Saturday, May 26, 2007

UroToday - AUA 2007 - Cystectomy in the Elderly: does the Survival Benefit in Younger Patients Translate to the Octocenarians?

UroToday - AUA 2007 - Cystectomy in the Elderly: does the Survival Benefit in Younger Patients Translate to the Octocenarians?:
"The authors thus concluded that while all age groups derive an overall and cancer-specific survival benefit following a radical cystectomy, this benefit is smaller in octogenarians than for younger patients."

This is an interesting study that shows the benefit of surgery for bladder cancer decreases as paient's are older.

I actually performed this operation in 6 patients in their 90s. All the patients did well with surgery without major complications, but most died within 1 year. 3 from other causes and 1 from recurrent bladder cancer. 2 were still alive at 18 months the last time I looked into it.


cw said...

Hi Dr. Savatta,
I happened to run across your site tonight - actually, I always feel that the good LORD always leads me to the right place for His own particular reason. I am just in awe of this wonderful tool and the doctors who are using it in the PC area.
I had the Robotic surgery a little over two years ago - two days before Christmas in San Antonio by Dr. Naveen Kella who had just joined the group - Urology SA. You probably know him as well as Dr. Randy Fagin in Austin?? Your group is such a small one in the country.
I am in the medical field - servicing and sales of microscopes - Peterson's Microscope Service, now for 39 years in the Upper Midwest, Texas and Idaho. My dad was in the business for 40 years.
When I received the word after the biopsies from my UA doc in San Marcos, I was on a business trip in Idaho. Fortunately, I was working in a hospital in Nampa were one of the Pathologist, Dr. Kronz, was an expert in PC from John's Hopkins. I was all set to come home after the trip and have it done the "old fashioned" way, but after talking to Dr. Kronz I found out I had some other options. I could have it done by a UA doc in Boise doing Laparascopic (this doc turned out to be my Best Man's doc - small world) and at that time he had done 80 surgeries. So, I cancelled the surgery back in Texas. I than called the Masonic Cancer Ctr. at the U of M, Mpls. where I had been doing their scopes for over 30 years to talk to a friend there. Also, I called a Pathologist in Seguin, Tx. who checked with a new UA doc in town and he directed me to UA SA and thus Dr. Kella. Even though he had not done the "over 40", way under that since he would be taking 5 hours, I had confidence in him.
My PSA had gone at age 61 from 1.8 to 2.9 on my yearly physical so my GP doc sent me to the UA doc after the meds did not bring it down. He took 3 biopsies in each gland. The left was OK but the right was a 3 + 4 = 7. From the Aug. test until the actual surgery in Dec. my PSA went from 2.9 to 4.0. Dr. Kella had needed time to put his team together in SA. This allowed the cancer to spread from the right gland to the left (although he did save the nerve and with Viagra I am 80% fine). It also spread out of the right toward the colon wall and he said I might need some "zapping" down the road. The first couple years I did the PSA check every 3 months and it was always below 0.1. The first time we went out to 4 months it did show below 0.2 reading. I will be checking tomorrow on my second 4 month check. So, the cancer has been laying dormant now about 2 1/2 years. Most of the UA docs and Pathologist that I do work for have told me NOT to worry until it got up to 1.0.
My experience after the five hour surgery was EXCELLENT. NEVER took any pain meds, up walking by 7 PM that night (I held the bag!!). Passed gas during the night so the nurse let me order a full breakfast (I ordered a Texas style one, ha). Up walking before breakfast, ate the WHOLE MEAL. Doc came in, pulled the drain tube and said I could go home that afternoon which I did. I had the catheter in for two weeks, no problem and went back to work the end of Jan.
Since than, I have done some mentoring for a couple of his patients and have really been a big advocate for men to get their PSA checked yearly through my business travels and organizations that I am connected with. I have just heard too many horror stories from men and their unfortunate circumstances with other surgeries and doctors in general.

SeaSpray said...

Hi Dr Savatta - sorry off topic but I see your friend - Dr Greenstein closed his blog. :( is that a permanent thing? Just wondering.

Domenico Savatta, M.D. said...

Dr. Greenstein has closed his blog and moved his practice.
I think he will be blogging again in the future!

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