Can these "truths" be proven?

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clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2667
   Posted 5/16/2011 10:22 AM (GMT -6)   

Reading Compiler's latest threat about Dr. Scholz, and some of the back and forth arguments about celebrity docs versus local docs, leads me to wonder about a number of "truths" we routinely see repeated here on HW.  I read some of these things, and my thoughts are always..."prove it." Maybe I'm just a born skeptic, but here are a few things that I constantly question:

We talk about docs like Scholz, and Walsh, and Strum and give their opinions tremendous value, but are there any objective criteria that show they are truly superior to other docs working quietly at major treatment centers around the country?  If so, I've never seen such proof cited, just the fact that these guys have published more and have garnered national name recognition.  What do their peers have to say?  Do other excellent surgeons, oncs, around the country share the enthusiasm for this handful of doctors that permeates our site?  Maybe they do, but where can I see these opinions?  Enquiring minds want to know.

We routinely suggest to newcomers that they shouldn't trust the biopsy pathology results they receive locally.  That their pathologies need to be reviewd by Bostwick or Epstein or others.  Do we have any demonstrable evidence that this is necessary?  Any evidence that those labs are "right" where others are "wrong"? Where's this advice coming from?  I've read on some pretty authoritative websites that reading prostate biopsy slides isn't actually all that difficult, and that they are generally read and agreed upon by at leat two pathologists anyway? Is this true?  Here on HW, we routinely say that reading these slides is some kind of "art," mastered only be a few.  Is there any empirical evidence that the labs that we often cite are actually better at reading slides? Or are we just relying on folklore and reputation?

Finally, I of course agree that a DaVinci surgeon should be experienced, but I've seen numbers from the National Institute of Health that suggest as few as 50 surgeries are required to master the technique.  Others say 250, others 1,000 or even more.  I suspect that a lot of masterful surgeons are being excluded because they haven't reached those plateaus.  Reason tells me that DaVinci himself (the artist, not the machine) demonstrated remarkable skills from the beginning of his career, and that he didn't need 1,000 paintings to become a master.  Similarly there may be many "DaVinci's" who are actually more skillful on the machine than some of these esteemed "veterans" even though they are relatively new to the procedure.  I've seen how younger people excel at video games, on the Wii, and in various kinds of manual dexterity, and so I wonder if they might not also excel and have a remarkably fast learning curve for DaVinci surgery.  That's why I emphasize reputation among peers more than sheer volume.

Just a few things that I continually wonder about as I follow the site, and I would feel much better if I could see some hard evidence rather than simple repetition.  Not saying they're wrong, just that I'd like to see some hard evidence.


daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 5/16/2011 10:41 AM (GMT -6)   
Another thing about the high number doc's. An assembly line gets routine, after 2 or 3 surgeries/day are you as sharp and caring as a doc that only does one or two a week and takes his time?

Just food for thought.
Dave in Durango CO

07-06 PSA 2.5
01-08 PSA 5.5 (Dr never told me)
09-09 PSA 6.5 (age 55)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 5-03-11 <0.04

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/16/2011 11:10 AM (GMT -6)   
Clock,

Most excellent post, and you said things that needed to be said. I agree with your post.

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 margin
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, 4/11 3.81
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

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 5/16/2011 11:19 AM (GMT -6)   

These questions come up from time to time..

Even the best surgeons can have a bad day and a new surgeon can have his best day....

Three years after the fact - I still don't know my procedures my guy did or has done. All I know is that I liked him and felt comfortable with him.

There's another member here that interviewed with my surgeon. Its not that he didn't like my guy but that he liked a different surgeon better... The other member here has since had to do radiation and I didn't. What does that tell us.... NOTHING... There are just too many variables to be able to come apples to apples.

SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 5/16/2011 11:21 AM (GMT -6)   
Well said.  The bottom line on all of this is we should never beat up on someone because of their treatment or doctor decision.  It is a personal thing that we all have to live with.  We should pass on our experiences but not preach. Just my opinion.  Squid.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 5/16/2011 11:34 AM (GMT -6)   
Squid,
 
Seems like the last couple of days I've been having the same opinions, but you've been getting them out there first. Guess I'm slowing down.

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 5/16/2011 12:10 PM (GMT -6)   
I heartedly agree with the concept of this thread.

Steve, you are right on about what does it prove about you experiences with your doctor and the other guy who chose someone else.

