Guest guest Posted January 23, 2011 Report Share Posted January 23, 2011 " Glen R. Fotre, CCIM " wrote: >I have recently been diagnosed, at age 73, with prostate cancer. >PSA is 5.8; stage is T2b; Gleason is 7 (4+3). I am interested >in the daVinci robotic surgery. > >1. How do I find a great doctor in the Phoenix, AZ area? >2. How can I determine how many daVinci procedures he has done short of >asking him and hoping that he tells the truth? Glen, The National Cancer Institute maintains a list of the cancer centers that they think are the best in the nation. There is one listed in Arizona, but it's in Tucson. Here it is: Arizona Cancer Center University of Arizona S. Alberts, M.D. Director 1515 North Avenue P.O. Box 245024 Tucson, Arizona 85724 Tel: Fax: That's not to say they're the only good place to have surgery done, but they may be worth a call. Sometimes you can also get a more objective opinion from a university cancer center than from a private doctor who has more of a financial interest in your treatment. The full NCI list is here: http://cancercenters.cancer.gov/cancer_centers/cancer-centers-list.html As for finding out about a particular doctor, that's a tough problem. I don't know if there are any agencies that keep track either of the number of procedures done by a doctor or of the outcomes. Maybe someone else knows of one? It sometimes helps to get opinions from other patients. If you know any health professionals, doctors or nurses, ask them who they would go to or send their husbands to. Maybe someone here has been treated in Phoenix? I also think that there's a lot to be learned by talking to a doctor. Does he listen? Is he patient? Does he take time to explain things to you? Is he willing to spend an hour or more with you answering all your questions? Or does he schedule you for a ten meeting meeting and then kick you out the door? Does he tell you about risks and alternatives (including radiation and active surveillance.) Does he admit that a significant number of his patients are incontinent and/or impotent and that many are not cured? Or does he insist that almost all his patients are cured and have no incontinence or impotence after a year (or whenever.) I think a doc that paints too rosy a picture is selling you a bill of goods and should not be trusted. Finally, although I think surgery is a very good choice of treatment, and robotic surgery a very good type of surgery, there are other very good choices too. If you haven't already done so, I suggest that you get consultations with at least one surgeon and one radiation oncologist. At least. If you decide to visit the University of Arizona in Tucson, I'd ask for appointments with both a surgeon and a rad onc. For myself, I'm inclined to think that if I met two doctors, one a surgeon and one a rad onc, I'd be inclined to seek treatment from the doctor I liked best. In other words, I regard the treatments as having comparable outcomes, on average, though with a different mix of side effects, and it's the skill and dedication of the doctor that I think might tip the balance to get a better than average outcome for me. Best of luck. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2011 Report Share Posted January 23, 2011 One more thing. There are some good websites to look at. I particularly like: http://www.yananow.org It's maintained by the estimable Terry Herbert, a frequent contributor to this list. Another I like is http://www.cancer.gov, the National Cancer Institute website. Best of luck. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2011 Report Share Posted January 23, 2011 Glen, Two men say that they keep a list of the ‘best’ surgeons in the US. If you go to http://www.yananow.org/resources.html#best you will see their contact details. I think it is essential to get the information you want on the number of procedures AND the outcome directly from the doctor you are talking to. If he hesitates or does not have the information available, go to another doctor. The decision you make concerning your coice of therapy is likely to be one of the most life changing decisions you will make. You are entitled to ensure as far as possible that it is the best decision for you. All the best Prostate men need enlightening, not frightening Terry Herbert - diagnosed in 1996 and still going strong Read A Strange Place for unbiased information at http://www.yananow.org/StrangePlace/index.html From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Glen R. Fotre, CCIM Sent: Monday, 24 January 2011 6:11 AM To: Prostate Support Yahoo Subject: Finding a Surgeon?? I have recently been diagnosed, at age 73, with prostate cancer. PSA is 5.8; stage is T2b; Gleason is 7 (4+3). I am interested in the daVinci robotic surgery. 1. How do I find a great doctor in the Phoenix, AZ area? 2. How can I determine how many daVinci procedures he has done short of asking him and hoping that he tells the truth? Glen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2011 Report Share Posted January 23, 2011 Glen The Mayo in Phoenix has a very good track record. http://www.mayoclinic.org/prostate-cancer/ "Il faut d'abord durer" Hemingway Finding a Surgeon?? I have recently been diagnosed, at age 73, with prostate cancer. PSA is 5.8; stage is T2b; Gleason is 7 (4+3). I am interested in the daVinci robotic surgery. 