Get A Surgeon Who Has Done At Least 500 Surgeries

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Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 5/20/2010 2:52 PM (GMT -6)   
I always read in these posts that you should select a surgeon who has done at least 500 surgeries.  How does a surgeon get to 500 surgeries if every patient picks a surgeon who had done at least 500 surgeries?  I picked a guy who had done 150 surgeries at my hospital & over 400 surgeries under Dr. Lee in Philadelphia.  I picked this guy because he was highly recommended & the hospital is only 20 miles away from me & is very highly rated.  I don't think I went wrong.  Yes, I have had severe incontinence but it is getting much better now 6 months after surgery.  My guy thinks it was due to the fact that my prostate was stuck to the rectal wall from the 4 biopsies over 4 years that I had.  On the positive side I was able to get a pretty good erection 18 days after surgery.  There are pluses & minuses of going to the guy at the big medical center who has done a lot of surgeries.  Many guys here complain that they never saw their surgeon after the procedure.  They were treated like a number.  I was not a number.  When I had problems, my surgeon was there for me to call or go see.  That can be a problem if you travel a few hundred miles to go to one of the big centers.  I have nothing against going with experience but remember each of these surgeons got their experience by doing operations 1 thru 500.  Yet no one wants to be patient number 499 or lower!  I think that you need to take every issue in to consideration when making a decision.  I also read a lot of criticisms on this forum of doctors.  Overall, I think the majority of them are sincere, hard working professionals.  These men & women work ungodly hours & they do make great money.  Overall though, I think they earn it.  The bottom line is that each of us is battlling a potentiallly fatal disease & each of us is unique & no two of us are the same.  This disease is relenltess & affects each of us differently.  Sorry for the rambling!
4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4177
   Posted 5/20/2010 3:01 PM (GMT -6)   
Dear Leaker:
 
I know there are other studies, but here is one that shows that experience does indeed count...at least at 250+
 
The article was summarized as follows in a Johns Hopkins health bulletin:

The importance of surgeon's experience as it relates to prostate cancer outcome is underscored by the results of a study reported in the Journal of the National Cancer Institute (volume 99, page 1171).

Researchers analyzed the outcomes of 7,765 radical prostatectomies performed by 72 surgeons between January 1987 and December 2003 at four major academic medical centers. "Biochemical" recurrence was defined as a postsurgery PSA level greater than 0.4 ng/mL followed by a subsequent higher PSA level. The analysis took into account patient and tumor characteristics, such as pre-operative PSA level and Gleason grade. The men's PSA levels were measured every three to four months in the first year after surgery, twice in the second year, and annually during the following years.

The researchers found that surgical outcomes improved along with the number of radical prostatectomies a surgeon had performed, leveling off only after about 250 surgeries. The five-year probability of experiencing a recurrence of prostate cancer was 18% for surgeons who had performed only 10 operations compared with 11% for surgeons who had performed at least 250 surgeries.

Bottom line on prostate cancer surgery: The results suggest that you can improve your odds of a successful outcome from radical prostatectomy by taking time to find a surgeon with extensive experience.

 
Tudpock (Jim)


Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!
Tudpock's Brachytherapy Journey: http://www.healingwell.com/community/default.aspx?f=35&m=1305643

Post Edited (Tudpock18) : 5/20/2010 2:07:19 PM (GMT-6)


Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 5/20/2010 3:08 PM (GMT -6)   
Tudpock18 said...
Dear Leaker:
 
I know there are other studies, but here is one that shows that experience does indeed count...at least at 250+
 
Tudpock (Jim)

Jim,

 

I realize that experience counts.  But back to my basic question, How does the surgeon get the experience if no one uses a surgeon with less than 250 operations?  I guess it's ok for the other guy to go to an inexperienced surgeon but not a good idea for us?  I'm not saying go to a guy who is doing his first surgery on his own, but how can every patient be number 500 plus?


