Which doctor to choose

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David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/25/2008 6:00 PM (GMT -6)   
 I live in the Los Angeles area an I'm currently talking to two Robotic surgeons.
 One is Dr. Kia Michel at Cedars Sinai,  the other Is Dr. Mark Kawachi at City of Hope.
  Both seem very qualified.  Does any one have any input on either of these surgeons?
 
  I have a Gleason 6, psa 4.1, T1c,
 
                                                                    Thanks, David T

Post Edited (David Fay) : 10/25/2008 6:03:12 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/26/2008 8:27 AM (GMT -6)   
Hi David,
Marc Kawachi and Tim Wilson at CoH are two of the best in the west. And the facility is wonderful. While I used Wilson, both he an Kawachi are close knit and are very reputable.

Second,
What is your age? A gleason 6 with a PSA of barely 4 is a marginal, possibly indolent, cancer. You have lot's of time to make a call. I am just curious how long it's been since you were diagnosed...

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, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/26/2008 8:57 AM (GMT -6)   
Thanks for the input on the surgeons. It's only been about six weeks since the biopsy.  I'm 64

Post Edited (David T) : 10/26/2008 9:00:31 AM (GMT-6)


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 10/26/2008 12:11 PM (GMT -6)   
Have you spoken with your primary care physician about the Urologist/Surgeon selection? I wouldn't make the decision based on a popularity contest, and I see you're looking hard for the best you can find. There are many surgeons who are experineced in the process. Earlier comments about the time you have to make a decision is medical advice best given by someone who knows you and your body - not by one of us commenting here.

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0

 


David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/26/2008 2:15 PM (GMT -6)   

 Mavica, I agree with everything you say. I just feel better when someone offers up personal experiences voluntarily as compared to calling people on a list the doctor gives me.

 

                                                                       Thanks for your response,  David T


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/26/2008 7:46 PM (GMT -6)   
The overwhelming concensus throughout the medical fraternity, both surgical and radiation is that given a Gleason of 6 and a PSA of 4 David would be in the low/intermediate group of prostate cancer sufferers and has plenty of time to make a carefully considered decision about his treatment. He asks for input on doctors he is looking at...............it is a bit off putting when someone asks for feedback on a forum with members who have been through the full gamut of treatments and outcomes and is then told to see what his doctor says. My assumption would be that that course of action has already been followed and now he's looking for on-the -ground input. This doe-eyed unquestioning enchantment with the medical profession can, in a lot of cases, be a recipe for disaster. Does anyone really think that any doctor is going to give you the name of any patient who is less than happy with the treatment and service they have received from him.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/26/2008 8:16 PM (GMT -6)   
Thanks for reading between the lines.

Dirtmover
Regular Member


Date Joined Apr 2008
Total Posts : 158
   Posted 10/26/2008 9:45 PM (GMT -6)   
Hello david t, i wouldnt put  alot of stock in the popularity contest comment the prior post mentioned , the best thing  about this site is that these are all real men and women whom are living this ,i would take a referal from an actual patient any day as opposed to a doc , docs sell there goods a patient can tell you whether it was a bill of goods or is the surgeon reputable , its only common sence, i shopped my surgeon thru word of mouth from PATIENCES not docs i followed up my resarch by doing thorough back ground checks on the docs,there are only a hand ful of docs who do this well , when i say well i mean superior results , lots of people say its all about age and health ,while those factors do play a big role its your surgeon who is the deciding factor on how your long term quality of life will be affected , this includes possible recurrance,it is a known fact that higher volume teaching hospitals have typically better out comes. please consider your options carefully  you get one shot  my brother. i went to kawachi i had to travel 400 miles to do it and stay in l.a. for a week,THERE IS NO BETTER SURGEON PERIOD, this is my opinion .however i have outstanding results to back it up,(so much for the popularity contest)not alot of people can say that.as was said previously, kawachi and wilson are the best on the west coast in a study done by ohio state university the kawachi wilson team were considered some of the best in the world ...i do have that study by the way i think they were 5 th or 6th, granted we dont personally know the actual people who did the study or criteria used, but i do have my own personal experience, which i will take to the bank , i dont know how many people would say this about there treatment choice ,but ill throw it out there,given all aspects ,i would do it the exact sameway all over again. and you guessed it,,, with dr.mark kawachi, PERIOD,while mac has an excellent point ...what dr,will tell you the name of a patient  with only ok results  hes right the doc wont ,,, but the patient will maveca,,,,,,,,,.........................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) : 10/26/2008 9:49:11 PM (GMT-6)


Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted 10/27/2008 8:08 AM (GMT -6)   

Mavica -

I've noticed in several of your posts that you seem to emphasize talking to your doctor and relying on their advice.  Do you think that the people on this site are not doing that?  I find the tone of some of your posts condecending and annoying.

