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Old 07-08-2010, 12:39 PM   #1
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Finding a Surgeon

Any advice on finding a surgeon for open and/or robotic Radical Prostatectomy?

Ideally I would like to screen on outcomes (succes rates, complication rates) then consult with the best. I'm finding that doctors require a consultation which seems like a waste of time and money. What's the best way to find a sugeon with the best track record?

 
Old 07-08-2010, 02:04 PM   #2
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Re: Finding a Surgeon

Hi Dave,

Welcome to the board! I hope you get multiple responses, but I'll put some thoughts in green.


Quote:
Originally Posted by davex View Post
Any advice on finding a surgeon for open and/or robotic Radical Prostatectomy?

Do you have any geographic limits?


Ideally I would like to screen on outcomes (succes rates, complication rates) then consult with the best.

Here are a couple of leads.

One is to check a site we can use on this board because it is Government sponsored, PubMed (Public Medicine): www.pubmed.gov . You could search for, say, " "radical prostatectomy" AND recurrence " (ignoring the outer quotation marks, activating the Limits feature for something like: only items with abstracts, Humans, Male, Clinical Trial. I just did that and got 203 hits. If you review the list, you can check the list of authors for studies that look like they may cover success and complications. Usually, one or two of the authors will be the surgeons whose cases are being analyzed, and frequently such a surgeon(s) will be the senior (last) author. By poking around you can figure out contact information. Many top flight surgeons will publish their results in this way, but many do not.

Some leading surgeons have written one or more books in which they discuss their results. Dr. Patrick Walsh from Johns Hopkins has done this, but he may be retired now from day-to-day surgery. Dr. Peter Scardino from Memorial Sloan Kettering has done this. I'm not sure whether Drs. William Catalona (Northestern U.) or Manni Menon (Michigan) have done this.

You could also check the lists of surgeons who have been invited as speakers at the National Conference on Prostate Cancer series. (The Prostate Cancer Research Institute (PCRI), and the Foundation for Cancer Research & Education, both non-profit organizations, have these lists.)

Another approach is to look into major reports from leading medical associations to see the names of authors/editors, who are often leaders. You can also check their annual conferences to see the names of people giving the important talks.

Many names of prominent surgeons have come up on this board.


I'm finding that doctors require a consultation which seems like a waste of time and money. What's the best way to find a sugeon with the best track record?

Often you can get key information with phone calls. Many doctors have published their information in ways that are convenient for patients.

Good luck.

Jim

 
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Old 07-09-2010, 07:15 AM   #3
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Re: Finding a Surgeon

Hi Dave, and welcome,

Unfortunately, there's no list that exists (that I know of) which identifies surgeons and all their statistical outcomes. I found that once I started searching using various techniques which came at the problem from multiple directions, that one lead would follow another, and soon enough I started to gather multiple inputs on a repeating number of surgeons.

I searched for published literature, similar to Jim's suggestion below, but another of the techniques I used was simply word-of-mouth. I went to a local Us Too chapter meeting, and guys there were more than glad to talk about their doctor experiences. Once friends of mine started hearing about my diagnosis, the experiences started coming out of the woodwork, so to speak. One of the friends I called told his wife, who called me back to say her former boss (and good friend) had PC surgery several years prior, and that she knew he'd be glad to talk to me about his situation. This was just one of many situations that came, as I said, out of the woodwork, but I ended up going with the same surgeon he had. (This was just one of many people I talked to, but this was the one that led to the surgeon I chose.)

I also posted the question here on this site in my own thread. (http://www.healthboards.com/boards/showthread.php?t=670728) In posting #8, I asked:
Anyone here have knowledge and/or experience with top specialists in the CHICAGO area? I am looking to make a short list for second opinions.
Several excellent responses were provided, and these became inputs into the process to further search, ask, learn.

best wishes...



Jim, by the way, I saw in your reply below you wrote [bold added]:
Quote:
Originally Posted by IADT3since2000 View Post

Usually, one or two of the authors will be the surgeons whose cases are being analyzed, and frequently such a surgeon(s) will be the senior (last) author.
Ive published in a (non-medical) technical journal with multiple authors and also have a US Patent with multiple inventors, and in both cases the first listed author/inventor is primary, not the last. Was your (last) a typo, or do you know medical journals to be sequenced this way?

regards...

