resident to perform RP

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klains
Regular Member


Date Joined Nov 2010
Total Posts : 79
   Posted 1/15/2011 8:24 AM (GMT -6)   
anyone ever have a RP perfomed by a resident overseen by a top notch doctor?  Sounds scary to me, long story,  the short version , insurance rules

Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 201
   Posted 1/15/2011 8:31 AM (GMT -6)   
Possibly.  I think it's sometimes done without the patient even knowing. 
At least you know going in.

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 1/15/2011 8:51 AM (GMT -6)   
I agree with Dave I am sure that probably happens most of the time. As long as the tried and true doctor is close by I would not think there would be a problem.
Let us know what you decide

peace to you
Dale
I was 45 at diagnosis with PSA of 16.3
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. Scheduled to have a radical on July 11th, 2007, surgery was aborted when it was discovered it had spread to the lymph nodes.
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.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
PSA July 22nd of 2010 is .71
PSA Sept of 2010 is .71
cancer in 4 of 6 cores
92%
80%
37%
28%

NEIrish
Regular Member


Date Joined Aug 2010
Total Posts : 245
   Posted 1/15/2011 9:37 AM (GMT -6)   
In my husband's case we found out that interns would be doing a lot of the work when he was minutes from surgery, laying on the gurney. We'd been told by the surgeon that he did the RP, but that morning the 2 interns seeing him said they would be doing much of the work, although the important part, "presenting" the prostate, would be done by the head of urology, who at that moment was still in his office. We had a mini freakout and nearly walked. They called the surgeon who came down to preop and spoke with both of us. The interns present had 5 and 7 years of experience, the head surgeon around 30. My husband decided to go through with it, although he nearly disconnected the lines already in his arm and walked. Lousy time.

Apparently it's often the case with open RP, and even the heavy hitters have others in the room assisting, especially in the teaching hospitals. Get your surgeon to be specific about what part is done by whom in the operating room. May put your mind at ease, or you may look elsewhere. Good luck...
Husband 60yrs., no symptms: PSA 10/04 2.73, 12/06 3.64, 5/09 3.9, 10/09 4.6, 1/10 5.0w/ free PSA 24
6 core biop 4/1/10 path rept: rt mid: adnocarc. G=3+3, 5% of core; R apx v. susp. minute ca, R base bnign w/ mod. atrophy, L side atrphy only; 2nd opnion JH confrmd
MRI - 15mm nodule
BiLatRP surg 7/6/10, path: T2c, nodes, sem.ves, extra caps. neg., adenoc both sides G=3+3 cntinent, Viagr-8/27 ED

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/15/2011 9:55 AM (GMT -6)   
My surgeon did the whole thing himself, and I liked it that way. I wouldn't have agreed to having resident do the op, thats just my opinion
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3634
   Posted 1/15/2011 12:28 PM (GMT -6)   
It can be ugly when the reality of cancer treatment and the fantasy that many people hold dear collide.....

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/15/2011 12:31 PM (GMT -6)   
Can you elaborate on your remark, Fairwind, sounded too cryptic for me to understand.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/15/2011 12:35 PM (GMT -6)   
Purg he is likely relating to the twilight zone of reality of PCa vs. our perceptions of how wonderful it is with all these experts at our fingertips. "It is a jungle out there...i.e. it is unreal and beyond your belief at times."

Post Edited (zufus) : 1/15/2011 11:38:39 AM (GMT-7)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/15/2011 12:44 PM (GMT -6)   
I believe that we forget to add this question when new members come here and ask "what are some questions for my doctor"...

Question:
Will you be performing the surgery or will someone else?

The consensus from the field of experts is that the skill surgeon matters. I don't know to what degree that is compromised when a resident or less experienced doctor does the surgery even under our "preferred" experts supervision, but this should be the patients choice ~ not the insurance companies or the institutions.

However, I would be somewhat not surprised when and insurance carrier gets a price break when a resident is selected as opposed to an expert.

I have a terrific surgeon from the City of Hope coming to our UsTOO group in February. I will ask him this question. I will get his take on it and post it in this thread. Also, I will reach out to another surgeon today and get his take on it, too...

