finding a good surgeon

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rick27
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Date Joined Sep 2010
Total Posts : 71
   Posted 9/9/2010 9:01 PM (GMT -6)   
I am trying to find out how to check a doctors record of outcomes after surgeries. I am planning to get a Robot LRP at Sloan Kettering. I heard Dr. Touijer is good. Appreciate the help.

Fairwind
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Date Joined Jul 2010
Total Posts : 3747
   Posted 9/9/2010 10:00 PM (GMT -6)   
Usually, there is no big rush to get to the operating room..Take your time and do your homework. Ask your GP to put some feelers out for you. Make an appointment with two or three recommended surgeons and sit down and talk with them. Yes, that will cost you a few bucks but it's money well spent..Ask them the pointed questions.

How many RRP's have you performed?
How many have you done this year?
Where were you trained to do this surgery?
On average, how long did it take your last 10 patients to regain continence?
What percentage are still not "dry" after a year?
How long were your last ten hospitalized?
How many have required transfusions during surgery?
How long will this procedure take to perform?
Other than the anesthesiologist, who will be with me during the surgery?
Will you yourself be performing this operation? (and not the resident you are training)

If they haven't walked out of the office by now, you should have enough information to make an informed choice..You can find excellence anywhere, you don't have to travel to faraway places to find it...If you dig around with Google a little, you can find all kinds of information about doctors and surgeons.

Good luck with your journey..
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G6,7, 9
RRP performed Sept 3 2010

rick27
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Date Joined Sep 2010
Total Posts : 71
   Posted 9/10/2010 4:42 AM (GMT -6)   
Thanks Fairwind.
________________________________________________

History: 2 brothers with prostate cancer
Age 56
PSA at age 40: 2.5
PSA at age 45: 4.7. DRE normal. Advice, biopsy (I waited)
PSA at age 52: 8.0. DRE normal. 1st biopsy 12 cores, negative
PSA at age 55: 9.5. DRE normal. 2nd biopsy positive 2 of 14, gleason 3+3.
PSA at age 56: 9.2. DRE normal. 3rd biopsy positive 4 of 14, gleason 3+4.

Paul1959
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Date Joined Nov 2007
Total Posts : 598
   Posted 9/10/2010 6:04 AM (GMT -6)   
Rick,
I also live near NYC and interviewed 5 surgeons.
My 2 cents...
The whole davinci vs open is highly over rated. Both are perfectly fine - it all depends on the skill of the surgeon. It is also easy to blur the reputation of the institution with the reputation of the surgeon. And while there is the logical conclusion that a great institution would tend to hire only the best, they also hire young docs with promise...not necessarily expertise. Also, in nyc all the doctors have trained, worked, studied with each other and at all the same institutions. They've all done Sloan, Cornell, Columbia, Sinai etc.

Badani at Columbia/Pres is their hot shot on the davinci. Good guy.
McKeirnan is an incredible person and a great doc at Col/Pres, but only does open. But HUGE success rate.
David Samadi (my doc) is one of the wunderkinden of the DaVinci world. He is an amazing person with a remarkable life story. He does more surgeries than anyone in a year. Sinai wooed him away from Col/Pres cause they wanted him so bad. He is the Rolls Royce of it all. His office is Madison Ave, he puts you in concierge hospital, etc. It's sort of the country club of surgery experiences. Also he is really good.

aaron Katz at Col/Pres is good, but into alternative therapies.
I had talked to two surgeons at Sloan, but both are now gone - they got offers they could not refuse.
LOL - how's all that for more info than you want to know?
BTW- I am going into PCa patient education at Mt. Sinai and working with several docs there in ED rehab. So, I'm just getting to know the Pca world in NYC. Email me with any questions or you just need to talk.
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!