4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 5/20/2010 3:16 PM (GMT -6)   
Some people have no choice -- they have to stay close to home, for financial or other reasons, and no surgeon where they live has substantial experience. Other people may be uninsured and have to take whomever is willing to do their surgery, as a "charity case." And then other patients simply do not make a smart choice -- they don't understand/appreciate the value of experience -- just like many other consumers, in various contexts, make suboptimal decisions. (Of course, those decisons can work out fine -- a guy can do his 5th surgery and do a great job -- but if you have options and you are playing the odds, then you might prefer the experienced guy to the inexperienced guy).
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/20/2010 3:43 PM (GMT -6)   
leaker, you brought up some good points in your post. we have men here that went out of their way to have the best of the best surgeon and went to a far away hospital, and still had no better results post surgeries. I have said all along, that there are great doctors and great surgeons tucked away here and there throughout the US and Canada. Just because they dont publish books or have a following, doesnt mean they don't do outstanding work. Its not always about brand names on everything. Experience is critical, but it is subjective in many ways. A big name surgeon may or may not actually do the work when it comes down to it, and may not even remember your name a month later.

medved - you too bring up a good point. due to family, other health issues, money, insurance limitations and other logistical reason, many of us dont have the option or luxury of handpicking a brand name solution to our PC treatment. Doesnt mean in any way that we are getting anything lesser at our respective local levels.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 5/20/2010 3:51 PM (GMT -6)   
There was a study that showed that in low risk cases, community settings had the same cure rate as the major centers. In high risk cases there was a significant difference in outcome between a community setting and a major cancer center. So I guess that anyone can cure a G6, but if you have a high risk PC your outcome will be a lot better if you pick a major center.

There is just too much evidence to ignore the fact that experience and skill level have a major impact in all treatments of PC. Even among the most experienced surgeons at MSK there is a 30% difference between the best of the best and worst of the best.

You have to believe that this forum contains a segment of the PC population that is more informed, more educated and more questioning than the average. Many patients simply take the advice of their 1st doctor without ever questioning it.

As my oncologist once told me, "Why would you even consider the 2nd best when the best is available?"
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


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 5/20/2010 3:53 PM (GMT -6)   
Heavy, perhaps you forget that a relatively small percentage of PCa patients come to this website, and I would venture to say that a great majority are uneducated in terms of their disease, treatment, and the expertise of the doctor. In fact, I would reckon that many don't want to know - that's what the doctors are for (to tell them). I do not mean this to be condescending in any way - just simply stating what I believe to be facts.

If I am correct, these individuals would account for the first 250 operations done by a surgeon. Most of us panic when we hear the word cancer and want to take care of it NOW. We often make decisions based on expediency without taking the time to think through the process. I also believe that many patients are reluctant to question a doctor and simply go with the flow. They might choose based on proximity (who's the closest to my home), or a friend's suggestion, their own doctor's recommendation. For those who do not have adequate insurance (or any insurance at all), cost is a major factor.

The bottom line is that not everyone wants to or can scour the country for the best of the best - sometimes we just have to go with what's available to us.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 5/20/2010 4:08 PM (GMT -6)   
I went against the norm. Going into the finding a surgeon, I wanted one that had done more than 250 surgeries. I ended up with a surgeon that had done 50 robotics and about 300 open. I ended up choosing him other more experienced surgeons because I felt more comfortable with him and he would email me and answer the hundreds of questions I had. I was lucky and do not disagree that experience counts but other issues should be considered. I have heard of surgeon performing over 5 surgeries a day and the surgeon gets upset if there are complications that cause him/her to spend more than 45 minutes in the operating room.
 
Age 48 at diagnosis
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
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 5/20/2010 5:00 PM (GMT -6)   
Here is a link to a surgeons results when he did his first 150 or so surgeries and you can see a big decrease in incontinence and impotence as his experience increased. He also grades other aspects of his patients recovery too

sites.google.com/site/drdommo/dr.savatta%27sresults
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery scheduled for 6/1/10


RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1247
   Posted 5/20/2010 5:08 PM (GMT -6)   
Does the number of operations completed make a surgeon a better surgeon?
 
