Due Diligence Backfires

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New Member

Date Joined Mar 2011
Total Posts : 1
   Posted 3/15/2011 4:49 PM (GMT -6)   
Hi everybody...I'm new to this forum.

This is one of those cases where trying to be careful and doing due diligence has backfired.

I was scheduled for a DaVinci radical prostatectomy with Dr. Randy Fagin in Austin last month.

Then I got a call from a friend of a friend who had been through all of this a few years ago. I told him that I had considered my options carefully, and spoken with several physicians to obtain second opinions before reaching the decision to have the DaVinci surgery. The consensus was that at my age (61), this was the best option. He told me that I had NOT gotten a proper second opinion, because everybody I had spoken with was working off of the same pathology report.

So I decided to postpone the surgery and had my slides sent to MD Anderson in Houston. The result was a slight downgrading. Initially I had 5 positive cores (1 3+3, 4 3+4's), and the new report was 3 3+3's and 2 3+4's. Last week I drove to Houston and met with one of the MD Anderson surgeons, whose opinion was that the slight change was not enough to alter the original recommendation. He told me that if my case were more serious, he would recommend MD Anderson for multi-track therapies, but that since my case was relatively simple, he had no objection to my choice of surgery in Austin, assuming a skilled surgeon.

So I returned to Austin and phoned to reschedule my surgery the next day. I was shocked to find out that Dr. Fagin will be leaving his group at the end of March. He will take on an administrative position with another institution in Austin, and will no longer be practicing surgery. Oh, and by the way, there are no available surgery slots before he leaves.

I am so bummed out. Having gone through the process of getting all psyched up for this, reading all the good testimonials for this surgeon and convincing myself that this was the right course of action, I now feel like I'm back to square one. Is it wrong to think that they could have at least given me a heads up about this when I called to postpone? Or even when I set up the initial date?

I'm trying to figure out what to do next. I liked the surgeon at MD Anderson (John Davis), and from what I've read he appears to be quite skilled. Should I just use him in spite of the more complicated travel logistics, or are there other Austin surgeons I should consider?

Any advice would be appreciated.

CB in Austin
Age: 61 PSA: 5.9
Biopsy: 11/2/2010 Gleason 5/12 positive (3+3's and 3+4's)

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 3/15/2011 5:22 PM (GMT -6)   
Hi CB,
I am a bit surprised that Fagin is hanging up the mask. We have quite a few of his members that have stopped by here. All that are very happy with his work. Perhaps you might try to get it from the horses mouth. Let him know that you delayed it with the intention of still having him do the surgery and was not told about this possibility. He could open anothe slot for you.

When you find out where he is going, perhaps you can drop it here. Good for him moving on, but not as good for a strong surgeon to leave the surgical community...

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

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 3/15/2011 5:23 PM (GMT -6)   
Welcome CB,

Tough story and a bit of bad luck for sure, but you should be able to find another good surgeon in your area. Your due dillegence wasn't the problem, you just didn't know about your original surgeons plans in the future. No fault there.
Please keep us posted of your journey.

David in SC
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 2/11 1.24
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 9/10,

Veteran Member

Date Joined Jan 2009
Total Posts : 2211
   Posted 3/15/2011 7:09 PM (GMT -6)   
Agree with David, and you have no idea why he is hanging it up. Sometimes it is good not to be the first nor the last. Your options are still fairly wide open. I think you did right by getting the second. Keep us posted.
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4
Started IMRT Jan. 2010 72gys
7month post SRT PSA .2

Regular Member

Date Joined Jan 2011
Total Posts : 78
   Posted 3/15/2011 8:27 PM (GMT -6)   
I flew out of town for my surgery and had no regrets.  If you find another surgeon that you are happy with that is great.  If on your own personal report card, you give the doctor in Austin a B and you give the doctor at MD Anderson an A, then make the trip.  The relatively small inconvenience of travel will hardly be a blip on the radar.  If you have imperfect results with a surgeon that you feel like settled for, you will have a long time to regret it.    
Good Luck!
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

open RP on 2/14/11 at Mass General

Post Surgery Pathology Report: Gleason 6, T2, Cancer in 35% of Prostate, All Margins Clear

Veteran Member

Date Joined Jul 2010
Total Posts : 3596
   Posted 3/15/2011 9:24 PM (GMT -6)   
How close to your surgery date were you when you postponed? Most highly skilled and sought-after surgeons can make FAR more money in the operating room than in an administrative office..When a successful surgeon quits, there is usually good reason for it..They are human too...

Veteran Member

Date Joined Feb 2010
Total Posts : 3771
   Posted 3/15/2011 11:29 PM (GMT -6)   
>>This is one of those cases where trying to be careful and doing due diligence has backfired.<<
that's one possible conclusion.  not the one i would have reached tho.

age: 55
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Veteran Member

Date Joined Apr 2008
Total Posts : 1131
   Posted 3/17/2011 5:29 AM (GMT -6)   
When I was diagosed, I considered Fagin given his experience but decided to stay my my uro in Houston. Fagin's office shold be able to provide other surgeons to consider. There are lots of good surgeons so you just need to find him/her. Good luck. I think you were right in getting a second opinion. I decided to go with Methodist Hospital but I did get my second opinion from MDA. I thought the doctor at MDA was an xxxhole but it could have been that I was scared too death and over reacted to him manner.
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

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2457
   Posted 3/17/2011 7:44 PM (GMT -6)   
I'm one of those who had their surgery with Dr. Fagin. He certainly is one of the best DaVinci surgeons. I received a letter from him telling me that he is no longer with the Urology team. He gave my case to Dr. Giesler for all follow up appointments. Doing the surgery at MD Anderson shouldn'd cause to much of a logistical problem. You only spend one night in the hospital and your first visit to get the pathology report and remove the catheter is one to 2 weeks later. After that you can have all follow up visits and PSA tests done locally.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

New Member

Date Joined Mar 2011
Total Posts : 4
   Posted 3/17/2011 9:21 PM (GMT -6)   
Had Di Vinci surgery with Davis on 2-28. Was driven to Austin on 3-2 after being released on 3-1. Back at office work on day 7.

Your milage may vary, but my recovery has been fast without incontinence and without some other usual problems.

Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 3/17/2011 9:55 PM (GMT -6)   
Overall, I would consider this a small bump in the road. There are are many good surgeons who will an equally good job.

Hopefully it doesn't bother you too bad. Plus, if you had gone ahead, and then he left, follow up would have been an issue.

Good luck.


New Member

Date Joined Mar 2011
Total Posts : 1
   Posted 3/24/2011 1:51 PM (GMT -6)   
Thanks to all of your thoughtful replies.

For those who asked about Dr. Fagin's future plans, I refer you to the following article in today's Austin Statesman:


cbmagi in Austin

Regular Member

Date Joined Nov 2008
Total Posts : 184
   Posted 3/24/2011 7:30 PM (GMT -6)   
cbmagi, you asked, so I'll offer an option. Search Dr. Kella at Urology San Antonio. In my opinion, Dr. Kella is one of the best. Contact me via PM if I can help.

Post Edited (coxjajb) : 3/24/2011 7:35:45 PM (GMT-6)

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