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Posted 1/16/2007 6:31 PM (GMT 0)
hello,

my husband and i are considering traveling to new york (from the pacific northwest) to see dr peter scardino at sloan-kettering. we've heard that he is one of the top guys and we managed to get an appointment. unfortunately this will force my husband to cancel a trip he has planned for a year and has been so looking forward to.... ugh! my question is whether or not any of you have experience with this doctor or hospital? we've heard good things, but it is going to be a real juggle to get there and we want to be sure it is better than what we have found so far.
we are still not sure how we are going to proceed. we've seen three doctors (top docs in their fields in the seattle area - a urologist, radiation oncologist, and the urology group at u of washington). all gave different advice. so frustrating!
one recommends seeds and external beam, another recommends surgery, another recommends external beam only (with possible hormones). the more doctors we see, the more confused we get.

my husband has an intermediate case : PSA 2.6 (rose from 1.4 in about 18 mos), gleason 3+4=7, 5/10 cores with cancer (anywhere from 3% to 62%), bone scan and MRI of seminal vesicles look clear. prostate size is small.

any experience or knowledge with this hospital/doctor would be very helpful.
thank you
Posted 1/16/2007 7:47 PM (GMT 0)
Hi gralestel,

If you go back through some of the earlier threads you will see many doctors mentioned. I can not recall Dr. Scardino's name, but Sloan-Kettering is one of the foremost cancer treatment hospitals in the world. You may also want to look up doctors Walsh and Partin at Johns Hopkins Hospital, Baltimore Maryland. Both are world renowned PCa specialists.

How old is your husband, and are there any other medical factors to consider? Good luck with your search, and we'll be here to help you as much as we can.

Glen
Posted 1/16/2007 8:09 PM (GMT 0)
Hi Gralestel,

I cannot give any specific feedback on the doctor's that you asked about.

However, I can give some general comments on traveling to find a top surgeon. I flew halfway across the country to have my surgery performed by Dr. Partin at Johns Hopkins. I stongly believe that your surgical outcome, particularly minimizing the chance of long lasting adverse side effects (incontinence and impotence) can be enhanced by having your surgery done by a top doc at a major medical center.

It may be that top surgeons and major medical centers are available nearby for you, particularly if you live near a big city. However, if this is not the case, it is well worth the short term hassle of traveling to get the long term benefit of a better surgical outcome.

I was reluctant at first to have my surgery done so far from home. However, we found a "residence" type hotel with two bedrooms (we had overnight visitors), two bathrooms, and a full kitchen. I think that both my wife and I were happier to have so much space. We could be together but have a bit more more space to spread out in than is available in a standard hotel room.

Good luck whatever you decide.

Ben
Posted 1/16/2007 8:40 PM (GMT 0)

Gralestel:

Scardino is one of the top urologists in the country.  You can't go wrong with him.  If insurance is an issue, I would check ahead of time to make sure Memorial is in your network.  Otherwise, your bill will be exorbitant if you are out of network.  I went to Memorial and saw Scardino's colleague, James Eastham, another "expert", but later found out Memorial was not in my insurance plan's network (should have checked first).  The cost for surgery would have been prohibitive for me had I opted for the procedure at Memorial.

However, I was fotunate that Hopkins was in my network.  I had a great surgeon (Partin) and great results.  Had about a two hour flight home.  No problem.  Two nights in the hospital, one night in the hotel post-surgery.  Based on my personal experience, Baltimore/Hopkins is a lot easier to maneuver than NYC/Memorial, particularly for an out of town patient who has to fly and check-in a hotel for a few days. 

Future life expectancy plays a big part in your decision on which path to take for treatment.  Rule of thumb:  the more years of life expectancy, the more compelling for surgery if it appears the cancer is still confined to the prostate.  Have someone give you your husband's score off of the Partin Tables.

