Best Medical Centers for Prostate Cancer in the U.S.

Perhaps those newly diagnosed or seeking second opinions will find this info helpful.

I checked the US News hospital rankings for both cancer and urology and here's what I found. In 7 cases, the same centers are ranked as both top 10 in the U.S. for cancer, and top 10 in the U.S. for urology. (Those are marked with an asterisk)

It's been widely reported that there's a strong correlation between the amount of experience of the doctor (whether surgeon or radiologist) and the quality of the care, after controlling for the stage and grade of the particular patient's disease. You really want to have your cancer treated by someone who's treated hundreds if not thousands like you, not someone who's using you to come up the learning curve. Particularly if you have a difficult case.

Top 10 for Cancer

M.D. Anderson – Houston*
Sloan Kettering – NY*
Mayo – Rochester, MN*
Johns Hopkins – MD*
Univ of Washington – Seattle, WA
Dana Farber – Boston
Mass General – Boston
UCSF*
Cleveland Clinic*
Ronald Reagan UCLA – Los Angeles, CA*


Top 10 in Urology
Johns Hopkins - baltimore*
Cleveland Clinic - cleveland*
Mayo Clinic - rochester*
UCLA – los angeles*
UCSF – san francisco*
Sloan Kettering – new york*
Duke – Durham NC
New York Presbyterian of Columbia and Cornell – New York City
MD Anderson - Houston*

Full report is here: http://health.usnews.com/best-hospitals

While these lists are helpful in locating where the major treatment centers are, how they are ranked is subject to interpretation..You can be sure there is a lot of back-stage maneuvering as these institutions jockey for positions on the list..Amplifying the positive factors and minimizing the negative factors is probably someone's full-time job.. Serious money is at stake here..

My permanent address is in Denver and that's where I will be treated. There are some first class treatment centers there staffed by doctors who can match the results of any of the "top ten" centers..There are plenty of "cow town" doctors and hospitals who can match their skills and results with anyone...

Patients are drawn to these "highly rated" centers thinking they will be treated by a nationally known and recognized expert using the very latest techniques and equipment..Many are disappointed to find out their actual treatment will be performed by an intern or resident physician who works under the supervision of the big name doctor. How close that supervision is depends on many factors not controlled by the patient..

An expert robotic surgeon is an expert robotic surgeon regardless if he practices in Omaha Nebraska or at MD Anderson....If you can find what you are looking for in Omaha, traveling to Houston is not going to change the outcome....

If you're going for the manual radical nerve sparing prosty, you can and should ask the surgeon how much of the surgery he actually does and how much residents are allowed to do. You should be able to find out who does the incision, who "presents" the gland, cauterizes etc. Even Walsh at Hopkins and Catalona in Chicago have others who are in the room, assisting. Get the numbers of the surgeries performed, and the percentages of of patients afterwards in your age group, with your numbers, who are cured, continent and potent. You've got to be your own advocate nowadays. I found this site most helpful for providing info for relief from concern and fears, especially post surg. conditions they seem to gloss over in the med lit. Who knew rectal pain lasting for 6wks. could be typical? Or the huge fatigue felt by mid-afternoon could last so long? That more frequent urination at night is common and can take weeks to subside?

Writing for my husband, who is 7wks. post-surg. T1c patient, 3+3 Gleason score

Of course, the best teaching hospitals do use interns and residents for some procedures (otherwise, they wouldn't be teaching hospitals) and so having the right physician matters. It seems to me that the senior people at the top hospitals are likely to be among the best around.

I'm fortunate to be living in San Francisco, near both UC Med and Stanford, so I asked around to find out who is considered to be the best urol oncol surgeon in the area -- and several people pointed me to the same guy (Peter Carroll) who happens to be at a very highly ranked center (UCSF). If I didn't luck out to live in a city with a top 10 hospital and top doc, I would have looked more broadly than my local community hospital. That's not to say i'd have crossed the country, but certainly I'd aim for a high volume major medical center that's highly rated. And I'd make sure I was in the hands of a respected doc with lots of experience, not someone who does one prostatectomy (or its radiological equivalent) every other week. A high volume of experience counts for a lot, both in cancer control and minimization of side effects. And as NEirish recommends, I'd ask a lot of pointed questions to make sure the doc I'm talking to is actually the doc who'll be doing the work.

That's not to say there aren't great docs who aren't affiliated with the major teaching hospitals, it's just that it's harder to find them. And its harder to verify that someone who presents himself (or herself) as a great, highly-experienced doc is not exaggerating or fudging their experience level or their clinical outcomes. They rarely write this stuff down for their prospective patients, and there's no way to audit what they say. Docs are only human, and they are subject to the same pressures as the rest of us to put our best foot forward.

