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Posted 7/29/2011 12:06 PM (GMT 0)
I received my diagnosis two months ago and I've now finished interviewing doctors. Ive decided upon surgery and I've seen three surgeons, each of whom I think would do a great job. So, my confusion has now switched from which treatment to which surgeon. Two do the open procedure and one does the robotic. I have no preference between the methods, as I firmly believe it's the doctor and not the method he uses that matters.

I'd be interested in how others made this decision. Thanks.
Posted 7/29/2011 12:33 PM (GMT 0)
Hi Frack,

I opted for radiation due to the advanced nature of my initial diagnosis. But, I had open heart surgery some 12 years ago and there were two statistics that were noted as being the key to successful treatment.

1. How many of the type of operation does the surgeon do in a year? The magic number was 200.

2. How many of the type of operatons are done at the facility you are using each year? The magic number was 1000.

The first goes to the skill and practice of the surgeon and his methods. The second is focused on the ability of the support staff and the technology available at the facility. For my heart surgery I went to a hospital that was ranked no 52 in US News Best Hospital rankings that year and the doctor was recommended by and a colleague of a heart surgeon who was ranked no. 2 in the Best Doctors in America that year. The doctor and the facility met the criteria and I have had not one problem since.

Good luck with your choice.

Don

Posted 7/29/2011 1:02 PM (GMT 0)
I like my surgeon right off the back and didn't look any further. I used the ol "gut reaction" method.

Posted 7/29/2011 1:45 PM (GMT 0)
Hi Frack,

I'm not aware of your particular stats, so here are three thoughts in addition to those mentioned above:

1. If your biopsy showed high Gleason score, perineural invasion or cancer in the apex (all signs of potential positive margins after surgery), you might want to ask what percentage of their surgeries result in positive margins. The rate for top surgeons is around 10%.

2. You might want to ask what percentage of their patients end up having to get post-op adjuvant or salvage therapy, as this may indicate how well the doctor stages the disease.

3. If you have high-risk cancer, you may want to find out how many lymph nodes will be sampled. I've read that robotic surgery is not as good as open surgery if pelvic lymph nodes need to be sampled.

Just some thoughts I've had since my own surgery.

Good luck,
Nellie
Posted 7/29/2011 2:01 PM (GMT 0)

I had the same decision to make as you when I had my diagnosis 4 years ago.  After I decided that surgery was best option, then I had to decide on what surgeon to use, and wheter to go with  open or robotic. 

In my city, my uro does about 5-10 open procedures a year and has done about 100 in her career.  She was a very nice person, caring, and with a good bed side manor, but I just did not feel comfortable with her experience level with this type of procedure.  Also with open, the recovery time would be a lot longer.  

On the other hand, in Rochester NY, about 3 hours from where I live, there was a surgeon who does only robotic surgery and had done over a 1000 at the time of my diagnosis, and was one of the first in the country to use the Da Vinci.  He was considered one of the best in the country at that time.   On the other hand, personality wise, I really didn't like him all that much.  He was a little arrogant because he knew he was good.  He had a terrible bed side manor, and  I always felt like I was being rushed when I talked with him.  He always was joking around and never seemed very serious, but I could not ignore the fact he had a lot of experience.

In the end I choose the robotic surgery and experience, over open and no experience.  My results where excellent.  No incontinece, and no ED issues.    

  

Posted 7/29/2011 5:46 PM (GMT 0)

at the initial consultation with my uro i asked him what he would do if it were him.  he told me without a doubt he would do HT, BT and IGRT.  four of us went to the consultation and we uninanimously agreed with him, even tho (in our ignorance) we were leaning toward surgery.

in the next two weeks i got my first shot of lupron and met with a radiation oncologist.

