Please help me with final decision.

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laswell
New Member


Date Joined Aug 2007
Total Posts : 12
   Posted 9/22/2007 9:16 AM (GMT -7)   
After much research and consultations, as well as discussions w/ my insurance company, I have narrowed down to two surgeons who are in network. I would have to travel for either surgeon but I don't want that to be a deciding factor.(although one is in Balt,Md and the other is here in Tx where I live) They both seem qualified but have very different resumes. I would be very grateful for your opinions . I have a tentative schedule w/each so I need to decide this weekend. It boils down to an excellent surgeon(Dr. Su) from a very pretigous hospital but with less actual robotic surgeries vs. a younger guy(Dr. Fagin) who has put up a crazy number of Da Vinci procedures in a short amnt. of time. I am a little concerned w/Dr. Fagin doing 4 surgeries a day @ 1-1.5 hrs. a piece. Does this mean they are cookie-cutter style vs. Dr. Su's 2 a day @ 2.5 hrs. a piece? Or does it mean Dr. Fagin is just really good and more efficient because of having done 600+ surgeries? I know there are many variables I can't control, I want to make best choice possible for my doctor. Thanks very much for your help!
Here are their bio's:
First the big gun-
Dr. Li-Ming Su -Associate Professor of Urology
Director of Laparoscopic and Robotic Urologic Surgery
James Buchanan Brady Urological Institute
Johns Hopkins Medical Institutions , BS/MD @Cornell University,Residency@Memorial Sloan Kettering
He has done 335 conventional lap procedures beginning in 2000. He will have done about 250 Da Vinci surgeries by my appt. in mid Oct. He does only 2 surgeries a day 3 days a wk. His surgery time is 2-3 hrs. He claims continence is 90% at one year. Potency is 75% at one year. He incorporates some of Dr. Walsh methods in his surgery.Is highly published and I would guess has learned from some heavies in prostate cancer, not to mention he is at the #1 hosp. in the country. He assures me he will do my entire surgery (no assistant/students at the console).


Now a guy who practices w/ a small private group called "The Urology Team" in Austin ,Texas.They purchased a robot and brought him in June,2004.
Dr. Randy Fagin attended medical school at the University of Buffalo in Buffalo, New York and joined The Urology Team from Syracuse, New York where he obtained his training in Urology. Dr. Fagin has trained with experts in Laparoscopic Urology in Paris, France, The Cleveland Clinic, New York University, Albany Medical Center, and Thomas Jefferson Hospital in Philadelphia.(I believe these were short training sessions) Dr. Fagin is currently the director of robotic surgey at St. David's Medical Center (small-ish Hosp. in Austin). He does not have the strong academic writings and bkgrnd of Dr. Su .He does seem to have impressive numbers performing daVinci robotic prostate cancer surgery. He performed 200 Da Vinci surgeries between 2004-2005. He claims to have performed 100 trad. open surgeries,300 trad lap. procedures and currently 600 Da Vinci procedures.He does 10 a wk - 4 a day Mon and Fri and 2 a day on Wed.

puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 9/22/2007 10:08 AM (GMT -7)   
The standard advice is the more actual surgical experience the better. The difference between your two candidates is pretty dramatic -- 250 vs. 600. But I wonder if the "experience factor" weighs as heavily once you get 200-300 DaVinci's under your belt (no pun intended)? My surgeon told me he does 2-3 surgeries a day, 3 days a week -- about 250-300 a year, the majority DaVinci. He also said that 2 to 2-1/2 hrs is pretty standard. I'm suspicious of the 1 to 1-1/2 hr prediction-- sounds a bit like an assembly line, if it's true. Doing 4 a day, day after day, would also concern me. I guess I wouldn't want to be #4 on a Friday! I dunno. This is a tough one. I'm a sucker for impressive credentials -- I'd probably to with the John Hopkins guy, but you're probably in very good hands with either one. Good luck and keep in touch!
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 9/22/2007 10:15 AM (GMT -7)   

Hi laswell,

This is a tough one.  You have a choice between good and good.  My only concern, which you seem to have addressed, is the notion that Dr. Fagin seems to have a kind of "factory" going, where surgeries are done one after another in a short period of time.  You'd want to feel comfortable that Dr. Fagin and Dr. Su would both take the time to pay very close attention to your specific disease situation and anatomy once inside your body :-)

If you feel comfortable with the individual attention you'll recieve, and you have some good second, third opinions on each surgeon's effectiveness for this surgery, then it probably doesn't matter which one you choose.  Again a choice between "good" and "good."  You are in control

I wish you the best in your decision and treatment!

