RP update: Hi i've been prescribed an... - Advanced Prostate...

Advanced Prostate Cancer

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RP update

Northcaptain profile image

Hi i've been prescribed an RP with limphadenectomy. Upon discussing with the top RARP surgeon (volume) he told me "i don't do well in your case G9 because i can't spare as much as i would" i recommend an "open approach".

So we have 1-Open 2-Laparoscopic (Manual 3- Laparoscopic with robot and 4- Retzius sparing (laparoscopic with robot but new technique generation 3 surgery)




I personnaly spoke with Dr Rha and they have so much experience they claim under 60 minutes console time for a nerve sparing surgery with 0 pads after 1 months. I'm quite sure this technique will make all other forgotten in 5 years but for now its limited to a few initiates since it started out in Italy (Galfano et al).

I feel like i'm getting my 2016 BMW 535 with about 47 computers on board to a indy shop that has an old Snap-On scope and 70s diagnosis technique.(no offend there i love old cars and i learned pro mechanics in the 70s)

But is it true that for high risk patient (G9) the requirement of both the RP and the limphadenectomy makes open surgery a better option ? I would be glad to read from experiences. Thanks

13 Replies

IMO open at all times with a surgeon who has over 1,000 RP's. A robot cannot do everything an experienced open surgeon can--I am a 9 also--The story is too long, but my surgeon working back and forth with Pathology kept taking tissue as needed and kept getting asap lab reports--and they kept this up until sure all that could be taken was. And we had one margin that was still positive, so my Doc. using his words, "I cauterized the shit out of it and closed, and those suckers will be dying for weeks".

Up to you--everyone is pushing the robot.


Hi Nalakrats you mean the surgeon was able to obtain real time pathology from whatever he was removing, thus helping him choose safely between cutting too much versus not enough?

That is right!


WSOPeddie profile image
WSOPeddie in reply to Nalakrats

Interesting. That's how it is done for MOHS surgery for skin cancer. I didn't know that it could apply to prostate surgery.

Nalakrats profile image
Nalakrats in reply to WSOPeddie

I understand though I was out--that he sent back margin material 3 times. And we agreed on 4 close nodes---that did not have cancer based on the scan--but we decided to take them anyway and check, as they were out. If any cancer was found hidden---he would have taken more nodes.


Excellent coordination! thanks for sharing

EricE profile image
EricE in reply to Nalakrats

I'm a G9 without lymph involvement. I had the robotic, non-nerve sparing RP. The procedure went very well but there was a margin he coudn't get so I still have a cancerous spot on the outside of the bladder. The problems I've encountered were bladder problems. I'm 8 months out an I still wear use a pad, one or two a day. From people I spoke with the open had a longer recovery. I was not told anything about open being better than robotic.

Nalakrats profile image
Nalakrats in reply to EricE

You will not find much on real comparisons--the new technology of Robotics, has become the favorite new go to method. I cannot prove one way or the other--I take my Surgeons advice, direction, and hours of conversations---as we are working on a joint paper for the Urological Society, in April. My scientific intuitiveness, what is left of it favors someone looking inside me, instead of a camera. My Surgeon did nerve sparring surgery, and after a couple of years on ADT---went on vacation--and the nerve sparring was a success, as I can perform when I want to.



I'm four days out of robotic RP and lymphadenectomy + 90 minute surgical tidy-up from prior colon resection (25 years ago). Because of the work needed on colon resection the surgery took 4 hours vs 2.5 expected. I have had two TURP procedures and two open resections in the lower abdomen. Referred shoulder pain (a result of 4 hours pumped up with CO2) was difficult to tolerate for two days but has now gone. I was discharged from hospital within 24 hours from start of surgery and now have full mobility, a little soreness around my tummy and prostate and a catheter (comes out in two days). To answer your question I would say it depends on the surgeon's experience. Mine had done 1500 RP using da Vinci Xi HD robot and there is no doubt about his skill. In my case, I would take robotic surgery over open every time. Hope this helps. Cheers. Harry

EricE profile image
EricE in reply to Harry_B

Yeah. Most of my pain after surgery was from being pumped up. It was intense for a few hours after surgery until they gave me something that made it go away.

I got my scintigraphy and CT scan (bone scan) and all is clear. So nothing on IRM, no invasion seen on biopsy and now no visibility on the other scan. I haven't seen an onco uro yet but I need counsel on the safe strategy to adopt. Should it be a remove all or spare.

I have yet so see if they have the staff to do real time pathology if I choose the RARP instead of the open.

Counsel welcomed

NBC News Tonight had a good piece on robotic surgery and the lack of training requirements in the US. There's no link yet buy folks may wish to keep a lookout for it. Some patients are being burned and the thesis is that it is likely a lack of training standards.

I had the open and had two hernias repaired at the same time. In Friday morning out Monday morning. Went well. MSKcc in New York City. (Dr. Eastham).

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 12/19/2018 10:28 PM EST

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