Picking the Right Surgeon - a Strong Recommendation

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julios
Regular Member


Date Joined Jun 2010
Total Posts : 38
   Posted 7/30/2010 3:30 PM (GMT -6)   
See my stats below. I got six different opinions from 4 different major med centers across the US on what method of treatment I should use. All but one recommended surgery, followed by radiation. The two local urologists told me all of the left nerve bundle, and possibly the right also, should be removed. One at a nationally prominent med center was emphatic that all nerves be removed; both sides. I did my research and was convinced Dr. Randy Fagin from Austin was the right one for me, in spite of concerns voiced by some that his notariety would result in "assembly line" care. The day after emailing his office I got a call from his office and had a tentative appointment. The next day Dr. Fagin called me and I finalized the decision. See results of nerve sparing and continence below. Not only was the surgery very successful, but the level of care and service was better than anything my local doctors have ever provided me. When I was in pain from bladder spasms a week after surgery and back in my home town, I called his office when I couldn't reach my local doctor. Dr Fagin called me back within an hour and called my pharmacy with a prescription. The next day he called me to check on me, and told me it was his night off that day but to tell the doctor taking his calls to put me through to him anyway. As a doctor's kid, I know how sacred their time off is, and this is simply unheard of. I cannot recommend this man enough!
Age 52
At Diagnosis of PCa, had Gleason 9 and normal PSA
Radical Prostatectomy on July 7th, 2010 by Dr. Fagin using daVinci
25% to 50% nerves spared on left, 100% spared on right.
Continent from day one.

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 7/31/2010 3:45 AM (GMT -6)   
Great story...
 
I had my cath in for five weeks due to not healing very fast...After taking it out - Surgeon and I made plans incase I had to have it put back in. He gave me his cell phone number which surprised me a lot. Luckily I didn't have to use it.
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.


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 7/31/2010 8:18 AM (GMT -6)   
Nice story.

Personal recommendation of a surgeon from a previous patient is something that definitely increases the comfort level of a PCa patients choice in selecting his surgeon. It is a shame there isn't a better way for prospective patients to get more info from previous patients.

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 on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean
PSA 7/15/10 Zero Club membership card issued (trial membership with 90 day renewal)

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/31/2010 2:05 PM (GMT -6)   
I also am very high on my surgeon. However, there is fine print under every surgeons name. Not all surgeries have the same outcome.

We have had men here go to some of the finest surgeons in the country, maybe world, and have not had such good results. Yes, the odds are a lot better, and I certainly would never suggest we don't go for the very best we can find, but as the saying goes S**t happens, or our PC is too far advanced, or whatever.

My surgeon from Cleveland Clinic recently got into a bad situation because one of his "assistants" was actually at the controls and something went wrong. It's called ghost surgery. I have given all the credit to my good results to my surgeon, but can't deny I don't wonder form time to time if he was actually the one doing it.

Anyway, congrats on a successful surgery and dry pants. Good luck on the rest of your recovery.
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
15 month PSA <.01

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/31/2010 6:13 PM (GMT -6)   
goodlife,

thats one advantage to my open surgery, i know for a fact, that my surgeon was the one that had his hands on my insides. he had an assistant from his practice with him, but told me that was only because of a surgical requirement by the hospital I went to.

david
Age: 58, 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: Aug 3
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 - 17 days, Total Blockage, Cath # 20 - 7/19

pogmothoin
Regular Member


Date Joined May 2010
Total Posts : 84
   Posted 7/31/2010 7:00 PM (GMT -6)   
I know that Dr Catalona was the one actually performing the surgery on me, but that he had assistance in closing from a resident. The resident was Dr Joshua Mills, and he struck me as someone to keep an eye on, from all of Dr Catalona's team. I mentioned that impression to Dr Catalona and he said I was 100% right in my assessment.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/31/2010 7:03 PM (GMT -6)   
David,

I had a ureteroscopy a few weeks ago where they run a scope all the way into your kidneys. I insisted on a spinal block, so I was awake the entire time.

My URO never touched the instruments. His resident did the entire procedure, under his guidance. I'm starting to think that once the lights go out, we really have no idea what goes on.

I'm sure your surgeon did as he said, and my surgeon told me he did it as well, however, I found it curious that my roommate in the hospital had his surgery scheduled at the same time, with the same doctor. I think the assistants get it all set up, and the big guy jumps on the controls for the snip snip, and then the assistants clean up.

Anyway, I'm not complaining, just don't want someone to think that because the doctor has good stats, and happy patients, that their procedure will be a slam dunk. Too many variables.
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
15 month PSA <.01

julios
Regular Member


Date Joined Jun 2010
Total Posts : 38
   Posted 8/2/2010 11:29 AM (GMT -6)   
Thank you, everyone, for your input. I'm grateful for blogs like this; hopefully many will benefit from our experience.

