Posted 7/7/2008 6:13 PM (GMT -6)

Miles--Welcome to the forum.  The more I read the more I am convinced that the number of prostatectomies a surgeon performs (open/daVinci) the better the results are likely to be.  That said, there are some high-numbers surgeons who are not as good as others. 

If you are willing to travel outside southern Oregon to a bigger city, I would ask the surgeon about his numbers, ask to talk to patients who have had this surgeon perform their prostatectomies, and see if you can talk to other health care folks in the area for their two cents about the surgeon. 

When I discussed the option of DaVinci with my urologist, he told me of a high-numbers surgeon who had a less-than-great reputation for his surgical outcomes.  This kind of information, while anecdotal, can be  helpful.  I ended up getting an open prostatectomy not a robotic.

Many of the posters here know of great surgeons in many different areas of the U.S., including the West Coast.  Research  as extensively as you can before making your decision and read some of the standard books on  prostate cancer listed on this forum. According to most here who have travelled elsewhere  for surgery, it wasn't too difficult to accommodate.

You will not regret making an informed, well-researched decision, rather than a hasty, ill-considered one.


Age 59  PSA quadrupled in 1 yr (0.6 to 2.5) 
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 2006 
Organ confined pT2a  Gleason 5   
Cancer-free for 2 years  PSA's undetectable 

Posted 7/7/2008 6:44 PM (GMT -6)
Thanks to all for your replies so far.
 
Barrows is the surgeon in Medford who was recommended by a local man.  I don't know how many robotic surgeries he's performed, but I'm taking my medical records over tomorrow.  Not sure if I'll make an appointment or not.  The local guy's niece is a surgical nurse in Medford, and she said Barrows was the guy to go with there.
 
I'm also thinking about UC Davis, which my local urologist recommended.  But how do you finally decide?  In the end, can I really compare one surgeon to another?  I agree this is the biggest decision I've ever made so far in my life, and I've had to make a few big decisions, but I don't know that I have the knowledge to make the right pick.
 
Mostly, I've been handling the emotional side of this very well, but as it gets close to the time to act, I'm starting to feel like a deer in the headlights.
Posted 7/7/2008 7:05 PM (GMT -6)
Miles-

By now you've got some doctors in mind and some hospitals. The first thing I do when I get a doctor's name is check him/her out on Google. Find out what schools he attended, what hospitals he's worked in and whether he's a Diplomate of the American Board of whatever specialty - in this case urology.

Also Google the hospitals you're considering. They usually list the professionals in each department. Google each of the docs as above. It's very important to do what I call "due diligence". It's much better to get it right the first time, than to have regrets and try to undo what's been done.

Liking the doctor is also a big part of it. If you have insurance, ask how many 2nd opinions they'll pay for. And ask several times - you'll get different answers from different people. I had 5 "2nd opinions". The first person I asked at my insurance company said they wouldn't pay for any 2nd opinions. Horse hockey!!!

And, yes, it's scary as hell. But you'll find out that it's not nearly as bad as you've imagined.

Good luck.

-Les
1/2005 Dx PSA 26.5 Gleason 7 (4+3) @Age 61
1/2005 Start Casodex and Zoladex
PSA drops to <0.01
7/2005-8/2005 5 weeks of IMRT and then HDR brachy
1/2007 Rad Oncologist orders CT scan of pelvis
because of complaints of pain in both thighs
MRI confirms pain not caused by cancer BUT
1/2007 CT scan of pelvis picks up a nodule at bottom of left lung
5/2007 CT scan of lungs shows 1/2007 nodule has grown and
there are numerous nodules on both lungs.
6/2007 Thoracic surgeon removes wedge of left lung for biopsy
6/2007 Path report says 95% chance of metastatic PCa, but she's
never seen cells like this before.
8/2007 2nd opinion at M.D. Anderson in Houston.
They confirm: mutated PCa, very rare, but seen there 2 or
3 times. Recommendation: have CT scans every 6 weeks
and watch for change. At that point start chemo and will
survive for 22 - 24 months thereafter.
PSA still undetectable, but get Lupron shot to bring T down from 27
2/2008 Trip to Houston – PSA now 0.5 and nodules larger. Lupron shot.
6/2008 Trip to Houston - Finally got results from doc. A number of lung nodules have grown, but, more important to him, is the fact that the malignant lesion on my pelvis seems to have flared up and he wants me to start chemo. He said I could wait a few months, but I told him I want to start now. He to get me signed up for a clinical trial in nearby NY.

