First interview with surgeon

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Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 12/12/2007 8:11 AM (GMT -6)   
I am seeing a Dr. Rabbani at Sloan Kettering tomorrow. I am also seeing Dr. McKiernan at NY-Pres next week. After reading all the posts here, I very well may call up Drs. Samadi or Tewari and see how they go. I know I'm fortunate to have so many Drs to choose from.
 
But, I thought I would ask your thoughts on questions I need to ask. I'm going to ask about the sling for incontinence or the new technique by Tewari. As far as I can tell, the impotence thing seems to be a crap shoot. Even if they can spare all the nerves, some guys are right back at it, and others seem to have lost it. Anything I should ask about that?
 
All these guys will have done hundreds of procedures, so that doesn't scare me too much. Of course the whole thing scares me, but that's beside the point!
 
Sloan Kettering does not take my insurance, but I get out of network coverage which only does OK. The general impression seems to be that they caught mine quite early and all the docs swear it is a slam dunk. Gee, they sound like car salesman. The only problem was, the same doctors also swore the biopsies would be no big deal and they were hell to go through and ended up with 5 weeks of blood in my semen. So I am a bit wary.
 
Hope to have surgery in early Jan.
Thanks.
Paul
 
DOB 12/08/59
 
1/06 PSA 3.15
1/07 PSA 4.6
10/07 PSA 5.06
Biopsy 3/07 just suspicious
Biopsy 11/07  1 of 12 with 20% involvment
Gleason (3+3)6
T1c
Father died of Pca 4/07 at 86.
The journey has begun!
 


naimnut
Regular Member


Date Joined Jan 2007
Total Posts : 93
   Posted 12/12/2007 9:45 PM (GMT -6)   

First off, based on what you said in your post, I have little doubt that you'll be cured of cancer after your treatment.  So don't worry about that.  You're looking for the quality of life details which will turn out to be a big deal...

First off, I'd ask the doctors what their statistics and standard practices are:

1. how long does a typical surgery last.

2. How long do they like to keep the catheter in

3. What are their statistics for men of your age with respect to nerve sparing, incontinence and recovery of continence, ED and recovery of erectile function.

4. I'd be sure to ask what percentage of their patients are able to recover erectile function without the use of drugs or devices.  That's a big one.  And one which I wish I'd known to ask before I had my surgery.

5. I'd ask for statistics on continence and erectile function at 10 days, 30 days, 45 days, 90 days and 12 months.  According to what I can recall from a conversation I had with one of Mani Menon's assistance, his stats are tops.  Tewari ought to be in the same ballpark.  Same with Patel at Ohio State. (I don't know if you realize that all those surgeons are Da Vinci specialists, but hey, that's my paradigm.)

I'm at six months post surgery and still frustrated by my lingering side effects.  I always thought I'd be an exception (you know, young, good health, active).  But I'm not an exception.  Hope you have the best of luck.


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 12/13/2007 10:26 PM (GMT -6)   
Well, went to Memorial Sloan Kettering today. Met with one of the doctors there who assured my that my cancer seemed small and early T1c. But he was quick to say that all those numbers are simply indicators and that who knew what the real story was.
One very surprising thing was that as a hospital, Sloan Kettering does not endorse the daVinci method. He insisted that the data was not there to support the claims. I was quite surprised. He admitted that they were, by nature, quite conservative, but he used to do laproscopic surgery and even robotic, but noticed that the results were not as good when it came to continence. 80% of his patients regain complete continece within one year with open surgery. and 70% regain potency. Are these stats good enough that I should just go with him?

I had really made up my mind to have the daVinci method since the healing seemed so much faster. He encouraged me to get more opinions, but went over the differences in the two surgeries and what he thought about them. I know it is the surgeon and not the technique that makes the biggest difference. So, now I am a bit uncertain what to do. Sloan Kettering is one of the leading hospitals in the country for prostate surgery, so this was a bit of a suprise.

Anyone have any insight? thoughts?
DOB 12/08/59
 
1/06 PSA 3.15
1/07 PSA 4.6
10/07 PSA 5.06
Biopsy 3/07 just suspicious
Biopsy 11/07  1 of 12 with 20% involvment
Gleason (3+3)6
T1c
Father died of Pca 4/07 at 86.
The journey has begun!
 


naimnut
Regular Member


Date Joined Jan 2007
Total Posts : 93
   Posted 12/13/2007 10:46 PM (GMT -6)   

Sloan-Kettering doctors will be very very good.  You could take him at his word and probably end up fine.  Couple thoughts though:

1. Regaining continence within a year does not sound like a super-accomplishment.  I think most doctors are probably up around that figure, or higher.  His figure for regaining erectile function--if it is accomplished without drugs--seems very good.

