Patient Outcomes rate

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qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 10/3/2009 12:58 PM (GMT -6)   
Here is a local surgeon in columbus area, he is the director of robotic surgery in urology department at the ohio state university. he did >700 da vinci surgery for prostate cancer patient. i fund his patient outcomes rate are following:

Average operative time: <2.5hrs
Conversion to open surgery: 0%
30-day reoperation rate: <1%
Average blood loss: 4 ounces
Transfusion rate: 1%
Hospital discharge day after surgery: 99%
Drain-free rate: >99%
Average catheter time: 5.5 days
Average number lymph nodes removed per patient: 11 nodes
Negative margins in organ-confined disease (T2c or less): >92%
Bladder neck contracture: <1%
Urethral stricture: <1%
Rectal injury: 0%
Bowel injury: <1%
Fecal (stool) incontinence: 0%


is that consider a good one?

Thanks a lot!'

Jennifer
husband 55 years young
PSA July 2009 5.5
Diagnosis confirmed Sep 21, 2009
12 Needle Biopsy = 7 clear , 5 postive
<2%, 10%, 25%
Gleason Score (3+3) 6 in all positive cores
stage T1c
Surgery or Radiation?


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 10/3/2009 2:14 PM (GMT -6)   

O.S.U. head of robotic.  You mean Ronney Abaza.  I saw him to.  What he did not tell you is the rates of treatment success.  How do you know what is happening to his patients in the long term.  This is exactly why I went to Johns Hopkins.  40 years of data....You have a better understanding of what you possible out come is with them..

Go to the Cleveland Clinc.  They have a lot more experience at RP then O.S.U. does.  Experience is extremely important with this surgery....

 

BTW I live in Powell....


Post Edited (ChrisR) : 10/3/2009 1:18:29 PM (GMT-6)


T40
Regular Member


Date Joined Oct 2009
Total Posts : 103
   Posted 10/3/2009 2:30 PM (GMT -6)   
Jennifer,

Those numbers look excellent. You can be pretty confident in any surgeon that has done over 800+ procedures. John Hopkins and places like MD Anderson have great brand names but you can still get excellent care close to home. I agree that John Hopkins has 40 years of data but Da Vinci robotics has been out maybe 10 years so not sure how that is relevant. Do what makes you comfortable. I chose a surgeon with almost identical success to the numbers you are reporting and I am pleased with my choice.

T
Age 40
Pre-op PSA was 5.8 from wellness test on May 19, 09
Follow up test from uro was 4.6 with a 9.3% free psa
Gleason 3+3 in one core, 3+4 in second core of 12 samples taken
Uro recommended Robotic for someone of my age. My research confirms.
Surgery performed August 19th, 09.
One side nerves spared. Nerve graft on other side.
Six weeks incontinence almost over. ED a work in progress but seeing some response.
Post op October 2nd, 2009 All margins were negative. PSA results in a few days.


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 10/3/2009 2:45 PM (GMT -6)   
Hi Jenniffer, with all due respect to Chris, I'd not think a 40 year history of prostatectomies (sp?) is relevant when it comes to daVinci surgery. I don't believe 'good hands' with open RPs necessarily translate into good hands with daVinci --- frankly, I'd think someone who had achieved the 20th level of exhaulted power in computer games might be the non-daVinci experience to look at !

I do agree with Chris that experience is important -- just that I'd be interested in daVinci experience. And, from the stats you've posted, and if he's done 700 daVinci, I'd be happy to lie down on his table and be eviscerated.

Also, don't forget, stats out the back end are influenced by what goes in the front end. It's easier to have good stats if you only accept easy, likely to have good outcome, cases. But, if something goes haywire while he's one the table a surgeon who has faced difficult cases might be of a lot more value than a guy who just takes the easy rides.

In the end, you'll look at all the stats, and all the information, but you'll want to go with the surgeon you trust --- you may not like him/her, but you'll trust them. I had total faith in the guy who did me. If all went well, I thought he'd do a perfect job. If he ran into problems I was convinced he would calmly and expertly deal with them. When I fly I want a pilot who can land the plane in a sudden cross wind, after losing an engine on final approach, without breaking a sweat.

