Need to pick: surgery in Jan or April?

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phillysub
Regular Member


Date Joined Nov 2007
Total Posts : 64
   Posted 12/10/2007 9:19 PM (GMT -7)   
I have a situation that I'd like to share with you.
 
I just saw one of the top robotic surgeons in the Phila area. He has performed over 1200 procedures. However, his first available appt for surgery isn't until mid-April. I saw another surgeon who may not be "the best", but is also a highly-qualified surgeon. He has performed over 400 procedures. I was able to get surgery scheduled with him for late January.
 
Just curious......if you were in this situation, would you wait until April and have your surgery done by the more well-known surgeon, or go ahead and have it done earlier by the other surgeon?
 
Your thoughts?

uncledan
Regular Member


Date Joined Aug 2007
Total Posts : 120
   Posted 12/10/2007 9:53 PM (GMT -7)   
How much more skilled is a guy who has changed 1200 tires than one who has only changed 400. Granted, there is a difference, but I wouldn't think a lot. Now if it was 1200 to 40 or even 400 to 40 I would think about waiting. There are DiVinci surgeons who are preforming successful surgeries after only a few under the eye of other surgeons. Some are performing surgeries with only 5 surgeries supervised. That's my take, but you have to make the decision that is right for you. Good Luck and God Bless. Uncle Dan
Age 67
No symptoms, DRE negative, 10 - 06 PSA 5.44, 01 - 07 PSA 6.47
5 - 07 CT and Bone scans negative, 05 - 07 Biopsies, 2 of 6 positive
Gleason Score (3+4) 7 Stage T1c
08 - 14 Dr. Dasari - Baptist Hospital, Nashville da Vinci RAP, five hours surgery
Some right nerve and all left nerve removed,
Hospital discharged 8 - 16
Pathology report Negative margins, Encapsulated, 50% left side
Lymph nodes 2 R & 1 L - Negative, R & L seminal vesicles - Negative
Gleason changed (4+3) 7 closer to 8 than 6
9 - 26 Great PSA 0.000, 9 - 27 Starting on meds for ED
10 15 Dry most of the time, occasional leak (dribble )
10-27 Received pump started use on 10-29 can see resulted, enlargement.
11-22 Viagra, Lavitra no help yet, Pump still not producing usable results either.
11-28 2nd PSA since surgery 00.00


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 12/11/2007 4:32 AM (GMT -7)   
Phillysub,

I think one of the more important criteria is your gleeson score.
If any other possible health issues are all the same now versus later,
 -AND your score is a 6, I'd personally go with the doctor and facility 
  I felt most comfortable with.  There are many subtleties to your choice.

A higher gleeson score might encourage me to move to a surgeon
    with a good rep and 400 daVinci procedures  - and 90 days sooner.

Another important question, how many "open" procedures has the each surgeon done? 
This type of expereince - or the lack thereof, cannot be discounted.

I also personally would be cautious of a surgeon that got to 1200 in record time.
(At what and whose expense was this experience accrued?)

Waiting itself might be good or bad for your personal situation.
These are just a few issues that come to mind.
Schedule both while you decide!

God Bless You!

CCedar
ICTHUS!
2 Years of PSA between 4 and 5.5  + Biopsy 23DEC06 
Only 5 percent cancer in one of 8 samples.  +  Gleeson 3+3=6
Radical Prostatectomy 16FEB07 at age 54.
1+" tumor - touching inside edge of gland.  + Confined:)
Pad Free @ 14 weeks.  Six Month PSA <.003  :)
Nine month PSA <.008
:)
At 9 months, ED treated with Pump Exercises & 100mg Viagra Daily
Texas Hill Country FRESH Produce Department Manager
Have you had your 5 colors today?


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 12/11/2007 7:24 AM (GMT -7)   
I agree with Cedar that your comfort level is the right measure not necessarily what we on the forum suggest. Your Gleason, PSA and DRE should all be considered. If I was making the decision a positive or suspicious DRE would have me going with the Janaury date. Also a Gleason of 7 or more would also have me deciding on January. A Gleaosn of 6 with a high PSA may also move me toward the January date. As you can see in my signature my PSA was 4.3, negative DRE and a Gleason of 6 in 1 of 10 samples. I waited three months for my surgery. I would suggest you ask both surgeons what are their complication rates. They should be able to tell you incontinence and impotence complication rates. A motto on this forum is knowledge is power so find out all you can then go with your comfort level.

