Decision time - selecting a surgeon

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mtguy1999
New Member


Date Joined May 2008
Total Posts : 9
   Posted 7/18/2010 7:36 AM (GMT -6)   
It's decision time for me on picking a surgeon. I've been in contact with two I am interested in.
 
Both in the Seattle area.
One is at Virgina Mason, the other is with Swedish Urology Group
Both have done 1000+ surgeries for robotic
Spoke with one on the phone but only after waiting 6 weeks and 3 calls to his office before I finally heard back.
The other replied via email to my questions I had sent to his office (thinking best use of his time would be to preview the questions and make best of the call but there was no phone call).
 
Both seen to be reputable and in well repsected organizations.
 
Based upon your experineces, what else would help me make a decision?
 
I was diagnosed early April as Stage 1 Gleason 6 but 7/12 samples had cancer and all samples on the left side had cancer. I want to get this thing done by end of August if possible and not wait any longer.
 
Thanks for any input!

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 7/18/2010 8:21 AM (GMT -6)   

Dear mtguy:

My advice would be to go to the Seattle Prostate Institute to get another opinion.  They are well respected and will provide you with another treatment option that will likely provide you with an equal chance of cure as surgery but with the liklihood of much less onerous side effects.  I understand your "get this thing done" mentality but you owe it to yourself to become fully educated and to reveiw all options before making a choice.

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"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/18/2010 8:34 AM (GMT -6)   
mtguy,

i agree with jim above, with the limited stats you provided, you should investigate all treatment choices, including the possibility of "Seeding". If you are reallly a Gleason 6 - Stage 1, then you should have the full slate of primary treatment options before you. Even though I had surgery (and a lot of lingering complications), you might find other treatment that will be less invasive and not as prone to give you major quality of life issues.

as far as the two surgeons you contacted, i wouldnt want to deal with doctors that you can barely reach, espeically the one that made you wait 6 weeks just to call you back. you would need to sit in front of these doctors, face to face, because there are a lot of questions you should be asking.

with your stated states, you have plenty of time to make an informed decsion. wish you luck on that process.


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, 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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 still in place


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4849
   Posted 7/18/2010 8:56 AM (GMT -6)   
I never asked my surgeon how many he'd done...But, I really liked him during the meet and greet which I felt was very important.
Age 55   - 5'11"   215lbs
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
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/18/2010 9:15 AM (GMT -6)   
I am not sure the how many is the issue as much as the how well you feel about the surgeon. It sounds to me like you are a bit uncomfortable with both doctors. With you stats being what they are like the others have said you do have a whole range of options. Take surgery serious and if possible try some other form of treatment. Explore all options in making this crucial life decision and no matter what you decide it will be right. Keep us posted please I assure you we all care.

peace to you
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 7/18/2010 9:36 AM (GMT -6)   
I agree with both Dave and Jim above. You don't seem comfortable with either doctor. I can understand your wanting to get it done at a specific time. I'm sure that timing may be convenient for you. But you are talking about major surgery if you opt to go under the knife. Such can have life changing consequences due to side effects. I'd advise you make sure that you are both knowledgeable of all facets of treatments and if you choose surgery be it with a surgeon you are comfortable with and have much confidence in. This is not like buying a car or hiring a contractor to replace a roof. This is your life you are talking about and the quality of it after any treatment.

Rick in CO
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy
 
2/16/10 12 of 12 Negative Biopsy 


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 7/18/2010 10:23 AM (GMT -6)   
I had my surgery by Bruce Dalkin at the Seattle Cancer Care Alliance (at Fred Hutchinson and University of Washington Medical Center). I asked a lot of physicians and nurses about him beforehand. Excellent reputation, straight shooter, and I had a great outcome. He only does open procedures, no robots. I'm glad I went with him. I never saw the advantage of robotic surgery. Even if you don't do surgery with him, he's an excellent resource for a second opinion.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 7/18/2010 10:26 AM (GMT -6)   
Tud is giving you some good advice. The Seattle Prostate Institute is one of the best in the country and has published long term data indicating better cure rates than surgery with much less side affects both temporary and permanant.
These are a comparison of the side affects at 24 months of sugery compared to Brachy.

Incontinance 21-30% vs 8%
urinary obstruction /irratation 12% vs 18%
ED 69% vs 45%
Bowel issues 5% vs 15%
Recovery period 3-4 weeks vs 1 day

In summary Incontinance and ED are much lower in Brachy patients and urinary irritation and bowel issues are somewhat higher.