Age 52
At Diagnosis of PCa, had Gleason 9 and normal PSA
Radical Prostatectomy on July 7th, 2010 by Dr. Fagin using daVinci
25% to 50% nerves spared on left, 100% spared on right.
Continent from day one.

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 8/2/2010 2:36 PM (GMT -6)   
Julios,
Dr. Fagin did my surgery as well. The one night stay and care at the hospital was first class. My recovery was quick with minimal pain. Dr. Fagin gave me his cell phone number and email in case I wanted to contact him. I have sent him emails in the past and he replied within hours. I highly recommend him.
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
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 5 months
2 months 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
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 8/3/2010 5:23 AM (GMT -6)   
I am from Houston and considered Dr. Fagin but ended up staying with a surgeon from Houston. I think there are lots of good doctor's out there. My doctor gave me is email address and I have probably sent him 50+ emails over the last 2 years and he has responded within day. I thought his assessibility made him different but after readying your post, I realize there are some good doctor's out there.
 
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

Paella
Regular Member


Date Joined May 2010
Total Posts : 52
   Posted 8/3/2010 7:53 AM (GMT -6)   
You can tell your surgeon that you wish him to do the entire procedure and, I believe, they are required then to do so.  You don't want to sound like a b_tt, of course.
 
Mac's robotic surgeon (after visiting 3 medical centers - UCS, UCLA and City of Hope in southern california) was Tim Wilson at Hope.   Mark Litwin (UCLA) would have been our choice had we gone open. 
 
The surgery was a huge success - tomorrow we get our first post-surgery PSA.  (and, of course, we're still nervous despite his excellent recovery in all areas.)
 
Paella

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/3/2010 8:02 AM (GMT -6)   

Paella,

That was the problem at Cleveland.  The surgeon did agree to that in writing, and then something came up or he forgot what he signed or something.  Like I said, once the lights go out, we have little or no control over what happens in our gut.


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
15 month PSA <.01

julios
Regular Member


Date Joined Jun 2010
Total Posts : 38
   Posted 8/18/2010 12:37 PM (GMT -6)   

I just want to follow-up on one person's response. He pointed out that some big-name surgeons actually let their assistants do some or all of the surgery. When selecting a surgeon, I recommend you ask him if he will be doing it himself, then ask him if you will be able to get an "Opertive Report" after the surgery. In that report they have to say who did the surgery, and who assisted. I can imagine surgeons who are also professors at university hospitals might tend to let someone else do it more often.

BTW, I got such a report from Dr. Fagin, and he performed the surgery himself according to the report. He had an assistant who did things like attaching clips during the surgery.


Age 52

At Diagnosis of PCa, had Gleason 9 and normal PSA

Radical Prostatectomy on July 7th, 2010 by Dr. Fagin using daVinci

25% to 50% nerves spared on left, 100% spared on right.

Continent from day one.

Pathology showed postive margins and extension beyond gland, including lymph nodes. Stage upgraded to T3b.

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 8/18/2010 2:20 PM (GMT -6)   
I have heard from at least one doctor at a leading teaching hospital that they refuse the "don't let any residents touch me" request that the occassionally get from patients. They consider training residents to be a part of their mission, so won't allow them to be excluded from participating in surgery. (But hopefully the attending who you requested as your surgeon will do the complicated/difficult parts....)
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
 

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/18/2010 3:33 PM (GMT -6)   
Julios,

I was readin g the surgery report that I got a copy of. The doctor told me that he was able to save both nerves. The surgery report said one was cut.

When I asked him about it, he said, well, I did spare both nerves. My resident wrote the report and must have mistaken what I said.

I still don't know what to believe, but whoever did mine, did a masterful jib in my opinion.
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
15 month PSA <.01

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/18/2010 11:54 PM (GMT -6)   
I have heard repeated good things about Fagin. Same with Catalona, Carroll, Wilson (who was also my surgeon), Kawachi, Samadi, Menon, and I am certain I am leaving quite a few out, but I am posting generally. I stress that the best way to avoid or minimize surgical side effects is to use the elite surgeons whose reputations proceed them. Many other great surgeons are out there, but it becomes muddy water trying to decipher who they are in the general pool. These guys are top notch...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/19/2010 5:14 AM (GMT -6)   
I had the same experience a goodlife. I was told that both nerves were spared, but when reading the surgery notes I found that one wasntken out. I don't know f the report was wrong or not. I never had a problem with ED and didn't bother to bring it up. I had my surgery at a regional hospital, however, my surgeon was well regarded and very experienced in DiVinci.
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/19/2010 5:18 AM (GMT -6)   
Just curious Julio, are you having radiation post surgery because of your G9 or did the PCa escape the prostate?
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work
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