I think this whole discussion is getting blown way out of sensibilty. I think we would all agree that any kind of radical prostate surgery is very complex, even with the best of doctors and the best of conditions. I think we would all agree, that if one is going to undergo surgery, they need to have the most experienced surgeon that they access and resources for, those two things go hand in hand.
When you get into the experience factor with a surgeon, its not so cut and dry. It's not something you can look up in a book and simply make a choice. The experience level depends on lots of factors, not just how many robotic or how many
open surgeries the dr. has done. A better question, does he do them well? How does he treat his patients? Is he really in tune to them? What kind of follow up does the doctor do with his patients? Etc, etc. The raw number part is very subjective at best.
On behalf of some of the newer men in here, or their "other halves" representing them, sometimes it hangs in the air, that unless you have some "name brand" surgeon operating out of a "name brand" hospital or clinic, you are going to get something less than first class treatment or results. I don't like that kind of thinking. Picking medical services shouldn't be like some botique shopping experience.
For the average Joe in here, like me, and probably for most that frequent here, we don't have unlimited time, money, logistics, or perhaps not even the greatest of health insurance to secure the alledged premium doctors and hospitals. Not everyone can fly to Europe for a test, or have a non-FDA treatment done outside the US, or go to a John Hopkins class hospital. But that doesn't mean our doctors, hospitals, or radiation clinics are any less first class.
I for one, am still content having a local surgeon, with nearly 30 years experience, that had done around 400-500
open surgeries, and had it done at the hospital that most of your would never have heard of , nor would I expecty anyone outside of SC to, that wins year after years the best patient care in the state.
I do not blame my surgeon for my recurrance issue, or my blockage issues. My problems are related to my own case and my own body.
Some times, in my opinion, these technical disccusions here get way beyond the needs of the average guy/patient dealing with PC. Disputes on how many surgeries a doctor has or hasn't done, won't help someone make an intelligent choice.
We also have men here, that chose and could afford to go to some of the best names in the country, at a top 10 hospital, etc, and have not had any better "luck" in erradicating their cancer then the rest of us. Some of these men have had almost instant recurrance, or terrible ED results despite having expert surgeons doing the nerve sparing ops.
On the issue of overtreatment, I think there is merit for that, but I am not sure by what standards we could all agree to. Giving bone scans, cat scans, and MRI as a prelude to an entry level, low grade, low core/% gleason 6 case to me, seems like an incredible waste of resources. That money could be well spent in other areas.
The problem would be, would it be fair to tell a man with a Gleason 6 in the perfect criteria for AS/WW that he can't have surgery, or cant undergo RT, until his cancer shows that is on the more, or has become more agressive? Who would get to decide that? With what I know now, after the fact, and considering just what I have and am still going thorugh, if I had met the criteria with a non-agressive low grade dose of PC, I for one, would absolutely be doing AS/WW without a doubt.
I have already played out my surgery card and my salvage radiation cards, in just a little over 13 months. I don't anything left curative on the table. No, not feeling sorry for myself, just the cards I was dealt, and I am trying to make the best out of it, and hoping I don't lose out on the next round of percentages.
As long as there are radiation clinics making big bucks, and surgeons making big bucks and hospitals competing for the same patients along with health insurance providers making deals in the dark for the money, not sure how it could ever be resolved.
Something needs to change. From a PC patient vantage, I think, and it has been discussed here a million times, that perhaps when a perfect test method that can tell the difference between non agressive and agressive prostate cancer can be developed, this circle will probably keep going round and round.
Meanwhile, all of us, experienced or new to the cancer world, will just have to keep making choices with what we have in front of us, and hope for the best for our own lives.
David in SC
57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.33rd Biopsy
: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3Open RP:
11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09Path Rpt
: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin