
Gleason score 3+4=7
One positive core 1.6cm
Acinar adenocarcinoma
PSA 6/12/23= 4.24
PSA 12/12/23=5.13
BPH on Finasteride
Prostate volume =34cc
Previous surgery double hernia repair more than 10 years ago.
What questions should I ask to make an good decision on treatment?
What should expect from him as far as they can offer?
What will be a red flag, that clearly tell me don’t trust your prostate to this surgeon?
Any advice or suggestions will be greatly appreciate it.

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@themurfs

If you don't mind my asking, what is the Hood technique?

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Here is a link describing the procedure:
https://pubmed.ncbi.nlm.nih.gov/33067016/
Basically, it preserves anatomical structure and results in much quicker return to continence in the data provided.

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Don’t believe any surgeon who gives you his batting average on ED and incontinence. I went to the “biggest” name in NYC - a man who advertises total potency and continence after the procedure. I have NEITHER almost 5 yrs out but I don’t really him for that since I know everyone is different and we all react differently. But I DO blame him for advertising something that is blatantly false.
Ironically I didn’t go to him for his advertising - I went because of the vast number of procedures performed and the fact that people the world over flew into NYC just to have him operate….go figure….

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@heavyphil

Don’t believe any surgeon who gives you his batting average on ED and incontinence. I went to the “biggest” name in NYC - a man who advertises total potency and continence after the procedure. I have NEITHER almost 5 yrs out but I don’t really him for that since I know everyone is different and we all react differently. But I DO blame him for advertising something that is blatantly false.
Ironically I didn’t go to him for his advertising - I went because of the vast number of procedures performed and the fact that people the world over flew into NYC just to have him operate….go figure….

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I would not trust any surgeon who guarantees an outcome. I do, however, believe that a surgeon who shares their previous patients experiences and their track record shows a surgeon who follows up with his/her patients post op and demonstrates a level of confidence in their ability. It’s another data point to help you make your decision vs just qualitative feedback from a chat group.

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Agree with all of the above comments. Oskarpr sounds like you are low risk with only one core showing Gleason 7. Maybe pause before jumping into any primary treatment. I am 61 yrs old, fit, non smoker, low BMI. Had RP on Aug 26. It will be 6 weeks Friday. Started with a PSA of 15.2 in 2023, MRI, fusion biopsy and then surgery. It was a lot to get my head around in a relatively short period of time. I really did not know what to ask my surgeon either. I liked him though because RP was his specialty, he had done a bunch, is in his late 30's or early 40's so in my mind hit the sweet spot between experience and youth. Also he did not promise anything except that I would have incontinence and ED afterward. His only stat was 70ish percent of his patients had close to normal sexual function at a year postop. A higher percentage had very little incontinence by then as well. That 70ish percent includes patients using pde5 inhibitors, injections or other approaches. Part of his discussion was that there are just too many variables and too much unknown to predict any sort of precise post surgical outcome.

So where am I at 6 weeks? Incontinence is basically sorted. I have been dry at night since one week after my catheter was removed. I wear a light Temu (?) pad during the day and it is basically dry at the end of the day. I am building up my confidence to go through a day without one. Why such a positive outcome? Who knows? I'd say luck and Kegels. I started full on Kegels the day after my biopsy results, 7 weeks prior to surgery. I believe they will be a part of my routine for the rest of my life.

As far as the ED goes, yes I have it. But that was my expectation all along. Six weeks is way too soon to expect any sort of normal sexual function. My surgeon has no specific post op plan for ED. He is not a believer in penile rehab and is open to basically whatever I want to try. So my plan is to start Viagra at six weeks, gradually increase the dosage as necessary, see how that works and move on to a pump after that if nothing is happening. After that we will see. At one year maybe I will rethink my approach if nothing has changed.

Good luck! Oh and I have my first PSA test in August. So we will see. That is really what is important after all. Beating the cancer.

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