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DanaA
Regular Member


Date Joined Jan 2009
Total Posts : 71
   Posted 4/21/2009 7:49 AM (GMT -6)   
The doctor yesterday said he's only done 30 of these operations, but added that his boss who'll be there with him has done about 1,000. Does it really matter how many his boss did if he's only done 30? Do both of them do the operation or is the boss just supervising? Sorry I've been overposting lately, but I really appreciate the help, he needs to decide soon.
 
Dana

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4275
   Posted 4/21/2009 7:57 AM (GMT -6)   

Dear Dana:

Shown below is some info I shared in an earlier post.  It it was me, I would NOT want the "student" doing the operation.  True, they have to learn on someone...but why you?  My advice is to seek out an EXPERIENCED surgeon per the info below.  I believe this is for open surgery and my feeling is that this is even more critical for robotic surgery.

Tudpock

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
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/1/09.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 4/21/2009 11:22 AM (GMT -6)   
Dana,
Why would you even consider settling for 2nd best when you can have the best. There is no way I would have someone that has done only 30 procedures cutting on me no matter who was watching. There are a lot of top surgeons available; pick the best even if it involves travel.
JT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 4/21/2009 3:58 PM (GMT -6)   
Hi Dana,
My hubby's initial biopsy and consult (and diagnosis) was from an experienced Urologist who did NOT do much work with younger men however he immediately told us this,  and discussed other Specialists. We ended up choosing our own Specialist in the end (by reputation), but the initial Doc also said he would be the very best one, when we had decided and saw him again for referral. The main thing is that the less experienced one was upfront with us.  He told me (the wife) he did not want to risk my husband's health and that he must now have a person VERY experienced. We appreciated the honesty and integrity of this first doc who was a fabulous overall Urologist.
 
I think with your other questions, your b'friend needs to make his own decision after much wider consultation if possible - but 30 operations is still in the learning stage I think - very early in the learning stage, actually. Therefore if possible, try to encourage him to seek another opinion from a more experienced person. I was a theatre (OT) nurse at one stage many years ago,  and you see some interesting things.  Due to this, my whole family always asks ANY surgeon if they will be doing the entire operation and if they have any trainees (that is usually the case but they should be able to tell you exactly what the trainee will do in the procedure). Our Specialist had done 1,500 alone. He did have an Assistant Surgeon these days who performed certain tasks not critical to the sparing of the nerves or the removal of the cancer. We felt much better knowing absolutely everything,  and if you want to know these sorts of things, there is no reason they should not be able to tell you.
 
Sorry this is long-winded, but you are asking all the right questions I think.  It sounds to me as though the trainee surgeon learning this procedure will be supervised by the "boss". However assuming he is not exagerating his numbers (ie. what if he's only done 8 completely by himself etc), this means your boyfriend's  life and health and recovery in his hands. It is really irrelevant I agree,  how many his Boss has done if he has only done 30 and he is performing the entire operation. Will the Boss be assisting in any way at all or checking anything? What was the success outcome of the previous 30 ops in terms of recovery and healing for the patient?  You may want to check out his Boss's reputation on the internet or elsewhere,  and ask for a joint consultation with the both of them maybe? Our Surgeon was very experienced, but he still required an assistant for his type of surgery, so beware of any false claims of being a good surgeon if he cannot prove it now. Keep questioning him on what you learn here. If he IS good (despite being less experienced), he won't have a problem answering all your questions about this. This guy might be fine - even a future genius in time -  but you need to be able to trust him right now, and he should be able to demonstrate his competence openly. That's what we found when trying to assess various doctors and what they said etc.  Hope this helps Dana. Good luck. keep posting, Lana


Creed_three
Husband 51 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery (< 0.1) specifically,  
June 2007: 0.01; Oct 2007: 0.02; April 2008: 0.02: Oct 2008: 0.03:
Nov, 2008: 0.02; April 2009: 0.03 
 

Post Edited (creed_three) : 4/21/2009 3:11:55 PM (GMT-6)


DanaA
Regular Member


Date Joined Jan 2009
Total Posts : 71
   Posted 4/21/2009 9:24 PM (GMT -6)   
Thank you so much for the helpful information. This forum has been a huge help and the love and caring you show by sharing is awesome. He needs to decide soon. I bugged him again tonight about posting here. He has a bone and CAT scan next week, I'm praying so hard it's good. I'll keep you posted.
 
Dana

mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 377
   Posted 4/23/2009 11:16 PM (GMT -6)   

The other guys above make a good point. Even though my local urologist had done many, many open prostatectomies I really didin't trust the guy. All my appointments over the years with him for annual PSA, digital DRE ended up being half a day wasted in his office while he came back from surgery. He did too many surgeries, was too gung ho about money if my opinion. His PA told me right after the second biopsy, which I knew would be positive for cancer, that he would never have the robot do the surgery because his boss was so good at the open procedure he could do one in less than an hour. That didn't impress me, I wanted somebody who took their time and tried to save my nerves. I went to a robotic surgeon 70 miles out of town and I asked him how many surgeries he had done. He told me up front he had done over 300 which was the most for anybody in his town. I went with him because I am a poor guy and couldn't afford the time and inconvenience of going further away for the surgery even though the more experience the better. I would definately try and find somebody who has done at least 250 of these surgeries. Somebody has to be in the first 250 but I am selfish, I don't want it to be me...............


my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
 
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
First post-op PSA=.01 on 10/15/08,
Second post-op PSA <.01 on 01/15/09,
Incontinence gone in early December '08,
ED remains, using daily Viagra and 2x/wk bimix/trimix injections for penile rehab


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/24/2009 12:39 PM (GMT -6)   
That's why I went with open, my surgeon was well over the 300 mark, and takes his time with each one, not a production shop surgeon. At the time, the only robot in town had one surgeon qualified and he had done 15, I didn't want to be the learning curve guy.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 

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