1. How do I find a great doctor in the Phoenix, AZ area? 2. How can I determine how many daVinci procedures he has done short of asking him and hoping that he tells the truth? Glen Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2011 Report Share Posted January 23, 2011 Chuck Maack wrote: > With a Gleason Score 4+3/7 at diagnosis, it is important NOT to > rush to surgery or radiation before determining our diagnostic > results. Please thoroughly review the following and discuss > with your physician. ly, you should visit with a Medical > Oncologist for an unbiased opinion on what is most advisable as > treatment based on your diagnostics: > Advanced Prostate Cancer./High Gleason Score at Diagnosis? > http://tinyurl.com/r2se89 Chuck, Glen reported a Gleason score of 4+3, but his PSA was only 5.8. With that small a PSA do you still think that he should get a bone scan for metastatic disease? The reason I ask is that it is my understanding that, when the PSA is under 20, it is exceedingly rare to have cancer show up outside the prostate on a bone scan. That doesn't mean that there isn't cancer outside the prostate, only that if so, it's too small to show up on a scan. There's a video by Gerald Chodak on his prostate videos website where he claims that false positives are many, many times more likely than true positives on a bone scan for men who have never had treatment and have a PSA under 20. And when a positive occurs there can be all sorts of complications in figuring out what to do - possibly even including a painful bone biopsy. So he recommends against it. I know that cancer outside the prostate is much more likely with men who have Gleason scores of 4+3 or above. However, with low PSA cancers, if there is cancer outside it is often times just a few millimeters outside - easily reachable with radiation and sometimes with surgery - or it may be in the lymph nodes, also easily reachable with both radiation and surgery. In my own case, I was treated with radiation for a 4+3 Gleason cancer that turned out to have at least one extra-prostatic extension that showed up on an endo-rectal MRI. This was not a separate area of cancer, it was a tumor in the prostate that had penetrated the capsule wall. My highest PSA before treatment was 10.3, but I suspect that I had some prostatitis at the time and that my PSA due to cancer was in the 6-8 range, though there's no way to know. I was in a clinical trial - which required a bone scan (negative) and CT and MRI scans - mainly because they were trying to get as much information as possible for the study they were doing. Now, seven years later, I still (knock on wood) appear to be cancer free. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 23, 2011 Report Share Posted January 23, 2011 Chuck Maack wrote: > With a Gleason Score 4+3/7 at diagnosis, it is important NOT to > rush to surgery or radiation before determining our diagnostic > results. Please thoroughly review the following and discuss > with your physician. ly, you should visit with a Medical > Oncologist for an unbiased opinion on what is most advisable as > treatment based on your diagnostics: > Advanced Prostate Cancer./High Gleason Score at Diagnosis? > http://tinyurl.com/r2se89 Chuck, Glen reported a Gleason score of 4+3, but his PSA was only 5.8. With that small a PSA do you still think that he should get a bone scan for metastatic disease? The reason I ask is that it is my understanding that, when the PSA is under 20, it is exceedingly rare to have cancer show up outside the prostate on a bone scan. That doesn't mean that there isn't cancer outside the prostate, only that if so, it's too small to show up on a scan. There's a video by Gerald Chodak on his prostate videos website where he claims that false positives are many, many times more likely than true positives on a bone scan for men who have never had treatment and have a PSA under 20. And when a positive occurs there can be all sorts of complications in figuring out what to do - possibly even including a painful bone biopsy. So he recommends against it. I know that cancer outside the prostate is much more likely with men who have Gleason scores of 4+3 or above. However, with low PSA cancers, if there is cancer outside it is often times just a few millimeters outside - easily reachable with radiation and sometimes with surgery - or it may be in the lymph nodes, also easily reachable with both radiation and surgery. In my own case, I was treated with radiation for a 4+3 Gleason cancer that turned out to have at least one extra-prostatic extension that showed up on an endo-rectal MRI. This was not a separate area of cancer, it was a tumor in the prostate that had penetrated the capsule wall. My highest PSA before treatment was 10.3, but I suspect that I had some prostatitis at the time and that my PSA due to cancer was in the 6-8 range, though there's no way to know. I was in a clinical trial - which required a bone scan (negative) and CT and MRI scans - mainly because they were trying to get as much information as possible for the study they were doing. Now, seven years later, I still (knock on wood) appear to be cancer free. Alan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 24, 2011 Report Share Posted January 24, 2011 Glen -- >> I am interested in the daVinci robotic surgery. My understanding is that daVinci surgery has shorter hospital stays, and shorter post-surgical recovery times, than open surgery. But I don't think daVinci surgery has lower rates of incontinence, or lower ED rates, or higher survival rates, than open surgery. If you have data that show otherwise, I'd be interested in seeing it. PS -- just to declare possible bias, I had an open radical prostatectomy 3 years ago. > > > > I have recently been diagnosed, at age 73, with prostate cancer. PSA is > 5.8; stage is T2b; Gleason is 7 (4+3). I am interested in the daVinci > robotic surgery. > > > > 1. How do I find a great doctor in the Phoenix, AZ area? > > 2. How can I determine how many daVinci procedures he has done short > of asking him and hoping that he tells the truth? > > > > Glen > Quote Link to comment Share on other sites More sharing options...
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