Maybe, but I feel some are better trained (i.e. completed a DaVinci Fellowship) and/or are naturally better.  For example, I could bat against major league pitching a million times and I would still not be even a good batter .... .300 hitters are rare, and you won't make a .200 hittter better by sending him/her to the plate more often.  If a surgeon makes the same mistake 250+ times did they get better. 
 
I'm not saying that you shouldn't ask how many operations the surgeon has completed, but I think you should also ask what type of training they received (i.e. a fellowship), and what their batting average is when it comes to continence and ED. 
PSA 2007 - 2.8
PSA 11/24/2008 - 7.6
Pc Dx 2/11/09; age at Dx 62
RLP 4/20/09
Biopsy - Invasive moderately differentiated prostatic andenocarconoma; G 3+3=6; PT2C; No evidence of Seminal Vesicle or Extraprostatic Involvement; Margins clear; Tumor identified in sections from prostatic apex.
Immediately continent after removal of cath.
ED - Trimix works well; viagra @ 60%
PSA - 7/31/09 <0.06
PSA - 12/1/09 <0.06
PSA - 3/29/10 <0.06
 
 
 


tallguy
Regular Member


Date Joined Oct 2009
Total Posts : 417
   Posted 5/20/2010 6:25 PM (GMT -6)   
You always need to read the results of studies carefully. Since I am mostly concerny about the incontinence issue here is what I noticed from the link you included;
 
"The most current group of patients have seen better urinary conrol.  I believe the first group was similar to open surgery.  As I have performed more dvPs, the control has been considerably improved to my open results.  The majority of this is too technical improvements in the operation, but I also have been stressing that patient's perform preoperative Kegel exercises more recently."
 
Are the "technical improvements" in the operation because of his skill or is he just keeping up with the times? Would one be better off with a young surgeon with modern techniques having done 20-30 operations or an older surgeon using the same techniques and on his 500th operation???
 
Certainly any Doc that keeps these good records and willing to publish the results says a lot about his openness and trustworthiness.
 
Food for thought!

 


64  year old male in excellent physical condition.
PSA jumped  3 to 8 in one year
pt2b NO Mx with a Gleason score 3+3=6.
DaVinci RP,  7/23/08. Tumor type: Acinar
size 5.5 cm x 5.7 cm weight: 77 gm.
Incontinence & ED. Dry nights , no control during day.
FUDS and cystourethroscopy testing 10/09.
24 hr pad wt. 219gm. AUA sympton index 13/35=moderate
Virtue sling surgery 2/3/10 NYU med center
Appeared to help but gradually returned to pre surgery condition.
Back to 3-4 pads/day, stopped drugs, plan for AUS July 2010.
Latest PSA 4/1/10 negative.
 


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 5/20/2010 7:22 PM (GMT -6)   
Certainly any Doc that keeps these good records and willing to publish the results says a lot about his openness and trustworthiness.

The last post is 2006, I wish he would have continued. I wonder what his stats are now?

When I had my consult with the Uro who is doing my robotic surgery, he gave me a copy of an article from a magazine called Urology (a trade journal for Uros, I guess) that compared robotic with open as far as complications and other parameters. The magazine review of the study was in 2008, but the data came mostly from 2001-2007

Overall robotic had fewer complications-6.6% for robotic to 10.3% for open. To me the difference was statistically insignificant when compared to the results from the individual doctors.

Complication rates varied from 2.3% to 32% depending on the doctor. That huge difference is alarming. Part of the difference is that there is no standardized reporting of complications. What one doctor reported as a complication another doctor wouldn't. But still that is a huge difference among doctors.

The magazine pointed out there were problems with data collection because hospital's data may or may not have been every single case that was run through the hospital during the data collection.

So, the study did have possible flaws

My conclusion is that the most important thing is the skill of the surgeon and not the method.

And my other observation is that I am surprised there has not been a better study with standardized data collection.

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery scheduled for 6/1/10


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/20/2010 7:56 PM (GMT -6)   
Cripes, who want to be case #1.  The surgeon gets a learning experience and you get a lifetime of pads and a soft P****.  Seems like a bad deal. 
 
