in search of the best robotic surgeon

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bcc
Regular Member


Date Joined Oct 2009
Total Posts : 46
   Posted 1/13/2010 5:31 AM (GMT -6)   
hi one and all. some of you may recall i was hoping to be able to have hifu but after 32 part template biopsy i have been told that hifu would have to hit all of prostate so its benefits over rp are greatly deminished ,so surgeon now suggests rp. i can have it done in uk but have heard there a some more experienced guys in the us .anybody got any names or can i check anywhere who has done the most with the best results cheers barry
PSA Aug 07 was 3, Mid 08, 3.5, mid 09, 7.27

First biopsy july 09 - t2a on left . 11 samples taken from 6 blocks. 4 blocks show positive for adenocarcinoma. 1 block 10%, 3 blocks 5%, overall gleason 3 plus 4. No perineural invasion seen. Seminal vesicles clear.

End Oct 2009, bone scan all clear, MRI shows 6mm lesion on bottom left and rest of gland diffused image. Late Nov 2009, a template biopsy of 32 from 20 sites adenocarcinoma, gleason 3 plus 4 at 10 sites; unfortunately spread over both left and right.


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4848
   Posted 1/13/2010 8:46 AM (GMT -6)   
Food for thought-> even the best surgeon in the WORLD can have a BAD DAY...
 
As large as the UK is - surly there are some very good surgeons...But I guess if money is no object - come on oversmilewinkgrin
 
Approx when were you thinking of coming over?
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
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


bcc
Regular Member


Date Joined Oct 2009
Total Posts : 46
   Posted 1/13/2010 9:15 AM (GMT -6)   
hi steve we all have bad days .we have a few good ones but one guy wanted to make me his first, no thanks.cant do anything till mid march due to biopsy cheers barry
PSA Aug 07 was 3, Mid 08, 3.5, mid 09, 7.27

First biopsy july 09 - t2a on left . 11 samples taken from 6 blocks. 4 blocks show positive for adenocarcinoma. 1 block 10%, 3 blocks 5%, overall gleason 3 plus 4. No perineural invasion seen. Seminal vesicles clear.

End Oct 2009, bone scan all clear, MRI shows 6mm lesion on bottom left and rest of gland diffused image. Late Nov 2009, a template biopsy of 32 from 20 sites adenocarcinoma, gleason 3 plus 4 at 10 sites; unfortunately spread over both left and right.


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 1/13/2010 9:47 AM (GMT -6)   
Bcc,
There are a lot of good ones and not just here. But if you had an idea of what city you would prefer that might help narrow it down. I agree with you I dont want to be the first. A regional hospital near me started Robotic last year and I was told by my wife's surgeon that the first surgery took 8 hours, ouch. I went to Atlanta as they had 2 who had performed over 1 thousand robotic surguries. Best to you in your research and you should be hearing from others soon.
Take care
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Consulting with Primary Urologist for further tx.
Great family and friends
Michael


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 1/13/2010 10:16 AM (GMT -6)   
No reply needed, of course, but are you certain you want to go robot? A really good open surgeon will likely create no additional post-op problems for you, and he'll have a much better view of the "theater of operations."

Just my own prejudices, of course, based upon my own open-surgery experience and the robot experience of others I know or know of. Minimally-invasive surgeries are generally gaining in popularity for many good reasons, but PCa surgery is one where I think the downside (not being able to see tissue surrounding the gland nearly so well) outweighs the benefits overall.
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, lymph node involvement 0/9, perineural invasion, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: 1 maxipad/day, with minor leakage when I get up from long seated position; ED pretty complete: some erection possible but current non-functional


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/13/2010 10:25 AM (GMT -6)   
bcc, when you say the surgeon recommends rp, it is unclear whether you are meaning rp=radical prostatectomy (usually means open) or meaning rrp, which is robotic radical prostatectomy. If you are speaking of robotic, ie- DaVinci, then MaxBuck has a point. There's lots of experienced rp (open) surgeons around, whereas you may have trouble finding an experienced RRP surgeon in your location. Such was my case, and I had a really good outcome from my open surgery. The open guys have ben doing it for decades, whereas the RRP ones are still on the expanding curve, not always available at a location that helps some of us. Just something to think about. P
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


bcc
Regular Member


Date Joined Oct 2009
Total Posts : 46
   Posted 1/13/2010 12:35 PM (GMT -6)   
hi james and maxbuck you both make good points about open but i have heard that a lot of surgeons are keen to use robots and if so many of our nhs hospitals are spending a fortune on the machines i think they must be confident in the system.i looked at several vieos on utube of the rad operation and the surgeons seened to think the visibility was enhnced and the control was better as therewas no chance of shaking cheers barry
PSA Aug 07 was 3, Mid 08, 3.5, mid 09, 7.27

First biopsy july 09 - t2a on left . 11 samples taken from 6 blocks. 4 blocks show positive for adenocarcinoma. 1 block 10%, 3 blocks 5%, overall gleason 3 plus 4. No perineural invasion seen. Seminal vesicles clear.

