Prostate Surgery

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venturajones
New Member


Date Joined Nov 2010
Total Posts : 2
   Posted 11/11/2010 8:53 AM (GMT -6)   
Hi There and Thanks in Advance for All You Wonderful Folks Who are Helping ---

I have been recently diagnosed with PC. Early stage T1c with 3 of 12 cores positive, Gleason 3 + 3, age 60, and parents who have long lifespan. You're never sure about yourself, but want to plan for that possibility. As a result, I have done lots of research and decided on surgery.

Unfortunately, I live in Southern California and have Kaiser Insurance. I'm going through a variety of consults with Kaiser, the next one with Dr. Gohar in Harbor City. In the interim, I have met with Dr. Kawachi at the City of Hope, who has done around 2,600 of the RRP operations with excellent success (his references are outstanding). The cost to me will be $42K, but I guess sometimes you have to spend the money. Anyway, the surgery will be painful, and so will the financial aspects.

I have a 2nd consult set up with Dr. Carroll at UCSF. I have heard, but not verified, that Dr. Carroll does NOT do many of the surgeries, and has a team of guys that handle it.

So, here's the question(s):

1) Anyone know whether Dr. Carroll does the surgeries himself or "shops it out to staff?"
2) Any input on the doctors I have mentioned (Kawachi, Carroll, or Gohar)?

Thanks in advance.

We're having fun now :)

Mike

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6947
   Posted 11/11/2010 9:01 AM (GMT -6)   
Just wanted to welcome you - we are always sorry to see new members, but you are welcome just the same.
 
I don't have any feedback on California, but there is often mention of Kaiser, so I am sure someone will speak up.

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 11/11/2010 10:19 AM (GMT -6)   
I admit I haven't heard much praise about Kaiser, but why would it cost you $42000 if you have Kaiser?
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

howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 11/11/2010 10:37 AM (GMT -6)   
 
My surgery was done by Kawachi. He has done over 3,000 robotic prsectomys. His bed side manner is nit great as i develpoed a blockage in my bladder neck and he kept telling me everything was fine. It did resolve itself after about 2 months. City of Hope is a very well ragarded hospital for it cancer care. All and all I would say you will be in good hands.
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.

Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 11/11/2010 12:14 PM (GMT -6)   
Ventura,
go where you have the confidence.  I'm in Nor Cal I don't know any of the Kaiser Doctors you mentioned. Kaiser is different insurance. My co-pay was $15. I guess that's the difference. My Doctor had only done hundreds. What ever you chose will be the right thing to do for you.
Best of luck and sorry your here, but welcome just the same.
Mike
Age 48 w/diagnosed
10/06 PSA 3.0
11/06 PSA FREE %13.2
10/07 PSA 3.4
12/07 Biopsy-neg
1/09 PSA 4.6
6/09 psa 5.8
2/10 psa 8.7
7/10 PSA 10.8
8/2010 3rd biopsy GG 3+3=6, one of eight cores -2%
Lap 10/22/10 Dr. Troxel
Path- Neg Margins, Gleason 6, Nerves spared
next appt 11/2

bcc
Regular Member


Date Joined Oct 2009
Total Posts : 46
   Posted 11/11/2010 12:35 PM (GMT -6)   
hi mate sorry you have joined us but you are among friends .you think you will have pain but i had none at all ,before or after my radical so dont worry be positive .

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3741
   Posted 11/11/2010 12:53 PM (GMT -6)   
You can be sure that The City Of Hope and Dr. Kawachi also accept Medicare patients. You should inquire how much Medicare would reimburse them (the hospital and the doctor) and ask if they would accept that same amount from you...The $42K is the "list" price and few people actually pay that.. Private insurance companies usually base their payments on the Medicare figure also, they may negotiate up a little, but it's always much less than the list price..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9

venturajones
New Member


Date Joined Nov 2010
Total Posts : 2
   Posted 11/11/2010 3:32 PM (GMT -6)   
To All-

I have Kaiser and if I use them it should be mostly paid for. But at the moment I don't have total confidence in them. That's why I'm looking at City of Hope, etc.

Relative to City of Hope, believe it or not, they quoted $68K for the surgery/hospital and will reduce the price to "only" $42K for writing a check (cash). But the comment relative to offering them the medicare amount is a very good one. Thanks to all who have replied, and will reply.

Mike

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/11/2010 4:11 PM (GMT -6)   
Hi Mike,
Keep working on the CoH guys. They can come down more.

I used Tim Wilson at CoH. Great facility and great surgeons. Peter Carroll does still do surgeries but your question is a valid one for him to answer. Kawachi is an excellent choice as well.

Keep up the diligent approach. You don't get any do overs with prostate cancer therapies and you have already learned about the fact that if you choose surgery, you want a wiz doing it. The names you have put out there are at the top of that list.

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

teallen
Regular Member


Date Joined Sep 2010
Total Posts : 38
   Posted 11/11/2010 6:07 PM (GMT -6)   
Welcome,sorry that you are here,I am sure you can probably find the answers to most all questions here. Good Luck!!
Age 42 PSA 7.4 4+4 G8
Davinci Sept.8 2010
No incontinence issues but ED issues
1st post surgery PSA <.008

Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 11/12/2010 9:50 AM (GMT -6)   
A claim of 2,600 surgeries performed would cause me to ask some more questions, such as over what period of time the surgeries took place.  Though a certain number of procedures are necessary to assure a certain level of comfort/competency of the surgeon (particularly concerning the da Vinci procedure), too many might mean the office operates a surgery mill where the surgeon performs little of the procedure and the bulk of the work is carried-out by associates, residents, med students, etc.  I really hope, for your sake, that you can find a way for the insurance company to pick-up the cost, or most of the cost of this surgery.  Best wishes for a successful outcome.
Age: 61 (58 at diagnosis - June, 2008)
April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior
June '08 had biopsy, 2 days later told results positive but in less than 1% of sample (Gleason's 3+3=6)
Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days
Dr. recommended robotic removal using da Vinci; Surgery 9/10/08
Northwestern Memorial Hospital, Chicago, IL; Dr. Robert Nadler, Urologist/Surgeon
Post-Op Gleason's: 3+3, Tertiary 4; Margins: Free ; Bladder & Urethral: Free
Seminal vesicles: Not involved; Lymphatic/Vascular Invasion: Not involved
Tumor: T2c; location: Bilateral; Volume: 20%; Catheter: Removed 12-days after surgery
Incontinent: Yes (1 to 2 light (woman's style) pad per day)
ED: Combination of Cialis and MUSE (alprostadil) once weekly: started 9-27-08
Returned to work 9-29-08 (18-19 days post-op)
PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0; 3/10: 0.0; 9/10: 0.0

sv
New Member


Date Joined Nov 2010
Total Posts : 3
   Posted 11/12/2010 7:19 PM (GMT -6)   
Dr. Kawachi just did mine also and he is certainly one of the best. Be advised that although he will perform the critical parts of the surgery, the rest as well as follow up is done by far less experienced doctors. That's the trade-off. But who cares who holds your hand later as long as the master cuts and saves your life as well as sex life. Fully continent when catheter came out in eight days and had 3/4 erections starting four days later. Sure I wish it was harder but for now it's enough for intercourse. He saved one bundle and half of the other. This guy is the best.
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