My search and the quest for the best led me to one who is supposed rank as one of the top in the world. Do I blame him for still having PCa, or having to undergo radiation, or mets and so on. No Way in Hades.

We have all said it here many times. PCa is still a crap shoot and there is no one best way, no one great doc, or no best drug. Every single case is individual.

Squid and 142, you say and believe in something that I feel very strongly about. In fact I tried to state it once again on the other thread about "When do we stop".

Every single one of us has only OUR OWN personal experiences that we can draw upon with facts. Every other thing is opinion, learned, read or researched. It doesn't make it right, wrong or indifferent. Ours is all we know for sure.

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09 Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
PSA .6 IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9
3/7/11 PSA 4.2
4/10/11 PSA 3.8

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5823
   Posted 5/16/2011 12:58 PM (GMT -6)   
I just wrote a long post, that I deleted by mistake, hate it when that happens. Summary. No one can prove a subjective thesis. You cannot prove your thesis any better than the " other " can prove there's. Your proof is the inability of the other to prove there's. The experienced surgeon issue is common sense IMO, we will all go to a practitioner, in any field who we think is better. The trick is finding them. self education , research, playing the odds all come into play here. The slides, oh the slides. A pathologist say from where I live may read 12 Pca slides a year, from John hopkins 12 a day. just generalizing here. Not all cancers look alike, PCA, different from, lung cancer , unless it is pca which has metatasized to the lung which will look different from cancer that originates in the lung.
would you go to a medical oncologist that specializes in skin cancer or one that specializes in PCA. Right depends on what cancer you have. Any way Caveat Emptor PS I am sure you are not saying that experience does not matter, that would be ludicrous. Actually on a reread of your post I do see your statement on experience. Who would you go with, the 50 or the 250 man. I get the frustration that generated the post, just dont want newbies to think the slides are not important and experience really matters here Reference tops in their field types, cream rises to the top because it is cream, not skim milk . Anyway I,m out of here to say yes to the world, Tah , Tah! and Aloha! PS When " truths" are repeated all the time it seems to take away their truth or make them trivial. For some reason this doesn't work with the Big Lie. But thats an issue that is not allowed here, rightfully so
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Post Edited (logoslidat) : 5/16/2011 1:11:06 PM (GMT-6)


John T
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Date Joined Nov 2008
Total Posts : 4227
   Posted 5/16/2011 1:39 PM (GMT -6)   
clocknut,
Very good questions. It is difficult for us patients to evaluate doctors, but the doctors themselves know who is good and who is bad. There is some emperical evidence but it is not available on an individual basis. Scardino at MSK states that they keep very good records on all prostate surgeries and there is a significant difference between individual surgeons. The average positive margin at MSK was 21% with the best surgeon at 11% and the worst at 48%. So we do have data that proves that some doctors are clearly superior to others. I doubt that they would ever release the individual statistics to the public. My wife was going to have breast cancer surgery from a surgeon at USC who she really liked. Her oncologist who had worked with this surgeon said no way, he is good at certain surgeries and breast is not one of them. There was no way we could have known this. This same oncologist recommended Dr Scholz when I was DXed; I would have never found him on my own.
Forums like this are also a good way to discove the best. Without forums we would never know about Fred Lee or Snuffy Myers or Volesgang who keep coming up from satisfied patients who have seen them.
You can easily see from Strum's answers to patient on P2P that he is clearly more knowledgable about PC than most doctors. His book also contains information not readily found else where. Without emperical data, which is sorely lacking, we just have to rely on trusted doctors' recommendations, experience and word of mouth.
Certaintly there are some good doctors that are not as experienced, but how does a patient evauate them. Having 30 years expereince in hiring for top management positions I know that interviewing has an inverse correlation to success and that past performance is the only good measurement of future success. Picking an inexperienced doctor is a crap shoot and entails more risk than I'm willing to accept.
There is also emperical evidence that says with low grade PC there is no difference in results between community centers and major cancer centers; but a significant difference between the centers in advanced cases. So if you are a low risk case it probably doesn't matter where you are treated, but if you are advanced it behoves you to find the best doctors available.
Re pathology: The Gleason score was developed with the parameters that 90% of pathologists would agree on the scores in a blind test. I believe that about 10% of all biopsy slides the gleason score is changed when reviewed by an expert, which statistically should be expected. It is also common sense to assume that a doctor that is treating 1500 patients a year for advanced cancer will do a better job than one who sees only 10 or 20 patients, just as a doctor that does 1,000 surgeries is better than one that is doing only a few a year. With lack of any emperical data one just has to rely on the doctor's experience in the treatment you are seeking.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 5/17/2011 8:38 PM (GMT -6)   
I would never have considered being treated by one of the high-volume surgeons because I'm convinced doing so would be dangerous to my health.  There's no convincing me that these guys are doing these surgeries themselves.  Others, residents or others are helping.  They run surgical factories.  But to each his own choice.  Many guys are influenced by the marketing here and elsewhere - recommending these surgeons.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/17/2011 9:00 PM (GMT -6)   
mavica,