You mention Ohio. Are you, by chance, anywhere near to Cincinnati?

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 10/3/2009 3:41 PM (GMT -6)   
Those numbers seem right in the ballpark for a good surgeon. Note that some of them like conversion from robotic to open or need for a transfusion are extremely rare in any case. Selection of cases can also affect the stats which is why major medical centers may seem slightly worse.

Sheldon
I asked my uro about the video game experience (he is too old to be a gamer) and he said that he thought not. He thought the most important thing was understanding what you were looking at.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & 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 leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 10/3/2009 3:50 PM (GMT -6)   
I concur with T40 and Sleepless. Our surgeon was head of Urology at UC Irvine, CA, where the DaVinci was invented. I think he had only done about 500 at the beginning of 2007 (compared to Manon's 1000), but he said many things that resonated with us, one of which was to state that he was more interested in quality and that it took a kind of production to have several surgeries per day. His max was two, because he did not think he could be fresh for the third. (adding with edit that Dr. is a researcher and teaches the procedure all over the world) This made a lot of sense to me, as did the method of surgical repair of the urethra with a robot that is actually a "sewing machine" making those tiny stitches. I would take one of those stitching my urethra back to the bladder over a human hand any day of the week. There are surgeons who talk about "feel" being superior to the robot, when comparing RP to robotic assisted laparoscopy. That just doesn't make sense to me. For removal of the prostate, which has no discernable borders (its like where the bridge of the nose meets the face), I would rely on the most precise blade at the most magnified view possible, and believe this is the best method available today.

On the other hand, I also fully believe we each are vested to our own recovery, with belief and faith being components just as important, if not more (it could be argued) than method. So those who are fiercely protective of their RP surgeons' method, good for them if it made them survivors.

By the way, Irvine is exploring the use of lowering the temperature of the prostate area during surgery, in order to cool the nerves and, therefore, to protect them from injury. Dr Ahlering had made the connection after reading that spinal cord injuries have a much better outcome when temperature is lowered immediately after injury. He believes this may improve regaining of functions earlier in the recovery after surgery.

Best to all here, Ciao!

Becky


Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery, then intermittent drips 4 wks out

Full erection, 12th day after surgery

2 mo’s post-op, some ED after penetration

3 month PSA 0.03

6 month PSA non-existent

1 year   PSA  non-existent

1 1/2 yr PSA  non-existent

Erectile function--up and running!

Two year anniversary on 2/27/09-Sex life back to normal!

 

Post Edited (B&B's World) : 10/3/2009 3:31:28 PM (GMT-6)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 10/3/2009 4:17 PM (GMT -6)   

Jennifer:

As you may recall from one of your other threads, I did not choose surgery  However, I did do extensive research before I made my final decision.  I would have chosen robotic, though do not fault those who choose open. 

However, the stats you provide should be the "givens" and not anything that wows you.  More important answers I got from the robotic surgeons I interviewed had to do with their rate of cure (albeit from a limited time), their statistics re incontinence as well as not only their ED statistics but their approach to the issue.  Additionally, I measured them on their honesty re the side effects that may not typically be discussed, e.g. loss of ejaculate, shortening of penis, catheter issues, etc.  I felt if they were honest and open on their stats and the issues then maybe they were worthy of my business.

Tudpock


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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 10/3/2009 4:25 PM (GMT -6)   
I also would agree that those are good numbers. I also agree that you have to feel good about his abilities.

I did go to Cleveland and was totally inpressed from start to finish. Dr. Kaouk is the department head, and has around 800 surgeries.

I liked the way he talked about his technique. He was super friendly, and acted as tho I was his only patient, even tho I knewthey were stacked up.

I would have gone to Columbus next if the Cleveland guy hadn't been such a confidence buolder for me.

Good luck.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 10/3/2009 6:02 PM (GMT -6)   
Wow! so much valuable information! I learned a lot again from everyone's input! Thanks!