In case you do not realize it the purpose of this forum is to offer information and support to people dealing with prostate cancer.  For you to insinuate that Tony is practicing medicine is absurd. Tony is one of the most informed people concerning prostate cancer you will ever come in contact with and he is only offering his opinion.  In fact, I would value his opinion regarding prostate cancer issues over 90% of the doctors.  This forum is lucky to have Tony posting his supportive and knowledgable opinions.

- John
Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 10/27/2008 8:39 AM (GMT -6)   
Contrary to what an above poster said you DO have plenty of time to learn and from that choose a treatment best for you. It's not a bad idea to maybe talk to your primary doctor about treatment options but he is not a urologist or an oncologist. In fact talking to my primary doctor turned out to be my telling him of a new treatment option I received he had no idea about, nor did he really need to know of it. I tell everyone new here to take your time and learn the treatment options available, their side effects and the impact of all this on your lifestyle and family. There is no need to rush and remember there are no do overs. Knowledge is empowerment. When everything you soon will learn becomes overwhelming I suggest you take a week off away from all of it. Later when you decide take a few days off to reflect before making the final decision. Then once you do don't look back.
Diagnosed 10/08/07
Age: 58
3 of 12 @5%
Psa: 2.3
3+3=6
Size: 34g
T-2-A
 
2/22/08
3D Mapping Saturation Biopsy
1 of 45 @2%
Psa:2.1
3+3=6
28g after taking Avodart
Catheter for 1 day
Good Candidate for TFT
(Targeted Focal Therapy)
Cryosurgery(Ice Balls)
Clinical Research Study
 
4/22/08
TFT performed at University of Colorado
Medical Center at Denver Fitzsimmons Campus
Catheter for 4 days
Slight soreness for 2 weeks but afterward
life returns as normal
 
7/30/08
Psa: .32 
 


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 10/28/2008 8:07 AM (GMT -6)   

Navy corpsman -  Learning of the personal experiences of those of us who are dealing with prostate cancer is an important part of the process a "newbie" goes through - very important.  However, when it comes to the diagnosis of someone's condition and dispensing of medical advice those tasks are best performed by trained professionals who know us individually, who have examined us, know our medical histories and who have analyzed our test results - not from well-meaning Monday morning quarterbacks - whomever they may be.  People seeking support and advice should be encouraged to find professionals whom they trust - not to distrust the medical profession.  Yes, everyone has opinions and should express them; these are mine.  Thank you for your comments.


Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0

 

Post Edited (Mavica) : 10/28/2008 8:15:22 AM (GMT-6)


David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/28/2008 5:53 PM (GMT -6)   

Dirtmover, Thanks for the response.  It's people like you, giving your experiences, with out being solicited from a list that some one gives me, that makes me feel much better about my choice of surgeons.

I plan on having Dr. Kawachi do the operation before the new year.

Thanks again, and I hope the best for you in the future.

                                                                David T


David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/28/2008 6:09 PM (GMT -6)   

Navy corpsman.  I think you are a little off-base with your post, but that's just my opinion.  If you find me condescending and annoying, I apologize.

When I used the term, armchair doctors, I was referring to all the post, not just Tony.  I know these boards are here for all persons to find information.  Unless a person has a Dr.  in front of his name, I'm sorry, but I will consider them a ________  doctor.  (no offense)


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 10/28/2008 10:22 PM (GMT -6)   
I thought the armchair Doc comment was sorta funny. Guess I have a different sense of humor.
Getting the we done, how done, who done's is all a part of the learning process. I listen and learn from just about everyone here. The last word we usually leave to the Doc. That's what we pay the big bucks for!

Just taking it all and being able to see whats out there is a bit like using the remote.... changin the channel a lot just to see if there's anything good to watch :>) Some posts are good, some solid information I can use and some are reruns. Kinda like educational TV!!! Everything is worth the read and very much appreciated :>)

Swim
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/29/2008 12:23 PM (GMT -6)   
David,
I don't think it's possible to have chosen a better surgeon as he is among the very best. I do have personal experience with that facility. It seemed to me, to be a great one. You will likely have a good experience there, too, as everyone I have met that went there have had nothing but good things to say. My comment to you about your 'low' PSA was because there is a lot of discussion about over treating iprostate cancer flying about the advocacy groups I have joined. I don't think suggesting that you know all of your options is bad advice. Merely pointing out that there is always time to review the different modalities and their side effects.

Mavica, et al,
I do not and have not given medical advice to anyone. And certainly a popularity contest is not what I am suggesting. But David's question is a good question, and the right question to ask a board like this one. It is good that a site like this exists so that we patients can share and compare our notes and stories and we can use them in whatever way we like. If my advocating that we all need to learn as much as we can understand about our disease, look into the history of the doctors who will treat it, know what the options are is considered giving medical advice...I say wake up and smell the coffee ~ this is merely common sense. One doctor recently told me that if I ask a hundred doctors a specific medical question, I may get a hundred different answers. Some good, some not as good. So if you always take the advice of one doctor, you just might end up with the not as good. In any case, it is not practicing medicine to advocate that we all should look into all of our treatment modalities and physicians who would perform it prior to making a decision to go with them, thus David's question is a good one.