Red Nighthawk
Regular Member


Date Joined Oct 2009
Total Posts : 289
   Posted 9/10/2010 6:53 AM (GMT -6)   
Rick, ask the surgeons HOW MANY surgeries they have done using the method you have selected (open or daVinci). I wanted to hear at least 700. The more surgeries they have done, the more different situations they have had to deal with and thus the chance of them being better at what they do is in your favor. Personally, I left my inexperienced davinci surgeron, who was my uro at the time, for a surgeon who was recommended by a friend who loved him and his work. Take your time and do the research. Good luck.
Age: 63
Pre-op PSA: 4.1
Post-op pathology:
Gleason grade: 3+4=7, present in both lobes, at least 1.1 cm, and occupying less than 5% of prostate by volume. pT2c NX MX
No lymphatic/vascular invasion present.
Seminal vesicles and extraprostatic soft tissue free of tumor.
Inked margins are free of tumor.
High grade prostatic intraepithelial neoplasia is present
Robotic RP: Sept. 15th, 2009 1 3

Woodworker
Regular Member


Date Joined Apr 2010
Total Posts : 90
   Posted 9/10/2010 10:50 AM (GMT -6)   
My PCP recommended 1 of 2 surgeons to me. It was his office that made the first appointment to me.  He told me that they were the only two local surgeons
that he would allow to do a prostatectomy on him if he needed it. It wasn't that the other surgeons weren't any good. He considered these two to be the best. 
The surgeon I had told me he quit counting at 1200 procedures. about 600 of them had been an open procedure the rest of them with the DaVinci.
 
Paul 1959 I disagree with you about the DaVinci being overated when compared to open surgery.  On an open surgery there is a large amount of blood loss that does not occur with the DaVinici.
Also, the DaVinci negates any tremors in the surgeon's hands and because of image manification and the machine itself the surgeon is able to make much more precise and delicate cuts.
 
My $.02 worth

rick27
Regular Member


Date Joined Sep 2010
Total Posts : 71
   Posted 9/10/2010 12:09 PM (GMT -6)   
Thanks all. I have to use Sloan Ketttering due to insurance limitations. Is there a big difference between Robot LRP and LRP? It seems some Drs that do both prefer the LRP.

compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 9/10/2010 12:13 PM (GMT -6)   

When I did my research, I did have a SLIGHT preference for the Da Vinci (quicker recovery). However, my decision was to get the best surgeon (based on reputation and EXPERIENCE), period.

I narrowed it down to two: Dr. David Woods at Umich and Dr. Mani Menon at Ford. Woods does both. He also mentioned that based on the biopsy, he thought Da Vinci would be the better choice (location of the tumor?). I ended up going with Dr. Menon, but either one was fine.

 

Mel


PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. Next PSA late Sept.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 9/10/2010 1:17 PM (GMT -6)   
I hate to sound pessimistic but after all is said and done, it is still some kind of crap shoot. I certainly agree that you should find the best surgeon you find.

1. I really think they pad their stats.

2. You are as big or even bigger variable than the surgeons skill. Has your pc escaped the margin, gotten into the seminal vessicles, or gotten into the perineural nerves ? Do you have an EPE? Do you have a high grade Gleason ?

3. You will have more than one doctor in the OR. Residents, doctors, interns, etc. After the lights go out, you really don't know what goes on. Not trying to scare you, just stating fact, and the importance of trusting the doctors there, that they will do their absolute best.

4. As many have tried, this process cannot be reduced to a formula. There are many variables, and yes, you can influence some, but not all.

I went with gut feel as much as all the stat stuff. So far, the gut did OK, but I have a lot of years to see.

Good luck.
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

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 9/10/2010 2:26 PM (GMT -6)   
Even if doctors don't pad their stats (and I suspect some do) you have to be careful what conclusions you draw.

For example, suppose you get self-reported stats from several docs on their rate of positive surgical margins. What does it really mean?
It could mean the doc with the lower percent of SM+ is a better doc.
It could mean the doc with the lower percent of SM+ is lying. Is he giving you his stats in writing? Is he using weasel words?
It could mean the doc with the lower percent of SM+ turns down high risk cases, ("I'm sorry, I can't squeeze you in for the next three months...") but their skills are no better.
It could mean the doc with the higher SM+ rate is the best one in town, and as a result, the nearby urologists send their most challenging highest-risk patients to him.
It could mean that the doc with the higher SM+ rate works in a teaching hospital in a tough neighborhood where the local patients tend to get less preventive care and so the patients show up with higher grade/stage disease.

You would only know what to do with this information if there were a uniform reporting system for all the different doctors that compared their results with predicted recurrence-free survival and morbidity rates, taking all the variables into account. Otherwise you just don't know what the information really means.

So get all the data you can, but other than the number of procedures done with the specific method you've chosen (open or robotic) take it all with a grain of salt.

