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Doctor 1 or 2 Which is more accurate?

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Posted 8/11/2017 9:45 PM (GMT 0)
Ok Everyone, I have met with two of the three surgeons I'm considering. Some of the top in Boston and here's what I"m being told. My situation is I"m a 40 year old male that's a Gleason 7 3+4 6 of 12 cores positive. All of the positive cores on the left side.

Doctor One - told me 97% of his patients were back to almost normal levels of incontinence and pre-surgery levels of erections within about 4 months post op. I'm a healthy guy but do need to shed some weight as it will help in my recovery. The first doctor said the only issue with my weight was the way the surgery is done, that would cause additional soreness from being almost up side down. He never mentioned my weight in terms of helping with incontinence. He even said the incontinence would be a slow drip and i'd need a pad and didn't mention full on depends at all.

Doctor 2 - said I should lose as much weight as possible pre surgery and after as it will help with incontinence because the extra weight pushes on the bladder making it tougher to be continent. I completely agree with this, but he also went along to say that it's possible that i'd fully need diapers for a bit and painted a much worse picture then Doctor A. He also talked about erections and said it could take 18-24 months until I had success in that dept.

My questions is do you with the guy who is more confident or what appears to me to be more realistic? They have both done several thousand procedures and both expected a good outcome for me for the long haul. Also, what was your experience more like - The one described by doctor 1 or 2? Thanks for all of your help, guidance and insight!
Posted 8/11/2017 10:03 PM (GMT 0)
The real question is: which one do you have more confidence in?

Both have said things that are a bit odd to me and both have said things I think are right on the mark.

ED could forever, recover in a year, but some guys are fine within weeks. Most guys only need pads after surgery. Some are dry from the moment the cath is out and some are never continent again.

before surgery you should try to not only lose some weight but start an exercise program - even just walking would be a plus.

Personally, both sound okay to me.
Andrew
Posted 8/11/2017 10:24 PM (GMT 0)
I don't like that the first Dr claimed 97% of his patients are back to presurgery levels for erections within 4 months. Continence? Sure, very possible. Erections? I think he's overpromising in hopes of sealing the deal.
Dr 2 sounds more truthful to me.
The question though "which one is more proficient" is the big one, and hard to answer.

I'd compare how many of the procedures they've done, and how many they do now per month. I'd ask if they do the entire procedure or do they have residents doing some of the work.
Posted 8/11/2017 10:24 PM (GMT 0)
InTheShop - I have more confidence in the first doctor, but is that because he didn't give me a realistic prognosis? Is it possible he just spent more time looking at his overall stats vs. my individual case, to make a better argument for me to choose him?

On the reverse, I am looking at it thinking maybe Dr. 2 is of the mindset of under promise over deliver?

I have confidence in both as they are highly recommended, but I just want to know which outcome given my situation is more likely. Continent at about 4 months only needing pads or needing diapers for who knows how long and then slowly getting better.
Posted 8/11/2017 10:34 PM (GMT 0)
MrB, for sure there are guys who are unlucky enough to hve serious continence problems after surgery, maybe even having to have more surgery to,install an artificial sphincter.

But these days it's the exception. My surgeon, who's one of the best (yeah, I know, we all think that), said 97% chance of full continence, and 65% chance of no erection issues. Which he later changed to 85% no ED after seeing the location on an MRI.

I ASKED him to define both, and he said no need for pads, and hard enough for penetration. I don't think many guys end up with "Pre surgery" erectile function in 4 months. At least not without pills.
Posted 8/11/2017 11:13 PM (GMT 0)

Pratoman said...
I don't like that the first Dr claimed 97% of his patients are back to presurgery levels for erections within 4 months. Continence? Sure, very possible. Erections? I think he's overpromising in hopes of sealing the deal.
Dr 2 sounds more truthful to me.
The question though "which one is more proficient" is the big one, and hard to answer.

I'd compare how many of the procedures they've done, and how many they do now per month. I'd ask if they do the entire procedure or do they have residents doing some of the work.


