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Thread: Prostate Cancer - Looking for people who have had the Da Vinci Surgery with Dr. Vipul

  1. #1

    Prostate Cancer - Looking for people who have had the Da Vinci Surgery with Dr. Vipul

    Good day. After a PSA investigations, I have discovered that I have prostate cancer. I have made the following investigations:

    - Fusion Biopsy in Milan, the result was 7 (positive)
    - A PET Colina Test which could not reveal the areas of the disease, only a bit in the adenopathy area of the pelvis.

    I am 52 years old and I would like to minimize any complications whilst preventing any impotence and incontinence. After personal research, I have discovered that Dr. Vipul Patel seems to be the go-to surgeon for the robotic surgery with Da Vinci, which is supposed to be minimally invasive and nerve-sparring which sounds exactly like what I need.

    If there are people out there that have had this surgery and would be up to give me advice to point me in the right direction, I would be grateful. Thanks.

  2. #2
    Bongiorno signor! Welcome to The Forum! Very sorry that you have been unwillingly drafted into the "PCa Club" but be assured that there are several exit strategies to get out of this ignoble Club!

    I am guessing that you are either a British or U.S. citizen working in Italy. Italian URO Surgeons are highly competent, so travel to the U.S. may not be necessary. Regardless, your health insurance likely provides coverage for U.S. hospitalizations and surgical procedures.

    Some information that would be helpful is:

    - PSA: Current value and history

    - Gleason Scores of your (+) biopsy (Bx) cores

    - Re "only a bit in the adenopathy area of the pelvis:" Is Lymph node involvement with PCa suspected?

    There is an old saying in the U.S.: "There is more than 1 way to skin a cat!" Quite fortunately the same applies to PCa! There are multiple treatment options.

    I have no personal experience with Dr V Patel and have no doubt that he is highly skilled and successful.

    However, If I were standing in your shoes about to come to the U.S., I would:

    - Set up a consultation with one of the premier PCa Programs = Johns Hopkins, Cleveland Clinic, Mayo Clinic, MD Anderson. You will receive a complete assessment and learn of all the best treatment options for your specific disease status and psyche.

    - Carefully consider my overall risk status. If you are higher than Low Risk (Gleason 6 & fully contained to the prostate gland), there is likelihood (approximately 30%) that Radiation and possibly other treatment modalities are in your future following radical prostatectomy (RP). The benefit of the above institutions is they will provide integrative and longitudinal treatment(s) & care.

    Thus RP is not always a "One and Done" procedure!

    Also, be prepared to have all of your PCa related medical records and lab results ready and available for the consultation with the U.S. MD(s). In addition, your Biopsy slides will need to be sent to the U.S. facility where treatment will be scheduled.

    Keep asking questions and seeking correct answers. Fortunately most forms of PCa tend to progress slowly. This allows some time to fully research ones options and arrive at a treatment decision based on advice from expert MDs who specialize in treating PCa.

    Keep us updated.

    Good luck!

    MF
    Last edited by Michael F; 05-09-2019 at 11:01 AM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  3. #3
    Top User garyi's Avatar
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    Quote Originally Posted by Michael F View Post
    Buongiorno. signor!
    I am guessing that you are either a British or U.S. citizen working in Italy. Italian URO Surgeons are highly competent, so travel to the U.S. may not be necessary. Regardless, your health insurance likely provides coverage for U.S. hospitalizations and surgical procedures.

    - Set up a consultation with one of the premier PCa Programs = Johns Hopkins, Cleveland Clinic, Mayo Clinic, MD Anderson. You will receive a complete assessment and learn of all the best treatment options for your specific disease status and psyche.

    There is likelihood (approximately 30%) that Radiation and possibly other treatment modalities are in your future following radical prostatectomy (RP). The benefit of the above institutions is they will provide integrative and longitudinal treatment(s) & care.

    Also, be prepared to have all of your PCa related medical records and lab results ready and available for the consultation with the U.S. MD(s). In addition, your Biopsy slides will need to be sent to the U.S. facility where treatment will be scheduled.

    Keep asking questions and seeking correct answers. Fortunately most forms of PCa tend to progress slowly. This allows some time to fully research ones options and arrive at a treatment decision based on advice from expert MDs who specialize in treating PCa.

    Keep us updated.

    Good luck!

    MF
    As usual, superb advise from Michael

    I do have first hand experience with the Dr. you mentioned. His office is outstanding, they handle many visitors, the advertising claims are second to none, and the good doctor is VERY rushed, does up to 10 surgeries a day utilizing two rooms...back to back. It's said he has done the same operation 12,000 times. Caveat Emptor.

    In my experience and opinion, you'll be better served at Dana Farber, Johns Hopkins, Cleveland Clinic or the Mayo Clinic. Good luck to you (again)!
    Last edited by garyi; 05-08-2019 at 06:51 PM.
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  4. #4
    Quote Originally Posted by garyi View Post
    As usual, superb advise from Michael

    I do have first hand experience with the Dr. you mentioned. His office is outstanding, they handle many visitors, the advertising claims are second to none, and the good doctor is VERY rushed, does up to 10 surgeries a day utilizing two rooms...back to back. It's said he has done the same operation 12,000 times. Caveat Emptor.

    In my experience and opinion, you'll be better served at Dana Farber, Johns Hopkins, Cleveland Clinic or the Mayo Clinic. Good luck to you (again)!

    how can one man do 10 radical prostatectomies in a single day. The operation takes at least a couple of hours. Even if a doctor was really fast and only averaged 60 minutes a procedure, that still seems like an awful lot with consultations examination and other work activities the man has to do.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  5. #5
    Quote Originally Posted by Southsider View Post
    how can one man do 10 radical prostatectomies in a single day. The operation takes at least a couple of hours. Even if a doctor was really fast and only averaged 60 minutes a procedure, that still seems like an awful lot with consultations examination and other work activities the man has to do.
    One surgeon can't, but he could have several docs learning/working under him, where he does only the critical steps and supervises, or perhaps "supervises," as in "Call me in if you need me."