The same applies if you already have a good doc and you want a second opinion, which is always a good idea. Or if you're hearing something that doesn't sound right and want a second opinion to be sure. It doesn't cost that much to travel a little to get a second opinion from someone with great credentials and lots of experience.

http://www.tucc.com/index.cfm/0/0/15/6-Mark-Jones.html
http://www.tucc.com/documents/dr_pdfs/Jones%20CV.pdf

Post Edited (Fairwind) : 8/24/2010 8:53:52 AM (GMT-6)

Is there a list of the "best" docs/centers for radiation oncology, along the lines of what is posted above for cancer and for urology? I often see discussion of the "best" surgeons but less often see the "best" prostate cancer radiation oncologists identified (aside from Datooli and RCOG, who -- in addition to being talented - must have very good marketing departments). Who are the "true artists" in prostate cancer radiation oncology -- the Catalona/Scardino/Walsh of the radiation oncology world?

Fairwind, I am located less than 200 miles South of you and have visited the TUCC just a few months ago. Shoot me an email if you feel like it.

erbob said...
Does anyone know where the National Cancer Institute/NIH fits into these "Best" Centers, if it does in fact fit in with them?

Yes.  The NCI/NIH are not treatment centers; the list of "best" centers are for treatment.

The NCI (which is part of the NIH) is the federal government's principal agency for cancer research and training.  Go here for more info:  http://www.cancer.gov/aboutnci/overview/mission

 

The major cancers centers in the US are rated on stringent criteria. They are the best because they offer a complete approach to treating cancers. I find it interesting that anyone would consider that rogue private practices are better when only the claim to be better is available. The fact is that these private practices seldom take part in clinical trials, seldom post corroborated statistical data of any kind, often refuse participation in trials and studies that could verify the veracity of their claims to treatment success. Many are great doctors, but they leave far more questions open about their practice than a nation institute or university.

The top major centers offer a complete package including top researchers, top clinical trial involvement, multiple treatment modality options, latest equipment and protocol, and less bias towards any treatment practice. These centers are typically responsible for bringing us the next generation of doctors, protocols, and accurate reporting of clinical data.

Does this mean they are flawless? But then no individual is either, and in fact they are more susceptible to miss opportunities to receive the latest information.

So what does this mean? Large centers will follow stringent protocol. Even to the point that they will only perform a proven protocol when a patient prefers to divert from standard protocol.

I personally refuse to accept questionable data on it's own merit. Uncontrolled studies are not my cup of tea. And I only give a little credence to retrospective data but only from larger institutions that have less biases and multiple programs in treating prostate cancer. Else it needs to be a controlled randomized trial that delivers level 1 study results.

You're likely only going to be able to find that at major centers...

Tony

My husband had his surgery done at NY Presbyterian. We called a recommended doctor at Sloan Kettering and we were told by his receptionist that we could get an appointment with the doctor in 2-3 months, but we need to know ahead of time the type of treatment we want. The doctor does not do consultations. I was so put off by this that I never scheduled an appointment. In that 2-3 month time period, my husband met with a surgeon, discussed options, had the surgery, and was about 6 weeks post-op.

Perhaps not all the doctors at Sloan are like that, but I thought it was completely obnoxious considering patients are coming to you with a life threatening condition.

<<we were told by his receptionist that we could get an appointment with the doctor in 2-3 months, but we need to know ahead of time the type of treatment we want. The doctor does not do consultations.>>

Wow. That sounds terrible. Is that a general practice of Sloan Kettering, or only this particular doctor?

I am considering following through on tentative appointments for Dx/Tx at the Dattoli Clinic in Sarasota. I know Cleveland Clinic, Sloan Kettering etc are highly rated,. Dattoli has 30 years experience with treating PCa, and I know several men who are cancer free 8-10 years post Tx. there. Dattoli seems very thorough. My case is more advanced than theirs: PSA was 18, Gleason 4+4, one bone met so far. I am going elsewhere because at my "5th ranked" center, I have been denied PET scanning to confirm possible other indeterminate areas. I have had one Lupron shot, due for the second soon, and the center has ignored my complaint of moderately severe allergic reaction, likely to the Lupron injectable carrier. They recommended Benedryl tabs. They will not do radiation if more mets are found, and have rejected the notion of brachyTx, if only the one met is found using their limited scans, and have rejected the idea of triple blockade (which would likely shrink the prostate to allow brachy) Basically, I have been given a death sentence.....no prospcct of Tx with curative intent.

I'd welcome any input from members with experience at Dattoli, or at one of the other highly rated TREATMENT centers, NOT just research-oriented centers.

Thanks

Bigbass,

I was treated at Dattoli Cancer center after a two months of research and other consultations. By far they were the most professional, experienced and thorough facility I could find.

They have been treating only prostate cancer since the late 1980's I believe. Highly recommended, even if I end up with a recurrence, I would not have regretted the treatment I had. So it's not just positive outcome bias.

So far .1 or less since ending treatment 8/2013, no side effects accept loss of ejaculate, but Finesteride and aging will do that anyway.