Biopsy 11/27. Appears to be early stage although Gleason is 6 and 7 but PSA is only 3. I think the Da Vinci is appropriate but our local surgeon has done only 150 to date. Drs in Texas are only a few hours away. Slawin, Fagin and Justin Lee all seem to have done close to 1000 or more. How important is this? Certainly easier to stay at home but at what cost re results. Several local DRs have used local surgeon with good results I hear.

To have a top surgeon is THE most important consideration.

Because someone has done 1000 operations does not necessarily mean they are a great surgeon.

There's recent information on a few of the very well regarded surgeons who are developing their techniques for nerve sparing robotic.

I'd be trying to find one of the top doctors available: whether they prefer open surgery or robotic would be a secondary consideration.

Biopsy 11/27. Appears to be early stage although Gleason is 6 and 7 but PSA is only 3. I think the Da Vinci is appropriate but our local surgeon has done only 150 to date. Drs in Texas are only a few hours away. Slawin, Fagin and Justin Lee all seem to have done close to 1000 or more. How important is this? Certainly easier to stay at home but at what cost re results. Several local DRs have used local surgeon with good results I hear.

My two cents worth:
You didn't mention your age and physical condition, one of the factors in choosing surgery. I'm 64 and a Gleason 7- after a reasonable amount of research had decided initially on robotic surgery with a doctor who had done about 400.
Then continued research and read about proton beam therapy (book by Robert Marckini, You Can Beat Prostate Cancer). After speaking with current and past patients, that's what I chose (University of Florida Proton Therapy Institute in Jacksonville), and never looked back at the surgical option. However, with what I learned, if I were to opt for surgery, I'd lean towards an open procedure. If robotic, it would be a doc that has a top rating and has done well over 1,000.

Biopsy 11/27. Appears to be early stage although Gleason is 6 and 7 but PSA is only 3. I think the Da Vinci is appropriate but our local surgeon has done only 150 to date. Drs in Texas are only a few hours away. Slawin, Fagin and Justin Lee all seem to have done close to 1000 or more. How important is this? Certainly easier to stay at home but at what cost re results. Several local DRs have used local surgeon with good results I hear.

My NYC surgeon had around 900 da Vinci procedures to his credit by the time he got to me in Jan 2007. IN MY OPINION, 150 repeats of any complex procedure is not enough experience.

I don't know how these things are measured in the rural parts of America and in obscure places around the world but in my region (which includes Boston, New York City, Philadelphia, Baltimore and Washington, DC), if a surgeon screws up too much or is just "okay" at a particular procedure, he usually won't ever get close to 1000 repeats before he gets removed from that particular procedure by his peers, the hospital, the patient insurer and his mal-practice insurer. If he's using a system like the da Vinci robot, I'm sure the company providing the equipment weighs in with their opinion. IN MY OPINION, the company that builds the da Vinci robot does not want "hacks" working their equipment. At the price tag associated with a system like the da Vinci, there's way too much at stake to let "drunks drive the bus".

I was told that, not only are the surgeons carefully screened and certified to do da Vinci procedures, even the patients are carefully screened for the da Vinci procedure because they do not want to risk failures, for any reason, that may possibly discredit the robot.

Just my OPINION again, if you find a surgeon that has done 1000 repeats of the da Vinci procedure, that surgeon is "well qualified" in the eyes of his peers, his mal-practice insurer, the patient insurer, the hospital and the da Vinci company. Rest assured, they are all watching the surgeon's performance very closely.

Just my opinion!:)

I have to disagree with able5 a bit here.

The DaVinci folks have nothing to say about who is a patient. They can suggest, advise, or recommend all they want but ultimately, all they are is a provider of equipment. If you go to their website, they even have a disclaimer as to any recommendation of the surgeons listed on their very own website. It is essentialy only a clearing house for names of surgeons that have the minimal credentials to fit in their list.

When I spoke with my surgeon, he did tell me that even at the 200 mark, he was still learning and perfecting his methods.

It's really kind of funny but a local hospital had just placed a robot a few months prior to my surgery. There was only one doc "qualified" (you really need to find out what that means) to run the thing, so my doc brought him in with the intent of possibly doing my op. After this other doc left the room, I asked my doc how many procedures his partner had accomplished. He said, "this Thursday will be his first solo". I politely declined and found one with a bit more experience.

Op counts are only one thing to look for. You also have to remember, they do not start at 400. Your doc started somewhere too. I would rather take a doc that hadd 300 and an extremely good record than one with 1000 with a few "oops". It is a tough decision.

Now the one thing I have always had trouble with is finding stats on the doctors involved. Asking them is not enough and I simply cannot find the info that one should have prior to making the call.

If anybody here has direction for finding such info, I, and I am sure many others, would be greatly appreciative.

I agree with Aus here.

I don't see many advantages to robotic. Quicker healing???? What, one day compared to two? Well, this is a lifetime decision.

