More evidence on value of experience to patient's outcome

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CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/1/2009 2:43 PM (GMT -6)   
There have been several threads in this forum dealing with the effects (risks) of choosing a less-experenced vs. a more-experienced surgeon. I came across this article: www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2637145 published in 2008 showing an improvement in outcome (being free of biochemical recurrence, i.e., rising PSA for 5 years):

1) for patients with organ-confined disease, new surgeons 85%, 2000 surgeries 98%

2) for patients with extra capsular extension, new surgeons 53%, 2000 surgeries 65%

In both cases the improvement flattens out at about 300-500 operations.

It's possible that there's some effect in there due to (maybe) more experienced surgeons taking tougher cases, but the article doesn't comment on that. There's more fine print in there if you care to dig into it.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 0.006


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 7/1/2009 2:54 PM (GMT -6)   
Then there are all the variables.
 
Who had too much to drink the night before?
Whose wife left him last week?
Who had a love one pass away.
The list goes on and on...
 
I was happy that my surgery happened at 9 am…Since I’m a morning person and am at my best in the morning, I figured all docs would be the same way. Then a good friend pointed out he’s a night person and doesn’t get warmed up till after lunch time.
 
What’s a guy to do confused
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/1/2009 3:24 PM (GMT -6)   
This is a very nice study. It looks only at open prostectomys and the data goes back into the 1990's. It seems to say that, If you have organ confined disease and a very experienced surgeon, your chances of no biochemical recurrence approach 100%. It also suggests that if your disease is not organ confined then no matter how much experience the surgeon has, your chance of non-recurrance is 70% or less. But it definitely makes the case for looking for more experience.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Pathology report. Lymph nodes negative, Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight unpredictable leakage day/1 pad.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 7/1/2009 4:00 PM (GMT -6)   
Thanks for posting this Larry.  Confirms what several noted authorities have said and that is find someone who has done the procedure at least 300 times and the more the better.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 7/1/2009 5:06 PM (GMT -6)   
There's a similar study for laparoscopic surgery at www.medscape.com/viewarticle/590539. They don't break out ECE vs. clean margins the way the other one does. The shape of the conclusions is similar, with even more emphasis on/need for experience with the robotic technique.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 0.006


JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 7/8/2009 11:10 AM (GMT -6)   
If we don't give less experienced doctors a chance, when will they ever get experience?
 
Ok...nough being politically correct.
 
When your life is on the line, it is usually best to go with a doctor who has experience. BTW: there are surgeons who have a lot of experience but are also behind the times. Given time, you'll know when the surgeon knows less than you do. That's when its time to leave and find another.
 
I chose the best when it came to cryosurgery. Of course, there are no guarantees with PCa and I hardly blame my surgeon for my psa rise. Fact is, I'll do a repeat cryo, if I can but I ain't going to Norway for it nono
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation

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