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Cancer: Prostate Message Board
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Old 07-13-2009, 08:26 PM   #1
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What to say to my doctor?

This is my first post. I am a 61 year old, formerly healthy, active guy. A quick time line of my situation:

May 19, 2009 my PSA was 4.16, which was a jump up from 2.78 the previous year. This triggered a biopsy on July 1. My wife and I met with my urologist to review the biopsy results, which showed 3 of the 12 samples had cancer, and to go over my options. My Gleason score is a 7 (4+3). My urologist is a surgeon who has been performing open radical prostectomy for 17 years and just recently started to transition to the deVinci robotic surgery which he strongly advised I consider having done. After much thought, research, and prayer I have to agree with my urologist/surgeon. He admits to having done only 20 robotic surgeries over the last two years. I have made an appointment to see a much more experienced surgeon in Boston. Am I making the right move in going to a more experienced surgeon over the urologist/surgeon who I have been going to for three years? How should I tell this man who helped find my cancer and hugged my wife and I after giving me the news. What words do I use to tell him I want him to remain my urologist, but I am having the surgery elsewhere? Thanks for any help. John

Last edited by Red Nighthawk; 07-14-2009 at 06:27 AM.

 
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Old 07-13-2009, 11:50 PM   #2
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Re: What to say to my doctor?

Usually honesty and directness works best in these situations. Any ethical professional should understand your desire to have a procedure as complicated and important as a radical prostatectomy performed by the most experienced specialist you can find. He would probably do the same were it him.
The chief of surgery of Memorial Sloan Kettering who was the foremost open prostatectomy surgeon but never transitioned to the robotic, hired the surgeon who pioneered the de vinci robotic procedure in Paris to head his minimally invasive prostate program because he had performed thousands of robotic procedures.
Any surgeon who has only performed 20 robotics is at the beginning of his learning curve and should understand why you choose a more experienced specialist.
All the hugs and warm feelings can't compensate for a less than optimal outcome.
While seeking a more experienced robotic surgeon you might want to inquire about the laparascopic procedure. Its the foreunner of the de vinci robotic and many of the top robotic experts are returning to the laparoscopic RP. The reason is that it has all the advantages of the robotic i.e.; minimally invasive, little blood loss, quick recovery. While the robot is of greater advantage to the surgeon the laparoscopic is of greater advantage to the patient because it allows the experienced surgeon more direct tactile feel with the instruments rather than manipulating the robot from a distance.
At least thats the opinion of Dr. Bertrand Guillonneau who developed the robotic prostatectomy in Paris and now heads up the prostate surgery program at Sloan-Kettering in NY. He now only performs the robotic if the patient insists and recommends the laparoscopic as the procedure of choice.
Good Luck, Bob

 
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Old 07-14-2009, 12:13 AM   #3
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Re: What to say to my doctor?

Your doctor isn't your best friend he is a doctor that is doing his job...and he gets paid well for doing it I might add. He is looking to you to increase his experience but you are smart in going elsewhere ...so Thank him for the offer to do the surgery but for the surgery you are already scheduled for the robotics with another a more experienced surgeon. Just be sure the surgeon doing it has actually done hundreds or whatever your count is for having experience. I find most surgeons are mostly just arrogant so if you find one that actually has a bedside manner all the better.

 
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Old 07-14-2009, 06:40 AM   #4
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Re: What to say to my doctor?

Thanks for the reply Bob. Your comment about the top robotic surgeons returning to the laprascopic RP has thrown me for a little loop. I didn't realize that, and now I am doubting my decsion. This is all so confusing. Back to research and prayer?

john

 
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Old 07-14-2009, 03:09 PM   #5
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Re: What to say to my doctor?

John:
I have a suggestion.
Rhode Island isn't that far from NY and probably not much further than Boston. Why not schedule a second opinion consultation with Dr. Bertrand Guillonneau, the leading robotic prostate surgeon in the world and the man who trained most of the early robotic surgeons. He heads the Dept. of minimally invasive prostate surgery and I've referred several close friends. I was actually sitting in his office with the 3rd friend I'd referred when he came out with his reversal back to the laparoscopic. When we both asked why (about 2 years ago) he said because with all the robotic RP's I've performed I've come to realize that the robot is of no benefit to the patient. There are fewer complications with the laparoscopic RP since the surgeons touch and skills can be brought more directly to bear.

Dr.Guillonneau is easy to see (when not skiing in France or Switzerland)and can be reached at Memorial Sloan-Kettering Cancer Center at 646-422-4406. (I don't know if I'm allowed to give his # on this board so it might be deleted.)
Its well worth the trip for a consultaion as well as having it done by him if you should decide.
Bob

Last edited by shs50; 07-14-2009 at 03:12 PM.

 
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