Chose the best surgeon. First, with the best record for cancer success. Negative margins. That is the purpose of the surgery, correct. Robotic patients do not have seminal vesicle removal or other things to know if all the cancer has been caught. That raised concerns for my husband and I. When one of the leading PC doctors said he would have Open, that changed our decision.

Then look for stats on who has the best records for side effects. Nerve sparring perfection. Incontinence issues. Etc. Quality of life is important, once you know that life will be there.

Many top surgeons have independent studies follow their patients. Ask the doctor if he has that. It is important who gathers the data. It was important to us. We turned one down because of that. We knew of a patient that he was unaware of that died of PC.

Lots to consider. You have one shot at making one of the most important decisions of your life.

Best wishes! Happy holidays!
Debbie

Thanks AUS. Any information on the best surgeons in the US? Or even the best place to find this type of info. I have ordered the Johns Hopkins white papers.

thank you Daff for your reply. I'm 63 and in good health. Is the proton beam anything like the ProstRcision procedure out of Atlanta that uses seeds followed by linear accelerator irradiation? What are the side effects of the proton? I will try to do more research. Thanks

For whatever it's worth...

Regarding prostate cancer surgery, some people think that all prostate cancer surgeries are interchangeable and that it's a "one-size-fits-all" disease. On the contrary, different types of surgery fit the various different prostate cancer stages. That's why there's a "staging process" so urologists can determine which surgery is best for their specific patient. Every patient does not necessarily qualify for every surgery. Early stage patients may qualify for the robotic procedure while those who are suspected metastasis may not. The open procedure is often used when metastasis is suspected and further exploration of the surrounding abdominal tissue is needed. Some patients are so far along and the cancer has spread so much that they are not qualified for any type of surgery. ;)

my thoughts are the same that this sage crew has already expressed: talk to your doc or docs, seek additional opinions from medical professionals. each guy's situation is unique to only him, and only docs can tell you what forms of treatment are appropriate for you. there'll likely be a number of ways you can go. the conventional wisdom is find a doc you're comfortable with and make your decision with him. i went from thinking robotic to open to non-robotic laproscopic. [i also thought about radiation, but didn't really pursue that. several docs i spoke with said this was also an option for me.]

as for how much experience is enough -- don't know how to think about this. my guy had done a ton of the procedure i had. but i have heard the wisdom articulated in an earlier post: that all the docs select patients carefully for whatever procedure.

your idea of seeking out the name brand celebrity surgeons was also appealing to me; that's what i did. but each guy is different in what he is comfortable with.

this part is easy for me to say now that it is behind me, but here goes anyway: the treatment is all much worse in anticipation than in realization.

good luck and keep posting.

thank you Daff for your reply. I'm 63 and in good health. Is the proton beam anything like the ProstRcision procedure out of Atlanta that uses seeds followed by linear accelerator irradiation? What are the side effects of the proton? I will try to do more research. Thanks

As you might suspect, I'm a strong proponent of proton beam radiation, having done a couple months worth of due diligence before committing to this. The majority of posters on this board have experience with surgery, but that doesn't mean there aren't other good approaches. Once you've seen them all and done your homework, you'll come to the right decision for you.

Most urologists don't even mention proton treatment. Of the 70 or so that were being treated in Jacksonville, nearly all were self-referred. The Marckini book is the best place to start. It's one of the top two or three books on prostate cancer on the Amazon website. You'll learn all about this, and about the group of more than 3,000 members who have taken this route.

It's most definitely not like the ProstRcision route. It's highly targeted proton radiation given over a period of about two months, so it's a big time commitment. Many, but not all, insurance companies pay for this (mine did, despite some delays at first) because of the expense. The physical plant costs about $125 million. The benefit vs traditional forms of radiation is that the radiation's energy is released in one's prostate and little damage is done to surrounding tissue. There's essentially no entry or exit dose that affects healthy tissue. There is some radiation that does hit the bladder and rectum, but very little.

Side effects for many are just urinary related-- part-way into the treatment, some have weak stream, urgency, and sometimes some burning. Drugs like Flomax generally relieve these side effects. There is nearly zero incontinence- I've never heard of anyone with that problem. Impotence is said to be less, but one may end up being in about the same or better situation than after surgery or other radiation treatments. (Of course, after surgery impotence is immediate and then hopefully functionality returns in a matter of months.)

They've been using proton beams since 1990 in Loma Linda, California, having done 7,000 or more prostates. The facility I went to in Jacksonville is only a little more than a year old, and I was very happy with that choice.
There is good testing done at the outset (bone scan, chest xray, mris and the like). I came across several that were there following surgery that didn't cure the cancer (they were having the prostate bed treated).