Kind regards,

Idaho

 


Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

PSA 0.04 (undetectable) 9/11/2007

Web site: http://pca-info.blogspot.com

 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 9/22/2007 11:05 AM (GMT -7)   
Hi Laswell

It might well be a toss up between the two doctors. However, I am very skeptical of any doctor who claims to do 4 robotics surgeries per day at an average of 1-1.5 hours each (i.e., Dr. Fagin). From what I have read the average time to do each one is often well in excess of his time frame. There are more complicated surgical cases where it can take a few hours to complete the surgery. You need to clarify this point very carefully. Also, you might see if you could get some references from some of his patients who have had surgery awhile ago.

Keep in mind that the doctors who specialize in prostate cancer at Johns Hopkins have long had a superior reputation and I wouldn't be overly concerned that Dr. Su has done fewer robotic surgeries than Dr. Fagin. He seems to have done enough to give him adequate experience. I know that getting your surgery performed locally would be preferable, but I wouldn't let this point be a deciding factor. The rule given by most prostate cancer experts is not to settle for less than the best doctors at the best hospitals.

Good Luck to you!

Dave
68, 29-core biopsy 9/27/06, PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area],  Gleason 6 [less than 5% in two other areas], negative DRE, bone scan and Endorectal MRI. Completed 39 Proton radiation treatments 2/22/07-4/18/07.  First PSA test 7/19/07 (3 months after treatment) was 2.1 or a 70% reduction in my PSA before treatment (this was better than the average expectation of a 50% reduction in PSA at this juncture, according to my radiation oncologist).
 

Post Edited (pcdave) : 9/22/2007 7:14:52 PM (GMT-6)


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 9/22/2007 11:39 AM (GMT -7)   
Fagin has a decent reputation. Li-Ming does have one plus that caught my eye...the focus on both lap and robotic assisted laps. That would probably be a selling point over Fagin. Either sounds like a winner actually. You'll get it figured out. Good Luck and best wishes.

swim
 


cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 9/22/2007 12:02 PM (GMT -7)   

Dear Laswell

      If you check my last post (today) you will see that I went through a similar decision- making process except with a set of equally good Robotic surgeons. Both Su and Fagin are excellent from my research. I tried to get appointment with Su but it took too long for appointement. I also heard that his surgery schedule is out to December/January now since he is cutting back on Robotic prostatectomy rather he started involving himself in other areas of robotic surgery (not sure area). I also was under impression that Su was one of the 1000 club in terms of number of robotic surgeries. If I did not opt for David Lee from Penn here in Philly (my home town), I would have chosen Tewari in New York. Both are excellent and I agonized as you over which one. Ultimatley it boiled down to being close to home with all other things considered equal. As for length of surgery - you have to be sure what time reference they are using - the acutal time doing robotic procedure or the total time including prepping you. I found that  2.5 hours included prep time and heard a range of time from 2.5 to 3.5 hours from the doctors I spoke to. By the way, although Hopkins is a great facility with great doctors who have done wonders for many in the Forum and elsewhere, there are many good surgeons around the country including your home town. I did not like my experience at Hopkins - the surgeon I met did both open and robotic (he even referred to Walsh's book as out of date)and  suggested to me that open was less invasive then robotic and was somewhat dismissive. While he was a well known and highly regarded urologist at Hopkins, for me - he was not the answer. As everyone  tells you - it is your decision - go with what you feel most comfortable with. I met with every surgeon I considered before I made my decision which included travel to NY, Columbus and Baltimore.  I wanted a personal meeting with each before deciding. Perhaps that is what you should do. Good luck.

CPB

 


Gleason 6 (3+3) - PSA-2.7 - T2a - Age 66
Diagnosed July 23, 2007
Da Vinci surgery scheduled - Oct 22, 2007


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 9/22/2007 1:39 PM (GMT -7)   
Hey laswell,

You have thoroughly studied your options. Now take a day off then go with your gut....

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 7/18/07 0.00. 
T level on 4/2/07 - 48     On 7/16/07 - 613
Started Tri-Mix on 8/7/07.  .02 ml and 50 mg Viagra.  It works!!!
Next PSA and T tests on 10/17/07
 
"Patience is essential, attitude is everything."
 


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 9/22/2007 3:57 PM (GMT -7)   
laswell,

There have been a couple of posters to this forum that used Fagin. Hopefully they will pick up on your post and reply. One of the unique services that Fagin provided was a physical therapists that specializes in helping to learn the right muscles to train to recover continence. As to the time for surgery I am not sure that there is any particualr standard. My surgeon had done over 900 Da Vinci's and 3,000 open type of prostatectomies. He does about 11 a week in three days and is the head of the urology department of a major university based medical center. I was told that my surgeyr would be about 3 hours. The day I had my surgery three were scheduled but at the last minute one was cancelled due to pre op complications. I was the first one done that day and when I woke up in recovery it had been about 4 hours since I had entered the OR. I asked my surgeon why it took longer and he just said that my prostate was large and he just decided to take the time to do as good a job as he could. I appreciated his commitment to doing a very good job.

