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Finding a surgeon who has done A LOT of robotic prostatectomies.

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

I am new to this group.  After an elevated PSA, I had a biopsy done in November and was diagnosed with a very small volume of Gleason 7 (4+3) PC.  My Dr. counseled Active Surveillance.  But after feeling like I was living with a bomb in me I went for a second opinion.  Second Dr. suggested an MRI which found two Lesions, one of which is fairly large, and that the biopsy missed.

I am leaning strongly towards robotic assisted prostatectomy.  But I’m struggling with finding the best surgeon.  Uniformly I am told to find someone who does this procedure all day, every day.  The more experienced the Dr. is, the higher a chance of a better recovery.

I cannot find any resource to tell me # of surgeries done per year, and # of years.  I’ve located one very highly regarded Dr. who does 200 of these per year and has for 10 year.  But I’ve had a few folks recommend holding out to find someone who is doing 500 – 750 pear year.  I can’t seem to even get close!

How do I find this person?  Any suggestions would be greatly appreciated.  And if anyone knows of someone local (I live n suburban Boston) I would be in heaven.  Not opposed to traveling, but with COVID my wife and I would like to avoid an airplane.  Any one in New York, Philadelphia, Baltimore or the like?

Thank you to any and all.    

Clevelandguy
Posts: 658
Joined: Jun 2015

Hi,

I would ask my General Practitioner for a recommendation or contact a local hospital network for Urologist/surgeons chief of staff to talk to.  Does not hurt to get more than one recommendation from different hospital networks.

Dave 3+4 

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

I will keep asking as I progress here.  Feedback appreciated, Dave 3+4

Paul

Molly110
Posts: 183
Joined: Oct 2019

These two robotic surgeons in Boston seem like a good place to start. Good luck.

"Who performs robot-assisted prostatectomies at BWH?

Adam S. Kibel, MD, and Steven Lee Chang, MD, MS, represent the robotic urology program at BWH, one of the largest robotic surgery practices in New England. Dr. Kibel, Chief of Urology, has specialized in minimally invasive surgery for urologic cancer for over 15 years. He is one of the most experienced robotic surgeons in New England and one of the most respected cancer surgeons in the country. He has lectured and published widely on the techniques and outcomes of robotic-assisted prostatectomy, partial nephrectomy, and cystectomy.

Dr. Chang completed a fellowship in urologic oncology at Stanford University Medical Center, with an emphasis on minimally invasive surgery. As a result, Dr. Chang employs robotic surgery for nearly all his patients with cancer of the kidney, prostate, or bladder. Dr. Chang frequently lectures on robotic urologic surgery and actively conducts research focused on optimizing robotic techniques and outcomes.

How can I learn more about robotic radical prostatectomy?

If you would like to schedule a consultation with Dr. Chang or Dr. Kibel, please call the Patient Referral Service - staffed 8am-5:30pm, Monday through Friday - at 1-800-294-9999, or fill out an online request form."

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

Hi Molly110.  I appreciate your specific feedback.  Very helpful.  Do you or your family work at BWH?  Or are you suggesting these specific surgeons due to experience with either one of them?  I will call the Referral Service and see if I can get them to give me numbers.  Thank you.  Paul 

Molly110
Posts: 183
Joined: Oct 2019

No, I don't have a connection with the hospital and have no experiemce with those physicians. They just seemed to meet your criteria of being highly experienced with robotic surgery for prostate cancer, so I shared them. I'm just monitoring this discussion board because a dear friend has prostate cancer and doesn't feel up to doing it. 

Warm best wishes for successul surgery,

Molly

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

Molly, again, thank you for your candor and feedback  You research is greatly appreciated.  You were able to give me such specific feedback I thought you might have some sort of "inside track".  You clearly can get more from the internet than I can, and I appreciate the help it gives me.  You are so kind to help and honor your friend this way. He is lucky to have you in his life, I will send good thoughts his way towards recovery.  Paul 

 

Molly110
Posts: 183
Joined: Oct 2019

Thank you, Paul. He will appreciate your good wishes. It looks like you're getting lots of good information from the me on this board.

Warm best wishes,

Molly

Fleet Foot
Posts: 10
Joined: Feb 2021

Paul,

you mentioned some people have recommended holding out for a surgeon that does between 500 - 750 surgeries a year.  I think your mark of 200 is the upper limit of one I'd consider.  If my surgeon was performing 750 RALP's a year I would think he was running a surgery factory and not one devoted to the individual patient.  I'd rely more on the specific recommendations of friends who went through similar surgeries in addition to other doctors' personal recommendations.