I'd be happy to answer more questions, but strongly suggest you inititally read the book I mentioned. If nothing else, you'll know what the alternatives are.
There are several more proton centers in the planning or building stage- it's used for other tumors (eyes, neck etc) in addition to prostate cancer. There is one being built at University of Pennsylvania to be completed in a year or so. Others in the works for Florida, Virginia, and Oklahoma.

Please ask if you have other questions, as I'm happy to help. And I'm not necessarily negative on surgery- it can fit the bill for some.

tck44,

I apologize if I misunderstood your initial post, I thought you were asking about a specific procedure (the robotic LRP). The da Vinci procedure is the procedure I chose and is the only treatment I can share with you from personal experience. I didn't realize that you were still considering and investigating other treatments as indicated by the variety of treatments represented in the replies you received. Sometimes I chime in where I don't belong.

Have a great Holiday!

:wave:

I have to disagree with able5 a bit here.

The DaVinci folks have nothing to say about who is a patient. They can suggest, advise, or recommend all they want but ultimately, all they are is a provider of equipment. If you go to their website, they even have a disclaimer as to any recommendation of the surgeons listed on their very own website. It is essentialy only a clearing house for names of surgeons that have the minimal credentials to fit in their list.

Good post gooby;

You speak with the authority of an insider who has personal knowledge and expertise about how they run their corporation.

From your description it seems very similar to taking delivery of a used Volkswagen Bus.

At something like $1.3M a copy (not to mention ongoing hardware/software upgrades and routine maintenance contracts), I think the relationship is much more intimate. I think there are contracts that make things much more legally binding with regard to performance and success.

I'm no corporate insider so this is just my opinion.

tck, you've gotten a lot more advice than you sought, i'll bet. ;) but, regarding patient selection -- i can only surmise, but the first doc i spoke with said he wanted to do daVinci, and if he'd like me as a patient if i wanted to go with daVinci. the clear implication was that if i wanted another procedure, i should look elsewhere. the guy i ended up with gave me a written report saying that i had sought his wisdom regarding surgery options [true] and that i was a good candidate for any of the three types of surgery we discussed. he also said that if i wanted laproscopy [sp?] without the robot, he'd like to do it. he said if i wanted open, his colleagues were the guys, and if i wanted robotic, he knew a robot guy. [he cited number of procedures for all these guys -- it was way up in the hundreds for himself and all the guys he alluded to.]

from this, i inferred that patient selection is widely practiced.

of course, someone more cynical than i am could infer that they are all hammers looking for nails. just kidding about that part.

regarding your original question -- i meant to be saying that in my view, you should certainly talk to the other more experienced guys and see how you feel about what you hear from each.

and yes, certainly be aware that here in this venue each person is familiar with a sample size of just 1 -- himself only. :)

Thanks AUS. Any information on the best surgeons in the US? Or even the best place to find this type of info. I have ordered the Johns Hopkins white papers.

tck44,

I'm sorry you have had to join our club, but it is a good group, and you are doing the right thing by digging in with research. As the old carpenter's maxim puts it, "Measure twice and cut once."

You've had several tips on finding the best surgeons. Unfortunately, the rules of the board do put some restrictions on what we can say about specific physicians, but we can mention resources like books.

Here's one way you can get a feeling for the leading da Vinci practitioners. Go to the free Government website www.pubmed.gov. Then enter this (without the quotation marks) in the search block: " da Vinci AND prostate cancer ". I just did that and got 36 hits. (I posted about using PubMed on December 24. It's not hard.) Then click on the blue hypertext authors lists to see an abstract of each study, if there is one. The authors list in the abstract will include the surgeon or surgeons upon whose work the study was based, but will not indicate who they were. The list will also provide contact information, such as an email address, or you can figure out the institution's website and work with it to learn how to contact the research team. You can also see whether the team is from the US, if that matters to you. The point of contact provided in the abstract (perhaps inferred from the email address) can provide a lead to the surgeon. If you want a list of medical libraries open to patients, so that you can get access to complete papers instead of just abstracts, go to the free Government site http://nnlm.gov/members/, click on Services Offered, and select the option for access to books and journals under the "For the Public" heading. You will be able to get a list by state. My local hospital library is quite helpful, often making copies for me for free.

The PubMed abstracts also suggests how the learning curve affects success with da Vinci robotic surgery. I've heard on several occasions that the surgeon should have at least 300 da Vinci operations under his belt to be well qualified, and I've also heard that under qualified doctors can make some serious mistakes. Some doctors avoid mistakes while learning by operating under the close guidance of an expert during the steep part of the learning curve. (If it were me, I would still want the doctor soloing on me to be an expert.) Note that the earliest study in the 36 PubMed hits was published in 2001. That's not very long ago, demonstrating how quickly this technology has taken hold.

The series of National (or International) Conferences on Prostate Cancer held every one to three years in the US has had presentations on robotic surgery by a doctor named Tewari. I'm fairly sure he addressed learning curve issues in at least one of the presentations in 2005 (Washington, DC) or 2006 (Reston, VA). (Robotic surgery was not addressed in the 2007 conference.) His conference talks are available on DVDs.