To me, yes me, (though I am the one who don't need surgery but I just can't put up my husband's slow movement and less proactive respond to his PA), here are the three surgeon on my list:

1, I most wanted, is Dr, Menon in Henry Ford hospital. He is the most experienced in the Da vinci within reachable distanse. I am very impressed what I read about him. The downsides are 4-5 driving and our insurance does't cover. Those don't stop us but will impact our decision.

2, Dr. Kaouk in Cleveland. He is very good supposedly but agin, there is 4 hours driving.

3, the last one is Ronney Abaza, who is the one I posted. the good side is he is in our local. My husband kind of want get in done here so it is easier to everyone ( i am sorry I can't agree with him). Thanks for everyone's opinion, now I feel much better. I should feel comforable let him surgery my husband.

It will be a battle for me to convince him go outsize of columbus. I told my husband that I feel I am the one who have prostate issue, not him. LOL


ChrisR, you did see Ronney and what do you think of him? please tell me more about him. we live in Dublin.
husband 55 years young
PSA July 2009 5.5
Diagnosis confirmed Sep 21, 2009
12 Needle Biopsy = 7 clear , 5 postive
<2%, 10%, 25%
Gleason Score (3+3) 6 in all positive cores
stage T1c
Surgery or Radiation?


B&B's World
Regular Member


Date Joined Mar 2007
Total Posts : 120
   Posted 10/3/2009 7:46 PM (GMT -6)   

Jennifer-

Well, this actually is a couple's disease.  But I hear you...I joked that I grew a little prostate myself through all of it.  My husband wanted to crawl under a rock, so I also understand your proactive stance.  I, too, would have gone anywhere, including Ohio, to get him the best care.  But part of the decision included a consideration of how much stress and strain the long distance would put on his overall health, never minding the matter at hand.  Our chosen surgeon did not take our insurance, but the cost to go "out of plan" was well within our means and were surprised at how affordable--totally worth it to us.   I would also venture to say that cancer is big business, and just because someone has the "brand" (i.e well-known name and stunning architecture) doesn't mean that there isn't someone highly competent, with excellent results, closer to home.  Our drive was four hours to get to Irvine, and we stayed the week down there after surgery (in a nice, affordable vacation rental on Balboa Island-very mood uplifting) in order to have the catheter removed etc.

What is so mportant is state of mind.  Do the work, find the one you feel the most comfortable with and follow your instincts. I thought that Dr. Abaza's stats looked good, except that I take exception to lymph node removal as a matter of course.  But that is a whole other subject.

Becky


Age 51

Gleason 3+3

PSA from 3.2 to 4.3 in one yr

Biopsy 11/06

DRE negative

4 of 12 cores positive, one lobe, less than 10%

Inflammation only second lobe

Stage T1C Clinical Dx

PSA prior to surgery: 3.9

Da Vinci Prostatectomy 2/27/07:

PCa in BOTH lobes 5-10% of gland

Gleason 3+3

Negative tissue margins

Bladder, seminal ves, vas deferntia negative

Two inguinal hernia repairs

Catheter removed 1 wk after surgery

Full continence (no pad needed) 1 wk after surgery, then intermittent drips 4 wks out

Full erection, 12th day after surgery

2 mo’s post-op, some ED after penetration

3 month PSA 0.03

6 month PSA non-existent

1 year   PSA  non-existent

1 1/2 yr PSA  non-existent

Erectile function--up and running!

Two year anniversary on 2/27/09-Sex life back to normal!

 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 10/3/2009 8:26 PM (GMT -6)   
Not to be half full or half empty or dark side (hello friends and lovers). Patrick Walsh the 'best and reknown expert of surgery for PCa-apparently' the Hollywoods pick and upper escheleon's pick of doctors, and if I were a real candidate for surgery would also probably wish I had such a person available. First off does surgery only on patients with Gleason level of 7 and under and usually hand picks his choices, many are gleason 6 level patients. Does not touch higher risk patients, also not to diminish his published or assumed cure rates via his own choosing and wisdom.

Do you have any idea what his cure rate is considered to be at this time???
Are you thinking 95% or higher???? You might have to get darker or less of a full glass here (LOL).

You will be surprised when you find out.