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


Mike A
Regular Member


Date Joined Feb 2007
Total Posts : 213
   Posted 12/11/2007 7:34 AM (GMT -7)   
Philly,
Cedar makes some good points about your PSA. It seems to me that 400+ surgeries should give you a level of comfort in the surgeon's skills. I know in my case I wanted the cancer removed as soon as I could get it done. Another factor to consider, minor maybe, at least it was for me is how I wanted to spend my recoup time. I decided if I was going to be laid up I would rather do that when the weather in upstate NY was cold and nasty. I was looking forward to Spring activities and wanted to be feeling well enough to participate by April.
Good Luck what ever you decide!
Best,
Mike
June 2005 - Age 53 PSA 4.8 at regular physical
October 2005 - After several rounds of anti-biotics, PSA 5.2 at Urlogist
November 2005 - Biopsy negative
July 2006 - PSA 5.9 at regular Physical
October 2006 - After several more rounds of anti-biotics PSA 8.1
November 2006 - Second biopsy - Positive
December 2006 - Gleason (3+4=7), Tumor T1c, CT Scan and Bone Scan Negative
January 2, 2007 Robotic Prostatectomy, University of Rochester Medical Center - Tumor confined but larger than thought, only one nerve able to be spared. Margins clear.
February 2007 - Three to four pads a day, no erection with viagara.
March 2007 - Down to two pads a day, had first intercourse with Erecaid pump and bands, otherwise still flat tire.
April 2007 - First Post-Surgical PSA 0.02 and a great relief! Down to one pad a day. Still unable to achive erection without pump.
May, 2007 - Still one pad a day, even try a smaller pad on occasion. Slight improvement on the ED.
July, 2007 - Six Month Post-op: PSA 0.04 still Non-Detectable. One small pad/day for a few drops only! No change in ED.
October, 2007 - Nine Month Post-op: PSA back down to 0.02 Non-Detectable...Yay! Almost totally dry! Only slight improvement in ED - Will try injections if not improved by next appointment.
"If patience is a virtue, I feel like the most virtuous guy on the planet!"


lawink
Veteran Member


Date Joined Oct 2006
Total Posts : 621
   Posted 12/11/2007 7:37 AM (GMT -7)   
We agree with Tamu and the others on this - your numbers are the big factor as well . . gleeson; PSA; etc.

To us, a surgeon with a less number of surgeries, but still a significant number as in your 400 guy, may still be at a stage where he is just a tad more cautious. . . . and therefore may have the same success rate than the one with 1200.

Ask the questions about incontinence rates, and complications. Sometimes the impotence factor depends on what part of the prostate the cancer is . . .in our case, one nerve was totally wrapped around where the cancer was growing, wasn't spared, so impotence in a case like this had nothing to do with surgeon skill.

Keep us posted.

;o) Linda & Bob
Bob (61) - Laproscopic Prostate Removal Sept 27, 2006.
2 of 12 malignant biopsy samples - gleason 3 + 3 = 6.
 
Pathology - cancer completely contained, even a second more aggressive, previously undetected cancer)
PSA UNDETECTABLE Nov 2006, Feb, May, Oct2007.  ONE YEAR!!!! WHOOO HOOOO! 

Bob also has two secondary conditions -- Polycythemia (elevated red & white cells & platelets) and . . Myelofibrosis) -- If anyone has experience with or information on these, please email us.


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 12/11/2007 8:59 AM (GMT -7)   

Philly--You've gotten some excellent advice from others to mull over.  I didn't find this forum until after I had surgery and think I may have done things a little differently if I'd had been here shortly after my diagnosis, although everything turned out fine.

One thing to keep in mind as well, is that numbers are, well, numbers. There is a local surgeon in our area who has high numbers, but is not considered the best to do the procedure. If you can get some insider information (not always easy to obtain) about who is best in your area, that may help you in your decision.


Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable


Fredg
New Member


Date Joined Dec 2007
Total Posts : 1
   Posted 12/11/2007 9:17 AM (GMT -7)   

Philly,

I went to Cooper Univ Hosp-had robotic surgery Oct 3, 2007-would stronly recommend them, I wanted the cancer out and feel good, surgery was very easy, no pain, still dribble alittle and have ED problem-but starting to get some felling down ther-so I just have to have patence-God bless

fredg


njiceman
Regular Member


Date Joined Sep 2007
Total Posts : 28
   Posted 12/11/2007 2:29 PM (GMT -7)   

philly,

Again, great advise from everyone.  You have to be comfortable with the surgeon.  I just had my done by a surgeon @ the NJ Cancer Institute in New Brunswick that has "Just 300" under his belt.  What made my wife & I comfortable was that we grilled his nurse before we met him.  She does all the follow-up on his patients and she had nothing but praise for him & his work.

Everyone is different and has different results.  At two weeks after surgery, I am @ 1 pad a day with some minor stress leakage, am taking 50 mg viagra a day toget the blood flow back.  Except for a restriction on heavey lifting I am leading my normal life (just being aware of the better control needed to be contenent)  driving, shopping and walking like before.

Be comfortable with the surgeon and get yourself in shape while you are waiting for the surgery.

Wayne


Age- 59
Diagnosed July 2007
PSA-4.0 (Free psa 11%)
Biopsy August 2007 - 2 of 4 on Right Side with 20%, Stage T1c
Gleason (3+4)
Cat Scan & Bone Scan both Clean
Planned DaVinci Surgery Nov. 26th RWJUH Cancer Center, New brunswick, NJ
11/27/07  Home & on the road to recovery
12/4/2007 Catheter Out!
Pathology Report:  Gleason 3+3=6
                          Stage   T2c
                          Organ contained Negative Margins


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 12/11/2007 2:37 PM (GMT -7)   
njiceman said...

 At two weeks after surgery, I am @ 1 pad a day with some minor stress leakage, am taking 50 mg viagra a day toget the blood flow back.  Except for a restriction on heavey lifting I am leading my normal life (just being aware of the better control needed to be contenent)  driving, shopping and walking like before.

Wayne

Wayne--It's good to hear that you are doing well post-surgery!  Take care and hang in there...Tim


Age 59 PSA 2.6 (Quadrupled in one year) Gleason 5
Bilateral nerve-sparing RRP 6/21/06
Cancer confined to prostate, post-op PSA's non-detectable

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