You said you were continuing to research options. I highly recommend this book: "A Primer on Prostate Cancer -- The Empowered Patient's Guide," rev. ed. 2005, by Dr. Stephen B. Strum, MD and Donna Pogliano. It is excellent on assessing a patient's cancer, available options, and tailoring the treatment to the patient, which is very important unless you are a thoroughly low-risk case. While the numbers you provided looked pretty favorable, that Gleason 7 in at least one core suggests that some additional tests or scans might be worthwhile.

Take care and good luck,

Jim

Is the proton beam anything like the.... I will try to do more research.

Just a quick note to add to my previous comments-- today's (12/26/07) national edition of the New York Times has a long article about proton treatment (beginning on page 1, far right column). One of the things mentioned is that there are five proton centers presently in the U.S. with more than a dozen more planned and others under consideration. Worth checking into to know that there are other approaches besides surgery to at least consider.
(The article does talk about the high cost for this, saying that Medicare reimbursement is about $50,000 vs half that for more traditional radiation.)

and yes, certainly be aware that here in this venue each person is familiar with a sample size of just 1 -- himself only. :)

Ditto! Well said CRS907...

No need to improve on that!

right on, able. we've morphed from a group of mutual supporters into something entirely different. but the pendulum will swing back.

The way I see it and how I look at these kinds of decisions in life, and thankfully we don't have them daily, is to think of them in an abstract way and relate that to the situation.

For me, I think about it as, what factors and choices do I use if I had to put my life savings, financials in someone elses hands? Everything you depend on?

How risky are you?
How much info do you need?
What details do you need to live a happy life after making those choices?
Confidence levels?
etc

For me, I find I can be a risk taker when I am in control of a situation. For example, I own a business. Not too scary to me... I control my destiny. For some, that is very scary.

But, I am risk adverse when others control my destiny. Very risk adverse. Call it bad experiences, whatever. Especially doctors. So, I want every ounce of details we can get and as much control as we can have. Especially when it is regarding our life, not life savings. My husband is similar. So this did eliminate a few options for us.

This is the process we used to make our decisions. That's the process everyone needs to look at. What options do you have? What choices can you live with? Do you trust in all the staging, educated guessing, Etc. So many people have different stages after pathology reports than prior to surgery, that concerned us. People have positive margins. Why does all of this happen then? Doctors are only human....tests are not 100% like PSA.... biopsies are only as good as the section removed....everything is not so simple.

It's tough but it is so individual. You need to look deep inside and think about that. What kind of choices do you make in life to keep you satisfied and comfortable? Use your standard desicion making skills and apply them here to your options.

As our surgeon - Dr. Klein - stated, the worst part of PC at this time, is the large variety of options available and the struggle to make a decision. Everyone always wonders if they made the right one. And everyone here will always wonder too - if they could only see the future.

Good luck to you! Anything you chose is better than no choice. That is step one.

Well, I was glad to see that my surgeon had over 100 entries in Pubmed. I still have trouble finding objective info about him though. Although there are literally thousands of ****** hits (he is the chairman of Urology in a prominant training hospital) and speaks, apparently, all over the country with great regularity.

It is fairly easy to find accolades but difficult to find an objective critique.

IADT, you seem to be a lot more informed as to where info can be found. Any suggestions where to find objective reports of a doctor? Prefferably without charging since most of them give you no real idea what is really in their reports about a specific doc until you actually read it.

able; concerning the contractual relationships between doctors and Intuitive (they sell the DaVinci robot);

any such recommendation by Intuitive would tend to bring them into a legal situation that I doubt they would take on willingly. I will ask my uro when I see him next if I can remember that long (couple months).

If you haven;t been to their website, head on over and read their disclaimers.

Good post gooby;

You speak with the authority of an insider who has personal knowledge and expertise about how they run their corporation.

From your description it seems very similar to taking delivery of a used Volkswagen Bus.

At something like $1.3M a copy (not to mention ongoing hardware/software upgrades and routine maintenance contracts), I think the relationship is much more intimate. I think there are contracts that make things much more legally binding with regard to performance and success.

I'm no corporate insider so this is just my opinion.

Able,

Do you think Boeing checks on the pilots when they sell a plane?

It's equipment. It's a sale. When it leaves their hands, their responsibility ends. The responsibility lies with the owner. The person that spent the $1.3M. As long as no one breaks the machine, I'm sure that no one is concerned. It is a business. Sad to say, but medicine is Big business.

Now reputation. That they worry about. That affects their business. So success ratios do impact them.

Debbie

... IADT, you seem to be a lot more informed as to where info can be found. Any suggestions where to find objective reports of a doctor? Prefferably without charging since most of them give you no real idea what is really in their reports about a specific doc until you actually read it....