What Prat said.
Posted 8/11/2017 11:34 PM (GMT 0)
MrB,

My surgeon sounded a lot like your guy #1, and he proved to be correct. Now, was that luck or skill or both? Who knows?

At this point, it becomes a gut call. I know, that doesn't help, but that's reality. Who do feel like you can relax with, knowing that he's on the job?
Posted 8/11/2017 11:53 PM (GMT 0)
As the owner of a one man service business for 41 years I always Hope for the best but PLAN for the worst. This is the best survival strategy. So believe Doc #2, hope Doc #1 is right, but their stats don't mean much. Do your kegels. I am still not happy but if you look at my thread of the last week re: incontinence, you'll see it's a long broad.

Meanwhile, start to educate yourself about diapers and pads, do a search here also. I am 23 days since surgery and 17 days since cath removal and I am leaking like a bad faucet. Forget how many pads someone says they use per day because each guy is different.

When I go to bed at night I am using a real embarrassing looking full adult diaper but hey, no one can see. I then put a maximum male absorbent pad (Depends makes 2 types) and then I fold into quarters a very absorbent paper towel. So I wake up about 5 times a night, run to the toilet, have a stream for 3 or 4 seconds, and then replace the paper towel. During the day I use the slim Depneds with a max pad again.

My point is that no one can say how long you'll need it and it's no big deal to wear "diapers", in fact no one is allowed to use that word in my house, we use: Depends. I have been working lately so I wear black jeans. The reason: I don't want any urine spot showing near my crotch area. So you should wear a slim diaper with a max pad no matter what when you're in public to avoid embarrassment and a wet feeling.

BTW, check out this thread I made:

https://www.healingwell.com/community/default.aspx?f=35&m=3889239&g=3889433#m3889433

As to weight, oh yeah, lose as much as you can! Helps with the BMs too, less straining, less stomach muscle pain. I lost 11 lbs by going 100% plant based, started a couple of weeks before surgery. Easy. Just need to find replacements for meat, chicken, fish and dairy. Pounds melt off. Ain't nothing wrong with meat, fish and chicken, it's the poison that's added into them that's the problem! Check out these for inspiration and you will lose weight quick!

FOOD DOCUMENTARIES
ON NETFLIX:
What The Health
Food Choices
Food Inc.
Fat, Sick & Nearly Dead
Forks Over Knives
Sugar Added
Vegucated
King Corn


Good luck,

Nick
Posted 8/12/2017 1:03 AM (GMT 0)
What did the radiation oncologists say. If you haven't considered radiation therapy, I suggest that you do. It is justly as viable as surgery and comes with less significant side effects.

Please meet with specialists in the SBRT external beam methods and consult with doctors tha use brachytherapy, both permanent seed and High Dise Tate.
Posted 8/12/2017 1:17 AM (GMT 0)
JNF - I started a new thread and maybe I shouldn't have because it is probably confusing. I spoke to a radiation oncologist and he said that in my case and situation, he would recommend surgery 99 out of 100 times. I thought that was pretty telling. I met with a Medical Oncologist, Radiation oncologist 2 surgeons (with one left to meet) and cancelled my SBRT consult after hearing from the Radiation oncologist telling me that. He even said to me for a guy my age, I can't "take the risk" on SBRT.
Posted 8/12/2017 1:50 AM (GMT 0)
Deja vue ;-)

I like #2......no pun intended.

My surgery was a few days before Nick2017, and I an mostly dry. I attribute much of it to surgeon skill, some of it to thousands of Kegels, and a bit of it to blind luck.

My surgeon never set the kind unrealistic expectations your #1 has. Just saying.....

