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Old 01-31-2011, 12:30 PM   #1
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Finding the best of the best

Hi all - Been reading the posts here for a few weeks a close family member was just diagnosed with PC. Seems to have been caught early so now evaluating all the options and this forum has been INCREDIBLY helpful in wading through the mountains of information and offered some very good advice. Thank you all!! One question for which I have not been able to find an answer. I have read that the outcome especially for a radical prostatectomy is highly dependent on the skill of the surgeon. I have read over and over just how important it is to 'find the artist.' How do I find the BEST of the BEST surgeons out there (specifically in the NYC area)? Is there a website that I can check doctor's outcome profiles, etc? Any advice greatly appreciated...many thanks in advance.

 
Old 01-31-2011, 01:45 PM   #2
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Re: Finding the best of the best

Quote:
Originally Posted by speranza99 View Post
Hi all - Been reading the posts here for a few weeks a close family member was just diagnosed with PC. Seems to have been caught early so now evaluating all the options and this forum has been INCREDIBLY helpful in wading through the mountains of information and offered some very good advice. Thank you all!! One question for which I have not been able to find an answer. I have read that the outcome especially for a radical prostatectomy is highly dependent on the skill of the surgeon. I have read over and over just how important it is to 'find the artist.' How do I find the BEST of the BEST surgeons out there (specifically in the NYC area)? Is there a website that I can check doctor's outcome profiles, etc? Any advice greatly appreciated...many thanks in advance.
Hi Speranza
At MSKCC site, you can find a list of their surgeons with resumes. For me I looked for a surgeon with more than 250 RP surgeries performed. I did some investigation by talking with two of his patients. The team of doctors attending the treatment should be also considered, and I look into the resumes of the Anesthesiologist too.
Here is a site with descriptive information on “How to pick a prostate cancer surgeon”. Just type this sentence in a net search engine.

Good luck
Baptista

 
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Old 01-31-2011, 02:32 PM   #3
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Re: Finding the best of the best

Very, very helpful - thanks so much, Baptista.

 
Old 01-31-2011, 03:27 PM   #4
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Re: Finding the best of the best

Hi speranza99,

Welcome to the Board!

It looks like you have already found some good leads with Baptista's help, so I'll just add some brief comments.

The New York City area has quite a number of expert docs, as you would expect, and MSKCC is one of the best sites in the world for prostate cancer.

Two names popped into mind when I saw your post: Dr. Peter Scardino, and Dr. Ashtush Tewari. Dr. Scardino, at MSKCC, has a world class reputation, perhaps for open prostatectomy rather than robotic. Dr. Tewari is one of the world's leaders in robotic surgery, and he practices at another NYC hospital.

I do have a question and a comment though. As good as the surgery option is for a case caught early, is there a reason that "active surveillance" is not mentioned as a prime option in your post? Also, radiation, at centers of excellence, appears to be at least as effective as surgery based on accumulating long-term research. Surgery is no longer "the gold standard" except in the minds of surgeons. Has radiation been considered? By the way, MSKCC is also a leader in radiation for prostate cancer.

Take care,

Jim

 
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Old 01-31-2011, 04:01 PM   #5
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Re: Finding the best of the best

Hi Jim,

We actually are considering all options including active survelliance as there was only 1 positive core with less than 4% cancer, a few others with PIN; Gleason 3+3; PSA 5.3; age 56. We are trying to get an appointment with Dr. Zeleski (radiation oncologist) at MSKCC and are trying to figure out which surgeons to interview. Interestingly, just today, someone gave us the name of Dr. Tewari as top-notch. Your recommendation truly validates that suggestion. I have to say that the choices are dizzying. We are trying not to get overwhelmed but just explore/listen/research all the options and then make a decision. I have stacks of articles from PubMed printed, books stacked and websites lined up thanks to so many incredibly helpful folks!

Thank you again for your very helpful reply!

 
Old 01-31-2011, 04:56 PM   #6
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Re: Finding the best of the best

Hi again,

You're welcome. Glad to help.

Dr. Zelefsky is definitely one of the world's leading radiation doctors for prostate cancer. One thing I like very much about him is that he is a prolific author and researcher. I hope you get the appointment.

Dr. Tewari has been the featured presenter on robotic prostatectomy for at least two of the nearly annual National Conferences on Prostate Cancer. In my book that's a strong mark in his favor. His results and research are also well published.

Dr. Scardino, in addition to being a top flight surgeon, is also, I think, a senior leader of MSKCC's active surveillance program. He is listed as the senior author on some of the MSKCC's AS research. He has authored a fairly recent book on prostate cancer directed toward patients.

What you have stated so far is consistent with active surveillance: only one core positive (less than 34% of cores); 4% cancer in one core clearly not exceeding 50% cancer in any core; PSA of 5.3 not exceeding 10; and Gleason not exceeding 6 (or 7 if older and other health concerns, a judgement call). With just 4% cancer in only one core, the DRE probably did not result in a palpable cancer; is that right? Up to stage 2a, based mainly on the DRE, is within AS concurrence limits. Do you know the PSA density (PSA divided by the volume in cc)? AS experts want the PSAD to be <.15; with a PSA of 5.3, the prostate could be as small as 36 cc and still satisfy this criterion. A larger prostate would decrease the PSAD, which would be even more favorable. Do you know the rate of change in the PSA over the past year or so? Ideally, it would be a PSA velocity (PSAV) of less than 1. However, PSAV is sometimes influenced by infection or by benign growth, giving some leeway if those factors are involved. These criteria are from the consensus statement emerging from the expert conference on active surveillance held in 2007.

One very important point is that age was not included as one of their criteria! In other words, patients of any age are deemed eligible for active surveillance if the risk features are appropriately low. Some doctors are still trying to shepherd patients toward active therapy by suggesting they are too young for AS, but that is changing as evidence of AS success continues to accumulate. However, the experts do look for especially low-risk features for very young men, and 56, though not very young, is on the youngish side. (I was diagnosed at age 56 too.)

With case characteristics that appear to be quite low-risk, an outstanding book to gain strategic perspective is the new book "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency," by Ralph H. Blum and Mark Scholz, MD, 2010. (Emphasis is on the word "unnecessary"; radical treatment is , of course, highly desirable in the right circumstances, as the authors make clear.)

Take care,

Jim

 
Old 02-01-2011, 02:31 PM   #7
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Re: Finding the best of the best

With a PSA of 5.3 and a Gleason score of 3+3 in 4% of 1 positive core, your family member is definitely a candidate for radiation therapy. That's very early PC. My own journey started with an 8.0 PSA, Gleason 3+4 in 3 samples. I did all of the research and after speaking with two surgeons, a friend who is an oncologist and a radiologist, I came up with radiology as my best bet. If you do a search on CyberKnife on this forum, you can find my journey-hopefully it will be an informative read. Feel free to contact me if I can help in any way.

Bob

 
Old 02-03-2011, 12:35 PM   #8
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Re: Finding the best of the best

Jim and Bob - Thank you so much for the helpful replies. Apologies for just responding. Traveling for work...

Unfortunately Dr. Zelefsky at Sloan is now booked out until May which is too long to wait. Sloan is recommending Dr. Brett Cox for an appointment. Does anyone have any information/thoughts on Cox? I did read his bio on MSKCC.

Any recommendations for another top notch radiation oncologist in the NY area? MANY many thanks - you are the best!

 
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