I wish I could help you, myself and all of us with that, but my strong impression is that free objective information is impossible to get for the vast majority of doctors. There are a couple of exceptions.

The most objective data in my opinion is from what are called "clinical series" that are reported in formal medical research papers published in a major peer-reviewed medical journal. A "clinical series" is a series of patients with certain characteristics that are treated in a specified way by a doctor or a specified team or institution and carefully tracked with case details and results documented. Similar highly objective data may be published as part of a clinical trial.

A number of leading doctors have their results published in this manner. Among surgeons, Dr. Patrick Walsh of Johns Hopkins is arguably the best known of such doctors, though Drs. William Catalona of Northwestern and Peter Scardino of Memorial Sloan Kettering also come readily to mind. Among radiation doctors, Dr. Michael Dattoli (Sarasota), Dr. Critz (Atlanta), Dr. Patrick Kupelian (Cleveland), and Drs. Blasko, Sylvester and Grimm (Seattle) have had their results well published. No doubt there are many other physicians whose results have also been so published. These publicized results appear to me to be highly reliable as many of these doctors are in faculty positions, which means their work is very visible both to students and to review committees, and they often work with expert research teams. Of course, most doctors are not so visible and yet may be very good.

Another exception is disciplined results tracking by a doctor himself. Some doctors keep careful records of case characteristics and results in a data base that can be queried and results displayed. While this information is vulnerable to great fudging by an unscrupulous or careless doctor, some doctors back up its validity by providing long lists of patient references that can be checked. In deciding my own therapy choices at several points, I questioned the reliability of some impressive results and called more than twenty patients on one doctor's reference list. That first-hand contact can give you a real feeling for whether the claimed results are valid.

I've heard that some insurance organizations and state governments are also trying to develop a way of marshalling objective data about physicians and hospitals, but I'm not familiar with these efforts beyond knowing that in many states you can obtain malpractice information. I also remember reading about some subscription advisory services, but again I don't know anything about these. Perhaps someone else can chime in here. Unfortunately, even if such data do exist, it's unlikely they would address the detail we would like to have.

Jim

Do you think Boeing checks on the pilots when they sell a plane?

Funny you should ask...

I know they do. That was my job until I retired. I was a field rep for Boeing. Our primary system was the CH-47 Chinook, twin-engine, tandem rotor heavy-lift helicopter. Our customer was primarily the US Army. Although other team members were responsible for ongoing yearly pilot training and certification, my team did the yearly training and certification for mechanics and crew chiefs. With multi-million dollar aircraft systems that sometimes can last for 30 years, there's always new hardware/software retrofits in the pipeline for each aircraft that has been deployed for fleet service. Never a dull moment! I think you'd be shocked if you saw how intimately involved Boeing got if a chopper crashed! :eek::eek::eek::eek::eek:

With regard to how da Vinci robots are sold and deployed, I must defer to your expertise. I'm merely guessing it's similar to Boeing especially when these systems are so expensive for such small hospitals and medical groups. However, you certainly sound like you are speaking from considerable da Vinci experience. I wish I was a corporate insider with the da Vinci company to know how their field reps handle service "after the sale". If it's remotely like Boeing, the customer relationship never ends while they still fly that particular "aircraft". Your description sounds cold.:( You make it sound like once the sale is closed, the company closes up and moves out of town. :( I wonder what happens when a da Vinci robot crashes? According to you, LOL!

Nevertheless, since this discussion (argument) is beginning to become very boring, let's agree to disagree and we can declare you the winner.;)

Sounds good to me... LOL

So Boeing didn't sell an aircraft if the pilot wasn't good? Aircrafts just fall from the sky?

Not cold answer, just the business answer. I deal with Fortune 500 daily. It is business. The makers make a quality product. They will service it, train on it, etc. for a long time but skill, passion and technique is not equal in everyone. They can't guarantee a "drunk" doesn't get behind the wheel. Hence, they won't recommend human factor. Can you blame them?

debbie;

You'll be interested to know that things are slow down at the hospital these days where I had my robotic surgery. So slow that, when the robot isn't making popcorn for the staff, he's working part time across the street at the local hardware store (Don't get upset, it's just a joke).:D

In an effort to move away from our dumb and boring argument :yawn: and on to the real reason for this thread, regarding How much robotic experience is enough ?...