i am with you on this one for sure. the high volume guys scare the willies out of me. not insinuating that you dont get good care or results with them, but not comfortable with the surgery mill concept. with my surgeon, if he's doing an open rp like i had, he has no other surgery scheduled that day, period. and he never does more than 2x a week by choice on the major surgeries. might cut into his income possibilities a bit, but when he operates on you, you are getting him, not a bunch of students or an enterouge of assistants. i don't mean he's in the operating room alone, of course. we have already seen here even among our community here on hw, that having a superstar high volume surgeon doesn't always translate to stellar results.

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 margin
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, 4/11 3.81
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

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 5/17/2011 9:37 PM (GMT -6)   
Leonardo Da Vinci started as an apprentice at 12 years of age. He mastered his craft just as Michelangelo, Caravaggio and Giotto did.

I personally don't agree with the point made here.

When initial choice was to go with my local guy here. He had done about 400 and told me the learning curve was 250. I don't know what that curve really is and if it's the same for everyone anyway but have read an article posted here that says the curve was 1000.

After talking to hospital administrators (in my town) oncologists and surgeons, including Mitchell Benson from NewYork-Presbyterian/Columbia, I changed my mind. Everyone told me that I had one shot at this, that I might not want to make this an emotional choice but rather consider trying to go with one of the best guys and that volume did equal "best". That is what I was told repeatedly. In my area that was my guy or Tehwari. The difference between the two from what I learned was that my guy does them all start to end whereas Tehwari uses assistants. That's why, among other reasons, I chose my guy.

It's a craft one masters, and if one only does those he/she has the luxury of perfecting that trade. Local guys, like my uro don't have that luxury.

I'm not even sure why they're referred to as "celebrity docs". They don't aspire to be celebrities, they have been recruited by the best centers for their skills and reputation and are passionate about helping people. Given the organizations behind them they have more visible profiles in the media and on social media. Actual celebrities may go to use their services, but they're not celebrities. At least not until they get a reality show...

This doesn't mean that there aren't hundreds of great surgeons and oncologists who have different profiles/visibility. And like someone above said, doesn't mean great ones don't have bad days. But I am definitely comfortable with the philosophy that it isn't so much the treatment one chooses, as this can vary from person to person, but the quality of their doctor. With surgery nobody is going to be able to convince me that volume/experience doesn't translate into skill. I'm not trying to prove that to anyone but the results I got from mine have certainly proven it to me and the family members that worked to convince me of this logic early on in my process.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3744
   Posted 5/17/2011 9:44 PM (GMT -6)   
Hey guys, lets face it, treating these cancers is BIG BUSINESS..Usually, when different specialists are involved treating a patient, if there is a conflict, it gets resolved backstage, the patient is never aware..I mean, these guys are all professionals, right? But when they perceive an encroachment into their territory, or a patient requests with a phone call that his records be sent to a competing doctor, the pot can boil over and the competitive nature of this business is revealed for all to see... There is serious money on the table here..It is very rare when a urologist and a medical oncologist have nice things to say about one another...

So not only does the patient have to deal with choosing the best possible treatment, he has to navigate through the minefield of competing doctors..

All in all, one would hope there are very few incompetent surgeons, urologists, medical oncologists and radiation oncologists out there..Failures and botched procedures get noticed just as quickly as outstanding work does and peer review boards get them out of the system...One at least HOPES that's the case..My doctors all seem to take their jobs and the responsibility attached to those jobs very seriously...

JohnT posts this: :The average positive margin at MSK was 21% with the best surgeon at 11% and the worst at 48%. So we do have data that proves that some doctors are clearly superior to others."

