Gathering information for the decision time

Did you mean da Vinci robot when you said cystoscope? Very very different things.

As I said before, And this is my opinion, Robots are for building cars. Get a surgeon that can do it traditionally. Robots can malfunction with out warning, all it takes is one wrong button pushed on the computer!!

Seems pretty clear that you need to get out of town if the two doctors are not up to snuff.

I would also suggest you get a list of questions to bring to whatever specialist you do wind up seeing.

Cystoscopes are very common and pretty much every urologist will have one. A TURBT is a TransUrethral Removal of a Bladder Tumor.

I can't do anything for your mistrust of doctors, but I will say it highly unlikely that they are out to get you or have plans to try to take advantage of you just because you don't know all the medical details. You may have had some crappy ones but most are not.

The prostate comes out because it is extremely likely that bladder cancer will spread to the prostate. They do nerve sparing now to try to maintain erectile function.

They can't just keep taking it out (the tumors) once they reach a certain stage. Once into the muscle it will spread throughout the body in a process called metastasis. If one waits too long to get the bladder removed once it becomes muscle invasive, the chances of metastatic disease are greatly increased (as is likelihood of dying from bladder cancer). It's not like the tumors are just benign moles or something--they are cancer.

Prostate tumors that are prostate cancer are different than bladder cancer that has spread to the prostate.

Treatment is certainly the choice of the individual. More aggressive treatment leads to higher life expectancy. The inverse is also true.

Trouble urinating is most likely the prostate causing the problem. However, that is really not very high on the priority list given you have bladder cancer to deal with. You really don't have a lot of time to mull this over. You need to get to a top bladder cancer hospital right now and get something done. Delay in treating muscle invasive bladder cancer can mean the difference between life and death.

Mike

I have had problems with my computer and haven't done anything here for a while. I really think the best piece of advice here has been to see another doctor. Unfortunately the only 2 urologists in town are Dr. Jacobs, that I feel has failed me miserably, and her partner. No only did she fail to do anything with an older, white male, with blood in his urine, she hasn't diagnosed the other problems I have had. The only follow up I am getting is being told get the replacement bladder or the cancer will kill you. My urine is still cloudy and I am still having trouble urinating. She hasn't even given me a chance to discuss the problems, let along identify the problem in order to make an intelligent decision on the bladder replacement alternatives. If I am having trouble voiding my current bladder, how well is a neo bladder going to work? Yes, if my problems are all in the bladder, replacing it will solve them. But I don't know that. I don't even know why my urine is still cloudy and Dr. Jacobs doesn't seem to see it as worth looking at. This is the doctor that after finding blood in my urine set up another appointment in 6 months and sent me home. Frankly, I think she is just waiting for her fat referral fee from my bladder replacement.

Nothing was said either by her or Dr. Koch about follow up after bladder replacement. Are scopes commonly used for it and what is TURBS? My confidence in them is zero. I still have a bad taste in my mouth from the way the local doctors took advantage of my ignorance involving a heart stent.

How common are the cytoscopes? Are they something Podunk General should have, or do I need to go to a major medical center?

Why take the prostate too? Can't prostate tumors be easily treated with proton therapy if caught early? I realize use of the cyclotron is new, but it seem sto be highly successful.

Having my cancer removed by cytoscope seemed to be a rather uninvasive procedure. So why can't it be removed again if it comes back? I am not sure what has been the problem behind my troubles. If it was the cancer all along, it took years before I was forced to do something.

What about a second, objective opinion on the pathology report?

Douglas,

Get the best dang surgeon you can get and let him/her decide robotic or not. Mine did not do the robotic. Jury is still out on that overall. There are pros and cons.

More or less success with the nerve sparing part of da Vinci isn't proven either way either. A skilled surgeon using the open technique may not be quite as skilled using the da Vinci because he/she hasn't done as many the new way yet. If your surgeon has done hundreds with the robot and feels better with that approach, by all means, go that route. Talk to your surgeon about their preference. You want them to be comfortable and confident in the technique they are using. That what translates into the best success for you.

My surgeon preferred open surgery and I was fine with that.

Mike

Thanks - such good advice. So, on to another question - is robotic or laproscopic surgery going to be better than traditional surgery? I hear there is less bleeding and more "nerve sparing" (clearly I am dancing around a topic here)

*still trying to have more gratitude around this whole thing... thanks again for such well considered, thoughtful responses.