Finally, since prostate cancer is a slow grower, I would call and try to change the date of the Scardino appointment so as not to conflict with the long-planned vacation.  (I decided to have my surgery on the day I was scheduled to leave for Hawaii.  If time/missed work is not an issue, don't miss the trip.)

Posted 1/16/2007 9:10 PM (GMT 0)
thanks for the replies.
there are a few factors making this complicated for us. the first urologist we saw (who is well-respected) told us he couldn't promise he could spare both nerves if he does surgery. the cancer is mostly on one side (the left side had 2 cores with 3%, the right side had 3 cores with up to 62%). this is a big negative for surgery for him. he is only 56 years old and quality of life is a big, big deal for him. we would be interested in scardino's opinion on this issue.
all indications are that the cancer is contained (neg bone scan and MRI and CAT scans), but his prostate is very small and the cancer is pretty aggressive (gleason 7 with perinueral invasion present in two cores), making the possibility of microscopic escape pretty high. (we are told that the scans wouldn't really show if the cancer had just begun to escape the prostate, so my husband is not completely confident that the cancer is totally contained). he doesn't want to do surgery and then have to go through radiation anyway.
this is not a cut and dry case and we are struggling witn the decision on how to treat it. we've had the slides from the biopsy reviewed by a second group of pathologists and they concur with the gleason 7.
good to hear that someone has heard of scardino. i will check on insurance but i'm thinking we'll be covered (thank god we have really good insurance). good to double check though.
Posted 1/16/2007 11:39 PM (GMT 0)
Hi Gralestel,
Let me add my congratulations on being able to see Dr. Scardino. He is one of the top cancer urologists in the country. He was chair of the Dept. of Urology at Baylor here in Houston, and then went to MSK. He recruited my doctor to Baylor when he was building his team here, and I really like my doc. But, you have a chance to see The Man!

There are, in my opinion, two books that any guy (and his mate) should read (buy or check out from the library) who has PCa. One is Dr. Walsh's book on surviving prostate cancer. The other is Dr. Scardino's Prostate Book. If you can get this before you go see him, try to. Dr. Scardino's book was one of the most hope-inspiring things I got my hands on before and after my surgery (especially the section on survival).

I had a somewhat similar case to yours, except that the biopsy didn't show neurovascular bundle invasion, but the post op pathology did, and my Gleason was a bit worse (4+3=7). Nevertheless, I believe surgery is the best way to go, at first, even if there is some advancement. A guy who counseled me at the beginning of my situation told me you can have surgery then radiation, but you can't have radiation then surgery (at least not in most cases). Sometimes, after prostatectomy, if the PSA starts going up again, they have to do supplemental radiation, but you don't have the prostate in, still being the source of cancer to ship elsewhere, and causing obstruction of urinary output as it grows in the capsule. I wanted as much of the cancer out as possible, and radical surgery seemed to me a way to get everything out that you can see. With my situation, they gave me a 91% potential cure rate with surgery, and 75% with any kind of radiation - - external beam or seeds. I was lucky to qualify for the robotic procedure, which has about the same percentage potential cure rate, and produces less wear and tear on the body. This to me was a no brainer, but everyone is different. Please keep us posted on how it's going.

All the best,
dj
Posted 1/17/2007 5:32 AM (GMT 0)

Graestel,

I had a similar experience with each specialist giving his/her best bet for a cure.  That's why the internet and this forum are so powerful.  It's up for you to decide.  I also purchased and read Dr. Patrick Walsh's book Guide to Surviving Prostate Cancer.  For awhile I was swinging back and forth about what path to choose.    After my biopsy, I initially assumed that someone would tell me just what to do.  It doesn't work that way. I'm looking forward to my post op pathology report, so I can put this cancer pretty well behind me.  With radiation and/or the seeds, I don't think I would be able to feel as good.

 I am three days away from my surgery at Virginia Mason in Seattle.  When I talked to my old family doctor, he even mentioned he heard a UW doctor had his surgery at VM as well.  They have done many of these surgeries and I have complete faith in them.  A friend of mine had his surgery November 1 and he's back on his feet and refereeing high school basketball, something I have to put on hold for awhile.