ed

Posted 7/29/2011 6:00 PM (GMT 0)
I 'interviewed' three surgeons (and two Onco's). Screened all on number of procedures, etc. Picked the one that 'clicked' with me best in terms of communications and rapport. Very happy with the choice.
Posted 7/29/2011 7:41 PM (GMT 0)
Hi FrackMe
I'm with Riviere, ask about their numbers, how many ops per year, nerve sparing, incontinence, positive margins etc. also remember some docs are choosy and won't do high risk patients as it affects their stats.
With surgery you want the trifecta 1. cure 2. continent 3. no ED
I was advised to go see a continence nurse prior to surgery to be shown how to exercise muscles and do keels properly etc. it was very enlightening as she see's all the surgeons work from around where I live and was able to offer an unbiased opinion, not that I asked for it mind you.
Her advice was "the local guys numbers are terrible in regard to 2. & 3. they think that the cure is all that matters and you can deal with the rest" " you wouldn't believe how many guys I see with continence problems post surgery" I told her I had an appointment with a specialist in a major city hospital and it was him who suggested I see her, she said it was rare for that as she only usually see's guys post op, when it is really important to get things in shape prior.
the surgeon rang me a week prior to the appointment with him, first time in my life a doctor rang me to see how I was doing! reassured me that I had a good prospect of a cure, but wanted more tests as I live a long distance from him so better to get it all done prior, X-rays, MRI, bone scan. Told me to start a list of questions and to bring someone with me to appointment.
I am very happy with my choice, you still have one to make hope this helps.
Ausboy
Posted 7/30/2011 12:15 AM (GMT 0)
I asked all 3 surgeons the same questions. One question was why this method rather than the other method. One Doctor answered "Because I am darned good at it!" Well, they all have the experience I was looking for, but I liked that answer the best. Maybe not an intelligent choice, but my gut chose it. GL with your decision.

p.s. He didnt use the word darn....this site fixed it for me...LOL
Posted 7/30/2011 4:34 AM (GMT 0)
Thanks everyone. All of the surgeons I spoke with have done over 2500 surgeries and all have impeccable reputations. I don't think I can make a wrong choice, but I want to make the most right choice. I agree with going with your gut, but my gut hasn't given me a clear cut decision yet. Hopefully, it will soon.
Posted 7/30/2011 1:33 PM (GMT 0)
Frackme

I had to make the same decision back in April. My URO gave me a copy of Dr Walsh's book to read before I made any decision as to what treatment to proceed with. Per Dr Walsh I asked the right questions of my URO and felt completely comfortable with him and his team. My URO is only 4 miles from home in the Birmingham AL area and the hospital with the latest model of the DaVinci robot was next door to his office. He has done over 600 RALP surgeries and he was very upfront with me about what to expect.

Per what Austboy and Riviere have posted I had the same 3 priorities

1.To be cured and cancer free to live out my life and see my grandchildren grow up. My first post op PSA is on August 30, but my URO is very optimistic he got all the cancer.

2. Continence,  my Uro told me had about a 98% success rate with continence in 12 months. His definition  of continence is pad and leak free, but he did tell me that feeling and bladder control would be totally different than pre surgery. I have been pad and leak free since week 3 post surgery. But he was right about how different things feel but you get used to it quickly.  one thing that is better before surgery I had a shy bladder and had problems going in public, unless my bladder was extremely full. Now I can pretty much pee on demand anywhere I want.

3.  ED my wife and I had a very good and active sex life, but this was the lowest of my priorities after my wife told me she would prefer to enjoy retirement with me alive and healthy over ever having sex again. My Uro told me that since I needed ED drugs prior to surgery I would need some type of assistance afterwards. After 8 weeks so far oral drugs have not worked and he wants to start injections next week as part of my rehab.

The final thing that assured me about going with my URO was when I conferred with my primary doctor whom I have complete confidence. I asked him if he had PCa who would he choose to treat it, he told me 100% he would use my URO. That was all I needed to hear and 8 weeks after surgery I still think I made the right choice.  Good luck on your decision and I hope you are successful and cancer free soon.

Posted 7/30/2011 2:15 PM (GMT 0)
I am like Steve n Dallas in that I went with my gut reaction. I hit it off well with my doctor. He responded to every email I sent him within 24 hours. I asked him every single question I could imagine and he responded every time. It sounds like you are in great shape in that you have great doctors to choose from. I wanted robotic from the start and it worked out well for me.
Posted 7/30/2011 2:33 PM (GMT 0)
Thanks guys. I'm trying to get past the idea that I should look only at their "statistics." First, unless the statistics are verified and peer reviewed, anyone can say anything. Not to get anyone here riled up, but the thread about Dr. Samadi's claimed 97% cure rate is case in point. I think if one looks at the best hospital list, it should be pretty certain that the top hospitals will have top doctors running their PCa practices.

For example, I'm sure one couldn't go wrong choosing the head of prostate surgery at MD Anderson, and I say that without even knowing his name. Not to say that doctors at less known hospitals can't be excellent, just that the hospitals that are world class must have top doctors. At least that's my thinking.

