Speaking of MD Anderson...?

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 11/16/2009 7:47 PM (GMT -6)   
Has anyone actually gone there for dx and/or treatment? If so, your impressions?
 
Also, if one is dx. with PC, is it worth going to a world class place like MD Anderson?
 
I'm thinking probably not for the "garden variety" PC (of course, one never knows if it is garden variety!) as there are plenty of really good experts all over the place. True?
 
Mel
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 11/16/2009 7:56 PM (GMT -6)   
Mel,

My wife has been going to MD Anderson, Houston since her diagnosis in November 2005. She required a Stem Cell Transplant and her insurance company considers them a Center of Excellence for SC transplants, among other things. We go there regularly about every 6 months. She goes to MDA Orlando (where we live) for the every day things and tests.

I talked with the folks out in Texas before I decided on my surgeon. In my case I felt that the doctor I chose was the right one for me. MDA is a fantastic facility full of top notch people, but my doc is regarded as one of the top 5-10 in the da Vinci arena.

I have a meeting tomorrow with a Prostate Radiation Oncologist at MDA Orlando to discuss my pending IMRT. He comes highly recommended and MDA has one of the best radiation facilities in Florida. Don't feel like I have to go to Texas for the radiation treatments.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 11/16/2009 8:01 PM (GMT -6)   

Hi Sonny:

 

Let us know what the radiation guys have to say!

 

Mel


PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 11/16/2009 8:11 PM (GMT -6)   
Yep, unless they just tell me to lean over, put my head between my legs and kiss my arse goodbye.

Sonny
61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
ALL NERVES SPARED
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 11/16/2009 9:21 PM (GMT -6)   
I live in Houston and had my second opinion at MDA. MDA is great but I never could convince myself they were perfect for all cancers. With that said, I stayed with my doctor and he is associated with Methodist Hospital. I didn't have anything against MDA but felt more comfortable with the doctor that diagnosed me with cancer.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 11/16/2009 10:35 PM (GMT -6)   
There was a recent study that showed that community hospitals had the same success rates with low grade PC as did the major cancer centers, but there was a large difference in survival rates when high grade or aggressive PC was involved.
So my take is that if you have low risk stats, low psa and G6 or G7 a local doctor would be OK, but when you are dealing with a G8 and above or a high PSA a place like Anderson would be the place to go.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 11/17/2009 11:02 AM (GMT -6)   
My friends:
 
I went to M. D. Anderson for my third opinion and eventually to have my Da Vinci surgery done in August 2008.  I have so many thoughts about MDA, but for this post I will generally try to keep my personal story out of it and try to give a broader picture.  One as objective as I can make it!
 
MDA has been the place to go for cancer treatment in Houston for many decades.  Here in Houston most people immediately think of MDA if they or a loved one gets cancer.  Until recently, to get in you had to know someone with connections there or have a particularly interesting case - MDA treats not only people from Texas and the surrounding areas of the United States but also the wealthy and powerful from all over the world. 
 
But things are changing, and for the last several months we have been hearing and seeing TV and radio advertisements for MDA saying that if you have been diagnosed with cancer, appointments are now available (including a special commercial about their proton beam center for PC).  That is an amazing development.  But I am getting ahead of myself.
 
MDA has a very well-staffed and expert fundraising and PR department.  It is tightly tied in with all the movers and shakers in Houston, and there is still a social and professional taboo about saying anything about MDA that even smacks of criticism.
 
There is no doubt that MDA is staffed with some of the best cancer specialists in the world [I was happy with Dr. John Davis there for robotic PC surgery, by the way].  But recently some people - including me - have been starting to speak more freely about our experiences there. 
 
During the past decade or so, many feel that MDA has gotten complacent.  Many people who work there - not all, by any means - have developed the attitude of "I am with MDA - you are extremely fortunate that I am talking with you.  So ... you will show up on time, you will wait for many hours, you will not ask when you will be seen, you will not leave to get something to eat, you will do what I tell you to do when I tell you to do it, and you will remain cheerful and very grateful towards me at all times." 
 
Other hospitals in town are picking up on this.  They have implemented programs to improve the personal experience of patients at their hospitals, and those programs are really starting to show results.  They sense that with an aging population which will get cancer in increasing numbers, there is a lot of money at stake here and that MDA is ripe for the picking.  As I said earlier, MDA is starting to fight back with a big media blitz - something that would have been unthinkable until very recently.
 
