Patient Outcomes rate

O.S.U. head of robotic.  You mean Ronney Abaza.  I saw him to.  What he did not tell you is the rates of treatment success.  How do you know what is happening to his patients in the long term.  This is exactly why I went to Johns Hopkins.  40 years of data....You have a better understanding of what you possible out come is with them..

Go to the Cleveland Clinc.  They have a lot more experience at RP then O.S.U. does.  Experience is extremely important with this surgery....

BTW I live in Powell....

Post Edited (ChrisR) : 10/3/2009 1:18:29 PM (GMT-6)

Hi Jenniffer, with all due respect to Chris, I'd not think a 40 year history of prostatectomies (sp?) is relevant when it comes to daVinci surgery. I don't believe 'good hands' with open RPs necessarily translate into good hands with daVinci --- frankly, I'd think someone who had achieved the 20th level of exhaulted power in computer games might be the non-daVinci experience to look at !

I do agree with Chris that experience is important -- just that I'd be interested in daVinci experience. And, from the stats you've posted, and if he's done 700 daVinci, I'd be happy to lie down on his table and be eviscerated.

Also, don't forget, stats out the back end are influenced by what goes in the front end. It's easier to have good stats if you only accept easy, likely to have good outcome, cases. But, if something goes haywire while he's one the table a surgeon who has faced difficult cases might be of a lot more value than a guy who just takes the easy rides.

In the end, you'll look at all the stats, and all the information, but you'll want to go with the surgeon you trust --- you may not like him/her, but you'll trust them. I had total faith in the guy who did me. If all went well, I thought he'd do a perfect job. If he ran into problems I was convinced he would calmly and expertly deal with them. When I fly I want a pilot who can land the plane in a sudden cross wind, after losing an engine on final approach, without breaking a sweat.

You mention Ohio. Are you, by chance, anywhere near to Cincinnati?

Sheldon AKA Sleepless

I concur with T40 and Sleepless. Our surgeon was head of Urology at UC Irvine, CA, where the DaVinci was invented. I think he had only done about 500 at the beginning of 2007 (compared to Manon's 1000), but he said many things that resonated with us, one of which was to state that he was more interested in quality and that it took a kind of production to have several surgeries per day. His max was two, because he did not think he could be fresh for the third. (adding with edit that Dr. is a researcher and teaches the procedure all over the world) This made a lot of sense to me, as did the method of surgical repair of the urethra with a robot that is actually a "sewing machine" making those tiny stitches. I would take one of those stitching my urethra back to the bladder over a human hand any day of the week. There are surgeons who talk about "feel" being superior to the robot, when comparing RP to robotic assisted laparoscopy. That just doesn't make sense to me. For removal of the prostate, which has no discernable borders (its like where the bridge of the nose meets the face), I would rely on the most precise blade at the most magnified view possible, and believe this is the best method available today.

On the other hand, I also fully believe we each are vested to our own recovery, with belief and faith being components just as important, if not more (it could be argued) than method. So those who are fiercely protective of their RP surgeons' method, good for them if it made them survivors.

By the way, Irvine is exploring the use of lowering the temperature of the prostate area during surgery, in order to cool the nerves and, therefore, to protect them from injury. Dr Ahlering had made the connection after reading that spinal cord injuries have a much better outcome when temperature is lowered immediately after injury. He believes this may improve regaining of functions earlier in the recovery after surgery.

Best to all here, Ciao!

Becky

I also would agree that those are good numbers. I also agree that you have to feel good about his abilities.

I did go to Cleveland and was totally inpressed from start to finish. Dr. Kaouk is the department head, and has around 800 surgeries.

I liked the way he talked about his technique. He was super friendly, and acted as tho I was his only patient, even tho I knewthey were stacked up.

I would have gone to Columbus next if the Cleveland guy hadn't been such a confidence buolder for me.

Good luck.

