Visit with Dr. Mike Koch

mrshisname
mrshisname Member Posts: 186
edited March 2014 in Prostate Cancer #1
He is the director of the department of Urology, Indiana University Medical School and Hospital in Indianapolis. His CV is 30 pages long, most of his research is in prostate cancer. The visit with him was quite interesting. He said that in his opinion, the top two options for Jesse were 1)DaVinci surgery and 2)active surveillance. If you've been reading the board you know my hubbie wants surgery to get it OUT asap. Dr. Koch said that even if he chose active surveillance, that eventually he WOULD have to do SOMETHING since he is only 51 and in 10 years it would be a problem. He said, since you are younger you have more to lose than if you were 10 or more years older.
He discussed radiation, said he does surgery on a number of radiation 'failures'. He says he was the lead investigator for HIFU trials at IU and that they had about a 60% rate of getting the cancer out without recurrence. Said there is virtually no incontinence with HIFU but that there is impotence. He also said that he was the president of the Americal Urological Association last year and that a statement was issued that it was the urological assn's opinion that HIFU out of the US was not advised since there is no followup available here. Also, the lead investigator there at IU that worked for the company that makes the equipment, (Suarez) was FIRED by the company and taken out of the clinical trials research and this is when he started practicing in Mexico. Dr. Koch also said that he is paying $10,000 'finders fee' to MD's here who get their patients to go to Mexico. Quite interesting.
Dr. Koch said that he would follow Jesse for active surveillance or do his surgery, whichever he wanted and Jesse scheduled surgey with him for 4/23. We are also seeing Randy-in-Indy's group (who was kind enough to meet us for dinner last night!) next Wednesday so will see what Jesse thinks of them, as well.
Dr. Koch said he used to do the open prostatectomies but his rates of incontinence and impotence have actually dropped with DaVinci.
He's done over 900 DaVinci procedures.

Comments

  • bdhilton
    bdhilton Member Posts: 866 Member
    #2
    Sounds like you are on track…
    Sounds like you are on track…
    Dr. Koch sounds like a great pick for your needs...….My observations are:
    Why an April 23 surgery date? Based on what you have stated as your husband’s grading etc… IMHO you have plenty of time prior to making a decision. I would make sure I was in the best shape of my life and diet was the best I could adjust for a few months prior to surgery as well…but that is me and what I did on a more advanced clinical stage situation…
    As far as open vs robotics I would challenge a general statement that “ incontinence and impotence have actually dropped with DaVinci” as from my research and stats I have studied stated the opposite…but perhaps Dr Kosh’s stats have changed with this newer process...bottom-line IMHO is experience, experience, experience with great, great, great stats says it all….. sound like you are on to something here…best of luck
    How come it does not sound “fishy” about a $10k referral fee for HIFU in Mexico :-)
    Thanks for the report…
  • lewvino
    lewvino Member Posts: 1,010
    #3
    Great research you two have
    Great research you two have done! One factor that helped me decide on Davinci was yes I knew there were possibilities of sexual and urinary functioning but I thought that at my age, 54 (Time of surgery and 55 one month after surgery) that I could over come quicker then further down the road at an older age. So far the gamble paid off and things are working pretty good at 7 months post surgery.

    Pretty well means 99.9% Dry (No pads a few little leaks)
    about 80% functioning using Levitra 2-3 times a week.

    Keep us updated on your journey with your husband. Tell him Men are allowed to post on the forum! LOL

    Larry
  • mrshisname
    mrshisname Member Posts: 186
    #4
    lewvino said:

    Great research you two have
    Great research you two have done! One factor that helped me decide on Davinci was yes I knew there were possibilities of sexual and urinary functioning but I thought that at my age, 54 (Time of surgery and 55 one month after surgery) that I could over come quicker then further down the road at an older age. So far the gamble paid off and things are working pretty good at 7 months post surgery.

    Pretty well means 99.9% Dry (No pads a few little leaks)
    about 80% functioning using Levitra 2-3 times a week.

