finding a good surgeon

Usually, there is no big rush to get to the operating room..Take your time and do your homework. Ask your GP to put some feelers out for you. Make an appointment with two or three recommended surgeons and sit down and talk with them. Yes, that will cost you a few bucks but it's money well spent..Ask them the pointed questions.

How many RRP's have you performed?
How many have you done this year?
Where were you trained to do this surgery?
On average, how long did it take your last 10 patients to regain continence?
What percentage are still not "dry" after a year?
How long were your last ten hospitalized?
How many have required transfusions during surgery?
How long will this procedure take to perform?
Other than the anesthesiologist, who will be with me during the surgery?
Will you yourself be performing this operation? (and not the resident you are training)

If they haven't walked out of the office by now, you should have enough information to make an informed choice..You can find excellence anywhere, you don't have to travel to faraway places to find it...If you dig around with Google a little, you can find all kinds of information about doctors and surgeons.

Good luck with your journey..

Rick,
I also live near NYC and interviewed 5 surgeons.
My 2 cents...
The whole davinci vs open is highly over rated. Both are perfectly fine - it all depends on the skill of the surgeon. It is also easy to blur the reputation of the institution with the reputation of the surgeon. And while there is the logical conclusion that a great institution would tend to hire only the best, they also hire young docs with promise...not necessarily expertise. Also, in nyc all the doctors have trained, worked, studied with each other and at all the same institutions. They've all done Sloan, Cornell, Columbia, Sinai etc.

Badani at Columbia/Pres is their hot shot on the davinci. Good guy.
McKeirnan is an incredible person and a great doc at Col/Pres, but only does open. But HUGE success rate.
David Samadi (my doc) is one of the wunderkinden of the DaVinci world. He is an amazing person with a remarkable life story. He does more surgeries than anyone in a year. Sinai wooed him away from Col/Pres cause they wanted him so bad. He is the Rolls Royce of it all. His office is Madison Ave, he puts you in concierge hospital, etc. It's sort of the country club of surgery experiences. Also he is really good.

aaron Katz at Col/Pres is good, but into alternative therapies.
I had talked to two surgeons at Sloan, but both are now gone - they got offers they could not refuse.
LOL - how's all that for more info than you want to know?
BTW- I am going into PCa patient education at Mt. Sinai and working with several docs there in ED rehab. So, I'm just getting to know the Pca world in NYC. Email me with any questions or you just need to talk.
Paul

My PCP recommended 1 of 2 surgeons to me. It was his office that made the first appointment to me.  He told me that they were the only two local surgeons

that he would allow to do a prostatectomy on him if he needed it. It wasn't that the other surgeons weren't any good. He considered these two to be the best. 

The surgeon I had told me he quit counting at 1200 procedures. about 600 of them had been an open procedure the rest of them with the DaVinci.

Paul 1959 I disagree with you about the DaVinci being overated when compared to open surgery.  On an open surgery there is a large amount of blood loss that does not occur with the DaVinici.

Also, the DaVinci negates any tremors in the surgeon's hands and because of image manification and the machine itself the surgeon is able to make much more precise and delicate cuts.

My $.02 worth

When I did my research, I did have a SLIGHT preference for the Da Vinci (quicker recovery). However, my decision was to get the best surgeon (based on reputation and EXPERIENCE), period.

I narrowed it down to two: Dr. David Woods at Umich and Dr. Mani Menon at Ford. Woods does both. He also mentioned that based on the biopsy, he thought Da Vinci would be the better choice (location of the tumor?). I ended up going with Dr. Menon, but either one was fine.

Mel

Even if doctors don't pad their stats (and I suspect some do) you have to be careful what conclusions you draw.

For example, suppose you get self-reported stats from several docs on their rate of positive surgical margins. What does it really mean?
It could mean the doc with the lower percent of SM+ is a better doc.
It could mean the doc with the lower percent of SM+ is lying. Is he giving you his stats in writing? Is he using weasel words?
It could mean the doc with the lower percent of SM+ turns down high risk cases, ("I'm sorry, I can't squeeze you in for the next three months...") but their skills are no better.
It could mean the doc with the higher SM+ rate is the best one in town, and as a result, the nearby urologists send their most challenging highest-risk patients to him.
It could mean that the doc with the higher SM+ rate works in a teaching hospital in a tough neighborhood where the local patients tend to get less preventive care and so the patients show up with higher grade/stage disease.

You would only know what to do with this information if there were a uniform reporting system for all the different doctors that compared their results with predicted recurrence-free survival and morbidity rates, taking all the variables into account. Otherwise you just don't know what the information really means.

So get all the data you can, but other than the number of procedures done with the specific method you've chosen (open or robotic) take it all with a grain of salt.

If you have friends who works in the medical field, or friends who have friends who do, ask them to work their network, and get their recommendations. When a doctor needs a doctor, they know how to find out who's good. Or start with a prostate oncologist who's neither a surgeon nor radiologist but who sees the results (including the failures) of a good many of both. They will know who's good.

On the robotic vs. open question, it seems the research data says that both procedures give roughly equal results in general. Provided they are done by highly experience surgeons in each case. Many docs prefer the Robotic because (a) it appears to be the wave of the future due to patient demand, and therefore they need to rack up their volume to stay competitive (b) it is physically easier on the doc to perform the robotic surgery.

Rick, I see you are only inquiring about surgeons and I cannot tell from your post whether or not you have considered other treatment options.  If not, you may want to consult a radiation oncologist and a prostate oncologist to review other possibilities.  It's quite possible that brachytherapy and/or IMRT would be possible choices for you...same cure rates as surgery with less onerous side effects.  However, I don't mean to be presumptive so if you have already considered the options and decided upon surgery I wish you well.

Tudpock (Jim)

Somebody said...
I spent the night reading hundreds of posts. I wasn't too scared before but now I am.

I know what you mean. In addition to extensive reading here, I've just completed "How we survived Prostate Cancer - What we did and what we should have done" by Victoria Hallerman. And am deep into Patrick Walsh's book where he is discussing surgery and radiation failure, ED and help for advanced prostate cancer. It is frightening.

The last time my husband had cancer - 7 years ago, he was diagnosed on Wednesday and had surgery on Monday. There was not enough time to get educated or to really even process the fact of his disease. Not saying that was necessarily a good thing but this time - diagnosis in July and surgery in October is allowing time for education but also too much time for thinking about all the "what ifs" scenarios I am reading about. It's like there is a grim overlay on our lives right now affecting everything everyday.

I almost didn't survive my reading of How we survived prostate cancer (only slightly tongue in cheek)!

"And am deep into Patrick Walsh's book where he is discussing surgery and radiation failure, ED and help for advanced prostate cancer. It is frightening."

Tell me about it....No sleep that night..

Rick, as you can see our histories are very similar..I think we both have had cancer for quite a while, living in blissful ignorance..Your second biopsy pulled a pair of threes, 3+3=6, the next one pulled a 4 card... 3=4=7

Don't get hung up trying to find the "perfect" doctor..In the NYC area, there will be many. Find one who has done many procedures and that you feel confident in..

Your next big milestone is not the surgery itself but the pathology report that will follow in a few days. That's when things really snap into focus..

Best of luck to you, we are all rooting for your complete recovery....

After deciding on surgery, I cast a wide net, researching surgeons all over the country but decided to go with my gut and selected a young local surgeon who had outstanding bedside manner and had done over 1000 Da Vinci. I am very satisfied with the outcome. I think long term outcome depends more on individual situation than the surgeon.