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

anxiety out the roof
Regular Member


Date Joined Aug 2010
Total Posts : 111
   Posted 1/15/2011 2:16 PM (GMT -6)   
Tell the surgeon you only want him. Put that info on the consent form in big letters at the top. My surgeon did mine except for closing me up. He had a resident do that. That was ok with me.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/15/2011 2:22 PM (GMT -6)   
Great, Tony, thanks. I think this will be interesting. I believe that much of this hysteria is based on patient myth, but I'll be interested in the responses you get. There are many steps to a complicated surgery like a prostatectomy, starting with the initial cuts, ending with stapling everything shut. Someone seeking an arguement might take a position that every step is important, but there are a much smaller set of steps in the middle of the procedure which are of key relevance. These are the steps that one seeks an surgeon with many prostatectomies for...not the stapling-up at the end of the procedure.

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 1/15/2011 2:38 PM (GMT -6)   
How does a top-notch doctor get to be that way? Practice, likely on us. As in any field, we can expect the juniors to be doing most of the work with the expert on hand for crucial parts of the procedure. At least I hope that's how it is...

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4089
   Posted 1/15/2011 3:30 PM (GMT -6)   
With all of the data that has been posted on HW about the importance of experience I personally find it hard to believe that any patient would allow a resident or intern to perform all or part of this procedure.  If you think that the residents only do the non-critical stuff then I have a couple of bridges to sell you...how do you think the residents get practice doing the critical stuff...duh..by doing it under supervision.
 
It probably works out just fine most of the time.  I just wouldn't want to be the one time that the nerves didn't get spared because the junior guy just wasn't up to the task. 
 
For my brachy I was VERY SPECIFIC about who was doing what and I would have been equally or more specific had I chosen surgery.  They are messing with very important real estate down there and I want the best odds possible.  But, hey that's just me.  If you want someone to practice on you, have at it..
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/15/2011 3:35 PM (GMT -6)   
Tud,
It's very interesting that you point that out. I know from my experience that technicians actually perform most radiation therapies as opposed to the radiation oncologist who prescribes it or the physiologist who designs the therapy. It would be interesting to see if the qualifications matter for those who actually operate the machinery.

That would indeed be an interesting piece of information. I mean would you want the technician doing their 1st administration of radiation or the one who has been in that lab 10 years?

Tony

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 1/15/2011 3:40 PM (GMT -6)   
I asked my surgeon if he is going to do the surgery. He said yes, but a resident will assist, since they don't assign two docs to one case. I agreed on the condition that he and not the resident will tease out the prostate.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3780
   Posted 1/15/2011 3:50 PM (GMT -6)   
Tony -- all my radiation was administered by technicians, and the actual people would change from day to day.  of course there was a doctor on site and i saw him once a week during treatment but i never saw him during treatment.  when i had my seeds implanted the rad doctor said he would do the whole procedure.  he said my procedure was a piece of cake and would take him about 20 minutes.  he did four procedures that day and was assisted by my urologist.
 
before BT my doctor asked me if i minded if two people observed the procedure.  i asked him if they would assist and he said they were not doctors; they worked for the company that supplied the seeds.  i had to sign a waiver.
 
i think we do our due diligence but at some point we have to trust the people we select to treat us.
 
ed
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3780
   Posted 1/15/2011 3:53 PM (GMT -6)   
oh, when i was talking to my urologist he said if i elected for open prostate surgery he would be the surgeon.  his partner did da vinci.  my uro said:  "if you don't want to p*ss your pants for the rest of your life i am your man".
 
ed
 
 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Post Edited (F8) : 1/15/2011 2:58:47 PM (GMT-7)


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 1/15/2011 3:59 PM (GMT -6)   
I had my surgery at a teaching hospital, by choice, not because of insurance. I just chose the best surgeon that I could find. I had an agreement with my surgeon that he would do the critical parts of the procedure, but I left it up to him as to what those critical parts were. Of course there were residents involved. I'd rather have a well supervised resident doing parts of the procedure, than an unsupervised fully trained surgeon with questionable skills or judgment. Once a urologist finishes his training, and has gone into private practice, they have the right to operate whether or not they are any good at it. Some are excellent, some are not.

I've had an excellent outcome. Based on statistics (and what people post here), I'm well ahead of the curve in continence, ED, and cancer control. For example, incontinence is something I haven't experience for a instant. I chose the best guy to do it. I figure teaching residents just forces him to be at his best at all times. Plus, being a professor at a major medical school demonstrates that he/she has proven abilities and accomplishments, and also that he/she's not just in it for the money.

Concern about residents participating is appropriate. I'd want the attending surgeon there in the room at all times, and I'd want to establish a relationship of trust with the attending. But, under those conditions, an academic urologist will often be a great choice.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/15/2011 3:59 PM (GMT -6)   
F8,
my experience with adjuvant radiation was the same as yours. They did not use gold markers or Calypso beacons and that would raise a new question. If your radiated area can move during therapy, then are you at the mercy of those who operate the gear to reposition it? I know that the odds of error are low, but the people doing the daily remapping are not the ones who design the program.