QUESTION: Has your hubby ever posted "his" view on this forum about why "he" opted for a treatment other than robotic?:confused:

Debbie-
Just a FYI regarding the negatives you listed for Robotic surgery. You stated that patients of robotic surgery do not have their lymph nodes removed. Wrong. My husband had 13 nodes removed with his surgery and they were cancer free! Just thought I should let you know that statement is wrong.
Molu

Debbie-
Just a FYI regarding the negatives you listed for Robotic surgery. You stated that patients of robotic surgery do not have their lymph nodes removed. Wrong. My husband had 13 nodes removed with his surgery and they were cancer free! Just thought I should let you know that statement is wrong.
Molu

Molu; Glad to hear your husband is cancer free. That's great news! From the way this thread is heading I'm beginning to think that some of us didn't really shop around for an experienced robotic surgeon when first diagnosed but rather, in our stressful pre-op state of mind, some of us may have just "gone along for the ride". Looking back at the initial posts of some of the hindsight experts on this forum, you get the impression that the decisions they were making at the time were made out of fear and anxiousness and were not decisions that were made with any great deliberation and personal forethought on their part. Being in such a state of stress, they were merely following the advice of their clinic. I challenge these experts to be honest with themselves and go back and re-read some of their initial posts to get a better perspective of how they arrived at their chosen treatment. They may find a completely different person with a completely different attitude in their "pre-op" days. Personally, I was much more humble and much less pretentious when I was first diagnosed. I viewed help, in any form, as relief. Although he provided me with detailed information on all of the treatments available for my specific case, my urologist suggested robotic surgery (he did not do the procedure). I liked him and felt confident and comfortable with his sales pitch. I viewed him as the prostate cancer expert. He introduced me to the surgeon who had over 900 repeats and who serves as a proctor to other urologists for the robotic procedure and that's how I made my choice. Pretty simple!

I have a question Molu. When your husband was considering robotic surgery, did he shop around for a doctor with a lot of robotic experience?:confused:

Debbie-
Just a FYI regarding the negatives you listed for Robotic surgery. You stated that patients of robotic surgery do not have their lymph nodes removed. Wrong. My husband had 13 nodes removed with his surgery and they were cancer free! Just thought I should let you know that statement is wrong.
Molu

Sorry Molu, I meant seminal vesicles.

Congrats on the cancer free! That's the goal!

Wishing you the best....

Debbie

debbie;

You'll be interested to know that things are slow down at the hospital these days where I had my robotic surgery. So slow that, when the robot isn't making popcorn for the staff, he's working part time across the street at the local hardware store (Don't get upset, it's just a joke).:D

In an effort to move away from our dumb and boring argument :yawn: and on to the real reason for this thread, regarding How much robotic experience is enough ?...

..... Able, then stop responding... LOL

QUESTION: Has your hubby ever posted "his" view on this forum about why "he" opted for a treatment other than robotic?:confused:

Maybe.....

debbie;

I went back in the archives of this forum to 07/01/2007 to review your posts on the thread entitled "Prostate Cancer Dilemma" just to reflect on our dialog back then. Judging from your posts back then, July of 2007 was a stressful time for you and we all empathized with your journey. I hope we were helpful to you during that time.

I was trying to refresh my memory as to whether I ever read a post by your husband that might offer us his first hand knowledge and experience on how he selected a doctor with regard to experience level. Did he post under a different user name?:confused:

Debbie-
Don't mean to be picking on you but he also had his seminal vesicles removed. So the Robot is able to remove all those important parts for the pathologist to inspect. Again you are right that the best part is clear margins! We're not out of the woods yet since he did have extra capsular extension but so far so good. Another PSA will be done in Jan. Keeping our fingers crossed since this first year is so important to watch for recurrence.

Able-
You are so right about going with what the dr orders at that horrible time of the diagnosis. It's panic time and hard to think clearly. My husband was so impressed with his surgeon he would not have anything to do with talking to any other dr. Made me very nervous because of what I'm reading here but this had to be his decision and he had to be comfortable with it. I did check into his dr more and found he did have a fellowship in robotic surgery and arthroscopy surgery. He studied in Sweden and also trained other doctors from around the world. I felt better when I saw his extensive training. We do have our problem with incontinence yet and my husband is going to PT to work on that. Lost both nerve bundles so emotionaly that has been very hard but he is cancer FREE at this time. One step at a time. One day at a time.
Molu

Sorry Molu, I meant seminal vesicles.

Congrats on the cancer free! That's the goal!

Wishing you the best....

DebbieWon't swear to it but I was under the understanding that removal of the seminal vesicles was included in all prostatectomies. They do not interface with anything other than the prostate so there is no use in leaving them from what I understand.

could be wrong...but...

as to the question of actively looking for an experienced surgeon:

I spoke with several doctors as to recommendations. I was provided three names. One in Detroit area, one in Chicago and one in Indianapolis (the guy that did the surgery eventually). I did my best to research each of them and the hospitals involved. I went back to 2 of the docs I asked for referals and ask them whom they would choose and ended up with the chairman of the uro department at IU Indy for my surgery. While I could find literally thousands of hits on a prominant search engine, most of them were from speaking engagements or published papers. While finding him so active in those two areas was a good sign, I still lacked the objective information I wanted, and never did find.

I do wish there was a more available clearing house for records of doctors. While those that are questionable in their abilities and histories would obviously not like the info published, I believe it would ultimately allow for a more informed patient and eventually possibly even lower incidences of lawsuits for malpractice (since the poorly rated docs would tend to be put out of business). One would think the insurance companies would welcome such a system.