Just an observation on the PCa world that we have to deal with.
 "I wouldn't join a club that would have me as a member" (Groucho Marx)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/3/2009 8:48 PM (GMT -6)   
It's been known for years that Dr. Walsh cherry picks his surgical patients, and yep, mostly low grade gleason 6 cases, and yep, does keep his published statistics for "cures" amazingly good. No denying that. But he's still considered a world class surgeon, and has done a lot of good over the years. He would have never taken my case from the start, but that doesn't hurt my feelings. Wasn't trying to chase after a brand name doctor or a celebrity class doctor. Too poor for that.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


pa69
Regular Member


Date Joined Mar 2009
Total Posts : 260
   Posted 10/3/2009 9:03 PM (GMT -6)   
Prior to my diagnosis for PC I suffered near urinary blockage for a number of years. There were times when I'd try to relieve myself and just couldn't. I finally was forced to seek medical help. If you review my stats you can see I was well along with my PC before I was willing to face it.

An associate I work with had prostrate surgery about 3 years ago. He treated it with little importance and seems to be in good health, so I took the news lightly when it was recommended that I have surgery to remove the prostrate. I never did any research and I let my family doctor select a urologist for me.

I met with my uro who exhibited a high degree of confidence and was willing to spend as much time with me as I and my family wanted. He told me he had done more than 300 robotic surgerys. I asked him if he had experience playing video games.

My surgery required more than 6.5 hours due to the advanced condition I was in. Among other things the bladder needed repair work.

At this time, about 10 months post surgery, my PSA level is still undetectable even though I was a stage 3. This is the most important factor. I'm still 100% ED even though the nerves were spared. At my age I don't really care. I'm still suffering mild incontinence but if I'm careful I can go the whole day without protection. This is something that I think will go away in time.

So you see I was in a relatively advanced condition. My surgery took place at a small town hospital by a urologist that to the best of my knowledge is an unknown. Compared to how I was feeling prior to surgery my quality of life has improved immensely. The surgeon might be an unknown but I think he did an awesome job considering what he had to work with.

After my surgery during my convalescence I stumbled upon this site and began to learn how serious and complex the procedure I'd been through was. Looking back I believe I took all the right steps but it wasn't because I knew what I was doing. Most of it was sheer luck. It certainly doesn't hurt to take a good look at the small town hospital and surgical staff in your own home town either.

Wishing everyone well,
Bob
Age 70, First ever PSA 7.8 taken June 2008, Biopsy July 2008, 10 of 12 cores positive, Gleason 3+3=6
da Vinci surgery December 10, 2008, catheter removed December 29 2008
St. Lukes Hospital, Bethlehem, Pa.
Dr. Frank Tamarkin
Prostate weight 73.0 grams, Gleason 3+3=6, stage pT3a
Tumor locations: right anterior apex, right posterior apex to mid
left anterior mid to base, left posterior apex to mid
extensive perineural invasion in right anterior apex, right and left posterior apex to mid
seminal vesicles negative
Three PSA tests undetectable, latest July 18


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/3/2009 9:50 PM (GMT -6)   
Bob,

Your 3 zero post surgery psa tests are great news, that's what you want. I personally agree with you, if there is a qualified surgeon with a good track record and sufficient experience where you live, why not use him/her. I did, and from what I have read of some of the high rated - known surgeons, not convinced from the data that they were any better in the post surgery side effects. While the skill of your surgeon is very important to consider, each body reacts differently to surgery and its aftermath. Also, a persons pre-surgery medical condtion and history has a lot to do with it as well. Considering the size of your prostate and the fact that you were a stage 3, looks like you are holding your own.

I hope you continue on that path, and keep those zeros coming in for many more years.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 10/3/2009 10:03 PM (GMT -6)   
Becky, I agree every word you said. i am glad that someone is in my shoe who know what I will go through. I read your signature, your husband's recovery is BEAUTIFUL! He is doing great!

pa69, though your stage was advanced but your psa and gleason scoure are not bad at all. My husband's father had similar situation like yours. He went to see doctor after he had symptom then fund out his PSA is 19. he was 73 at the time. He didn't had surgery, just radiation. now 10+ year past he still doing fine.
husband 55 years young
PSA July 2009 5.5
Diagnosis confirmed Sep 21, 2009
12 Needle Biopsy = 7 clear , 5 postive
<2%, 10%, 25%
Gleason Score (3+3) 6 in all positive cores
stage T1c
Surgery or Radiation?