    Keep us updated on your journey with your husband. Tell him Men are allowed to post on the forum! LOL

    Larry

    Lew
    Larry, yes, I know I keep telling him but he is content to just read, he is not a big internet person at ALL. SOunds like you are doing great and one of the many successes I can tell hubby about.
  • mrshisname
    mrshisname Member Posts: 186
    #5
    bdhilton said:

    Sounds like you are on track…
    Sounds like you are on track…
    Dr. Koch sounds like a great pick for your needs...….My observations are:
    Why an April 23 surgery date? Based on what you have stated as your husband’s grading etc… IMHO you have plenty of time prior to making a decision. I would make sure I was in the best shape of my life and diet was the best I could adjust for a few months prior to surgery as well…but that is me and what I did on a more advanced clinical stage situation…
    As far as open vs robotics I would challenge a general statement that “ incontinence and impotence have actually dropped with DaVinci” as from my research and stats I have studied stated the opposite…but perhaps Dr Kosh’s stats have changed with this newer process...bottom-line IMHO is experience, experience, experience with great, great, great stats says it all….. sound like you are on to something here…best of luck
    How come it does not sound “fishy” about a $10k referral fee for HIFU in Mexico :-)
    Thanks for the report…

    BDH
    Yes, his stats are better, he is saying 97% (with 3% having some incontinence or impotence, I don't know how far out from surgery)versus 94 or 95% with the open method he used to do. Would have to investigate that further.
    As far as April 23, I've had 2 surgeries in January and we have met our out-of-pocket. (we owe $3000 for this year in medical bills and then another $900 for a surgery I had last year). Hubby is losing his job in May. At that time, we will be switching to my insurance and having to pay a great deal more for it, as well as meet ANOTHER deductible and out-of-pocket. I'd be more than willing to do that, and maybe have him wait till fall, but he wants to save $$ since he knows he wants surgery anyway, and if done before his insurance ends is covered at 100%. I have known Dr. Koch for about 2 years, our son goes to college in Indy (his freshman dorm was right down the street) and he had to be treated for kidney stones twice in the last 2 years. We have a level of comfort with this guy we didn't have with the other surgeon. And he is highly regarded in the field, does review of pathology slides of prostate cancer, it is his focus of research and his specialty.
  • mrshisname
    mrshisname Member Posts: 186
    #6
    mrshisname said:

    BDH
    Yes, his stats are better, he is saying 97% (with 3% having some incontinence or impotence, I don't know how far out from surgery)versus 94 or 95% with the open method he used to do. Would have to investigate that further.
    As far as April 23, I've had 2 surgeries in January and we have met our out-of-pocket. (we owe $3000 for this year in medical bills and then another $900 for a surgery I had last year). Hubby is losing his job in May. At that time, we will be switching to my insurance and having to pay a great deal more for it, as well as meet ANOTHER deductible and out-of-pocket. I'd be more than willing to do that, and maybe have him wait till fall, but he wants to save $$ since he knows he wants surgery anyway, and if done before his insurance ends is covered at 100%. I have known Dr. Koch for about 2 years, our son goes to college in Indy (his freshman dorm was right down the street) and he had to be treated for kidney stones twice in the last 2 years. We have a level of comfort with this guy we didn't have with the other surgeon. And he is highly regarded in the field, does review of pathology slides of prostate cancer, it is his focus of research and his specialty.

    PS
    And as a researcher, Dr. Koch keeps stats on EVERYTHING. Jesse had a detailed questionairre he had to fill out before seeing him. Then, he got into the 'sling study' where 1/2 of the patients get a bladder sling and the other half don't. Detailed questioning about incontinence before and after the surgery and the coordinator will call him soon for more questions. Kinda nice to know that he will help find out if slings are worthwhile in this situation, for men in the future.
  • randy_in_indy
    randy_in_indy Member Posts: 496 Member
    #7
    mrshisname said:

    Lew
    Larry, yes, I know I keep telling him but he is content to just read, he is not a big internet person at ALL. SOunds like you are doing great and one of the many successes I can tell hubby about.