The Memorial Hermann Hospital Group in particular is investing a lot of money in facilities, doctors, and staff to make a run at MDA.  But other hospitals, including St. Luke's and Methodist, have had good cancer programs for a while [an aside: Dr. Brian Miles at Methodist has a good reputation for robotic surgery for PC; he was going to do my surgery until insurance problems intervened].  It will be fascinating to watch this titanic struggle for medical dollars between a world-renowned but perhaps too complacent MDA and very hungry competitors who see a real business opportunity here. 
 
Generally, I would say that if you have an early stage of one of the more "common" cancers (prostate, breast, colon, lung, etc.) and you want to be treated in Houston, I would look at one of the other hospitals to see if you can get the same quality levels as MDA but with a better overall patient experience.  [As always when dealing with cancer or any other serious illness, due diligence is critical.]  If you have an advanced stage of any cancer, or a case of a more unusual or highly aggressive cancer (tongue, anal, pancreatic, etc.), I think you are still best served at MDA.  Just resign yourself to the arrogance and foolishness and resolve to keep your eye on the ultimate goal of survival. 
 
I'll write more if people are interested or have specific questions.
 
Obviously, all of the above is just my personal opinion; I may be wrong about any or all of it!
 
Zen9 
 
 

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 11/17/2009 2:47 PM (GMT -6)   
That is very interesting. I've heard generally very good stories about how people were treated at MDA. As you said, perhaps it has changed for the worse.

Mel
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro!
 
History of BPH/prostatitis.
 
Awaiting results of my PCA-3 test which will determine whether a biopsy is in my immediate future


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 11/17/2009 3:07 PM (GMT -6)   

Compiler,

There are certainly many people who speak highly of their experiences at MDA.  It is a huge organization, and no generalization - good, bad, or in between - is going to be completely accurate.

But I think it is almost beyond dispute that at least some other hospital organizations in town see a business opportunity in the current situation and are backing that insight with cash investments. 

I wish you luck and hope this entire discussion remains of academic interest only to you.

Zen9   


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1132
   Posted 11/17/2009 9:46 PM (GMT -6)   
Zen9, I was not prepared for MDA. It hit me like a ton of bricks going to MDA to see a doctor and seeing that huge waiting room (yep I am a wimp). However, my doctor seemed to be a total aXXhole. He is a great doctor but I did not have as good a relationship with him as I did with the surgeon I chose. Everyone kept telling me to go MDA but I was very happy with Methodist and the doctor I chose.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 11/18/2009 10:16 AM (GMT -6)   

rob2,

Yeah, MDA can be a scary place, can't it?  I was there by myself - how I envied the men who had spouses and/or friends for support!  You are not a wimp!

As I said in my post, I was all set to go with Brian Miles at Methodist until insurance reared its ugly head.  Methodist is a very good hospital, and I suspect that you were in good hands.
 
It seems that you made good choices, and I wish you all the best.
 
Zen9
 
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/18/2009 10:29 AM (GMT -6)   
Not too flattering a portrayal of MDA. Patient care is way high on my list. In the Greenville, SC area, we have two real choices, either the GHS (Greenville Hospital System) which is the largest hospital system, or St. Francis. In my 16 years in the area, I have had 9 surgeries, all of them at St. Francis. All of them good experiences, this hospital systems is the hands-down winner of patient care and satisfaction year after year, and for a reason. A dedicated and caring staff. GHS is much bigger, but people talk often about the blasse attitude of the staff and being more like a number to them then a person.

I contend that while I have absolutely nothing against big brand hospitals or name brand doctors, there are lots of good small community hospitals and doctors and specialists, that can do just as good a job in my opinion.

For a lot of here at HW, we don't have the financial resources, the highest level health insurances, and even the logisitics do seek out and use the other level of providers.

The trust factor between a doctor and patient is so very critical, you have to click, and I don't mean at some shallow personality level. You have to trust the advice you are given, you have to trust as much as your life into the hands of that doctor.

During my current rounds of SRT, I go to Cancer Center of Carolinas, and I am treated like a king when I walk in the door. Despite the number of patients they see in a day, they know me by name, always show the highest level of respect and dignity. The staff is sympathetic to the pains and sufferings of those they serve. This was an important factor to me in deciding this path.

The place your describe, if the rudeness and arrogance is really that obvious to a patient or patient's family, I would never darken their door.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place

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