Post Edited (qjenxu) : 10/4/2009 6:39:49 AM (GMT-6)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3741
   Posted 10/4/2009 6:38 AM (GMT -6)   
Those statistics are interesting but don't tell the full story. I'd like to see: incontinence rates at 3 month, 6 month, 1 year. Potency rates without drugs at 6month, 1 year. Potency rates with drugs at 6 months 1 year. PSA at 6 months and one year.
Every man on this list can write their own numbers in 30 seconds.
Those are more important to me than operating time, days on catheter, etc. (writing this while wearing a pad. )

Maybe this is just me but I am not convinced "2000 surgeries" is better than 500 for example. when they have it that mechanized. 2.5 hours (and when they are getting $3000 per surgery) I believe there is a temptation to do multiples per day 3? 4? If it is no big deal for them then maybe they went out the night before.
If you have to wait 6 months before the procedure that might indicate he is a great surgeon, but it will definitely indicate you are a number.
I want my surgeon to know me. And I want to know where he lives. ;-)
Jeff

Post Edited (Worried Guy) : 10/4/2009 6:10:47 AM (GMT-6)


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 10/4/2009 7:48 AM (GMT -6)   
OhioState, I was just joking with zufus. Maybe halloween is here soon. please don't take it seriously.
Jennifer
husband 55 years young
PSA July 2009 5.5
Diagnosis confirmed Sep 21, 2009
12 Needle Biopsy = 7 clear , 5 postive
<2%, 10%, 25%
Gleason Score (3+3) 6 in all positive cores
stage T1c
Surgery or Radiation?


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 10/4/2009 7:53 AM (GMT -6)   
Worried Guy, by reading all the input here, I do open my eyes knowing so much I need to know when choose a surgeon. I like to ask you guys, when you guys choose surgeon, how many you interviewed? how you decide if one is good enough for you?
husband 55 years young
PSA July 2009 5.5
Diagnosis confirmed Sep 21, 2009
12 Needle Biopsy = 7 clear , 5 postive
<2%, 10%, 25%
Gleason Score (3+3) 6 in all positive cores
stage T1c
Surgery or Radiation?


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/4/2009 8:55 AM (GMT -6)   
Jennifer,

Sure I will get laughed at or slammed for my answer. In my case: just one. Have lived in the local area for 16 years, used the same GP for 13 of that, my wife is a well experienced nurse. The number of good surgeons in my area is limited, and those with an excellent reputation is on a short list. I was refered to the surgeon that was on the top of that list, considered the best urological surgeon in the state, not just my area. He is an open surgeon guy, and had performed 400 plus. Robotic was too new in my area, at the time, only about 15 had been done, and in the end, complications with my body would have excluded me from robotic.

It was just as important to include my family in the entire process, and the logisitics and expense of having it done several hours out of the area was just too complicated and expensive.

Now if I had lived somewhere without a suitable and qualified surgeon, would have had to explore other options. The sheer numbers of operations gets blown out I think sometimes. you also want a quality operation, not just a guy that did 5,000 of them. Plus if you look at the post surgery condition of some of the men with the high buck surgeons, not convinced they are any better off.

Just my take,


David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 10/4/2009 10:07 AM (GMT -6)   
Hi Jennifer,

I spoke directly one-on-one with four surgeons, but one was a relative and not a candidate. The first, the guy who did the biopsy, was an open surgeon. The second was a da Vinci surgeon. The third was an open surgeon who did HIFU. I had an appointment to see a second da Vinci surgeon but after meeting the first, and going to a pre-surgery clinic at his hospital, I was convinced that if I was going to be eviscerated he was THE person I wanted doing the work and the hospital he worked out of THE place I wanted it done. In addition, through a close doctor friend, I got information and feed back on several other surgeons and did a lot of research on HIFU. One of the best resources I found for checking out a surgeon was the anethetists who worked with them. Through my doctor friend I got some fascinating feedback on surgeons from the folks at the head of the table passing gas. If I was sure I was a Gleason 6 I'd likely have had the HIFU in Toronto. But, as a second pathology reading said I was a 3 + 4 = 7 I knew that although statistically I was still an excellent candidate for HIFU I wanted to know the pathology of the whole prostate and what I was facing. It was a personality choice -- what I would be happy and could best live with --- not so much a medical one.