If you have friends who works in the medical field, or friends who have friends who do, ask them to work their network, and get their recommendations. When a doctor needs a doctor, they know how to find out who's good. Or start with a prostate oncologist who's neither a surgeon nor radiologist but who sees the results (including the failures) of a good many of both. They will know who's good.

On the robotic vs. open question, it seems the research data says that both procedures give roughly equal results in general. Provided they are done by highly experience surgeons in each case. Many docs prefer the Robotic because (a) it appears to be the wave of the future due to patient demand, and therefore they need to rack up their volume to stay competitive (b) it is physically easier on the doc to perform the robotic surgery.

Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 9/11/2010 5:46 AM (GMT -6)   
Rick, we too live in the NYC area...born and raised in one of the five boroughs but now live in the 'burbs north and west of the City. When my John was diagnosed in February 2008, he was using a urologist near our home with an excellent reputation (in fact, my husband's regular MD uses this urologist for his personal needs and had non PCa surgery done by this urologist). When we got the word that John had PCa and when he decided that surgery was his treatment of choice, I gave him the option of heading into NYC to meet with other surgeons before choosing. I offered him Sloan (but they wouldn't take our insurance), Columbia Presbyterian and NYU...all excellent hospitals. In addition, I researched another top notch surgeon located at another hospital in our area but further south. My husband loves his urologist - and frankly so do I - and was very happy with using him for the surgery. The bottom line is that we went with the original surgeon and never looked back on what we should have done. The care we both received before, during, and after has been wonderful. We never felt unimportant - in fact, when John's surgical path report came back (and scared the you-know-what out of me), the surgeon spent time on the phone with me walking through every aspect of it and explaining the terminology and what it all meant for us. I won't forget that kindness to me. This particular doctor is extremely well know in my neck of the woods, and we know many people (men and women) who use him. Haven't heard one bad word about this doctor but I doubt he's on anyone's list of nationally recognized "experts" but he's certainly on my list of great doctors who care about their patients.

As to outcome statistics, I tend to shy away from those especially if you're talking about a one of the major research hospitals as they tend to choose their patients carefully in order to boast their success rates or increase their funding. We had personal experience with this type of situation, and were told frankly by the doctor's assistant that this is how the doctor (a PCa specialist) chooses his patients. Doesn't give you a warm and fuzzy feeling but that's the reality of medicine these days.

I wish you luck with your surgery.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 9/11/2010 7:22 AM (GMT -6)   
Rick, I see you are only inquiring about surgeons and I cannot tell from your post whether or not you have considered other treatment options.  If not, you may want to consult a radiation oncologist and a prostate oncologist to review other possibilities.  It's quite possible that brachytherapy and/or IMRT would be possible choices for you...same cure rates as surgery with less onerous side effects.  However, I don't mean to be presumptive so if you have already considered the options and decided upon surgery I wish you well.
 
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"!

rick27
Regular Member


Date Joined Sep 2010
Total Posts : 71
   Posted 9/11/2010 8:24 AM (GMT -6)   
Thanks all. The problem with the stats is... I can't find any. It appears that the only thing you have to go by is what each individual surgeon tells you. I would like to find out at least how many surgeries each Dr performed and what type. I'm surprised this info is not published somewhere.
I have decided on surgery as opposed to radiation. I'm not sure whether to insist on the robot laparoscopy or just plain laparoscopy. I don't want open. My urologist said to let the surgeon decide, depending on my particular case.
I spent the night reading hundreds of posts. I wasn't too scared before but now I am.

pipedream
Regular Member


Date Joined Aug 2010
Total Posts : 64
   Posted 9/11/2010 10:33 AM (GMT -6)   
Somebody said...
I spent the night reading hundreds of posts. I wasn't too scared before but now I am.


I know what you mean. In addition to extensive reading here, I've just completed "How we survived Prostate Cancer - What we did and what we should have done" by Victoria Hallerman. And am deep into Patrick Walsh's book where he is discussing surgery and radiation failure, ED and help for advanced prostate cancer. It is frightening.

The last time my husband had cancer - 7 years ago, he was diagnosed on Wednesday and had surgery on Monday. There was not enough time to get educated or to really even process the fact of his disease. Not saying that was necessarily a good thing but this time - diagnosis in July and surgery in October is allowing time for education but also too much time for thinking about all the "what ifs" scenarios I am reading about. It's like there is a grim overlay on our lives right now affecting everything everyday.