If I was the chief of surgery at MSK I would find this to be unacceptable..Why should ANY patient accept a 48% risk when a different surgeon can lower that to 11%...That's far to great a spread to ask patients to accept..Perhaps these surgeons have different criteria for accepting patients which results in markedly different outcomes..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 5/17/2011 10:30 PM (GMT -6)   
Fairwind,
It follows a distribution curve just like everything else in the world. If the average is 21% then 50% of the doctors are going to be below that and 50% above that. There are always going to be doctors at the extreme tail end of each curve. I agree that the spread is just too great to be acceptable, and the doctor that is at 48% needs some training, but it also indicates the normal difference in individual skill level and experience. You want to find those doctors on the extreme end of the positive side of the curve and stay away from those on the other end.
There are absolutely some 6 simga doctors out there (6 standard deviations from the mean), just like there is a Warren Buffet and a Tiger Woods. If you can identify and get these doctors you are in a much better position. Anyone who thinks that all doctors are created equal is living in dreamland.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/17/2011 10:49 PM (GMT -6)   
John, I don't think anyone on this board thinks that al doctors are created equal. I have never heard that expressed or insinuated.

I think with the some of the "top notch" ones have long been accused of cherry picking their patients, in order to keep their sucess numbers high, this has been said for years with Dr. Walsh (and I am a fan of him) and even this Dr. Samadi, and a handful of others whose names get pushed around a lot by large media and advertising budgets.

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 margin
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, 4/11 3.81
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

davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4093
   Posted 5/18/2011 5:01 AM (GMT -6)   
David - I doubt that's true. I know it's not true in the case of my doc for instance as I know he has taken on several complicated cases with much higher gleason score than a 6 for instance. Also, some here have insinuated that he cherry picked someone like me ( gleason 7), Obviously he didn't because I sought him out, but let's imagine for a second you're right, how could this supposed cherry picking result in immediate complete urinary control and in erections? Wouldn't something like that have a lot more to do with his skills than with supposed cherry picking?
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

Sagittarian
Veteran Member


Date Joined May 2011
Total Posts : 546
   Posted 5/18/2011 5:37 AM (GMT -6)   
I agree with your analysis.
Surgeons can be marketed to create a facade.
At work we know people who are perceived as
being great, but we know different.  They spend
more time with their image, than they do with their job.
 
As far as second opinions on pathology.
It wouldn't have changed my course of action.
DOB=DEC-1957, NJ, PSA HISTORY, FPSA=7%,
2002=1.83, 2006=3.18, 2007=3.09, 2008=3.20
2009=3.50, 2010=3.50, 2011=4.70, 2011=4.20
DRE, CT-SCAN, Bone Scan, =All Negative
BIOPSY, 12 Cores, APR 2011, 4 POS, 2(3+3), 2(3+4) All Left Side
% on Positive Cores, 2(40%) 1(70%) 1(90%), PNI=Not observed

Da-Vinci Surgery=23 May 2011

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 5/18/2011 7:36 AM (GMT -6)   
The first surgeon who is willing to spend the $0.75 it costs to record all 6 hours of the DaVinci procedure and has the confidence to give it to the patient will have my vote as potentially being the best in the business!

A video recording would help answer questions like:

Was that nerve spared? Check the video.
Did the celebrity doc only come into the room for 15 minutes? Check the video.
Was this prostate removal more difficult that expected? Check the video.
Was the Cowpers gland spared? Check the video.
Was anything left behind? Check the video.
Margins? Check the video.
Is this guy really good or is he only taking good patients? Check the video.

I'll throw down the gauntlet now.

I will add such a recording device at my expense to the first surgeon willing to put it on the machine he uses under the condition that he promises to record the next 50 prostatectomies he performs and provides the patients with the entire recording of their procedure. Both the patient and the surgeon may use the recording any way they see fit. (Hospital infrastructure costs, if any, must be borne by the hospital or surgeon.)

This is not an idle offer. I am well aware of FDA rules and regs. My resume includes the development, production and successful attainment of FDA 501k permission to market for a life support device (portable emergency ventilator) among other things.

Any takers?

My email is turned on.
Jeff

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/18/2011 9:37 AM (GMT -6)   
Sag: who are you agreeing with? You didn't specify.