You owe it to yourself to get a 2nd opinion from one of the best prostate care centers in the US since they are close to you.
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


freinds
Regular Member


Date Joined Jun 2010
Total Posts : 76
   Posted 7/18/2010 10:31 AM (GMT -6)   
I know what you are going through. As I was making my decision I remember reading from some Johns Hopkins literature that picking the most experienced surgeon is a top priority. They said to find one with at least 250 procedures - sounds like either one covers this.
I chose a surgeon two hours away because he had more exp than my local doctor. I don't regret it, however there would have been some comforts to me and my family if I would have stayed local. I guess if both guys are equally qualified I would tend to go with the one who is easier to get in with post surgery as you may have issues that need to be addressed.
Best wishes to you.
age 50, diagnosed April 2010
pre-op PSA 3.7
Gleason 6
post op. surgical margins clear
 


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6084
   Posted 7/18/2010 10:55 AM (GMT -6)   
I also Had Bruce Dalkin at UDUB. I can't say enough about him and the hospital. My experience was excellent. The seeds sound good and I,m sure are. My concern is the high volume you have and and your staging does'nt sound right with the stats you provided. Also my guess, and it is an edumacated guess is you will find you may have a gleason 7 rather than a 6. Have the Dub do a read on your biopsy slides. You do have time for all of this, but unlike alot of folks here, unless it is a solid GS6 I don't believe the time is as luxurious as some say. This is not to scare or rush you. My personal belief is the more volume you have, the older you are and the longer you have had it and I think gleasons migrate up with time, no data on that, but it was so with me. This argues for surgery, not seeds. I called Seattle cancer care allience in Sept once and had appointment in October and surgery a week later. If you do choose seeds, the Prostate cancer center, is the place to go. You do have time to check them all out.
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


Drums
Regular Member


Date Joined Mar 2010
Total Posts : 134
   Posted 7/18/2010 11:17 AM (GMT -6)   
Being able to reach someone at the Dr's office in an easy manner post-surgery is going to be even more important if you have any complications or questions. If you're satisfied with the Dr's surgical skills and reputation, then the responsiveness of his office is another consideration.
Bill
Age 52 at diagnosis, father died of PCa
 
PSA: 10/16/09 - 2.8; 1/11/10 - 3.8
Biopsy 11/25/09, 11 core samples - HG PIN on right side
Biopsy 2/17/10, 11 core samples - left side, adenocarcinoma, Gleason 6, one core at 5%
Notified of dx on 3/12/10 (27th wedding anniversary) via phone by the nurse! (dropped this Uro!)
MRI 3/17/10 and bone scan, 3/23/10, indicate: gland volume is 27mL, PCa is confined to prostate, seminal vesicles and vas deferens are unremarkable.
 
RALP conducted 19 May 2010 by Dr. Lee at U. Penn Presbyterian
Pathology report on 10 Jun 2010: Gleason 6; gland involvement by carcinoma < 2%; tumor in peripheral zone on BOTH sides; no capsular, extracapsular extension, lymph node, or seminal vesical involvement; and no positive margins.
 
Incontinence: first four days after catheter removal - only1-3 pads/day (but urethra was inflammed); 2d week (after inflammation) - 8-10 pads/day (sometimes more!); 3d week - 4-6 pads; 4th and 5th weeks - 3-4 pads; 6th week down to 2 pads. Of course, all this depends on how much I stand and it gets worse later in the day.
 
ED: started the pump the 4th week after the catheter removal. Four sets, twice a day per instructions. Not as fun as it sounded.


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 7/18/2010 11:51 AM (GMT -6)   
By the way, the Seattle Prostate Institute is just another name for the Swedish Urology Group.

mtguy1999
New Member


Date Joined May 2008
Total Posts : 9
   Posted 7/18/2010 12:48 PM (GMT -6)   
Thanks for all of the quick responses. I should have provided more information since this is not a simple decision as everyone has pointed out.

Age 58 Wt 170 Ht 6'
No history of cancer in my family other than my younger sister was just diagnosed with intial stages of breast cancer. She just had her surgery and margins were clear.
Health: Heart Mitral Valve replaced 12 yrs ago and on blood thinners for life. Prostate is also growing into my bladder. DRE saw no signs but a scoping by my urologist found it was growing that way. No other health issues.
PSA: Apr 2010 = 3.2 July 2010 = 2.9
Biobsy: 7 of 12 samples showed cancer with ranges of 5% to 40%. All rated Gleason of 3+3

Why I am leaning to surgery:
1. Urologist said my growing prostate into my bladder is already an issue.
2. I need to be careful with blood loss and being on thinners. I would prefer the less invasive surgery to manage blood loss.
3. Once you do radiation, surgery is not an option. I want to leave some room open in case I develop other issues later.