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

FF, you looked at this from an entirely different perspective than the one I was approaching from.  Thank you for reminding me to consider multiple layers to multiple issues at the same time.  A good reminder.  Paul

Georges Calvez
Posts: 503
Joined: Sep 2018

Hi there,

You do have to face the fact that blind chance or maybe an individual patient's suitability for surgery plays a part as well.
Experienced surgeons have a small proportion of cases that remain incontinent, erectile problems post surgery are a lot more common, increasing rapidly with age, other effects like hernias are rarer but they do occur.

Best wishes,

Georges

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

Thank you Georges.  I am aware of side effect risks.  What I hope to do is make the odds as small as I reasonable can.  But as a cancer patient I am firmly reminded that there are absolutely no guarantees.  Paul 

 

 

hopeful and opt...
Posts: 2304
Joined: Apr 2009

A radiologist ranks the likelihood that there is a significant cancer on a scale of 1 to 5, 5 being the most likely and 1 not likely . A tumor is not necessity a cancer. This information is listed in your mri report. Can you share this information. 

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

Hi h & o.  I will share that per the MRI, there are two lesions.  The larger of the two is rated as PI-RADS 5.  The smaller of the two is PI-RADS 4.  Does this information help you give me any insight to my underlying question?  Thank you .  Paul  

 

hopeful and opt...
Posts: 2304
Joined: Apr 2009

Generally the cancer and the aggressive is indicated by the results of  a biopsy.

Treatment may be indicated in your case

I wonder your age. A surgeon can perform a perfect operation. The results are age related. A man of 50 may have no side effects while a man of 70 will. 
Surgery is a localized treatment that is more likely to have side effects than radiation. I don't recommend surgery but if I was to get surgery there is a Dr Tewari of NYC who developEd a procedure to limit ED. He does lots and lots of them. Men come from all over to see him. (I am in California)

I suggest that you strongly consider radiation. Radiation treatment can extend outside the prostate to treat, that surgery does not. Radiation has less side effects. There is a type of radiation called SBRT of which cyberknife is one of the machines that deliver the radiation. This is done in 4 or 5 sessions in less than two weeks. If you want to know more about this, there is a dr katz (also of nyc) who published a ten year study of his patients listing cure rate and percent side effects that you may wish to google. 
 

I wish you well. I am available for any and all questions. 

hopeful and opt...
Posts: 2304
Joined: Apr 2009

PaulM64yowithPC
Posts: 8
Joined: Feb 2021

h & o, thank you for sharing these articles.  Very informative.  I'll do some more research on Dr. Tewari.  P 

 

Old Salt
Posts: 788
Joined: Aug 2014

Because you live near Boston, there should be a number of excellent prostatectomy surgeons around. Once you start investigating, ask them not only how many they have done (see Fleet Foot's warning) but also what their surgical margins are and their ED and incontenancy outcomes. 

BTW, they would want to know how close the two MRI lesions are to the margins of your prostate. THis is important for several reasons.

Don't be bashful; you are in charge!

Josephg
Posts: 266
Joined: Jan 2013

Paul,

I live in the greater Boston area, and it appears that you do, as well.  I don't know where you are currently being evaluated, but if you have an option, or a desire, to select another healthcare provider for your longterm PCa related consultations and treatments, I strongly suggest that you consider talking to the folks at Dana Farber Cancer Institute (a part of the greater B&W healthcare organization).

I've been with Dana Farber for my entire PCa journey, and I believe that they have treated me very well, and I have a Medical Oncologist there who is my focal point for all of my consultations and treatment therapies.  My Medical Oncologist suggests specific doctors for each of the different treatments that I have had, including surgery and radiation therapies.  I have yet to meet a doctor there, who I did not feel was totally qualified and experienced to treat me.

Let me know if you want to discuss further privately.

lighterwood67's picture
lighterwood67
Posts: 285
Joined: Feb 2018

Looks like you are doing your homwork.  I am from a small town in South Carolina.  Once I was diagnosed with PC (4+3=7), I changed urologist and got into the Levine Cancer Institute system.  That is where I found my surgeon.  Also, was seen by a radiation/medical oncologist.  I went with the surgery based on what I was told at the time.  Most importantly, the cancer has not escaped the prostate.  If it has escaped, then it is my understanding no need to do the surgery.  Just my opinion, the surgery is the hard road to go.  My RP was 3/2018.  For now, I am a success story (No detectable PSA; fully continent (no diapers; pads; thins); intimate.  There are success and horror events on both sides of surgeries and radiation.  There are 2 curative paths to treatment, surgery and radiation.  Keep looking and researching.  Good luck on your journey.

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