My guy had done 1200 cases, and had a great reputation, and I got 0 pads.  I thought this was mostly luck, but that website shows a really huge learning curve.  Seems like picking the right surgeon trumps EVERYTHING else. Who cares if they do the surgery with a robot or with a rusty steak knife, as long as they know what they are doing.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 5/20/2010 7:59 PM (GMT -6)   
The argument about skill vs experience is moot. You need both. No matter how skilled a surgeon is he needs experience to achieve superior results. The experienced surgeon needs natural skill to achieve superior results. If you are lacking either the patient is sure to suffer.
The most naturally skilled surgeon will not be competent after only a few surgeries and an experienced, but poorly skilled surgeon will never be competent. What's so difficult to understand. Some doctors are clearly more skilled than others and will achieve even better results as their experience grows.
If you desire below average results then pick either an inexperienced surgeon or an unskilled one and you will surely be happy.
I can practice and play just as much as Tiger Woods and never come come close to his natural skill level, but if Tiger had only played golf 10 times then I'm fairly certain I could beat him.
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


Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 5/20/2010 8:11 PM (GMT -6)   
All of you have made good points but I return to my original question. How does a surgeon get 500 operations completed if every patient will only be operated on by a surgeon with 500 operations completed? I can't believe that these surgeons get their experience doing only charity cases etc. My feeling is that if most guys were honest they would say "I deserve the surgeon with the experience, let some other guys suffer unitl my surgeon has the experience to do an excellent job for me". Any comment on this statement? Am I wrong?
4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/20/2010 8:15 PM (GMT -6)   
Dont forget, probably the bulk of the surgeon's patients would never think to ask the question in the first place, not that we are all so smart here, but definitely more informed about these matters than the average patient. So the others wouldnt know if they were number one or number one thousand
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 5/20/2010 8:27 PM (GMT -6)   
Before I chose surgery, I asked an oncologist how did he get his experience. He said city hospitals. People with no insurance or any ways of paying are standing in line to get services. The oncologist gained a lot of experience working for free. I was told surgeons did the same thing.
 
Age 48 at diagnosis
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
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue


profman
Regular Member


Date Joined Jan 2010
Total Posts : 55
   Posted 5/20/2010 8:45 PM (GMT -6)   
There are always trade-offs, but I went for the experienced old guy (the surgeon is 67 years old) and was glad I did as I had an anatomical anomaly - a blood vessel lying on the prostate that was supposed to be somewhere else. Since this vessel led to the penis, and my nerves were being spared, the surgeon spent over an hour carefully saving the blood vessel. Because of this I lost a liter of blood in a robotic surgery, but I am grateful as the vessel is important for erectile function. I am not sure if an inexperienced surgeon would have had the patience, or know how, to save this vessel. As the doc told me after surgery, not everyone's anatomy is what they learn about in medical school!!
Diagnosed 9/4/09, age 59
PSA 3.5, up from 1.8 year before
First biopsy showed 3/10 positive cores, Gleason 3+3, less than 10% involvement in all three cores, diagnosed as T2a; prostate size estimated at 32 gram
Thinking of Active Surveillance but
Second biopsy showed 5/10 positive cores, Gleason 3+3, left side (4 postitive cores) had 40% involvement
RRP on 12/15/09, home 12/16
Catheter out on 12/29/09 (failed cystogram earlier)
Path report was all good news, Gleason 3+3, no margin involvement, no perineural involvement, everything clean other than core of prostate, tumor on both sides, but more prevalent on left side, 5% involvement, 42 gram organ
Within two days down to one pad a day, pad free at six weeks
Back to work 1/4/10
First PSA 1/28/10 - nondetectable (<0.1), next scheduled June 2, 2010
ED present, although blood does flow after Viagra. working with pump now - still trying!