I have read a lot on the side effects, risks, and possible outcome success rates for ED and bladder control.

The one surgeon I did talk to (both reviewed my pathology report) said that since there seemed to be more on the left side, he may have to do more which could impact the left nerve bundle and reduce my chance of full erectile function.

I live 500 miles from Seattle so running over for a visit is difficult. My local urologist recommended one of the surgeons I am considering.

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 7/18/2010 1:14 PM (GMT -6)   
Sounds like you have some complicating issues! My understanding is that although bleeding is a big issue with any prostate surgery, one genuine advantage of robotic surgery is less bleeding. Also, the risk of going off blood thinners (warfarin) with a mechanical heart valve (if that's what you have rather than a pig valve) is a stroke. Seems like you should include a visit with a radiation oncologist on your trip. If the prostate is big, hormonal treatment can be used to reduce the size prior to radiation.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 7/18/2010 3:33 PM (GMT -6)   

Dear mt, re your reasons for choosing surgery:

1. Your prostate growing into your bladder MIGHT mean that the prostate is too large for seeds...or might not.  In any case the Seattle Prostate Institute can make an excellent determination for you.

2. There is a chance for blood loss in either of the types of surgery.  There is infintesimal chance of blood loss with brachytherapy.

3.  Your comment about no radiation after surgery is generally true but is a not a very good reason to pick surgery.  This issue has been discussed on this forum many times.  The fact is that there are just as many effective ways to salvage after failed radiation as after failed surgery.  For example seeding with a different isotope, HDR, cyro or HIFU.  (You can confirm this if you consult with the Seattle Prostate Institute).Furthermore, FYI I have copied and pasted a previous post on this issue that was written by one of our most knowledgeble posters, JT.  Here it is:

Choosing a treatment option because if it fails you have a 2nd backup sounds good, but in fact is faulty logic. You have to look at the reasons that local treatments fail.
1. The cancer is systemic and not local. No local treatment will cure you and no salvage therapy will work.
2. If you have surgery it can fail because you have extra capsular extension, or the tumor is located in a hard to get to place and not all of the PC cells are removed. In this case you can have salvage radiation with some degree of success. (about 30%) If in fact this is the case, you were not a good candidate for surgery in the 1st place and radiation would have resulted in a cure if used 1st instead of surgery. A color doppler ultrasound can give you a bettter idea if surgery will work.
3. You have a poor surgeon who fails to get all the prostate tissue. This is more common that one is led to believe. There is always prostate tissue left; good surgeons leave less.
4. Radiation fails because the dose given is not enough to kill the PC. With IMRT now being able to deliver 81 gys vs 65gys the killing power is much better. A combination seeds and IMRT will give close to 100gys, more than enough to kill everything in the prostate and 10mm to 15mm in the surrounding bed. If you have a reoccurrance it will in all probability be systemic and not local.
5. You have a poor radiologist who fails to target the entire prostate with the correct dose and leaves dead spots.
You can easily eliminate #3 and #5 if you choose only the best, most experienced doctors.
Having the pathology after surgery and knowing where you stand is always brought up as a major advantage; but what are you going to do with the information? 50% of extra capsular extensions never progress and you will just wait for your psa to rise indicating failure just like everyone else does before you do anything. Forget the final pathlogy; either your psa stays low and you are cured or your psa rises and the surgery failed. In either event you actions are based on your psa levels and not the pathology. Great pathologies have reoccurrances and poor pathologies sometimes don't. It's the psa not the pathology that indicate success or failure, unless the pathology reveals major PC in the ajacent organs. A color doppler can give you this information without having to operate.
JT

 
Finally, as "friends" said, experience in a surgeon DOES matter.  There have been studies demonstrating MAJOR differences in success for surgeons with over 250 procedures.
 
I understand that 500 mile trip to Seattle is an inconvenience.  But, I can't imagine choosing a surgeon based on a phone conversation...don't you want to sit down and look the guy in the eye?  Dude, that's important real estate they are messing with!  And, while in Seattle, do yourself an favor and get another opinon on a treatment option.
 
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"!

RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1268
   Posted 7/18/2010 4:24 PM (GMT -6)   
mtguy
 
I was on warfarin for a while (for a Pulmonary Embolism) and had a hernia repair while I was on the blood thinner.  The surgeon took me off of the blood thinners at about 5 days presurgery and then I went back on thinners immediately after surgery, so I know surgery can be done on a person taking blood thinners.  However, with prostate sugery I feel you should really consider the post-op bleeding risks.  I had blood in my urine for two days after surgery (DaVincied).
 
I can understand your wanting to get the cancer out as quickly as possible (I think you said .... end of August) .... I know I felt the same way.  For me, it was a hard feeling to control, or rationally explain to someone else.  But it was there.  Having said that I do think you should continue to look at other treatment options (specifically seeds) for all the good reasons given by other posters.  It would seem to me you might be able to stay on the warfarin when the seeds were implanted ... did they take you off of warfarin for your biopsy? I had a tooth pulled while on warfarin and the dentist made me come off the warfarin (5 days pre extraction).
 
If you do decide to go with surgery, I would recommend you only go with someone you really trust and like. It sounds to me that the two guys you've talked to are good; just busy.  If you can, go meet them.  
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.
70 gram prostate.
Immediately continent after removal of cath.
ED - Trimix works well; viagra @ 70%
PSA - 7/31/09 <0.06
PSA - 12/1/09 <0.06
PSA - 3/29/10 <0.06
 
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/18/2010 4:55 PM (GMT -6)   
I of course would continue to advise at least talkng with radiation guys about seeding/IGRT, and have some good factual info on all the normal options.

I am a firm believer in impressions and feelings. I of course am concerned with stats, number of surgeries, etc. But I had to fell like this guy was someone I liked. This made me feel comfortable. Not all doctors have great personalities, are good communicators, or have a pleasing bedside manner. I have found that even tho we can argue that skill and stats are the number one priority, that sonetimes the doctor's personality and communication skills affect what goes on in the operating room. Confusion, conflict, and poor communcation are not what we desire when the guys have their hands or robots in our gut.

I talked with 2 surgeons and 2 medical oncologists. I went with the guy who gave me confidence and a good feeling. When he talked to me, he was with me, and wasn't trying to get out of the room.

Call me crazy, but I would find a doctor that I liked, and felt comfortable with.
Goodlife
 
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 7/19/2010 12:48 AM (GMT -6)   
Sorry, I gave some wrong information on one of my replies above. I clicked on the link for the Seattle Prostate Institute that keeps popping up as sponsored link on my browser when I google prostate cancer. It's the name of just one practice of 4 radiation oncologists at Swedish Hospital, not for the urologists or for the whole prostate program at that hospital. There are also other prostate cancer radiation oncologists at that hospital. The different prostate groups at Swedish Hospital are listed at http://www.swedish.org/Services/Cancer-Institute/Services/Prostate-Cancer

Woodworker
Regular Member


Date Joined Apr 2010
Total Posts : 90
   Posted 7/19/2010 9:30 AM (GMT -6)   
I went through this same process about 3 months ago. My PCP had set me up an appointment with a Urology Group. The Urologist tested me and I came back positive.  After that I was dealing with such a huge amount of information that I went to my PCP and asked his opinion.  After all, his sole concern is what is best for me.
 
He was quite emphatic about robotic surgery (my age, etc).  However, when he found out who the surgeon was he became upset.  He told me that he had directed them to send me to either a Dr. Givens or a Dr. Lance and if they were not available then I was to go to John Hopkins or Sloan Kettering.
 
He set me up with Dr. Lance and the difference was quite dramatic.  He is highly experienced (in excess of 1200 procedures). Come to find out the first guy wasn't even board qualified.  I am not saying the first surgeon was a bad one.  I just felt a lot more comfortable with Dr.  Lance.
 
To sum it up. You may want to talk to your primary care physician.  Since he is not a specialist his judgement shouldn't be clouded by his own skill sets.

_________________________________________
Age : 56
Diagnosed 3/29/2010
Pre-Surgery
Placed on 5mg Cialis daily on 6/2/2010
Started pre-operative physical therapy on 6/2/2010
PSA 2.7; Gleasen (3+4) Biopsy 2 cores of 12 25% positive
 
DaVinci surgery 6/25/2010
 
Post Surgery
    Final Biopsy report
   5 slides of 35 showed 2% positive for cancer
   Clear Margins
   Final Gleason (3+4)
Incontinence:  None
ED:  Still dead as a door knob
        Still taking 5mg Cialis Daily

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