Tamu
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06
No more pads as of 1/13/07
Began injections in April '07
Undetectable PSA on 6/25/07


uncledan
Regular Member


Date Joined Aug 2007
Total Posts : 120
   Posted 9/22/2007 7:45 PM (GMT -7)   
You now have the hardest part to do, choose a surgeon. I opted for a surgeon who had done a fellowship with Menon and trained another surgeon in the Da Vinci. My surgery was almost 5 hours. I asked the surgeon about t his and his reply was there were certain things that needed to be taken care of, he also made the statement "I don't want any one or two hour prostate surgery done on me". Seems that his concern was less than two hours was rushing things. You are welcome to go to my thread and see how things have gone for me. I have tried to update my situation regularly. I am now nine days into a ten day coach trip and things are going fine. I have ridden over 2500 miles the last few days. No problem. God Bless, Uncle Dan
Age 67
No symptoms, DRE negative
10-06 PSA 5.44 01-07 PSA 6.47
CT and Bone scan negative
05-07 Biopsies, 2 of 6 positive
Gleason Score (3+4) 7 Stage T1c
08-14 Dr. Dasari - Baptist Hospital
da Vinci RAP, five hours surgery
Hospital 2 1/2 days, 8 -14 to 8 -16
Pathology report Negative margins
Cancer encapsulated,
Lymph nodes 2 R & 1 L - Negative,
R & L seminal vesicles - Negative
Gleason changed (4+3) 7 closer to 8 than 6
9-20 Small infrequent leaks,
Use pad when out, Sleeping without pad.


GreenAcres
Regular Member


Date Joined Jul 2006
Total Posts : 474
   Posted 9/23/2007 6:43 AM (GMT -7)   
Hi, Las - good for you on scheduling a visit with your two choices in surgeons. We selected Dr. Fagin based on his availability for discussion, credentials and face-to-face impression. He took 2.5 hours with the actual procedure. (And our opinion going in was the less time under the knife/anesthesia, the better.) In other words, he won't rush through, which would be common on any physician's schedule, I imagine. We liked the fact that he was younger - we joked with the staff about him teething on a game console. He also seems to have boundless energy - his first rounds post-surgery started at 5 a.m.

A second plus is his post-surgical rehab program - he's eager to see men of all ages return to as much of a normal life as possible and does everything in his power to see that it happens. His team is exceptional; the hospital is equally outstanding.

Third, he took us even on Medicare, which is basically hideous when it comes to reimbursing a fair amount. And he continues to have us come back for rehab discussions and PSA checkups, in spite of that.

You'll be in great hands, whoever you choose. We know these decisions are not easy. Good luck.
Husband age 66
PSA on 5/1/06: 4.2 (had doubled in 13 mos. and rising monthly)
DaVinci Surgery 8/2/06 - Austin, TX w/Dr. Randy F.A.G.I.N.
T2a (at biopsy)
At pathology - cancer cell leakage into fatty tissue
Post-Surgical PSA on 10/06, 4/07 - undetectable!
Update: 11/1/06 - perhaps bladder neck involvement; 30%-50% chance of recurrence
Future: PSA tests twice-yearly for now - Next one: 10/16/07
 


common man
New Member


Date Joined Aug 2007
Total Posts : 13
   Posted 9/23/2007 12:15 PM (GMT -7)   
Sounds like one is doing piece work and the other is doing quality. I don't want a dr in a hurry to get to the next operation as it is a life he is messing with
age 66 , pc discovered 2005, psa 9+, did radiation and psa went down to .4, psa apr07 3.4 aug 07 went to 7+ gleason is 8


PianoMan
Regular Member


Date Joined Feb 2007
Total Posts : 365
   Posted 9/23/2007 5:04 PM (GMT -7)   
Laswell, I'm with Biker. Take a day to let things settle in.  Go out and have a nice meal and some wine.
Then, put it in the hands of the higher power and your decision may come to you.
I'm no holy roller, but when I was at the crossroads (very scared and confused) I put it in the hands of God one night and my path arrived the next day.  Before I knew it, surgery was over and healing was underway.  I've never looked back on my treatment/doctor decisions.
Best to ya.
You'll be fine.
Tom


D.O.B - 8/9/52

PSA: First ever was 9.8 in late Oct. ‘06, two weeks later, 10.1

DRE: Negative

Biopsy results 11/22/06.  Both lobes involved.  Six out of eight cores positive - from 100 percent to 90, to 60, to 50, two 20s and two zeros.

Gleason 3+3 = 6

Da Vinci Robotic RP surgery, City of Hope, Jan 12, 2007

Post surgery pathology – Organ confined, Gleason still 6, margins clear.  Volume of tumor much less than biopsy suggested.  14 percent overall.

First post-surgery PSA -- Undetectable, 2/20/07

Second post-surgery PSA -- Undetectable, 9/11/07

Post Edited (PianoMan) : 9/24/2007 7:29:09 PM (GMT-6)

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