End Oct 2009, bone scan all clear, MRI shows 6mm lesion on bottom left and rest of gland diffused image. Late Nov 2009, a template biopsy of 32 from 20 sites adenocarcinoma, gleason 3 plus 4 at 10 sites; unfortunately spread over both left and right.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/13/2010 12:46 PM (GMT -6)   
bcc You are spot-on. With information known today, it is not possible to say that one procedure is better than the other. Your best bet is to find an outstanding & experienced surgeon and let him use whatever tools he feels most confident with.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 1/13/2010 12:54 PM (GMT -6)   
BCC,
I had my rrp in Austin Texas done by Dr. Randy Fagin. He has done over 1200 DaVinci surgeries and is World known. There are many others. I've heard of a Dr Joseph in Rochester N.Y. Many on this Forum have had good experiences with other doctors.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/13/2010 1:05 PM (GMT -6)   
bcc, just as a cautionary measure, I'm gonna repeat that experience is the deal breaker for us. A health care system that is switching over to the new robotics is naturally enthused about it, but this also reminds us that their surgeons may not have the skills to do the new-to-them procedure. Given the choice between an open surgeon with hundreds of procedures and a robotic one just beginning the learning curve, I would personally choose the open. I may be reading what you are saying about the new system being pushed wrong, but it sounds like you are saying since the procedure is new and the system is excited about it, that you are willing to go with them even if their surgeons haven't been doing it many times. . Personaly, I wouldn't use a robotics surgeon with less than a couple hundred operations under their belt. The learning curve for it is steep and difficult. That you are in the NHS may make a difference in what you are able to get, but I would really be cautious about how much experience and how many procedures my surgeon has had. I'm not discounting the system itself, just the skills required to do a good job. Coming to the State, Canada or another European country is a whole different ballgame. Again, just my personal opinion.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4848
   Posted 1/13/2010 1:14 PM (GMT -6)   
If you come to the US will you be coming alone? Seems like a trip for 2 to the US for several weeks will cost more then the operation.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 1/13/2010 2:34 PM (GMT -6)   

Dear bcc:

There are plenty of great robotic (and open) surgeons in the USA and I will leave it to others to give their personal perspectives as appropriate.  However, I think the info you got from James in his last post was spot on...experience counts.  There are many studies that show this to be true.  In a recent presentation, one of the world's best known prostate surgeons, Dr. Peter Scardino, made these points concernng experience:

  • It takes about 250 operations to learn to do a radical prostatectomy well.
  • Even then, good surgeons are improving their skill and technique until they have done at least 1,000 procedures.
  •  
    One other thought...have you considered brachytherapy and/or IMRT?  Many men (including me) have had great succes with this non-surgical approach.  Studies conclude that the cancer cures are just as good as for surgery.  And...the side effects are far les onerous.  Anyway, for your consideration...
     
    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 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

    Paul1959
    Veteran Member


    Date Joined Nov 2007
    Total Posts : 598
       Posted 1/13/2010 5:35 PM (GMT -6)   
    David Samadi at www.RoboticOncology.com is certainly one of the most prolific here. He is now the favored Dr. for the New York Times. He is practically superstar in NYC when it comes to that whole Dr. persona thing. He is on TV and in the paper all the time. Very vocal proponent for PCa treatments. He is proficient on open, Laparascopic and Robotic. As he said, if something comes up and he needs to finish surgery as an open procedure, he is skilled to do it. He was with Memorial Sloan Kettering, Columbia-Presbyterian then finally Mt. Sinai gave him the moon to go there.
    He is also an amazing person - smuggled out of Iran as an orphan boy during the revolution, raised on the kindness of strangers, he considers it his mission in life to give back to all the people who helped him. Gives you his cell phone etc.
    Paul
    www.franktalk.org ED website for PCa guys

    46 at Diagnosis.
    Father died of Pca 4/07 at 86.
    10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
    Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
    Saved both nerve bundles.
    Path Report: Stage T2cNxMx
    -Gleason (3+3)6
    Pad free on March 14 - (10 weeks.) Never a problem since.
    ED - at one year, ED is fine with viagra.
    Two year PSA - undetectable!


    Tony Crispino
    Veteran Member


    Date Joined Dec 2006
    Total Posts : 8128
       Posted 1/14/2010 2:15 AM (GMT -6)   
    The surgeon experience is more important than the procedure selected.

    LOL...I know of quite a few with over 2000 RP's like Walsh/Catalona/Menon/Kawachi/Carroll/Patel as examples. If each would be available to do your surgery in the time you want to proceed, then I'd choose the best city next to spend a few weeks. In that order it's Baltimore/Chicago/Detroit/Los Angeles/San Francisco/Orlando...Orlando and LA are best during the winter? And as Mark Twain said "The coldest winter I ever saw was a summer in San Franciso" :-)

    Choose the best surgeon you can, not the procedure, er, or the city...

    Tony
    Prostate Cancer Forum Co-Moderator


    Casey59
    Veteran Member


    Date Joined Sep 2009
    Total Posts : 3172
       Posted 1/14/2010 7:51 AM (GMT -6)   

    This is my second reply in this thread.

    I agree with Tony in the previous thread when he said "Choose the best surgeon you can, not the procedure, er, or the city...".  Tony's comment was consistent with my prior posting which said "...find an outstanding & experienced surgeon and let him use whatever tools he feels most confident with."

    These comments notwithstanding, I saw some additional data this morning that might also help you.  IF you are mentally locked-in to robotic surgery, then this list shows the hospitals that have performed the greatest number of RLRP (Robotic-assisted Laparoscopic Radical Prostatectomies) as of June 2008.  In either procedure, you will generally get the best results from the most experienced surgeons.
    1. Henry Ford
    2. City of Hope
    3. St Vincent AL
    4. USMD Hospital
    5. Vanderbilt
    6. Univ of Chicago
    7. Cornell
    8. Strong Memorial
    9. Hackensack
    10. OSU

    Ref.:  http://www.weisshospital.com/robotic-surgery/questions-to-ask/

    Use the hospital web site to find the specific experienced doctors.

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