Jennifer-

Well, this actually is a couple's disease.  But I hear you...I joked that I grew a little prostate myself through all of it.  My husband wanted to crawl under a rock, so I also understand your proactive stance.  I, too, would have gone anywhere, including Ohio, to get him the best care.  But part of the decision included a consideration of how much stress and strain the long distance would put on his overall health, never minding the matter at hand.  Our chosen surgeon did not take our insurance, but the cost to go "out of plan" was well within our means and were surprised at how affordable--totally worth it to us.   I would also venture to say that cancer is big business, and just because someone has the "brand" (i.e well-known name and stunning architecture) doesn't mean that there isn't someone highly competent, with excellent results, closer to home.  Our drive was four hours to get to Irvine, and we stayed the week down there after surgery (in a nice, affordable vacation rental on Balboa Island-very mood uplifting) in order to have the catheter removed etc.

What is so mportant is state of mind.  Do the work, find the one you feel the most comfortable with and follow your instincts. I thought that Dr. Abaza's stats looked good, except that I take exception to lymph node removal as a matter of course.  But that is a whole other subject.

Becky

It's been known for years that Dr. Walsh cherry picks his surgical patients, and yep, mostly low grade gleason 6 cases, and yep, does keep his published statistics for "cures" amazingly good. No denying that. But he's still considered a world class surgeon, and has done a lot of good over the years. He would have never taken my case from the start, but that doesn't hurt my feelings. Wasn't trying to chase after a brand name doctor or a celebrity class doctor. Too poor for that.

David in SC

Bob,

Your 3 zero post surgery psa tests are great news, that's what you want. I personally agree with you, if there is a qualified surgeon with a good track record and sufficient experience where you live, why not use him/her. I did, and from what I have read of some of the high rated - known surgeons, not convinced from the data that they were any better in the post surgery side effects. While the skill of your surgeon is very important to consider, each body reacts differently to surgery and its aftermath. Also, a persons pre-surgery medical condtion and history has a lot to do with it as well. Considering the size of your prostate and the fact that you were a stage 3, looks like you are holding your own.

I hope you continue on that path, and keep those zeros coming in for many more years.

David in SC

Those statistics are interesting but don't tell the full story. I'd like to see: incontinence rates at 3 month, 6 month, 1 year. Potency rates without drugs at 6month, 1 year. Potency rates with drugs at 6 months 1 year. PSA at 6 months and one year.
Every man on this list can write their own numbers in 30 seconds.
Those are more important to me than operating time, days on catheter, etc. (writing this while wearing a pad. )

Maybe this is just me but I am not convinced "2000 surgeries" is better than 500 for example. when they have it that mechanized. 2.5 hours (and when they are getting $3000 per surgery) I believe there is a temptation to do multiples per day 3? 4? If it is no big deal for them then maybe they went out the night before.
If you have to wait 6 months before the procedure that might indicate he is a great surgeon, but it will definitely indicate you are a number.
I want my surgeon to know me. And I want to know where he lives. ;-)
Jeff

Post Edited (Worried Guy) : 10/4/2009 6:10:47 AM (GMT-6)

Worried Guy, by reading all the input here, I do open my eyes knowing so much I need to know when choose a surgeon. I like to ask you guys, when you guys choose surgeon, how many you interviewed? how you decide if one is good enough for you?

Hi Jennifer,

I spoke directly one-on-one with four surgeons, but one was a relative and not a candidate. The first, the guy who did the biopsy, was an open surgeon. The second was a da Vinci surgeon. The third was an open surgeon who did HIFU. I had an appointment to see a second da Vinci surgeon but after meeting the first, and going to a pre-surgery clinic at his hospital, I was convinced that if I was going to be eviscerated he was THE person I wanted doing the work and the hospital he worked out of THE place I wanted it done. In addition, through a close doctor friend, I got information and feed back on several other surgeons and did a lot of research on HIFU. One of the best resources I found for checking out a surgeon was the anethetists who worked with them. Through my doctor friend I got some fascinating feedback on surgeons from the folks at the head of the table passing gas. If I was sure I was a Gleason 6 I'd likely have had the HIFU in Toronto. But, as a second pathology reading said I was a 3 + 4 = 7 I knew that although statistically I was still an excellent candidate for HIFU I wanted to know the pathology of the whole prostate and what I was facing. It was a personality choice -- what I would be happy and could best live with --- not so much a medical one.