    LOL, Jesse you have Maria right where you need her
    Doing all that fact finding and conversing with all of us. It was a pleasure at dinner last night and looking forward to more comradarie. Very interesting about what Koch said regarding the HIFU Gal's proclaimed "GURU" of HIFU in Dr. Suarez in Mexico.

    Bdhilton had it right nothing more than a "SNAKE OIL SALESMAN" HiFU gal never did answer me on working for HIfU International...getting a fee for getting patients....hey, it's even possible she is one of his assistants, perhaps even a relative, or even more absurd..his wife! No matter, we did feel something was not right with the effort that particular poster pushed forward with. Then again with proper testing and trials maybe it will be the golden choice of treatment in the future...who knows...

    One thing I do know...I had mine removed...it's gone...and technically according to the last PSA test so is the cancer...and that is a fact. The other facts...I am continent and have full sexual function...day 78. God Bless My Surgeon & God Bless Annette, my sweetheart for dragging me to the health building at the state fair to walk through the Giant Rectum..for that is where I found my first PSA test that led me down this path and into this club so I could take care of this problem and save my life.

    I believe it's time to Celebrate St. Paddy now!

    randy_in_indy
  • bdhilton
    bdhilton Member Posts: 866 Member
    #8
    mrshisname said:

    BDH
    Yes, his stats are better, he is saying 97% (with 3% having some incontinence or impotence, I don't know how far out from surgery)versus 94 or 95% with the open method he used to do. Would have to investigate that further.
    As far as April 23, I've had 2 surgeries in January and we have met our out-of-pocket. (we owe $3000 for this year in medical bills and then another $900 for a surgery I had last year). Hubby is losing his job in May. At that time, we will be switching to my insurance and having to pay a great deal more for it, as well as meet ANOTHER deductible and out-of-pocket. I'd be more than willing to do that, and maybe have him wait till fall, but he wants to save $$ since he knows he wants surgery anyway, and if done before his insurance ends is covered at 100%. I have known Dr. Koch for about 2 years, our son goes to college in Indy (his freshman dorm was right down the street) and he had to be treated for kidney stones twice in the last 2 years. We have a level of comfort with this guy we didn't have with the other surgeon. And he is highly regarded in the field, does review of pathology slides of prostate cancer, it is his focus of research and his specialty.

    I can relate
    I still feel blessed but no job next month will be 2 years and my medical benefits did become more costly this year than the last 17 years :-(
    You have a great surgeon (+ part of a study which IMHO is a plus) and is stats are based on who he selects for his surgeries and you are selected so the odds are extremely good...sounds like a no brainer...
    In any event, once you decide never second guess yourself and more forward with confidence knowing you have a great surgeon and you made the best decision fro yourself..
    God bless
  • bdhilton
    bdhilton Member Posts: 866 Member
    #9
    randy_in_indy said:

    LOL, Jesse you have Maria right where you need her
    Doing all that fact finding and conversing with all of us. It was a pleasure at dinner last night and looking forward to more comradarie. Very interesting about what Koch said regarding the HIFU Gal's proclaimed "GURU" of HIFU in Dr. Suarez in Mexico.

    Bdhilton had it right nothing more than a "SNAKE OIL SALESMAN" HiFU gal never did answer me on working for HIfU International...getting a fee for getting patients....hey, it's even possible she is one of his assistants, perhaps even a relative, or even more absurd..his wife! No matter, we did feel something was not right with the effort that particular poster pushed forward with. Then again with proper testing and trials maybe it will be the golden choice of treatment in the future...who knows...

    One thing I do know...I had mine removed...it's gone...and technically according to the last PSA test so is the cancer...and that is a fact. The other facts...I am continent and have full sexual function...day 78. God Bless My Surgeon & God Bless Annette, my sweetheart for dragging me to the health building at the state fair to walk through the Giant Rectum..for that is where I found my first PSA test that led me down this path and into this club so I could take care of this problem and save my life.

    I believe it's time to Celebrate St. Paddy now!

    randy_in_indy

    Corn beef and cabbage tonight
    My grandfather is Irish and if I was born one day sooner my name would had been Patrick...If it smells like rotten cheese it probable is rotten cheese...Yes HIFUgal was something :-)
  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,346 Member
    #10
    Hi , from what you wrote, this doctor seems to be a good
    choice.....and fit for you and your husband.