Thanks to all for your replies. Hopefully my answer will come to me soon so I can get on with putting this behind me.
Posted 7/30/2011 3:23 PM (GMT 0)
Frack, I totally understand where you are on this. Went through this 2 years ago. At the time I also had the distraction of my wife being in a comma in ICU when I was diagnosed.

And that is how I came to HW. I asked and the brothers here answered. Like you my decision was for surgery. I interviewed 3 surgeons. The first was a staff member of my Uro's office. Nice guy, I felt comfortable with him, but did not feel comfortable with the amount of time he had spent on the da Vinci.

The second (another local facility) came from research that showed a great number of surgeries and great stats and national exposure. A little too glossy in our meeting, a little too full of himself, way too much press and marketing of his abilities and not enough detail to back up his "tremendous" stats.

The third had great credentials. Studied and mentored under a dr who is mentioned often here as the godfather of dealing with PCa. The godfather's book is required reading it would seem for every newcomer.

I clicked well with the 3rd dr. He answered every question I had to my satisfaction. He provided details about the success rates of recurrent Pca, incontinence and ED. These had been published, peer reviewed and at the time were the first 5 year follow-ups of da Vinci PCa surgeries in the industry.

He had pioneered new ways of dealing with patient comfort related to catheter (did not use a foley) and extensive development and improvement of procedures dealing with nerve sparing for ED.

This is not a commercial for the dr. This is just the thought process I went through. Fortunately I was not bound by travel restraints or financial issues.

So I traveled 1200 miles to be treated. I was home in 8 days. I have been continent since day one and at about 17-18 months post surgery I was 95% recovered from ED issues without the use of drugs, shots or otherwise. I am still dealing with PCa, but, I would not change anything about my decision. We all know what a fickle farker PCa is and we know it has a mind of it's own on how it will respond to anything.

There are good guys out there. Guys who care and they are the ones that just do a great job and aren't full of themselves. It is a shame that we continue to see the other type that prey on guys who find themselves in the position we are in.

Best of luck to you in your research and decision. I know that you will find that "right and comfortable" fit for you.

Sonny
Posted 7/30/2011 3:56 PM (GMT 0)
You have received a lot of good advice.

But I will add...

1) If you are in a city with a prostate cancer group, try and go to a meeting and see if you can get some personal recommendations on your surgeons from actual patients and also hear firsthand what the recovery was like robotic vs open. I was fortunate enough to have two friends who previously used my eventual choice of surgeon and those recommendations were the most important deciding factor.

2) If recovery time is not highly important to you, than robotic vs open is probably not an issue. But a longer recovery time (usually) means the catheter is in longer, harder to move around, longer to resume normal activities like lifting, working, exercise etc. For me this was important. If EVERYTHING else in your decision process balances out to be equal, the robotic procedure will normally get you back to normal activity sooner. Or another way to state it is that some of the discomfort aspects of the recovery will be over sooner.

Dan
Posted 7/30/2011 4:35 PM (GMT 0)
Here's an answer you don't hear too often. I let my wife choose! I narrowed down the choice to an excellent robotic guy and an excellent open guy. I figured she was the one who would be taking care of me, so if I had incontinence or ED issues..Hey, don't blame me. I didn't pick the guy!

A year later she often says how glad she is that we went with the open RP guy. I had negative margins, have been less than .01 for a year and she doesn't care about the ED or the pads. So there you go, another perspective.
Posted 7/31/2011 11:51 AM (GMT 0)
All three doctors I'm considering have great reputations and similar statistics. The only place they seem to differ is in the surgical time. Something tells me that I rather be under anesthesia for the shortest time possible. One of the doctors takes only 1.5 hours and the others take 2 to 3 hours. Maybe that should be the deciding factor.

Has anyone used this as a way of deciding? Thanks.
Posted 7/31/2011 11:58 AM (GMT 0)
I did not think about that FrackMe but it has a good point. I did have the open and I can tell you I have looked at the guys that had open Vx robot and the results seem to be just about the same. I always thought that if I would have danced with the robot I would not have had the ED issues but as I talk with my brothers here they have just as man issues with ED and countenance as the guys that have had open.

I was one of the lucky guys that managed to be dry from the day after the rubber snake was pulled. ED was a totally different thing.