I almost didn't survive my reading of How we survived prostate cancer (only slightly tongue in cheek)!
Husband DX @ 64; 7.5 year survivor colon cancer; father had PCa @ age 65
04/09 - PSA 3.06 - retest in 6 mo
10/09 - PSA 1.55 Free PSA 7.74% - retest in 6 mo
04/10 - PSA 4.26

Biopsy 7/10
R base - 3+3=6 10%
R mid & apex - benign
R anterior horn - 3+4=7 20%
L base - 3+4=7 90%
L mid - atypical small acinar prolif
L apex - 3+3=6 < 5%
L anterior horn - 4+3=7 60%

RP Surgery - October 1, 2010

Mike H
Regular Member


Date Joined Jan 2010
Total Posts : 72
   Posted 9/11/2010 10:44 AM (GMT -6)   
Rick,

e-mail me at mah7777@aol.com. I have some first hand experience with MSKCC that you might find helpful.

Mike
8/12/09 Diagnosed at 49 years old. DOB. 6/11/60
12/2/00   PSA was 4.9
5/5/03     PSA was 5.4  -  Biopsy Negative
6/10/09   PSA hit a all time high of 6.9
7/23/09   Biopsy Positive. 10% cancer in 1 of 12 cores. Gleason 3+3=6.



10/29/09 Surgery at Memorial Sloan Kettering Cancer Center, NYC
11/25/09 Catheter Out (4 weeks)
99% continent the day the catheter came out
Wore the pads for 2 weeks to be safe but had minor drips at most.
12/16/09 First PSA (7 weeks) < .05 Undetectable

Post Surgical Pathology:
Gleason 3+3=6
Tumor confined to prostate
Seminal vesicles not involved
Bladder neck not involved
Surgical margins free of tumor
Lymph nodes not involved

6/16/09 6 Month PSA < .05 Undetectable

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3747
   Posted 9/11/2010 11:28 AM (GMT -6)   
"And am deep into Patrick Walsh's book where he is discussing surgery and radiation failure, ED and help for advanced prostate cancer. It is frightening."

Tell me about it....No sleep that night..

Rick, as you can see our histories are very similar..I think we both have had cancer for quite a while, living in blissful ignorance..Your second biopsy pulled a pair of threes, 3+3=6, the next one pulled a 4 card... 3=4=7

Don't get hung up trying to find the "perfect" doctor..In the NYC area, there will be many. Find one who has done many procedures and that you feel confident in..

Your next big milestone is not the surgery itself but the pathology report that will follow in a few days. That's when things really snap into focus..

Best of luck to you, we are all rooting for your complete recovery....
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G6,7, 9
RRP performed Sept 3 2010

Post Edited (Fairwind) : 9/11/2010 11:32:49 AM (GMT-6)


rick27
Regular Member


Date Joined Sep 2010
Total Posts : 71
   Posted 9/11/2010 5:39 PM (GMT -6)   
Thanks for the support everyone.
Mike, I can't tell you how much I appreciate you taking the time to help me. Thank you.
Rick
History: 2 brothers with prostate cancer
Age 56
PSA at age 40: 2.5
PSA at age 45: 4.7. DRE normal. Advice, biopsy (I waited)
PSA at age 52: 8.0. DRE normal. 1st biopsy 12 cores, negative
PSA at age 55: 9.5. DRE normal. 2nd biopsy positive 2 of 14, gleason 3+3. both cores <5%
PSA at age 56: 9.2. DRE normal. 3rd biopsy positive 4 of 14, 3 cores <5%, 1 core 7% Gleason 3+4 in 1 core, prostate 81cc

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 9/12/2010 9:16 AM (GMT -6)   
After deciding on surgery, I cast a wide net, researching surgeons all over the country but decided to go with my gut and selected a young local surgeon who had outstanding bedside manner and had done over 1000 Da Vinci. I am very satisfied with the outcome. I think long term outcome depends more on individual situation than the surgeon.
Age 65 Dx; 3/10 PSA 10.7, 6/10 biopsy positive Adenocarcinoma, Gleason 3+3 & several atypia; Clinical stage T2; 7/10 CT, Bone Scan, MRI all negative

8-23-10 RRP; Pathology Stage: Negative margins, Lymph nodes, Seminal Vesicle; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason grade 4. AJCC Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 full continent partial potency day 1, great surgeon!
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