Debbie-
Don't mean to be picking on you but he also had his seminal vesicles removed. So the Robot is able to remove all those important parts for the pathologist to inspect. Again you are right that the best part is clear margins! We're not out of the woods yet since he did have extra capsular extension but so far so good. Another PSA will be done in Jan. Keeping our fingers crossed since this first year is so important to watch for recurrence.

Able-
You are so right about going with what the dr orders at that horrible time of the diagnosis. It's panic time and hard to think clearly. My husband was so impressed with his surgeon he would not have anything to do with talking to any other dr. Made me very nervous because of what I'm reading here but this had to be his decision and he had to be comfortable with it. I did check into his dr more and found he did have a fellowship in robotic surgery and arthroscopy surgery. He studied in Sweden and also trained other doctors from around the world. I felt better when I saw his extensive training. We do have our problem with incontinence yet and my husband is going to PT to work on that. Lost both nerve bundles so emotionaly that has been very hard but he is cancer FREE at this time. One step at a time. One day at a time.
Molu

MoLu,

I'm wishing you nothing but "ZEROS" at your next PSA readout. I have a feeling you (both of you) will do just fine...

I don't want to belabor the point about the "reality" of how most of us made the decision about a specific surgeon and treatment. I can only share my personal experiences. When my urologist first told me I had prostate cancer, I went into shock for a few weeks. Regretfully, I'm just not the type of geek who can separate himself from his situation in order to make objective decisions. How can a person think and act in a purely clinical way so soon after a cancer diagnosis? As the actual patient, I was not able to detach myself enough to not be influenced by my personal feelings. Under these stressful circumstances, I believe that it's very good to have the objective opinions of an informed and experienced team of professionals. Personally, I don't mind following the recommendations of people like that. In all honesty I can say that my research took a distant second place to the advice of my urologist. Regretfully, some folks simply don't remember how stressed they were after the doctor said, "It's cancer.":(

able; concerning the contractual relationships between doctors and Intuitive (they sell the DaVinci robot);

any such recommendation by Intuitive would tend to bring them into a legal situation that I doubt they would take on willingly. I will ask my uro when I see him next if I can remember that long (couple months).

If you haven;t been to their website, head on over and read their disclaimers.

Thanks gooby,

One question...

Are you offering your opinion or do you know this to be their policy?:confused:

Thanks gooby,

One question...

Are you offering your opinion or do you know this to be their policy?:confused:it is only opinion but as mentioned previously, if I can remember to ask, I will ask the surgeon. I have an appointment in Feb.

I am not an attorney but seem to have a slight understanding of such matters. Whenever a company explicitley recommends something, they can get hooked up into legal problems. Actually they would get brought into any suit anyway but by specific recommendations, they cause themselves a much greater level of exposure to having some liability.

Dang, eveybody in todays world (especially the med arena) wants to be able to deny liability. Even providing training could be dangerous for them although I would think they do provide training as part of the sale. You can only sell so much equipment if you do not at least tell somebody how to use it.

I would like to link it but fear it would cause a problem but you really need to visit Intuitives site specifically the "product Training" and "service and support" sections. It is loaded with disclaimers. It looks like after sale support is a purchase option, or at least anything above some basic level is. If Intuitive was so wrapped up in who used it and the rep of their machine, I could not see them offering such services as an option. That tends to make me believe it is closer to a you bought it, it;s yours situation.

Good stuff gooby,

You make some good points.

I'm familiar mostly with government contracts and never had much experience in serving private enterprise.

As a major supplier to the government, we had to bid with other similar suppliers for government needs. For the most part, lowest qualified bid got awarded the contract. Within the specs of any contract were provisions about training, certification and maintenance that usually lasted for the life of the contract term.

I assume that Intuitive is the only company making the da Vinci system. I assume they do not compete with other robot makers since, to my knowledge, no other such companies exist.

When you consider that it's their basketball and they own the court, I guess they are in the position to make the rules.

Good discussion, thanks for the thoughtful insight.

I'm just starting to feel a little guilty that I'm perpetuating a discussion that has little to do with "How much robotic experience is enough ?"

It might be a good idea to give tck44 his thread back?

:)

[QUOTE=MoLu;3364547]Debbie-
Don't mean to be picking on you but he also had his seminal vesicles removed. So the Robot is able to remove all those important parts for the pathologist to inspect. Again you are right that the best part is clear margins! We're not out of the woods yet since he did have extra capsular extension but so far so good. Another PSA will be done in Jan. Keeping our fingers crossed since this first year is so important to watch for recurrence.

Hi MoLo,

Just going on what we knew. Some here said that to be the case also. I guess it depends on the surgeon. My apologies.

Best wishes for more zeros!

