Getting close to a decision

My partner has been diagnosed with borderline intermediate/high risk prostate cancer. PSA 6.5 four out of twelve biopsies cancerous Gleason grade 9. We have been working with Dr Raul Hernandez in San Francisco/Daly City who does Robotic surgery. He seems very knowledgeable, is a good listener and gives thorough answers. He has ordered a prostate MRI to see if the cancer has spread after which we will be deciding on a treatment, and, from all we've researched, robotic surgery looks like our best bet. My partner asked Dr Hernandez how many Robotic surgeries he has done in the past and he has only done about twenty five. Has anyone here been treated by him? Had surgery from him? Everyone talks about Peter Carroll at UCSF as the best but our fear is that trying to get an appointment with him may delay treatment by an unacceptable amount of time and we know from the numbers that we are under a time crunch to deal with this situation. A comfort and trust level has definitely been established with Hernandez, which may compensate for the rather small number of procedures he's done with Robotics.

I agree with Mackattack, 25 surgeries, really is no where near enough experience.
I understand with a Gleason 9, time is not on your side, but please research some more surgeons, before you rush in.
Thankfully his psa is relatively low.
Hoping all goes well for your partner, please keep us posted.

I agree with other posts. Patrick Walsh's book recommends at minimum someone who has done over 300 to 400 surgeries.  We opted to go with someone who did 1500. Also make sure you ask you will do the actual surgery and how much a resident will do. You want to make sure they do it. Maybe they have the resident remove lymph nodes, etc which is fine but the major stuff should be by the guy you choose.

Also when scheduling tell them he is a Gleason 9. Many of these offices will accommodate you for a sooner schedule or a cancelation list.

Good luck and all the best.

Please do not limit your search to surgery. High Dose Radiation brachytherapy has proved to be as effective over a ten to fifteen yer period and has far fewer and less severe side effects, Jeffrey Demanes MD is the pioneer having performed HDR since 1981 and heads up the radiology at UCLA medical center. Also a Dr Hsu in California is expert as well. Check out the procedure and long term results at www.cetmc.com.

I recently had HDR here in Atlanta and am very pleased. I also had IMRT and hormonw therapy. My post treatment PSA is ,0.10. I was G7 with all cores positive. HDR is preferred in the intermediate and high risk situations which your partner clearly is. The problem with surgery in that situation is that there is a high probablilty of cancer escaping the gland and requiring radiation after surgery. Why go through two sets of risks and side effects?

My urologist would not perform surgery on me and I confirmed that the greats like Walsh and Sardino wouldn't either because they won't operate on people that have a significant probability of the cancer being slightly out of the capsule.

I trust your doctors have walked you through the Partin tables and nonograms....if not they should. It will give you a better idea as to the type of treatment that will do the most good wiuth the least harm.

i would urge you to seek someone with more than 25. If you have to, travel, it's worth it. You only get one shot at the surgery and you need someone who is skilled and experienced. I think that once you make that decision you'll feel more serene about it all.

Don't risk it. You need someone that has done over 1,000 of these procedures.

See Dr Carrol as you can't go wrong with his experience. Also look into combination seeds/IMRT as it may be more successful in your situation if it likes like you will be receiving salvage radiation.
JT

Great news. We have an appointment with Dr Carroll for a week from today.