  6. #6
    Top User garyi's Avatar
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    It ain't easy to get to a number of 12,000, even if the VA is funneling all their surgery business to him. I read somewhere that he takes down ~ 15 million a year from the gov't and Medicare. His good buddy used to do the same in NYC.
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  7. #7
    Moderator Top User HighlanderCFH's Avatar
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    Nov 2011
    Posts
    7,206
    Welcome to the forum, mission.

    It would definitely help us give more helpful comments if you can give us your PSA history and biopsy results. Looks like 7 positive cores?

    What were the Gleason scores, etc?

    If it is, indeed, possible for a surgeon to do as many as 10 surgeries a day, he must have several staffs working on the non-critical aspects of the surgery in several different rooms.

    My surgeon at Mayo Clinic, Dr. Matthew Tollefson, is a tremendously gifted surgeon and a really nice man. He probably does not do more than 10 surgeries a WEEK because he once told me he doesn't want to get too tired -- wants to be at his sharpest for these complicated surgeries. I believe he operates one or two days a week and doesn't do more than 3 or 4 in a single day.

    My best advice is to seek out a great doctor like mine, who does these surgeries all the time, but not like a runaway freight train. Doing several a day is fine, but not ten.

    Try to find a major clinic that does these surgeries all the time -- such as Mayo or Cleveland Clinic, Johns Hopkins, MD Anderson, etc. That is where you'll benefit from the great experience of these doctors.
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  8. #8
    Newbie New User roamer321's Avatar
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    Mar 2019
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    9
    I do not understand some of the comments about Dr. Vipul Patel that I am seeing here on this thread. People making comments without a basis of fact. Dr. Vipul Patel is my surgeon. He performed my robotic prostatectomy on April 1, 2019. Nerves were spared and I am doing very well with my recovery. I have never had a doctors office that has been so helpful and responsive to me in my life. He does surgery on Monday, Tuesday, Thursday, and Friday. Wednesday is his clinic day to see patients. I have been told by surgeons that you want someone who does your type of surgery frequently. Dr. Patel also heads the Global Robotics Institute that collects data from all the patients to continuously update his procedures and recovery instructions. He has patients from all over the world come to Orlando because of his reputation. I was blessed to live very close to his facility. If you have any questions I would be glad to answer you.
    Diagnosed at age 59 - 9/19/2018
    PSA in 2/2018 4.4
    PSA in 6/2018 4.8
    Biopsy on 9/12/2018
    Malignant in 7 of 12 cores. Gleason 3+3=6
    4/1/2019 Robotic Radical Prostatectomy (Dr Vipul Patel)
    Adeno 15% of gland 4+3=7 pT2 Negative Margins
    Two lymphs benign. Nerves spared.

  9. #9
    Thank you for all your responses and for your wishes. I would like to apologize for mistyping my age, it's actually 48. The last PSA score was 9.46, the Gleason score was 3+4. There is no cancer growth outside of the prostate as far as the doctors could tell, the biopsy has been given. I also have a few ganglions outside of the prostate which should, supposedly, be removed as they say. In the DRE examination, nothing was seen or felt.

    I am researching continously, however it is a bit difficult to approximate my chances of success since many posts are more than 10 years old and I thought there would be some medical advancements done since that period that would increase my chances of keeping the impotence and incontinence away.

    @Michael F I there are a few ganglions(lymph nodes I think) outside of the prostate. I e-mailed the institutions you mentioned, thanks a lot for recommending them. I am trying to consider my options to find the best treatment options available for my specific case.
    @HighlanderCFH, could you tell me more about what your post-surgery side-effects and recovery plans? I will consider your doctor as well, and I seem to be hearing a lot of good things about Mayo Clinic, Cleveland, and Hopkins so I am looking into what they offer and a possible consultation date.
    @roamer321, sent you a message.

  10. #10
    Senior User
    Join Date
    Nov 2012
    Posts
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    For me personally if I had to do it all over I would not change a thing, let alone doctor Patel. I had some other medical complications and Dr. Patel and his office made sure that all the base's were covered prior to my surgery. One of the complications was from prior surgeries and scar tissue. He had another doctor that specializes in that field come in and clean up all the scar tissue prior to Dr. Patel doing his surgery. This was all done roboticaly. Also, I am on blood thinner and that involved another doctor. All the doctors and their staff at Celebration Hospital were great. I have no complaints what so ever! And for what it is worth, they went out of their way to make sure my wife was informed and taken care of during the procedure and our stay at the hospital.
    Age: 65 / At surgery
    10/01/12 PSA 5.7 & climbing
    10/25/12 Transrectal biopsy / results T2 b/c Score of 3-4 & 4-3 / Gleason Score 7
    10/28/12 Consultation with Surgeon Dr. Vipul Patel (8,000+ surgeries) for Da-Vinci Radical Prostatectomy (my choice)
    01/11/13 Da-Vinci Prostatectomy, Florida Celebration Hosp. (above surgeon), Cancer confined within prostate capsule & none found in margins or lymph nodes.
    02/26/13 PSA test <.01
    06/11/13 PSA test <.01 and Testosterone 510
    09/09/13 PSA test <.01
    01/15/14 PSA test <.01
    07/21/14 PSA test <.01
    07/28/15 PSA test <.01
    02/02/16 Quadruple Bypass Heart Surgery
    06/28/16 PSA test <.01
    03/18/19 PSA tested yearly and to date still <.01

 

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