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pws1
New Member


Date Joined Dec 2008
Total Posts : 3
   Posted 12/11/2008 7:06 PM (GMT -6)   
I think i've made up my mind to go with DaVinchi But the dr with over 1500 rp's cant even consult with me until Jan 21 and won't tell me how long after they can do the surgery. The other dr can do the surgery this month but has only done 400+ surgeries. I think after over 400 the learning curve would be over, but ? Wait or go for it ?

age 44
diagnosed 10/15/08
psa 5.7
gleason 3+3 6

mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 12/11/2008 7:30 PM (GMT -6)   

Hi PWS1,

I can't answer for your choice, but the experienced ones here place a lot of value on the particular surgeon, how many procedures, outcomes, comments from patients. I've been able to find good general info on surgeons and # of procedures done, but, not so much on outcomes or side effects.

As a lot here have said, losing the cancer is #1, choosing a procedure based on desired outcomes I don't think is as important as the rep of the surgeons or...getting clear of the cancer.

I'm a newbie here. Search out the experienced posters. A wealth of info here. I'm only starting to it figure some things out.

PS: Ever have a problem with pain in the perineum? Mine's been excruciating at times.

 

M

 


 
Lower left groin hernia; mesh and large scar: surgery early 2006
Nov/Dec 07 and March 08 and now Dec 08: Severe perineal pain (between scrotum and rectum). Septra/Bactrim for 8 months for diagnosed prostatitis previously.
PSA start of 08: 5.3
PSA June of 08: 7.3
6 DRE all benign or nothing felt
TRUS Biopsy Nov 08: Got copy of pathology recently (see below).
General Health: pretty good, 5' 10", 180 lbs, slim.
Bone scan Dec 08: waiting for results
 
Biopsy Pathology: 5 of 8 cores positive, adenocarinoma in both lobes
1) 30%, GS 3+3, perineural invasion identified
2) 40%, GS 3+3
3) 60%, GS 3+3
4) 65%, GS 3+3
5) 30%, GS 3+3
 
Open RP recommeded. Looking at nerve sparing da Vinci in London, Ontario.
Wonderful wife...and 1st grandchild on the way.
 


pws1
New Member


Date Joined Dec 2008
Total Posts : 3
   Posted 12/11/2008 8:45 PM (GMT -6)   
Hi Mikey1955

I haven't hade any pain of any kind, just some pain between my ears trying to decide what treatment to get. Did you look into HiFU in Canada? Hifu looks interesting but not yet offered in the states.

age 44
diagnosed 10/15/08
psa 5.7
gleason 3+3 6

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 12/11/2008 9:34 PM (GMT -6)   
To me Mr 400 sounds experienced enough. However if you decide to wait for Mr 1500, it's unlikely to make your condition any worse. PCa is generally slow growing and a two or three-month delay is unlikely to make a difference. Gives you a little more time to enjoy what you have left!

I'm a bird-in-the-hand guy, so I'd go with Mr 400 -- provided everything else stacks up.

Mikey -- sometimes I have a pain in the ass, but it's not medical :-)


Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 12/12/2008 12:02 AM (GMT -6)   
There are many surgeons, good surgeons who have the requisite experience to do a super job with da Vinci and I, personally, wouldn't be impressed with the high numbers someone had. In fact, I'm leary of the guys with such high numbers . . . unless they were amongst the first to do the procedure. I didn't want a mechanic, but a well-rounded surgeon who was also my Urologist. Best wishes for a successful surgery.

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

 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4119
   Posted 12/12/2008 7:27 AM (GMT -6)   

Dear PWS 1:

Pertaining specificically to your question regarding experience, thie info below is copied and pasted from a topic I posted in November.  Statistically speaking, this would indicate that your 400+ guy probably has the requisite experience.  However, the real question is your confidence in his ability to do the job for you.  Also, with your Gleason and PSA hopefully you have taken the time to explore all treatment options.

Tudpock

I subscribe to John Hopkins health alerts on "Prostate Disorders".  The following is quoted from today's bulletin and emphasizes what many veteran HW members have advised re surgical experience:

The importance of surgeon's experience as it relates to prostate cancer outcome is underscored by the results of a study reported in the Journal of the National Cancer Institute (volume 99, page 1171).

Researchers analyzed the outcomes of 7,765 radical prostatectomies performed by 72 surgeons between January 1987 and December 2003 at four major academic medical centers. "Biochemical" recurrence was defined as a postsurgery PSA level greater than 0.4 ng/mL followed by a subsequent higher PSA level. The analysis took into account patient and tumor characteristics, such as pre-operative PSA level and Gleason grade. The men's PSA levels were measured every three to four months in the first year after surgery, twice in the second year, and annually during the following years.

The researchers found that surgical outcomes improved along with the number of radical prostatectomies a surgeon had performed, leveling off only after about 250 surgeries. The five-year probability of experiencing a recurrence of prostate cancer was 18% for surgeons who had performed only 10 operations compared with 11% for surgeons who had performed at least 250 surgeries.