    I guess that I am naive, so I am surprised that there is a 10K finders fees to doctors.....I wonder if a doctor can lose his license over this.

    On the other hand, I notice that different doctors in various specialties really push extra services in their own specialty, and collegues in their group or hospital. Personally, I came across a few. {probably others have also come across some.

    Since you work in the medical field, you might have a greater insight about this than I do.

    Ira
  • luckyman2
    luckyman2 Member Posts: 54
    #11
    hopeful and optimistic said:

    Hi , from what you wrote, this doctor seems to be a good
    choice.....and fit for you and your husband.

    I guess that I am naive, so I am surprised that there is a 10K finders fees to doctors.....I wonder if a doctor can lose his license over this.

    On the other hand, I notice that different doctors in various specialties really push extra services in their own specialty, and collegues in their group or hospital. Personally, I came across a few. {probably others have also come across some.

    Since you work in the medical field, you might have a greater insight about this than I do.

    Ira

    HIFU might one day be the best choice
    Living in Canada, I seriously considered HIFU at a Toronto clinic, but opted for surgery instead. The post-opt pathology demonstrated that surgery was a wise choice (for me) because of the location of the cancer.

    It's quite possible that HIFU might one day be the best choice for most PC patients. It's just so unfortunate that one or two individuals have engaged in finders fees. It only hurts the credibility of HIFU as a viable option.
  • Hoosierdaddy
    Hoosierdaddy Member Posts: 16
    #12
    Dr Koch
    It's a difficult decision. Any treatment is not something you want to do if not necessary, but at the same time P.C. is a big problem if you wait too long and it metastasizes. If my gleason was low and tumor small & centralized I would have seriously considered active surveillance and enjoyed full potency a while longer. But it's a very personal decision...can you live with knowing it's there? Read all you can.
    Dr. Koch did my prostatectomy by daVinci on 12/21/09, and said he was able to spare the nerves. I am 55 and also part of the sling study trial. I have been pretty much continent since catheter removal, fortunately. No complications or problems. Able to have orgasms (but feels a little different), however not the slightest trace of an erection. At the 30-day followup meeting PSA was zero. Dr. Koch said I was welcome to try viagra and/or the pump but in his opinion they were of no value yet, just wait a few months.
  • randy_in_indy
    randy_in_indy Member Posts: 496 Member
    #13
    Hoosierdaddy said:

    Dr Koch
    It's a difficult decision. Any treatment is not something you want to do if not necessary, but at the same time P.C. is a big problem if you wait too long and it metastasizes. If my gleason was low and tumor small & centralized I would have seriously considered active surveillance and enjoyed full potency a while longer. But it's a very personal decision...can you live with knowing it's there? Read all you can.
    Dr. Koch did my prostatectomy by daVinci on 12/21/09, and said he was able to spare the nerves. I am 55 and also part of the sling study trial. I have been pretty much continent since catheter removal, fortunately. No complications or problems. Able to have orgasms (but feels a little different), however not the slightest trace of an erection. At the 30-day followup meeting PSA was zero. Dr. Koch said I was welcome to try viagra and/or the pump but in his opinion they were of no value yet, just wait a few months.

    Interesting about the ED advice of Dr. Koch
    I will disagree with Dr. Koch 100% on the use of ED drugs and saying that they are of no value - this was simply not at all true in my case. I interviewed him for my surgery and considered but then decided on using Hollenesbe and Scott instead based on my personal comfort level and had it 12/29/09.

    I have used Viagra (generic from India) since I have had my cath removed that was at day 13th following the surgery because of a leak found in the cystogram on day 7 when I went to get it out the first time. I have had usable erections...SOLEY due to the drug....pump only gets blood to the tissue...and unless you use a ring it doesn't stay...but the drug...makes a usable erection!....I think Dr. Koch needs to do more research on the ED part....I would be nowhere for not the drugs...just as an experiement tryed several times without the drug....absolutely no go....need the Viagra to make things work. I have also heard if you let the dog lay without any therapy it will attrophy and you may never get it to work...my surgeon said it's crucially important to get blood flow to the memeber if you want to have a chance later after the nerves heal from their tramatic disruption of the surgery.

