To view this post on my blog site and subscribe to future posts, please click here.
I have previously blogged on the issues surrounding robotic prostatectomy. Recently I was asked by my professional society, ASCO (the American Society of Clinical Oncology) to provide commentary on two experts “debating” the pros and cons of open (tradiational) prostatectomy vs. the robotically assisted laproscopic approach. Rather than give a long, repetitive blog to you, I am just going to have you click on THIS LINK to read the post.
The issue is largely going away because of the dominance of the robot in clinical practice, but I thought that the experts did a great job explaining their positions.
prost8blog 
After suffering the destructive surgical prostatectomy which ruined my sex life, caused leaking and left the edges intact, I only recommend robotics. Unfortunately University Hospital was not doing robotics in 2007
I think the main points in the reviews speak to this. In the end there are two factors (maybe 3, counting “luck”) that determine the degree of damage that patients experience from surgery of either type: 1) the skill and expertise of the surgeon, and 2) the patient’s anatomy. I have seen many cases of incontinence etc. from both open and robotic surgeons whose OVERALL outcomes are terrific. Why a relatively few patients from these surgeons have bad outcomes is unfortunate, of course, but in my opinion, unrelated to the technical aspects of open vs robotic approaches.
I wonder what information there is regarding one approach vs. the other in those of us with high risk prostate cancer. With a Gleason 9 it is my understanding that I had an 85% chance of recurrence no matter what primary treatment was tried. I did robotic three years ago and retained my continence but…..The Beast returned anyway.
I don’t know of any specific “high risk robot vs open” articles, and certainly no randomized trials. The issue in high risk disease is usually whether to go straight to radiotherapy, recognizing that there may be extra-prostatic extension, positive margins, and/or nodes that would require post-op radiation.
Thank u uncle mike
Sent from my iPad
>
Gleason 8 and 9 may be “systemic” when treated, meaning tiny metastases which don’t show in imaging or blood tests. If the tumor is already “out of the barn” it is tough to cure.