Bottom line on prostate cancer surgery: The results suggest that you can improve your odds of a successful outcome from radical prostatectomy by taking time to find a surgeon with extensive experience.


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
27cc
Brachytheraply volume study done on 11/14/08
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort. 


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 12/12/2008 9:06 AM (GMT -6)   
Yeah, I had heard that the magic number was 300 RP procedures. Improvement levels off after that. Of course, the skill set levels off at higher or lower levels of excellence for different doctors. And in most cases it is almost impossible to tell who produces better results.

The guy I saw said he did about 5 RPs a week, operating twice a week. But he has access to multiple Davinci machines at GW Hospital (in Washington, DC). Allowing for abundant time off, if he operates 40 weeks a year, that means he does 200 RPs a year. I'm sure he was north of 1,000 procedures. That's probably pretty standard for guys who have ready access to Davinci machines.

My two cents,
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 was suspect.  

May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph nodes and associated glands all appear to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 12/12/2008 10:55 AM (GMT -6)   
My surgeon actually did 4 surgeries the day he did mine. He is now over 1500. I have mixed emotions about assembly line mentality. Ultimately, I decided that the reason he was able to do that is because of his skill and the demand for his services. I would say regarding him that he was always a gentleman that seemed in every respect to be genuinely concerned. He is also a young man (around 40), extremely bright, knowledgeable, and of course obviously very capable of handling DiVinci equipment as second nature.

There was a local DiVinci guy where I live that had done about 500 at the time I chose my surgeon. I am very sure either one would have been fine, I went with the one I went with because of his reputation. I decided he is able to do what he does and maintain an impeccable reputation because he is that good. I do think you must be very convinced, not just OK with the person who works on you. I felt at the time of my surgery and still do that I went with the best. I wish you blessings in your decision - I know it is hard and whatever you decide will be fine.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 12/12/2008 4:06 PM (GMT -6)   
PWS1, my doctor has over 1,000 under his belt. I was told there would be a long wait to get on his schedule. There didn't seem to be concern about the possible wait from my referring doctor. At my consult, the surgeon told me he had a cancellation and I could have the appointment. I think the more experience the better. If you have a poor outcome from Dr. 400, you may second guess your decision to go with him / her and beat yourself up. You don't need that.
Age 50
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
ED, need a little help from Levitra
First post op PSA 11/11/08, 0.00


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 12/14/2008 9:05 AM (GMT -6)   
bump for chinito

James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
Present- 1 year: ED- Viagra, pump continues, no response- Trimix ..35ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 12/14/2008 9:11 AM (GMT -6)   
Not a chance in this lifetime I'd let a surgeon work on me as his 3-4th surgery of the day! Operator fatigue can cause a surgeon to become less careful or worse. I'd agree so long as I were 1st or 2nd on the list.

Swim
 


chinito
Regular Member


Date Joined Dec 2008
Total Posts : 28
   Posted 12/14/2008 9:15 AM (GMT -6)   
thanks for bumping up the thread...how do i find out the drs reputation other than from what he says...the dr has quite the bio, but only 50 davincis...

kw
Veteran Member


Date Joined Nov 2006
Total Posts : 883
   Posted 12/14/2008 8:49 PM (GMT -6)   
All you can do is go with your gut feeling. As far as the number game? You should also consider that many of the High number guys may be at teaching hospitals. You may be going to "The Guy", but once the lights go out you don't really know who is "doin the work". Ask your questions, make your decision, and go for it.
Wish you the best,
KW
    43 at Dx and Surgery (RRP)
    PSA 5.7, Biopsy 3 of 12 positive (up to 75%) all on left side of prostate, Gleason 7
    RRP on Oct. 17, 2006 - Nerves on right side saved. All Lab's clear. 
    Cathiter in for 28 days due to complications in healing. Removed Nov. 9, 2006
    First Post op PSA on Dec. 11, 2006  Undetectable 0.00.
    ED workable and usable with Viagra.
    Feb. 20th, 2007 - Feb. 4th, 2008  Cystoscope, Two Collagen injections,Second Opinion Consultation for Incontinance at OU Medical Center, Bio-Feedback training, Chiropractic, Accupuncture  to try to resolve ongoing incontinance (4-6 pads a day)  All PSA's 0.00.
    Feb. 22nd, 2008 - Surgery to install the AMS AdVance Male Sling.
    March 27th, 2008 - Sling not working, Little or no improvement.
    April 18, 2008 - Collagen injection.  Back to using 4-6 full pads a day within a week.
    May 14, 2008 - Another collagen injection to try to Band-Aid the leaking for our June cruise.  Will start making conusultation appiontments for AUS after we return.
    July 14th, 2008 - AUS consultation with Dr. Morey at UT Southwestern (Dallas).
    July 30, PSA 0.00.
    Aug. 22nd, 2008 - AUS Surgery by Dr. Morey
    Oct. 6th, 2008 - AUS Activation by Dr. Morey
     

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