Good luck....again.
Posted 8/12/2017 1:52 AM (GMT 0)
Baseball I think you have done enough reading on this forum to know that what the first doctor told you probably is telling you the very best case scenario, the second doctor is is more realistic. What is kinda strange to me is why neither doc talked about seminal vessels or nerve bundles and all the variables that can happen. My doctor at the Mayo specifically talked about all the things that can happen and he never once bragged about how I would be continent and about ed he said probably would take at least 6 months or more depending on whether could save both nerve bundles or not . I'm a few years older than you but have been very active all my life: running, biking, cross country skiing, snow shoeing, walking try to eat a well balanced diet. After reading so many sad stories about men on here where surgery didn't go so good for them I feel very fortunate that I had a very good surgeon at the mayo as you can see on my signature that my cancer turned out quite worse than we had initially thought. Remember any time you have a major surgery especially involving male sexual organs there are going to be consequences and not only that a lot of nerves are going to be moved to get out the prostrate so my only advice I would offer is if surgery make sure your surgeon is the best and you have to have 100% confidence in him if your having doubts already keep looking.
Larry
Posted 8/12/2017 2:41 AM (GMT 0)
MrB-

As I said, I think it is a mistake to ask and to take advice about one specialty from a doctor in another specialty. That goes for a specialist in one kind of radiation opining about a technique he doesn't use. I suggest you talk to the SBRT doc and hear for yourself what an actual practitioner with experience at it has to say.

Of the surgeons... Some are just blowhards, but that doesn't mean they are bad surgeons. I'd assess them on:
• The # of RPs under their belts
• their positive surgical margin rate
• if they themselves do the operation
• if they take frozen sections with a pathologist standing by
• if they've been innovative in their practice
• if they have plans for penile rehab and continence recovery
• if they plan to monitor your recovery using validated questionnaires
• if they seem like they will remain accessible

As for the weight - yes, it can make a difference in the success of your treatment. Here's what one study concluded:

Yamoah et al. said...
BMI of greater than 29kg/m2 is an independent predictor of adverse RP-risk requiring additional RT, particularly in patients with intermediate risk disease. This select group of patients may be best treated with definitive radiation therapy to prevent the additional toxicity from adjuvant or salvage RT following RP. We propose including BMI in clinical decision-making for appropriate treatment recommendation for patients with intermediate risk prostate cancer.


meetinglibrary.asco.org/record/90459/abstract

Interestingly, the periprostatic fat is a benefit for radiation. It acts as a buffer between the prostate and other organs - kind of like the spacer gel we were just discussing in another thread.

As for the side effects one can expect from surgery, Mike Scott came up with a pretty comprehensive list:

/prostatecancerinfolink.net/2015/12/14/understanding-the-range-of-risks-associated-with-prostate-cancer-surgery-today/

Being younger is certainly in your favor - you are more likely to repair better than an older guy. His rosy picture of post-RP erectile function is not realistic. In most studies, only 21%-27% of men who were previously potent return to the same baseline sexual function after nerve-sparing RP:

Back to Baseline: Erectile Function Recovery after Radical Prostatectomy from the Patients’ Perspective

Comprehensive analysis of sexual function outcome in prostate cancer patients after robot-assisted radical prostatectomy.

Is a return to baseline sexual function possible? An analysis of sexual function outcomes following laparoscopic radical prostatectomy.

I'm not saying this to scare you away from it - but I think it's important to have realistic expectations. Too many men are unpleasantly surprised not only by erectile dysfunction, but by penile shrinkage, climacturia, etc. Knowing this upfront will, I hope motivate you to engage in penile rehab early:

A survey of patient expectations regarding sexual function following radical prostatectomy
Posted 8/13/2017 11:20 PM (GMT 0)
Excellent. Thanks for all the help. I am torn 50/50 on which to choose, but do have one more left to meet. Tall Allen - thank you for all the help and articles and all that you have provided.

I"m hung up on two things I heard last week - so please help - A radiation oncologist when asking who I was considering for surgery said "You want a top Doctor from a top Cancer institution." The other thing is that I spoke to one of Doctor #2's patients and he RAVES about him and said "I am living and loving life one year Post OP..YOu have to choose him." #2 is a top Doc, but not from a top Cancer Institute. He has however done nearly 4k of these procedures. I do also have a client of mine who told me about Doctor #1` as he has 3 different clients who all used Doc 1 and Raved about him ( I have not spoke to them directly).
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