Post Edited (Gordy) : 7/7/2008 7:39:42 PM (GMT-6)

Posted 7/7/2008 8:36 PM (GMT -6)

Hi

Welcome to a great forum.  You have some good infromation here and especially the things that Gordy has said.  One other thing I might suggest is to check your states Medical Board to see if the Dr has had any problems with his license.  I guess it's the cop in me.  Take care and let us know how you are doing. 

Mika

attempted to edit out dead space at bottom of post- failed miserably...lol  James C.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Post Edited By Moderator (James C.) : 7/13/2008 7:29:09 AM (GMT-6)

Posted 7/7/2008 9:10 PM (GMT -6)
miles . which u.c. davis are you considering ? also consider the hospital C.O.H. is  the 19th leading hospital in the u.s. in urology but it was the doc  that impessed me. most docs are errogant when you consult them ,they have to be , if you can get past that and recognize there actual achievements your on the right  road , your gonna be asleep anyways. type in the docs name i had or any for that matter and you will see the difference you dont wantt a good advertizer you want to see thee results are they willing to let you talk to there patients  mine was and they all had similar results .im not saying a certain doc has never had a bad out come   ,if they tell you that ,turn around and run , but compare the percentages , i considered .u.c. davis  chris evans is cheif of urology and not only a great doc but just plain nice guy but the numbers just werent there for  me and it was only an hour drive which would have been much more conveinent take your time if you would like to contact me i can give you the  email of a professor in ohio whom researches top docs all over the world  ..     dirtmoverz@comcast.net  your gonna do fine just take your time hell im just thrilled you caught it in time . :-) ...........dirt

p.s. whats more gordy is absolutly correct its not as bad as your mind makes it out to be .


Diagnosed November 2007   (43 years old )
PSA 3.9 / Gleason 6 / TC1 6 cores 1 shows 25%
Sugery scheduled 5/29/08 - City of Hope - Dr. Mark Kawachi
 "First show of the day"
 and now for the new ive been waiting for
 FINAL PATH REPORT:gleason upgraded to 3+4 T2c bilateral disease,tumor involvment 5%
extra prostatic extention:absent
seminal vesical invasion :absent
pathological staging:pTNM pT2 ORGAN CONFINED
margins free of carcinoma
usable erections ;6-6-08 with little blue pill
continence; 1 pad a day, dry at night

Post Edited (Dirtmover) : 7/7/2008 8:13:25 PM (GMT-6)

Posted 7/12/2008 2:43 PM (GMT -6)
My two cents: I was told that 300 robotic surgeries is sort of the majic number. The surgeon is not going get dramatically better after that. But - more experience is always better.

kcragman
Age: 52
March 2006: PSA 2.5
Dec 2007:   PSA taken for insurance application. I did not see the results until late Jan '08 - after I was rejected. Their lab said PSA 4.5. PSA again in Feb '08: 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were cancerous and the 6th did not look good.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.
Post op: Gleason 9 (4+5). 15% of prostate involved. Negative margins. Lymph nodes and associated glands all appear to be cancer free.

Posted 7/13/2008 1:01 AM (GMT -6)
Miles I'm a COH guy too. That have two of the very best PC surgeons on the west coast and clearly from what I read, the world. Their program is awesome.

