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Randy7652
New Member


Date Joined Nov 2017
Total Posts : 1
   Posted 11/9/2017 9:10 AM (GMT -7)   
Hello everyone,
New to this forum and also newly diagnosed with prostate cancer with 8 of 14 cores positive, 3-4 and 4-3s. Looks like surgery is in my future and am looking for the most skilled Dr. Which leads me to a question....does a high number of surgeries equal a skilled doctor. I have been seeing Leslie Deane at Rush and have scheduled a visit with Dr Zagaja at UC for a consultation. My concern/question is whether a doc who does a high number surgeries could get complacent. From what I can discern, Dr Deane has done over 250 and performs about 1 per week. Dr. Zagaja- several thousand. Also, what % of the surgery they actually do or if a resident performs a part of it? As of now, I know Dr Deane would do the complete surgery himself. I’m just not sure of Zagaja. Any thoughts on either of these Drs. would be greatly appreciated.

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3388
   Posted 11/9/2017 10:17 AM (GMT -7)   
Welcome Randy, sorry you have to be here but we will help.

Why limit the treatment options to surgery?

You also have several radiation based therapies that should be considered. Brachytherapy, both High Dose Rate and permanent seeds, and external beam SBRT/Cyberknife are very effective with generally less significant negative side effects compared to surgery. All should be considered.

While researching surgeons also seek a few appointments with radiation oncologists that specialize in PCa. With any practitioner and especially surgeons, higher volume is generally better. Most men on this board would not consider a surgeon with less than 750 procedures and would want to see several procedures each week.

But first, you should have the biopsy slides read by either Bostwick or Epstein. These are the two true PCa specialists and a second opinion of the diagnosis is always a good idea. While doing that, read the sticky thread at the top of these thread that provides direction for the newly diagnosed.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta

SueCAll
Regular Member


Date Joined Jan 2015
Total Posts : 236
   Posted 11/9/2017 10:21 AM (GMT -7)   
Hi Randy, Welcome to the forum and we're sorry you have to be here. However, you have found one of the best forums on the Internet with lots of knowledgeable people. They will be along shortly with lots of tips and info. In the meantime, review the stickies at the top of the page. There's lots of good info there. Also, be sure to have your slides sent to Epstein for a second review. It's usually covered by insurance and it's well worth it. My husband was downgraded after a second read. He only reads prostate slides and knows his stuff. Again, welcome and hang around! Sue

tennisplayer
Regular Member


Date Joined Nov 2016
Total Posts : 306
   Posted 11/9/2017 1:48 PM (GMT -7)   
Randy,

Everything I read about this surgery advised looking for the most experienced surgeon possible. That was what I looked for. Zagaja and his colleague at U of C, Shalhav, each have done over 2,000 RRP's. I believe there are experienced surgeons at Northwestern, Loyola, North Shore Univ. Health, and Rush. We are fortunate to have good teaching hospitals in Chicago.

Take your time, and talk to a few surgeons before deciding.

In addition, educate yourself on radiation therapy. There are excellent treatment options that could give you the same outcome as surgery, with different side effects. You should meet with a Radiation Oncologist to learn more. There are a number of forum members who chose radiation and they can be a source of information.
Age at diagnosis-66 Diagnosed 6/16
RALP 10/16 at U of Chicago, Dr. Shalhav. Experienced internal bleeding post op requiring transfusion of 2 units.
Pathology Gleason 3+4=7, tumor volume 15% Margins negative except for one focal margin, .1mm
pT2c,N0,MX,R1
PSA @ 6 wks <0.02;16 wks <0.02; 5/17 <0.02; 10/17 <0.02
My storywww.healingwell.com/community/default.aspx?f=35&m=3777359

halbert
Veteran Member


Date Joined Dec 2014
Total Posts : 3102
   Posted 11/9/2017 7:40 PM (GMT -7)   
Randy, good input to you so far. From what I understand, most surgeons (like 90% or more) do the actual prostate removal themselves. Residents and fellows will do the preliminary work and the closeout. I know that in some cases the trainees may have dual control systems on the robots, so they can see what the surgeon is seeing and "feel" what he feels.

The usual statement is "it takes 500 procedures to get competent at it".

And, yes, talk to the radiation oncologists too before you make your decision. Even if you choose surgery, you'll know you did your due diligence, and didn't jump right into a life changing decision while you're still in the emotion driven mess.
Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA 3/10/15: 0.10
5/18/15: <.04
8/24/15: <.04
11/30/15: <.04
2/29/16: <0.04
8/30/16: <0.04
2/15/17: <0.006
8/22/17: <0.006
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Wilderness
Regular Member


Date Joined Feb 2015
Total Posts : 262
   Posted 11/10/2017 5:43 AM (GMT -7)   
Hi Randy -

Agreed that choosing a doctor, and particularly a GP or a surgeon, merits full diligence. Yes, some doctors do get complacent and some overbook procedures - work more for their bank accounts than their patients.

In matters of skill and outcomes surgeons are people like carpenters, teachers, lawyers, all of us. There are teachers who've been at it 40 years and are still learning, still innovating. And there are teachers who did their best work in their second or third year in the classroom and grow stale, distracted.

I suggest you look for an experienced surgeon with deep self-discipline who is meticulous and always learning. References from other medical professionals help. Ask all your questions and note especially the tone of the responses.

I think it also helpful to read books like Complications (Atul Gawande) or admissions (Henry Marsh) to for insight into the perspective of excellent surgeons.

Best to you,

Wilderness
8/14 DRE felt notch
9/14 DX 12 core. One 5% 3+4; one <5% 3+3
12/14 ORP Dr. McGovern MGH pT3a 47g 15% Gl 3+4 in r. post. q. focally & l. extensively; "established, extensive" EPE+ PNI+ SM- SV-
2/16 diet upgrade
PSA 8/14 2.38; 12/14 2.90; 1/15 .01; 3/15 .02; 5/15 .01; 8/15 .02; 10/15 .01; 1/16 .03; 2/16 .06; 3/16 .04; 6/16 .03; 7/16 <.014; 11/16 .03; 1/17 .06; 3/17 .03; 6/17 .03; 8/17 <.014

Progressing
Regular Member


Date Joined Aug 2017
Total Posts : 37
   Posted 11/10/2017 5:54 AM (GMT -7)   
Randy, you’re getting good advice. I found a surgeon at Memorial Sloan Kettering on the other coast who does 200 prostatectomies per year, 2500 lifetime, instead of the local hospital where the total annually for the two surgeons is 24. He also showed me the MRI, pointed out the tumor, and said he thought he could get it all.
And he did!
Age 75, excellent health except PCa
7/20/17, Biopsy, 5/12 cores PCa all right side, none on left, Gleason 4+3, PNI, suspicion of EPE
PSA 20.44
MRI and CT no evidence of metastasis, no lymph nodes, no seminal vesicles, focal bulge
Laparoscopic surgery 10/31/17, left nerves spared
11/9/17 catheter out, little leakage, pathology report T3aN0, G4+3, focal EPE, no cancer at any surgical margins
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