2. It has been said and I believe it is true that, in the hands of the most skilled practitioners (note I said most skilled, not run-of-the-mill) results are comparable.  But I'm going to argue, here, for DaVinci.  Ever wonder why surgeons arms are so tremendously strong? Try putting on a rubber glove, covering it with soap suds and then try to carefully slice a tomato, for instance.  Or  hold a flashlight up for 45 minutes, holding it steady.  Or how about this--turn off your electrical power, get a flashlight, open up an electrical outlet, disconnect the wires, then throw the wires and outlet down into the hole in the wall that the socket was in.  Now, you can only get them out, and reattached, using tweezers, a flashlight, a screwdriver and a mirror.  Tough, innit!  But (IMHO) this is not far off of what a radical prostatectomy is like, actually a radical prostatectomy is far more difficult.  Can you see that fatigue will set in?  Only tremendous stamina and strength can work here.  I give credit to those guys who do opens, or laproscopic.  They've got to be brilliant in order to even be able to get close to doing it.

3. compare the above to DaVinci. The surgeon is at a console. The surgical field is brilliantly illumined, by a robot that never gets tired. The surgical field is magnified and the loss of blood is minimal, because the pressure of the gas which is inflating the stomach is the same as the pressure of the blood in the vein.  The surgeon can see, perform refined and tiny movements.  He's sitting down, his head immersed in the display.  Fatigue is much less of an issue.  The surgery takes about an hour.  I think the best Da Vinci's are seeing results slightly above the  other treatment options.  Call Menon at the Ford clinic in Detroit. Talk to one of his assistants, or Tawari.  I think you'll hear more impressive statistics than what your surgeon told you.


Cedar Chopper
Regular Member


Date Joined Mar 2007
Total Posts : 432
   Posted 12/13/2007 11:10 PM (GMT -6)   
Paul1959,

Naimnut said it best I think. Your doctors encouraging second opinions also spoke well.

Specialists are passionate about their specialty.....

If you like the surgeon more than others, and this surgeon is better at open,
   then choosing open surgery is not such a big deal.
Bluebird's Buddy chose retropubic open (See their Journey) and I had to have open as the robotic tools could not penetrate lesions from previous surgeries.  (They tried for an hour.)

I personally would not make my decision on just healing time  - or weak statistical claims about open versus robotic.  Depending on your circumstances, these are pretty much a wash - with a slight statistical advantage to robotic. 
Some surgeons have suggested to me that this robotic advantage may be skewed a little by experience as "open" is no longer the norm but rather the exception.  
I still suspect the fine tuning of movements and deliberate magnification available in robotic gives some advantage as well!
Med students now flock to observe any open procedures scheduled.

However, concerning your decision process for choosing a surgeon, 80% continence after one year is just average for either open or robotic with an experienced surgeon.
And 70% "potency" after a year is a vague claim.  This usually means "penetration" is achievable and erection quality is some fraction of your peak as a teenager.
  Still, 70% is a good track record.  The general cliam is 90% at two years with those that use injections recovering first and those just using the pump & Viagra, etc. second and those doing nothing third.

Sloan-Kettering is most excellent
and if you like this surgeon that would be a good reason to go with him/her.
I only recommend that you get a second opinion from the best facilty and surgeon you can manage.  Any surgeon worth her/his salt will welcome and assist your second opinion.
(Mine set one up for me at M.D. Anderson.  It was a great time to ask questions and get away for awhile.)

Your decision will include such things as 
    Travel distance (some distant surgeries require switching to a local physician for recovery),
    Wait-time for a surgery date versus your thoughts on waiting, and
    most importantly 
     - Your comfort level with your surgeon of choice and the treatment facility.

My numbers were promising and suggested I could take my time to move to surgery.
However, the pathology report showed the tumor was touching the inside edge of the capsule.
I also suggest you wait no longer than necessary. 
Schedule now. 
Schedule with both possible choices if necessary but good surgeons will have a waiting list.
When you cancel as timely as possible, another patient can move up and
   - you too may get to move up if it fits your needs.

Your numbers are promising.  As you noted, only the post surgery pathology report will tell you close to almost certain whether or not you have capsular penetration.
The information from this pathology report is a big motivator for many without other complications to choose surgery.
We still get micro PSAs forever - even with a best-case scenario report.

Your Friend,

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?

Post Edited (Cedar Chopper) : 12/13/2007 10:25:00 PM (GMT-7)

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