I don't think I will ask my family doctor about prostate cancer surgeons, however. We did have a conversation or two (more) since my surgery. He has never heard of the surgeon I did select, but did say CoH had a good reputation with prostate cancer. But then I knew that already because I did my own research and I knew that the guy I selected ran the prostate cancer program. And I can probably name 5 of the best surgeons in the country, and many here at this site will have heard of them. But my GP doesn't know any of them, he has no need to. As he said to me, he would use word of mouth if he had the disease as that is the best recomendation anyone can give.

But that's not a popularity contest. It's just not a bad idea to ask other patients about who you are considering to perform a major surgery.

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, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 

Post Edited (TC-LasVegas) : 10/29/2008 12:34:31 PM (GMT-6)


David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/29/2008 1:08 PM (GMT -6)   

Thanks Tony again for your feedback on Dr. Kawachi.  Makes a guy feel a lot better when he gets positive comments about a surgeon who you plan on using for a situation that will possible have an effect on you for the rest of your life. 

I agree with you 100% about all the options, and believe me, I have checked them. I know I would be a perfect candidate for a lesser option (watchful wishing, etc).  I believe that it is a fix it now or fix it latter situation, but regardless, it will have to be fixed.  For me fix it now is the only option, hands down. 

 
 
                                                                      David T

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/29/2008 3:13 PM (GMT -6)   
David T,
I think you are a little off base in your reply to Navy Corpsman. His comments were directed at Mavica whose answer to all queries by most posters is to see what their doctor thinks. (this is in no way a criticism of Mavica.....we are all entitled to our opinion). But as I earlier pointed out this is a forum of prostate cancer patients at all stages of the disease and who have undergone many types of treatment over many years and by a great variety of doctors............. so who better to provide, as Tony has correctly pointed out, feedback on their experiences. As has been stated the advice to follow unquestioningly what a particular doctor has to say is very foolish indeed as opinions can be as varied as the number of doctors. At the end of the day this is one disease where the patient needs to make his decision based on all the information he can gather. I personally in the year or so that I have been a member of this forum, never seen direct medical advice dispensed here, but I have found the posters experiences with treatments, successes, not so successful and varied outcomes to be a resource without comparison and that includes all the various doctors I have seen in my journey. You are on the right track in learning all you can from as many sources as you can before making your ultimate decision. Never base that decision on what one doctor may think.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


David T
New Member


Date Joined Oct 2008
Total Posts : 11
   Posted 10/29/2008 7:41 PM (GMT -6)   
Navy Corpsman,I owe you an apology.  I miss read your post.  Very sorry.
Billy Mac, thank you for bringing that error to my attention.

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 10/30/2008 7:56 AM (GMT -6)   
As a previous poster use to always say. MD does not stand for medical deity.

As I always say. Knowledge is empowerment. Take your time in choosing a treatment, for there are no do overs afterward.
Diagnosed 10/08/07
Age: 58
3 of 12 @5%
Psa: 2.3
3+3=6
Size: 34g
T-2-A
 
2/22/08
3D Mapping Saturation Biopsy
1 of 45 @2%
Psa:2.1
3+3=6
28g after taking Avodart
Catheter for 1 day
Good Candidate for TFT
(Targeted Focal Therapy)
Cryosurgery(Ice Balls)
Clinical Research Study
 
4/22/08
TFT performed at University of Colorado
Medical Center at Denver Fitzsimmons Campus
Catheter for 4 days
Slight soreness for 2 weeks but afterward
life returns as normal
 
7/30/08
Psa: .32 
 


Navy corpsman
Regular Member


Date Joined Aug 2008
Total Posts : 61
   Posted 10/30/2008 9:55 AM (GMT -6)   

David T -

No worries.  Keep learning and asking questions.  This is the best place on the net for prostate cancer information and support.

Stay in touch.

- John

 


Age:  44
We have a family history of PCa.  My Dad and uncle died from it at 65 and 53. My PSA velocity increased in the last 2 years and I had to talk my GP into refering me to a urologist.
Biopsy results:  5 of 11 cores positive, all 30%. Gleason 6. T1c. PSA 2.53  Date of biopsy 15MAY08.
Open RRP at Johns Hopkins with Dr. Partin on 09JUL08.
Pathology report:  Gleason 6, pT2, neg. margins, 0 lymph node and seminal vessical, organ confined, I lost 1 nerve bundle and 22 lymph nodes.
As of today, about a month after surgery, I feel at about 80%. Urinary control seems to be improving. Little Elvis has taken a nap and has not awakened yet. I hope when he wakes up he is well rested because he is going to get one heck of a workout.
 
 

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