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/20/2010 8:53 PM (GMT -6)   

I don't believe for a minute that urologists get their experience by doing their first 500 cases for free in public hospitals. Have you ever been in a big city University hospital?  Many public hospital see huge volumes of the most difficult patients, and their senior surgeons have the greatest and deepest experience.   

I think urologists during their residency training have very limited chances to operate, and when they do, they have a more senior person hanging around keeping them out of trouble.  Then they graduate and find a job out in the community, and start working.  They get their experience on paying patients who may like their doctor's personality but are too naive or trusting  to investigate that surgeon's experience and track record. If they aren't getting enough patients, they start running ads on television and putting up fancy websites.


RickyD
Regular Member


Date Joined Dec 2009
Total Posts : 163
   Posted 5/21/2010 2:23 AM (GMT -6)   
I am not sure if there is an ethical question here but the assistant surgeon may simply count all of the surgeries he/she assited in as his/her number of surgeries. This would help him/her get to those first few hundred while actually just "assisting".


Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09: 1 of 12 cores positive with less than 5% volume
Gleason 3 + 3 = 6
Prostate Size Estimate on 12/2/09 = 28 cc
RALP performed on 4/7/10 at Vanderbilt University MC with Dr. Joseph Smith (3000+ RALPs)
Final Pathology on removed prostate:
Prostatic Adenocarcinoma present bilaterally from apex to base and extending to inked margin at right apex.  Gleason 3 + 3 = 6, stage pT2c
Prostate Size  = 59 grams, Tumor 5% of total prostate volume.
SV negative, EPE negative, PNI present. Lymph nodes - not checked
 
 
 


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 5/21/2010 6:15 AM (GMT -6)   
postop, I don't disagree with you. I am just reporting what the oncologist told me. He was telling me how many cases he had. I said who would want to be #1. He aIS he did a lot of charity cases at the county hospital. I am sure he was supervised but he said there were a lot of people willing to be #1.

Ricky, I have often wondered if they count the time they are assisting as well. As we've said, there is more than the numbers game you should look for.
 
Age 48 at diagnosis
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
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 5/21/2010 9:39 AM (GMT -6)   
I agree with JohnT that both experience and skill are important. But I think people focus on experience because it is easier to measure experience than skill/talent. Assuming the doctor is not lying to you, if he says he has done 2,000 open surgeries, and another doctor says he has done 75 of them, you can understand the difference. But skill is very hard to measure. You can't very well ask "are you an excellent surgeon, with terrific skills?" Well, of course you can ask that - but what's the point. You can ask about statistics (what percent of your patients have biochemical recurrence within __ months, are LFPF, regain erectile function, etc.). But there are all sorts of problems with evaluating the responses -- even assuming the responses are honest. There are questions about the doc's patient mix, his approach to patient selection (we have all heard of patients who are turned down by one surgeon, and then operated on by another), the varagies of patient reporting about their results, etc. If a patient could know, for sure, whether a surgeon he is considering is "very skilled" or not, of course he would ask. But we typically can't get a meaningful response to that. So we ask about experience because there's a clear, measurable answer.


Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


DS Can
Regular Member


Date Joined May 2009
Total Posts : 195
   Posted 5/21/2010 11:18 PM (GMT -6)   
So at one of my followup visits to my Uro/Surgeon I asked him how many DaVinci surgeries he has done now.  He supposes he has done about 40.  Timewise I am thinking I would have been about #30 for him.  I do not know how many open surgeries he has done.  I would not hesitate to reccomend him to anyone facing surgery.  I can easily understand that many surgeons have less than 500 experiences.
Dan 
 
PSA Jan'07:1.2,  Jan'08:1.9,  Jan'09:2.5
BIOPSY Feb'09  PCa DX, age 52
Right: 3+3=6, 3/6 cores 10% involved,PNI-Y
Left:  3+3=6, 1/7 cores <5% involved,PNI-N
LARP April 9,2009 nerve sparing. Final pathology:
GS 3+4=7, Margins uninvolved, 2 lymph nodes negative
Catheter 8 days, Last pad May 2,2009
latest PSA: April 8,2010 <0.1
 
 

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