 
Old 07-09-2010, 08:45 AM   #4
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Re: Finding a Surgeon

Hi kcon,

I'll quote your question in a brief excerpt and then answer in green. It's a good one.


Quote:
Originally Posted by kcon View Post
Hi Dave, and welcome,
...

Jim, by the way, I saw in your reply below you wrote [bold added]:

Ive published in a (non-medical) technical journal with multiple authors and also have a US Patent with multiple inventors, and in both cases the first listed author/inventor is primary, not the last. Was your (last) a typo, or do you know medical journals to be sequenced this way?

regards...
Yes, as in your experience, the first author is usually the "primary" - the guy or gal who really quarterbacked the effort and had the most input. However, the last author is usually the "senior" person, often taking a "producer" type role, often the director of the particular laboratory team/facility that provided the key infrastructure and institutional backing for the study, or whose patients constitute the data for the study, and also bearing a large share of the overall responsibility reputation wise, along with the first author.

The senior person, in the case of surgery studies, is often the surgeon whose results provide the data, while the first author is often the one who conceives of the study and designs it, makes sure the data set is appropriate for the study, does the statistical analysis or oversees it, often writes most of the study, performs quality control, shepherds it through the submission, review and journal acceptance process, and serves as point of contact for correspondence - clearly deserving the lion's share of the credit (or sometimes blame). (I get the sense that sometimes others do some of this work.) I think you see that a lot in research involving Dr. Patrick Walsh, MD, of Johns Hopkins or Dr. William Catalona, MD, now of Northwestern, or Dr. Peter Scardino, MD, now of Memorial Sloan Kettering, for instance, but I haven't verified that.

It's my impression that sometimes you have the Edison or Benjamin Franklin pattern - the study is the brain child of the senior guy and so important that the senior guy also does the first author work, as in some of the D'Amico teams' work on the importance of a rise in PSA of more than 2, for patients diagnosed with prostate cancer, in estimating aggressiveness. I think that's so because studies often become known by the first author, so papers expected to be major advances will often be led by very senior and respected physicians/researchers.

In the experiences I've had as a "consumer reviewer" (meaning survivor representative) of prostate cancer research proposals for the Congressional Directed Medical Research Program (CDMRP), I've gotten a strong sense that the professional medical researchers pay attention to the number of publications for which a proposing "principal investigator" is listed as the first or last author, with somewhat more emphasis on first author papers. The in between author positions are of course important, but they are clearly quite secondary to the first and last positions. Glancing at the authors lists has become a habit with me; when I see a list of multiple authors, I automatically check at least the first and last to see if they are names I recognize, and that helps provide me with context for the study.

I'm thinking this explanation is probably consistent with your experience. Is that so? It took me a while to catch on, and I'm still trying to figure out if there are customs for determining who is listed earlier in the middle author positions. For instance, is being the second author considered much preferable to being the fourth? These matters don't seem important to us layman survivors, but they are the building blocks of reputations for researchers.

I'm disappointed that I have not yet been invited as a reviewer this year for the CDMRP's prostate cancer proposals. I believe it is now too late as the review panels will meet in early August and the review agreements and packages are usually provided about a month in advance of the panels. I had set aside this month for doing the work, but at least I'll now have more time for this board. This would have been my fourth year as a reviewer, and the CDMRP has a fairly flexible goal of three years of service in order to allow a substantial influx of new reviewers each year. It's a tradeoff of experience versus freshness, with both being important. Doing the CDMRP reviews - helping decide how the $80,000,000 is spent - has been profoundly fulfilling for me. I've found it demanding and a lot of work - probably my lowest pay ever per hour of reviewing/panel work for the $1,250 stipend provided, but I would do it again in a heartbeat! (Also, having all expenses paid and a very nice hotel is cool!)

Take care,

Jim

 
Old 07-09-2010, 10:01 AM   #5
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Re: Finding a Surgeon

Learned something new today. Will look at the list of authors differently from now on, based on your first paragraph, below. Thanks for the explanation. I had previously understood the sequence from first-to-last indicated a greater-to-lesser contribution.

Enough about us...


Dave, how's your search coming?

 
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