Now. Travel. da Vinci wasn't available in my home city, Winnipeg, and so I went to Edmonton. At first I wished I'd just been able to stay at home, close to friends and support. Turns out I was delighted to be away from home and friends and support. My sister (bless her) flew in from Victoria to be with us, and that was nice. But what was really nice was she was the only family/visitor I had. No one from the office showing up. No family coming by to see how my urine bag was doing. PLUS after one night in the hospital I was in a hotel just a couple of blocks away. For $89 a night (hospital rate) we had clean sheets every night, clean towels, room service, a huge TV I could watch from bed, wireless internet, halls to walk in, an elevator, a coffee shop, a barber where I had my hair cut, a little shop with all sorts of goodies to look at, interesting places to walk outside, and a big enclosed shopping mall near by where we went every day to walk and to have lunch.

It was like a week vacation package to Hawaii, except no beach. No business papers, no need to deal with getting the lawn cut, no yoga class for my wife to decide if she would attend, or stay home with me, not postman bringing bills, no need to grocery shop. It was wonderful. My surgery was on Monday, we were booked to fly home on Friday, but on Thursday we were enjoying being on our own, and staying in the hotel, so much we moved our go-home flight to Sunday.

Sheldon AKA Sleepless

Jennifer -

Sounds like ou have only good choices here, so rest easy.

In my research, I found that the "plateau" for established urologists learning daVinci surgery was around 300 cases or so. That is the point at which docs who felt quite comfortable doing open retropubic prostatectomy developed an equivalent sense of comort and competency working at the robotic console. So I agree that doing 5000 daVinci procedures is not nececessarily better than doing 700. In fact, I would be concerned about a surgeon who has so many cases that they are booking 3+ per day. In such an environment, multiple robots are required to maintain the throughput. That means that case #2 may be started by fellows or assistants before case #1 is finished. So then what happens to pt #2 (already asleep on the table, robot docked, ports in place) if your super-experienced primary surgeon is delayed by some complication in his first case that day? Best to be blunt and ask about that, and also do whatever you can to be sure you are daVinci case #1 for your surgeon that day.

One unusual statistic you mentioned was an average of 11 nodes per pt - that seems extraordinarily high, especially since 92% of your surgeons cases were pT2. Even back in the "bad old days" when everyone got retropubic dissections and nodes were easy to grab, I seldom saw more than 5 ot 6 nodes coming out with a prostate. The stats you provided otherwise were quite good. But face it, as much as you want to control this process, the disease going into surgery is what it is, and you have no control over that. Any surgeons margins are better on pT2 cases than pT3, so if you get down to the point of comparing surgeon A vs B, be sure you are looking at stage-matched data where possible.

One final piece of information you may seek is how complications are dealt with. Local urologists who do NOT do daVinci can probably tell you about that. Face it, there is a lot of marketing going on in this niche surgery, especially among some of the large programs that are competing for non-insurance cash business. Having to document late complications (strictures, etc) reflects poorly on the outcome statistics of the overall program, so these pts may be referred back to their primary referring urologist for treatment. Your local urologist should know if the big referral center is being honest in dealing with their complications.

Best regards,

Doc

Greetings, Jennifer.  Just a couple of thoughts that helped me make my decision.  I was prepared to go to another place if I felt like it was necessary.  Since I live in the Richmond, VA area, the most common place that people recommended I should try was Johns Hopkins.  The first contributing factor to my staying in Richmond was the fact that I had great confidence in my urologist who diagnosed the cancer.  I had seen him a few times with other diagnoses (mainly kidney stones) and had come to not only like him but to have confidence in what he said.  He doesn't do cancer surgery and highly recommended the surgeon I eventually used.  In fact he said if he ever had to have surgery, the doc he was recommending would be the only doc he'd use.

I met with the surgeon and he spent an hour with my wife and me - and yes it is most definitely a couples disease.  The men may have the surgery but the women get us through it and are more important in recovery than any other single factor.  After we decided that he was the guy, I didn't pursue going out of town or talking to any others.  I also made sure that I was scheduled to be the first surgery on Monday morning.  You don't want to be his last surgery of the day or to be later in the week when he is not as fresh.

Finally, after we were convinced that we had found the right guy, i asked my son who worked at the same hospital my surgeon uses to do some checking.  The OR folks said he was top notch - very professional - and had excellent results. My son worked in the cardiac cath lab so ended up in OR on occasion when his procedures went bad so he had access to good information.   

Please keep us posted on how things are going.  David