Jeff: what a great idea, but i wouldn't think you would get many, if any, doctors to take you up on the challenge, they would claim liability issues i am sure.

davidg: you don't have to jump out of the box every time Samadi is mentioned, he doesn't need you to be his attorney. he is a high volume surgeon with a big ego, and a huge campaign to increase his name and the volume of surgeries he does. doesn't mean he's good or bad. i wonder if he even takes on high risk or riskier cases. you are only fooling yourself if you think certain big name surgeons don't cherry pick.
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 margin
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, 4/11 3.81
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

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5823
   Posted 5/18/2011 9:59 AM (GMT -6)   
DavidG I read most of your posts, this is new to me that you feel some think you were cherry picked. When you throw that out, arguably to prove your point, it just distorts the whole discussion, could you point that post out. You usually do bring up the post that indicates your poin, if in question. Just a request, Ich mach nix!!

Off for a run to say yes to the world and myself, 6am here in maui nei! South wind ocean flat
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 5/18/2011 10:00 AM (GMT -6)   
David,
I will let the offer cook here for a while. If there is no response I will make my own thread.
To maintain sterility I would locate the recording device in a nearby room and have the images transmitted wirelessly.
I'd have a lot of respect for any surgeon who was willing to do that.
Jeff

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2667
   Posted 5/18/2011 10:18 AM (GMT -6)   

Davidg, you said, "I'm not even sure why they're referred to as "celebrity docs". They don't aspire to be celebrities, they have been recruited by the best centers for their skills and reputation and are passionate about helping people.

In regard to your surgeon (Dr. Samadi), I woud use the term"celebrity doc" because I see him about once a week on Fox New or the Today Show or elesewhere.  I would argue that he definitely basks in the celebrity lifestyle.  He has cultivated a national reputation, and I don't know what else to call that but "celebrity."  I frequently end up annoyed with his commentary because he's only about surgery.  I've never heard him mention seeds, external beam radiation, proton therapy, or any of the other possible treatments that might be appropriate in specific cases.  And just last week I saw him again promising that today's prostate surgery virtually eliminates worries about incontinence or erectile dysfuntion.  Pardon me, but I say, "B.S."!

I know things have worked out well for you, and I'm happy for you  I also had an exellent outcome with a very low volume surgeon, as my stats will show.  My continuing ED is certainly explainable by the loss of a nerve bundle and being nearly 66 years old.  If I had gone in with your stats,  at your age, and in your physical condition (which I had at age 40), my low-volume, not famous surgeon would have almost certainly had equal success as far as ED goes.  I seriously doubt that any of the big-name doctors could have saved that nerve bundle without risking a recurrence of cancer.

No one has had much to say about the interpretation of the pathology slides.  Am I wrong in understanding that the Gleason 4's and 5's look so different from other cells that they're relativey easy to read, while it's the lower grades that are difficult to distinguish from one another?  If that's correct (and correct me, please, if it's wrong), then isn't it unlikely that any competent pathologist would miss the high-grade cancers? 

Also, if the super-surgeons and super-readers of slides know things that the majority of docs don't know (e.g., Dr. Samadi always references a certain specific technique that he perfected), why don't they share those secrets with the medical community?  Maybe they do, but they seem proprietary about these things.

I appreciate that some surgeons have a higher level of surgical skill than others, just as space shuttle commanders probably have varying degrees of aeronautical skills, but just as the shuttle commanders are all outstanding pilots, I tend to hope that the bar is set so high for urologic surgeons that all but the very weakest of surgeons are capable of doing consistently excellent work, and until I can see some objective proof to the contrary, I guess I'll keep believing that.

 


Post Edited (clocknut) : 5/18/2011 10:31:54 AM (GMT-6)


Sagittarian
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Date Joined May 2011
Total Posts : 546
   Posted 5/18/2011 10:24 AM (GMT -6)   
My agreement was with clocknut

John T
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Date Joined Nov 2008
Total Posts : 4227
   Posted 5/18/2011 10:40 AM (GMT -6)   
Clocknut,
Then I guess you would feel very comfortable with just picking out a name in the phone book under "Urology" and have him do your surgery.

David, I'm sure that some doctors preselect their patients. Walsh won't operate on anyone over 70 and probably rejects some cases he feels are too advanced. The question is: does the doctor do this to make his numbers look better or is he looking after the patient's welfare by not doing a procedure that would have a high probability of not being successful.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Fairwind
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Date Joined Jul 2010
Total Posts : 3744
   Posted 5/18/2011 10:45 AM (GMT -6)   
Worried, I suspect there ARE videos of most da Vinchi procedures..But with the waiting room full of lawyers, doctors and hospitals guard them very carefully...There would be a HUGE pressure to destroy incriminating videos...Some surgeons might refuse to operate if the operation was being recorded..

Next time I see my surgeon, I'll ask him!!
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