Now. Travel. da Vinci wasn't available in my home city, Winnipeg, and so I went to Edmonton. At first I wished I'd just been able to stay at home, close to friends and support. Turns out I was delighted to be away from home and friends and support. My sister (bless her) flew in from Victoria to be with us, and that was nice. But what was really nice was she was the only family/visitor I had. No one from the office showing up. No family coming by to see how my urine bag was doing. PLUS after one night in the hospital I was in a hotel just a couple of blocks away. For $89 a night (hospital rate) we had clean sheets every night, clean towels, room service, a huge TV I could watch from bed, wireless internet, halls to walk in, an elevator, a coffee shop, a barber where I had my hair cut, a little shop with all sorts of goodies to look at, interesting places to walk outside, and a big enclosed shopping mall near by where we went every day to walk and to have lunch.

It was like a week vacation package to Hawaii, except no beach. No business papers, no need to deal with getting the lawn cut, no yoga class for my wife to decide if she would attend, or stay home with me, not postman bringing bills, no need to grocery shop. It was wonderful. My surgery was on Monday, we were booked to fly home on Friday, but on Thursday we were enjoying being on our own, and staying in the hotel, so much we moved our go-home flight to Sunday.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3741
   Posted 10/4/2009 10:57 AM (GMT -6)   
I spoke with an operating room nurse who has seen many surgeries. One surgeon was famous for doing open RP but was rude to the staff and sloppy in the room. Unofficially of course the staff called him "the Sanguinator". (look up "sanguine". It means he was messy and left blood all over the place.) However, he was well respected outside of the OR.
The surgeon I selected to do my DaVinci was recommended by two OR room insiders. He was skillful, polite, accessible and had a good track record.
My appointment with him was on time, not rushed, and we could talk freely. I did not shop around after meeting him.

Doc
New Member


Date Joined Sep 2009
Total Posts : 18
   Posted 10/4/2009 11:45 AM (GMT -6)   
Jennifer -

Sounds like ou have only good choices here, so rest easy.

In my research, I found that the "plateau" for established urologists learning daVinci surgery was around 300 cases or so. That is the point at which docs who felt quite comfortable doing open retropubic prostatectomy developed an equivalent sense of comort and competency working at the robotic console. So I agree that doing 5000 daVinci procedures is not nececessarily better than doing 700. In fact, I would be concerned about a surgeon who has so many cases that they are booking 3+ per day. In such an environment, multiple robots are required to maintain the throughput. That means that case #2 may be started by fellows or assistants before case #1 is finished. So then what happens to pt #2 (already asleep on the table, robot docked, ports in place) if your super-experienced primary surgeon is delayed by some complication in his first case that day? Best to be blunt and ask about that, and also do whatever you can to be sure you are daVinci case #1 for your surgeon that day.

One unusual statistic you mentioned was an average of 11 nodes per pt - that seems extraordinarily high, especially since 92% of your surgeons cases were pT2. Even back in the "bad old days" when everyone got retropubic dissections and nodes were easy to grab, I seldom saw more than 5 ot 6 nodes coming out with a prostate. The stats you provided otherwise were quite good. But face it, as much as you want to control this process, the disease going into surgery is what it is, and you have no control over that. Any surgeons margins are better on pT2 cases than pT3, so if you get down to the point of comparing surgeon A vs B, be sure you are looking at stage-matched data where possible.