Debbie

debbie;

I went back in the archives of this forum to 07/01/2007 to review your posts on the thread entitled "Prostate Cancer Dilemma" just to reflect on our dialog back then. Judging from your posts back then, July of 2007 was a stressful time for you and we all empathized with your journey. I hope we were helpful to you during that time.

I was trying to refresh my memory as to whether I ever read a post by your husband that might offer us his first hand knowledge and experience on how he selected a doctor with regard to experience level. Did he post under a different user name?:confused:

It was a stressful time, and I expressed how I make decisions, and offered my questions at the time, but this wasn't my decision, it was my husbands.

Not sure why you are confused about my husband and his posting or not....

He didn't and won't. In his opinion, he won't waste his time on the board. He said he choses to live life, enjoy now and never signs on. If he had issues, questions, etc, maybe, but he is doing great and wants to enjoy it, not spend his time on here. To each his own.

You know what Able, my husband has the right attitude. I have no reason to be looking on here anymore. This board was a help while needing to know what to do to prepare for surgery, the time after surgery, the first PSA tests, the side effects, etc. I am grateful for that. But life moves on and things are good.

Time to get back to life and enjoying my husband and avoiding this board. Time on here is time not with him. I need to get back to life without prostates!

Good luck to all of you. Best wishes for a New Year filled with good health, happiness, love, and success.

Debbie

good luck and definately enjoy your husband. The loss of his prostate does not remove his personality. (it may dampen his spirits for a while but he is still in there).

hopefully you will stop by occasionally and let all knwo how things are going and maybe lend an ear and a bit of advice to those that need and seek it. It is difficult for anybody to understand what this is all about until you have been there and because of that, I believe we have an obligation to lend our experiences to those just beginning their journey.

debbie;

I agree with gooby's assessment...

I'm sorry to see you leave the board but I fully agree with your reasons. I've followed most of your posts since you joined and, in my opinion, much of the time you have offered a great deal of comfort to many prostate cancer newbies as they embarked upon their difficult journey.

I didn't have the benefit of this forum in the initial months of my prostate cancer journey. I did not find this forum until I was two weeks post-op. Essentially, my wife and I traveled this road alone. Not many of our questions got answered so we were pretty much "in-the-dark" for the entire pre-op experience. We relied almost completely on the advice and guidance of the team of professionals that were within our insurance coverage.

My view of this forum is that "none" of us are experts or professionals concerning prostate cancer. There's only "one" thing we can offer to others on this forum and that's our personal experiences. The more honest and truthful we are about those experiences, the better we are at helping those who follow in our footsteps. The more we try to treat each other with respect, in spite of our differences of opinion, the better this forum will be. It's always good to sprinkle in a little humility and always keep in mind that we all were once newbies and we were all frightened to death.

Our sage, CRS907, expressed it very well when he said, "and yes, certainly be aware that here in this venue each person is familiar with a sample size of just 1 -- himself only."...

The one thing that I will always be, until I die, is a cancer survivor. On this forum, cancer survivors have a single purpose. That purpose is to help the cancer newbies as they jump through the hoops that we just went through. That's my opinion. If I can make that journey easier for those behind me, I'll hang on and remain an active forum member.

I'll miss your participation...

By the way, I love your parting shot, "I need to get back to life without prostates!" I guess that could be expanded to breasts, kidneys, spleens, lungs, colons, stomachs, brains, etc., etc., etc.,

Relax, only kidding! :D

Bye:angel:

debbie;

By the way, I love your parting shot, "I need to get back to life without prostates!" I guess that could be expanded to breasts, kidneys, spleens, lungs, colons, stomachs, brains, etc., etc., etc.,

Relax, only kidding! :D

Bye:angel:

Happy New Year All!

Stopped in to see the response to my post and to wish all of you a healthy happy New Year. I'll keep you in my thoughts and prayers for continued success.

LOLOL, Able. Geez. Sensitive?

You can expand that to whatever you would like but I have those items. I never had a prostate. LOL. And I've heard, learned and discussed more about an organ that I don't even have than I care to think about. What I meant was, I want to get back to me... my life.. without a prostate, or talk of it. Normalcy for most woman. My husband is fine, life goes on and he is doing great.

Relax, lighten up!

Happy New Year to you too, debbie;

Welcome back! You gave me the impression that you decided not to participate any longer when you posted, "I have no reason to be looking on here anymore."

I think you have a great deal to offer this forum. Especially to other women who find themselves supporting their men with this disease.

"LOLOL, Able. Geez. Sensitive? Relax, lighten up!"...

Uh, okay? If you say so?:(

I just love your wit and sarcasm! ;)

Hope you keep posting!:D

:angel:

i was 35 yrs old when came the news of stage 3 prostate cancer gleason score of 8.....i had the robotic surgery and the only doctor i would reccomend is dr kuhn in north little rock arkansas at baptist springhill doctors offices the man did wonders took out my prostate and left everything i mean everything intact