Surgeon appointment for Robotic Prostatectomy: Questions to ask?

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.

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.

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….

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.

Praying for a very speedy recovery and complete healing and NO more cancer! Hugs to you!

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

why i decided for the same procedure with same results. I too am clean 4 1/2 yrs now. Hoping no reoccurrence. But I have been reaching out. I had nerve sparring robotic surgery but I am incontinent and impotent. Although I dont work at either. I am following this site. Good luck.

I am 71 yo. Just completed RP currently day 9 post op. I had a urologist I had great confidence in and who had 12 years experience in robotic surgery. For good measure I also got a RO consult. Journey started when I was
Having BPH symptoms but PSA was 30. Biopsy showed G 4+5=9 and MRI and PET scans negative for Mets. Just got
My pathology back and clear margins, negative seminal vesicles and nodes. I feel
I made
The right decision as now I know and don’t have to wonder about
Microscopic spread. Will see how my PSA does and take it as it comes. Good luck!

Thanks for the details. Mn281 had great suggestions of what to ask the surgeon. I suggest you check them out if you haven’t already done so.

I’m glad to see that you’re getting care through a center of excellence and that they’ve been thorough and pragmatic with their diagnostic approach. From all appearances, you’ve got what many people would characterize as low risk disease and have a number of possible treatment options besides RP available through UF. These include HIFU and TULSA-PRO. It is my understanding as a layman that both of these procedures carry a lower risk of ED and incontinence than RP yet both leave the door open to multiple salvage treatments such as RP, RT, ADT, and Chemotherapy should the primary treatment fail. You’re a young man and if your sexual health is important to you you’d do well to consider asking your surgeon if either of these treatments would be appropriate for you.

Best wishes for success on your journey to be cancer free.

Thanks Robert
To answer your questions:
All procedures through College of Medicine/Urology/Oncology Dept University of Florida
MRI before Biopsy Multiple parametric.
Biopsy guided fusion
13 cores,12 normal, 1with 3+4 lesson.
Decipher test= low risk