Tony

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3780
   Posted 1/15/2011 4:06 PM (GMT -6)   
Tony -- they did not use gold markers on me either.  they used three tattoos.  the techs would place me on the table and my legs would go into the personalized mold.  then one tech would get on either side of me and would line me up by pulling the sheet back and forth.
 
then they would leave the room.  the table would then shake a bit as it made the final adjustment....and then you know the rest of the procedure.  a tech told me the margin for error was 1mm.
 
my buddy started radiation a couple of weeks after i finished.  he received straight IGRT, which was i think 44 sessions vs. my 28 sessions.  they used gold markers on him.  i really never asked the doctor why the difference but i will next month if i remember.
 
ed
 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Post Edited (F8) : 1/15/2011 3:11:00 PM (GMT-7)


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 659
   Posted 1/15/2011 4:30 PM (GMT -6)   
My informed consent indicated that my surgeon would be present for the entire surgery and perform the critical parts of the surgery. Informed being the "operative" word. When we spoke about the surgery in general I was the party that indicated his team could and should function as normal. I didn’t want to upset the balance. Remember complicated surgery is impossible to complete with one person. Special surgical nurses and techs have extremely complicated and critical roles in assisting. Without appropriate skills of theses supporting cast of professionals you and your surgeon are in a heap of trouble. On the day of surgery I made a comment to one of the fellows to be sure and take lots of lymph nodes…as it turned out she did.
Hero

Pocketman
Regular Member


Date Joined Aug 2010
Total Posts : 121
   Posted 1/15/2011 4:32 PM (GMT -6)   
My surgeon, with 700+ procedures, flat out told me he'd be doing the surgery and his equally experienced partner would be the patient side assistant. I felt pretty confident and the results are panning out as expected. I have all along wondered though, someone has to be the first patient. If new doctors do not get the necessary experience, the next generation of PCa victims are going to be SOL.
Age 61, Diagnosed July 2010
PSA 04/09 - 2.5; 05/10 - 3.7; 07/10 - 4.7
DRE and Ultrasound - Negative
Size at biopsy - 32 grams
T1C, 3+3=6, 1 core of 12 60% positive
da Vinci nerve sparing RP 10/29/10
Post op biopsy indicated bilateral Gleason 6 tumors
Continent 90% and hopeful
Minor ED - 85% naturally, 95% with Cialis
6 week PSA - "undetectable"

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 1/15/2011 4:40 PM (GMT -6)   
I had robotic surgery. I was told up front that my surgeon, Dr. Menon, would be controlling the robot and his team would do the opening, insertion of robotic tools/arms, and closing. It was made clear to me up front.
 
I had one of the top surgeons in the USA, but my results were still disappointing (pathology-wise).
 
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. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/15/2011 4:41 PM (GMT -6)   
Good deal Ed,
I also have another resource who was a resident at Harvard's radiation oncology center. He specializes in IGRT technology technologies. He has already been emailed...I have asked about what the process is for when the technician discovers that the target has repositioned itself...

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

TTaylor
Regular Member


Date Joined Nov 2010
Total Posts : 102
   Posted 1/15/2011 5:22 PM (GMT -6)   
I am living proof that lack of experience will cause you complications. Don't be afraid to ask the right questions. How many have you done, will you conduct the complete surgery, what are your complication and infection percentages and what are my chances of passing surgical clips. Take your time, write down your questions and be assertive. If you don't like what you hear go to another doctor. Personally I would consider getting the book "Surviving Prostate Cancer" by Dr Patrick Walsh and making yourself familiar with certain terminology so you can ask poignant questions and let the Dr know you know what you are talking about. In most cases we are at their mercy. I certainly was and now I am living to regret it. All of my reading has been done after the fact. Do yours before the fact. I wish you the best in your decisions.
TTaylor
Age 67. Robotic prostatectomy 10/26/2010, due for RT in Janury 0f 2011. Eight of 12 lobes positive. Gleason Score 4+4=8, Margin envolvement was present with adipose tissue invasion and perineural invasion, glandular and stromal hyperplasia present,pT3 pNO and no evidence of metastatic adenocarcinoma. 1st psa after surgery Nov. 24, 2010 was .3
HT started Nov. 24, 2010.
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