    Randy_in_indy
  • bdhilton
    bdhilton Member Posts: 866 Member
    #14
    randy_in_indy said:

    Interesting about the ED advice of Dr. Koch
    I will disagree with Dr. Koch 100% on the use of ED drugs and saying that they are of no value - this was simply not at all true in my case. I interviewed him for my surgery and considered but then decided on using Hollenesbe and Scott instead based on my personal comfort level and had it 12/29/09.

    I have used Viagra (generic from India) since I have had my cath removed that was at day 13th following the surgery because of a leak found in the cystogram on day 7 when I went to get it out the first time. I have had usable erections...SOLEY due to the drug....pump only gets blood to the tissue...and unless you use a ring it doesn't stay...but the drug...makes a usable erection!....I think Dr. Koch needs to do more research on the ED part....I would be nowhere for not the drugs...just as an experiement tryed several times without the drug....absolutely no go....need the Viagra to make things work. I have also heard if you let the dog lay without any therapy it will attrophy and you may never get it to work...my surgeon said it's crucially important to get blood flow to the memeber if you want to have a chance later after the nerves heal from their tramatic disruption of the surgery.

    Randy_in_indy

    I agree...15 days out from
    I agree...15 days out from surgery my doc gave me a penile injection and gave me a partial erection in his office and gave me 5mg Cialis for daily use and injections 2x week (until I get good erections from Cialis or naturally ....I am now 17 days out from surgery and I am getting partial erections (first night I took 5mg Cialis last night)...Both my surgeon and urologist believe it is critical to get blood to your penis as soon as possible to assure a future of erections and sex....but I am not a doc but seems to be helping

    Best to all
  • Hoosierdaddy
    Hoosierdaddy Member Posts: 16
    #15
    randy_in_indy said:

    Interesting about the ED advice of Dr. Koch
    I will disagree with Dr. Koch 100% on the use of ED drugs and saying that they are of no value - this was simply not at all true in my case. I interviewed him for my surgery and considered but then decided on using Hollenesbe and Scott instead based on my personal comfort level and had it 12/29/09.

    I have used Viagra (generic from India) since I have had my cath removed that was at day 13th following the surgery because of a leak found in the cystogram on day 7 when I went to get it out the first time. I have had usable erections...SOLEY due to the drug....pump only gets blood to the tissue...and unless you use a ring it doesn't stay...but the drug...makes a usable erection!....I think Dr. Koch needs to do more research on the ED part....I would be nowhere for not the drugs...just as an experiement tryed several times without the drug....absolutely no go....need the Viagra to make things work. I have also heard if you let the dog lay without any therapy it will attrophy and you may never get it to work...my surgeon said it's crucially important to get blood flow to the memeber if you want to have a chance later after the nerves heal from their tramatic disruption of the surgery.

    Randy_in_indy

    Drug source
    Randy, what was your source for the viagra from India?

    moyer0502@msn.com
  • mrshisname
    mrshisname Member Posts: 186
    #16
    bdhilton said:

    I agree...15 days out from
    I agree...15 days out from surgery my doc gave me a penile injection and gave me a partial erection in his office and gave me 5mg Cialis for daily use and injections 2x week (until I get good erections from Cialis or naturally ....I am now 17 days out from surgery and I am getting partial erections (first night I took 5mg Cialis last night)...Both my surgeon and urologist believe it is critical to get blood to your penis as soon as possible to assure a future of erections and sex....but I am not a doc but seems to be helping

    Best to all

    viagra etc
    I must say that Dr. Koch's non-agressive attitude towards this is bothering me. Glad we have an appointment with Hollensbe and Scott on Wedsnesday. Thanks for the info guys! Shared it with Jesse. He said this information (about exercising the 'muscle') was also echoed by the urologist who was at the DaVinci surgery support group meeting we went to a few weeks ago - early and often is the key !

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