One final piece of information you may seek is how complications are dealt with. Local urologists who do NOT do daVinci can probably tell you about that. Face it, there is a lot of marketing going on in this niche surgery, especially among some of the large programs that are competing for non-insurance cash business. Having to document late complications (strictures, etc) reflects poorly on the outcome statistics of the overall program, so these pts may be referred back to their primary referring urologist for treatment. Your local urologist should know if the big referral center is being honest in dealing with their complications.

Best regards,

Doc
PCa Dx 07/09: 3+3 in 2 cores
Age at Dx 54
daVinci RRP 09/17/09
Final path 3+3, <5%, margins neg, pT2a.
 


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 10/4/2009 12:12 PM (GMT -6)   
Jennifer

I interviewed only one but he was part of a practice with many urologist/surgeons that also did da vinci. He consulted with the whole practice before deciding that I was too "at risk" for either seeds or da vinci. He was also Chief of Surgery for a number of years at the hospital where I had the surgery.

As it turned out, I'm quite happy with the results. Incontinence was over quickly, ED took longer and turned into Peyronies Disease but I think that was my fault. I injected too close to my body for awhile.

My PSA has stayed at zero for over 18 months, so the most important thing is that it's gone. I can live with the rest.
Age 60, PSA 2007 4.1, PSA 2008 10.0
Diagnosed April 2008, Biopsy: 6 of 12 cores positive, Gleason 4 + 5 = 9
CT and Bone Scan negative, Open surgery at Shawnee Mission Medical Center May 21, 2008
Right side nerves spared, Radical prostatectomy and lymph node dissection
Cather removed on June 3rd, totally dry on July 9th, pT2c, lymph nodes negative
PSA Sept 28, 2008 0.00, PSA Jan 22, 2009 0.00, PSA June 29, 2009 0.00
ED Status- Currently using Trimix, Levitra daily for increased blood flow.
Noctural Erections have completely returned on a nightly basis, same hardness as before.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 10/4/2009 2:26 PM (GMT -6)   
Greetings, Jennifer.  Just a couple of thoughts that helped me make my decision.  I was prepared to go to another place if I felt like it was necessary.  Since I live in the Richmond, VA area, the most common place that people recommended I should try was Johns Hopkins.  The first contributing factor to my staying in Richmond was the fact that I had great confidence in my urologist who diagnosed the cancer.  I had seen him a few times with other diagnoses (mainly kidney stones) and had come to not only like him but to have confidence in what he said.  He doesn't do cancer surgery and highly recommended the surgeon I eventually used.  In fact he said if he ever had to have surgery, the doc he was recommending would be the only doc he'd use.
 
I met with the surgeon and he spent an hour with my wife and me - and yes it is most definitely a couples disease.  The men may have the surgery but the women get us through it and are more important in recovery than any other single factor.  After we decided that he was the guy, I didn't pursue going out of town or talking to any others.  I also made sure that I was scheduled to be the first surgery on Monday morning.  You don't want to be his last surgery of the day or to be later in the week when he is not as fresh.
 
Finally, after we were convinced that we had found the right guy, i asked my son who worked at the same hospital my surgeon uses to do some checking.  The OR folks said he was top notch - very professional - and had excellent results. My son worked in the cardiac cath lab so ended up in OR on occasion when his procedures went bad so he had access to good information.   
 
Please keep us posted on how things are going.  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


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 10/4/2009 2:56 PM (GMT -6)   

In defense of zufus...not that he needs any help, but I find his skepticism to provide a healthy balance on this forum.  I do not find his commentary any more radical that that of one poster who repeatedly (and naively, IMHO) encourages patients to put their faith in their primary care doc to guide them through the process.

I personally "interviewed" multiple doctors in multiple disciplines before making a decision.  One noted robotic surgeon didn't even do a DRE...just looked at my pathology and, within 5 minutes, tried to get me to schedule the robotic surgery.  Do you think that just maybe he had a bit of interest in amortizing the cost of his robot by doing a ton of surgeries?  Look...there are surely good docs and ones that graduated at the bottom of their classes.  The best approach, again IMHO, is to become well informed before making a decision.  If zufus helps just one patient maintain some healthy skepticism then his posts are certainly well worth reading...

Tudpock


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 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!
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