Potential Surgeon List

Mikla I'm from the east coast of Florida and I trusted Dr Patel to tackle my surgery. I am 100% pleased. Great surgeon and great hospital. Send me an email if you have any questions or concerns about Patel. I'll give you honest answers. Best of luck in your decision process.

I had Dr. Menon from Henry Ford Hospital do my surgery. Mine was a hard case, but he did a good job. Dr. Menon did the first DaVinci prostate surgery in 2001 and had done multiple thousands of them. He developed the "Veil of Aphrodite" procedure to save nerves and a catheter-free approach to drain urine while in recovery. I regained bladder control in about two months and was making great progress with Mr. Happy - that is until I started hormonal therapy.

The only negative is that Dr. Menon does so many surgeries it feels a bit like an assembly line. But for me that was a small price to pay to get his experience.

I'd add Dr. Robert S. Figenshau at Washington University/Barnes Jewish Hospital in St. Louis.

I'd also suggest, that if this list is to really be useful, it would need to be somehow broken down by state or region (in the US). It's not too long at all. I'm just musing about this...but could it be broken down in terms of the known experts at the major NCCN treatment centers?

Hi Mikla,

That's an extensive list you have. And, while I appreciate the effort and thought that went into this list, I would hate for people to be swayed by the supposed "rock star" reputations without asking some hard questions.

For example:
How long will the surgery take?
How many prostatectomies does the surgeon do each day?
Does the surgeon do the entire surgery?
Is the surgeon going to be hopping from one OR to another?
What is the plan as far as lymph node dissection?

FWIW, my husband's surgeon is on that list and, if we had to do it over again, we would go with a different doctor--one who wouldn't rush through the surgery and who would have done a proper lymph node dissection. Just my two cents.

Overall stats are of interest, but more important are the stats for men with similar PCa diagnostic profiles. Some surgeons see a larger percentage of difficult cases. Ask about their stats for incontinence, potency (return of erections), and oncological outcomes for men with a diagnostic picture similar to yours.

If your lesions are at the prostate base, the chances of saving one or both neurovascular bundles diminish. Also, high risk men may want to inquire whether their surgeons do intraoperative frozen sections and whether your case so merits.

Most positive margins occur because the surgeon could not cut wide enough without damaging adjacent anatomical structures. However some positive margins are the result of surgeon error. (Positive-margin rate is one of the criteria used to evaluate surgeons when they are learning to do prostatectomies.)

From what I've read and seen in Forum Brothers' profiles, about 50% of surgeons take no lymph nodes for men who have had G6 biopsies. But you don't know if you harbor higher-grade lesions until after the surgery. Another point to inquire about IMO when interviewing surgeons.

Be realistic about your chances of having adverse features after surgery. Lesser/higher risk correlates with:

-- Lower/higher Gleason score on biopsy

-- Lower/higher score for metastatic risk on genomic testing of biospy tissue

-- Pre-op PSA: <10 vs. 10-20 vs. >20

-- Imaging workup (CT/MRI, possibly, PET, and bone scan, usual done for 4+3 and higher biopsies) and overall estimation of prostate-confined vs. not prostate-confined disease (e.g., bulging, or tumor growth through, prostate capsule, suspiciously enlarged pelvic mets, indications of seminal vesicle involvement, etc.)

The greater the number and extent of any adverse features found after surgery, the greater the risk of needing adjuvant or salvage therapy.

If you've opted for surgery, choosing a surgeon is the single most important thing you can do to ensure the best possible outcome for your particular case. Lastly, outcome stats are somewhat better at large institutions vs. smallar ones.

Djin

I appreciate the posts about stats but who is keeping those stats? For example, DH's NYC "rock star" surgeon sees many people from out of the area and out of the country but he doesn't keep in touch with them. Once we went back to the west coast, there was no subsequent communication about side effects or even recurrence. How accurate can this surgeon's stats be?

The other guy was Samadi. He claimed over 7,000 operations at that point.

With number like 7,000 and 5,000 (Tewari) you would expect reasonably common sampling. BUT
Samadi wouldn't do anyone who was metastatic. Tewari had to deal with my post-chemo prostate.

My point was that Tewari is doing harder stuff than Samadi BUT Tewari's stats are still better.

ANB said...
The other guy was Samadi. He claimed over 7,000 operations at that point.

With number like 7,000 and 5,000 (Tewari) you would expect reasonably common sampling. BUT
Samadi wouldn't do anyone who was metastatic. Tewari had to deal with my post-chemo prostate.

My point was that Tewari is doing harder stuff than Samadi BUT Tewari's stats are still better.

Tewari also does frozen section intro-operatively, as well as requiring an MRI pre surgery. Samadi, at least when I saw him, does not do either.

Since you’ve narrowed it down to Tewari and Samadi (if I read correctly), feel free to contact me via email, and I’ll fill you in. You can find my email by clicking on my screen name on the left.

Or you can just read the NY Post article link, posted by SrSailor.

I think i read that the experience benefit levels off at about 1300 surgeries. Still, i would think more is better. My totally unscientific gut feeling

To Mumbo: I agree that once you get to number like 5,000 and 7,000 these guys aren't necessarily any better than guys who did 2,000. My understanding though is that this is a very difficult thing to master and it takes many actual operations before they really hit the groove. 1,000 would be good enough for me, but I wouldn't do less.

ASAdvocate said...

......I have read/heard hundreds of testimonials about Dr. Patel in Celebration, Florida. He seems to get 10 out of 10 from all his patients.

Not my experience, at all. Nice office, fine hospital, well trained staff, but he scoots in and out of multiple simultaneous procedures, with his nurses doing much of the initial and clean up work. My physician friends say he runs a, take a number, production line factory, a major revenue generator, and that he shuns tough cases.

What the truth is...who knows, but I suggest many of those support group people you mention may be reacting to the before surgery office glitz, rather than to any long term post surgery experience.

Every pilot is required to keep detailed logs of every aspect of their flying...I'm amazed that there is no such requirement for physicians.

Has any one heard of or used Dr Kane of UCSD or Dr Reiter of UCLA for Radical Prostatectomy - and was it done robotically. If you had surgery by them how was your recovery? and what was your Gleason score and pre and post op vitals, do you have ED or incontinence?