Good luck on your decision, and I'll keep the forum updated on my upcoming date.

Posted 1/19/2007 12:20 AM (GMT 0)

Gralestel,

As you are considering consulting him, reading of Dr Scardino's book which I recommended to you would seem worthwhile, if you havn't already done so.

The chapter on Surgery, technique, nerve sparing and nerve grafts is applicable, and he could elaborate on the specifics which are more relevant to your situation.

A top surgeon will provide the best possible outcome given the circumstances. With the main aim being good long term prognosis, as you mentioned, no surgeon can promise sparing of both nerves: he has to judge how to best deal with the situation he's presented with at the time.

John

Posted 1/20/2007 9:16 PM (GMT 0)
Graestral, HI! I had my surgery at Sloan Memorial Cancer Center. It is a Great Place. My Dr. was Dr. James Eastham and is my HERO. PSA was 3.3  2 out of 12 3+3=6  Oct 12th RRP . He saved both sides of the nerves  had sex with Viagra  1 week after catherter was removed at 2 months Had PSA under .05 That is as low as they measure totally undetectable. I use 2 pads a day but am walking and doing the Kegels. Dr Eastham was very accessable and his Staff. the last visit dec 13th we were laughing  about the my wife and I having sex 2 time a week. I go back in April and then Probably once a year. Dr. Eastham works with Scardino and has done over 2,000 RRP,S.  I highly recommend Dr Eastham and Sloan Kettering .  Cancer contained in the Prostate .     Good Luck      Shepla

Posted 1/25/2007 7:33 PM (GMT 0)
Dear Gralestel

You do not indicate your husband's age which is a very important factor in deciding on treatment. Dr. Scardino is considered one of the best surgeons for radical open prostate surgery. To the best of my knowledge he does not perform lathroscopic or robotic surgery. Please read the post under my name elsewhere in this website.

https://www.healingwell.com/community/default.aspx?f=35&m=709462&g=709962#m709962

Good luck to your husband.

Dave
Posted 2/1/2007 3:35 AM (GMT 0)

Dear Gralestel,

My heart goes out to you and your husband.

Your particular situation requires the very best counsel in the country--you have a far more challenging case than most who post here.  I doubt that you will find better counsel than Scardino or Dr. Eastham at MSK. 

One of my prostate cancer mentors went to Seattle, about 9 years ago, for brachytherapy.  He raves about the quality of treatment he received there.  If you go that route (brachy) or brachy with external beam, you're in a city with some of the best in the world.

As I have explored and researched various options I have found great variation in how various doctors view the best treatment options.  Where I live there is only one hospital that has a davinci robot--few surgeons have experience, and fewer still are up the learning curve to the point where they're really reliable.  Now I've heard that another hospital will be getting a davinci, so we can expect more public acceptance and understanding throughout the medical community of this treatment option.

I seem to be rambling, and I'm sorry.  The point I'm trying to make is, using the davinci robot option as an example, that many doctors do not know very much about things outside their direct area of experience.  This is understandable.  Surgeons prefer and trust surgery, radiation oncologists will counsel their treatment approaches.  All of them will have a risk of side effects and no one can guarantee your results.  The main thing is the skill and experience of the practitioner, whatever the specialty.

The aggressiveness of your tumor and specifics will require the greatest skill (I know I am stating the obvious).  I would seek the counsel of the two or three top options in the country, Scardino at MSK, someone like Partin at John Hopkins, plus the advice of the top radiological oncologist in Seattle.  Stick with the research until you are confident of your choice. 

Oh, just thought of one more factor to consider, and that is that Scardino is one of the best and one of the few doctors who is doing nerve grafts.  Most won't even touch this procedure.  If it were me, I would be very interested in his views on the applicability of this for your situation...

Best of luck and you will be in my prayers.

Markus

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