If your going with surgery just make sure you get a good surgeon.

Cajun Jeff
Posted 7/31/2011 12:55 PM (GMT 0)
Surgery time is is based upon if everything goes perfect and is the actual time you are under the knife with your surgeon.  You will be under anesthesia much longer for the prep time which can add an hour or more and any complications that may arise. In my case with RALP my URO told me the actual surgery time averages 13/4 hours but I was under from 7:30 am to almost 1pm due to complications from Appendectomy surgery and  a lot scar tissue when I was 8 years old. It took almost 2 hours extra to clear out the scar tissue to get to my prostate.

Rather than worry about surgery time be more concerned about how many surgeries the doc has done and results. Go for experience and results over speed.  Although from what I know experience also increases speed.  Also look into what the URO's peers say about him and talk to your primary doctor if you have a good trusting relationship.

Posted 7/31/2011 1:13 PM (GMT 0)
Hi Water Guy,

The times I listed are times under anesthesia, not actual surgical time.

I read on the johns Hopkins web site that Dr. Partin does the open surgery in an hour and he says that is from being wheeled in to wheeled out, so the 1.5 does not seem overly fast.

I understand that these estimates are based upon no unforeseen complications, but that is all I can go on.
Posted 7/31/2011 1:25 PM (GMT 0)
Frackme,

I assume open surgery can be shorter as there is a lot of set up time with the DaVinci Robot all done while you are under. I was told it takes close to an hour to set up the robot before the surgeon begins working. In my case all the prep was done while I was under including the shaving of my private parts. The last thing I remember was being wheeled out of the pre op room and then waking up in the recovery room over 5 hours later. My poor wife had to sit in the waiting room all that time, but she was fully informed about my scar tissue problem and the extra time it took.

I never considered open surgery for several reasons, one it is hard to find an experienced URO surgeon in our area who still does open surgery. All of the major hospitals in our area have the DaVinci robots and I liked the better recovery times that they provide. A good friend of mine had open surgery in 2000 prior to robots and he had a rough time with blood loss and spent 5 days in the hospital. He was wearing a pad for over a year and has been 100% impotent since even though he supposedly had nerve sparing surgery.

Posted 7/31/2011 1:39 PM (GMT 0)
I chose Da Vinci because thats what my URO did and he was experienced. I have heard that there is a faster recovery with robotic, less chance of needing blood and supposedely more chance of saving nerves. But a good surgeron should be able to accomplish these either way. Best of luck on your decision.
Posted 7/31/2011 3:52 PM (GMT 0)
Thanks all for your replies. I'm pretty sure I've made my decision. Now I just need to get it scheduled and go through it. I hope that I'll be able to get some valuable tips about how to prepare for the surgery from the veterans here. Again, thanks!
Posted 7/31/2011 6:48 PM (GMT 0)
FrackMe,
I chose the surgeon. He does robotic, or falls back to open if required by complications. So I had robotic.

As to time under, I had minor complications, and was under several hours. As to recovery, I spent 4 days in the hospital. So neither of those two "advantages" played in my case.

For prep, read the thread:

Prostate Cancer: The Really Useful List made by HW people for HW people.
https://www.healingwell.com/community/default.aspx?f=35&m=1717641
Posted 7/31/2011 7:25 PM (GMT 0)
For me it was rather easy after meeting with a number of Doctors. The "radiation type" folks didn't trill me one bit. They couldn't or wouldn't answer a number of my questions. So I cut them from the list. The surgery folks, well it was easy for me to narrow them down after meeting with a few of them. The VA was not the answer, the head intern would be doing the surgery in a teaching hospital. Not on me you don't, I don't want anyone practicing emergency surgery on my body. One doctor chosen because he was local and I could have been closer to home was dropped from the list. He canceled appointments for my consult, then wanted me to see him in his second office further away from me! The thought of him canceling my surgery was very troubling.
Being in close proximity to NYC, I started looking at options there. Memorial Sloan Kettering was what medical folks had recommended to me early on. I checked out a number of Doctors using their web site, and narrowed down a few whom I wanted to speak with. I met with Dr. Karim A. Touijer and felt comfortable and reassured during our consult.
He was the Surgeon who preformed my prostate removal. His staff the nurses, technicians,
assistants were all very caring and professional.
A month after surgery, I feel I have made the right choice.
Yeah, it was a gut feeling based on some research.
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