A word about avoiding travel. My Coh visit could have been done in three days. I stayed in the area for 13 days as I had family in the area, but I could have come home on the third day and had local support to remove the catheter and follow up care. I guess I should mention that I live where my screen name indicates. We are NOT a small town and I have heard about bad surgeries here and at this site. Don't skimp this part and get to a major center at least for that all important second opinion, and likely surgery. Quantity has nothing to do with selecting a surgeon. The program that the center has is far more important. Once you've been to a major center, you will see what I mean.

West Coast centers I considered:
UCI,
UCLA
USC
COH
USF
Mayo Clinic
MD Anderson (technically not west coast)
Huntsman

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
 

Posted 7/13/2008 10:20 AM (GMT -6)

 

Hey Dirtmover

Give Sacramento a little more respect.  Dr Brian Naftulin of the Sutter system is one of the most experienced and best respected DaVinci surgeons on the west coast.

Yea, he did my surgery.  30 miles east too...

lifeguyd


biopsy 10/16/06
T2A,  PSA 4.7
Gleason  4+4=8  right side
DaVinci Surgery  1/16/07
Post op confirms gleason 4+4=8
no extension or invasion found
no continence problems
PSA 90 day -.01  , 6 month -.01 , 9 month +.02 , 1 year +.02
Ed problems continue
Now using Bi-mix
 
 

Posted 7/17/2008 7:22 AM (GMT -6)
milestogo,
My husband and I faced the same issue 2 years ago. We're in the Tampa area. My husband was adament, as you are about getting the absolute best in the field since this is a one shot deal. After meeting with several of the leading candidates here, he just didn't feel right about any of them.

We chose Dr. Mani Menon at the Henry Ford Institute in Detroit who pioneered the DaVinci method. The appointment with Dr. Menon and his associates was the most timely, (it was for 11:00, and they actually called us up right on time) orchestrated, informative, professional for any type of appointment I've ever experienced.

We sayed at the residents' dorm which is steps away from the hospital (and a wonderful, very inexpensive cafeteria). For about $30.00/night, we had a clean, quiet sparsely furnished apartment.

My husband had the DaVinci, nerve sparing procedure. After the surgery, Dr. Menon explained that my husband's was a "textbook case", clear margins, everything great. However, it took him 11 months to achieve a usable erection (with Viagra). It has been improving ever since. Prior to that, he tried the pump and injections, along with Viagra. (No problems with ED prior to surgery).

Everyone is different, nerves take time to heal.

The best of luck to you.
fibro, PTSD, depression/anxiety, mitral valve prolapse, high blood pressure,
peripheral neuroma (3 surgeries on right wrist)
 
 
accupril, xanax, percocet, wellbutriun

Posted 7/18/2008 11:28 PM (GMT -6)
 i in no way wanted to dissrespect sac , i grew up there brian naftulin was my second choice and i did consult with him, however at 125 divincis (which is very little experience) and those were his numbers that isnt close enough for me the article written by one off the foremost experts on the divinci at city of hope clearly states a min of 500 to be a good  ,im sure he did a great job and really is a nice guy, , at least till you cancel surgery with him (wheres the respect there)  hey he does have a nice office in folsom ,hope you didnt take my post wrong , im here to help not offend ,the same way these people helped me...................dirt



Diagnosed November 2007   (43 years old )
PSA 3.9 / Gleason 6 / TC1 6 cores 1 shows 25%
Sugery scheduled 5/29/08 - City of Hope - Dr. Mark Kawachi
 "First show of the day"
 and now for the new ive been waiting for
 FINAL PATH REPORT:gleason upgraded to 3+4 T2c bilateral disease,tumor involvment 5%
extra prostatic extention:absent
seminal vesical invasion :absent
pathological staging:pTNM pT2 ORGAN CONFINED
margins free of carcinoma
usable erections ;6-6-08 with little blue pill
continence; 1 pad a day, dry at night

Post Edited (Dirtmover) : 7/18/2008 10:35:56 PM (GMT-6)

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