Choosing a Facility: How important is it?

I'm not a medical professional nor do I have any special expertise in this matter, so take my laymans comment with a grain of salt. Prostate cancer can be a difficult disease to treat correctly, so regardless of which primary treatment option you select my belief is that it's worth the effort to find the most experienced and technically proficient medical professionals you have access to. Obviously if someone doesn't have that option, then just find the best care that is available. I was in a position with options (original medicare & a good supplement) so I did make the effort to travel out of town to an NCI designated CCOE and it was one of the best decisions I ever made. The results exceeded my expectations. But even if things hadn't worked out so well, at least I'd have known I had tried to get the best care I could find so hopefully I wouldn't have had any regrets. Just my 2 cents. Best wishes.

I would go with surgeon’s competence’s first but don’t discount the caliber of the hospital. Higher caliber hospitals will generally have higher caliber pathology departments on site for possible real time pathology during surgery. They will usually due to the high cost of capital investment have the latest technology in place, i.e. single port robotic’s versus muti-port robotics. My Surgeon who attends all the conferences hears that is’s not that his colleagues don’t want to perform single port surgery, it’s their institution’s that don’t want to commit to the capital investment and learning curves for expertise necessary for their surgeons. My surgery was not done a COE but like yours a very highly rated hospital. I put all my success into his skills and the hospital keeping up to date. Now that doesn’t mean with a BCR that you don’t transfer your care to a COE for their access to latest up to date clinical trials , radiation therapies, etc. I would say generally if you had a convenient choice between the two, it could likely be a COE with a skilled surgeon. I was fortunate with my surgeon and although I had three COE’s within 90 minutes I went with my highly rated hospital and skilled surgeon 15 minutes away. I was also concerned if I needed ER I wanted treatment at the hospital of my surgery. Now many years ago I did travel to one of the COE’s for participation in a clinical trial for lymphoma and I knew that was something I wasn’t getting just locally.

@wheel1 I’ve always valued your input as I continue to move forward to what most likely will be surgery depending on upcoming Pet.
What criteria would (or did) you use to research the best facility/surgeon when long distance travel isn’t an option?

@ireland1964
I have plenty of Doctors I see,
Gastroenterologist, Hematologist, Oncologist (prior to my prostate cancer),
Cardiologist, GP, Urologist. I asked all of them for surgical recommendations for a prostatectomy as my beginning. Now with the advent of internet and AI, google them, check with state licensing boards for disciplinary action, review the sites that rate doctors, look for patterns in the reviews, check how often the surgeon performs certain procedures. Hospitals are reviewed for surgical procedures. I also like to use the example of Urologist’s, sure they do surgeries but often vasectomies, biopsies, some more urinary issue surgeries, and also will do radical prostatectomy’s but not in the numbers of those surgeries you would want your surgeon to have performed. They may very well be a terrific urologist, but even the number one thing you hear on this board is to find the number they do. They have so many other responsibilities they become the jack of all trades, but master of none, just in my opinion. Don’t hesitate on local prostate cancer support groups in your area to ask who their surgeons were. When my very first urologist moved after I had seen for 15 years and sold his practice, I did not like the new urologist, he bought the practice but was seeing patients in two other locations and was expanding into the area and was likely going to need to bring in someone. I blasted an email to everyone in a group I was in, that we did volunteer work figuring most these people had a urologist. I got a great number of referrals, and it was interesting to see a couple urologists that saw multiple of these volunteers. Then i started looking at those and spoke specifically to those volunteers to learn more about their interactions with their urologists and I finally settled on one I have been happy with. Good luck and thank you for your gracious comments.

If you have an aggressive case where you go can be very important. There can be a dramatic differences between treatments People get from recognized centers of excellence and other facilities.

There is a place in South Carolina that is considered a center of excellence by the NCI.

South Carolina
Hollings Cancer Center
Medical University of South Carolina
Charleston, South Carolina
Clinical Cancer Center

I don’t know how close you live to Duke, but it is a really good place to go for advanced treatment. The doctor like I have listed here may not want to see you unless you have a very aggressive case. If you do you want the best treatment you can get.

Duke North Carolina Durham
Dr Daniel James George GU Oncologist

I live in a relatively remote part of America, so I knew from the outset, that finding a truly qualified and respected, but local, or even regional surgeon, oncologist or facility, was likely to be a 'no-go'. And so, regardless of any travel constraints, I would strongly recommend that you seek-out the very best you can, in the way of oncologists, surgical expertise, as well as facilities and their professional reputation(s).

In the end, I chose a facility about 600-miles away from home, and was advised by a highly-respected surgical oncologist (who had thousands of robotic prostatectomy procedures under his belt), that I was not a good candidate for surgery. Instead, he referred me to an equally well-respected radiation oncologist within the very same institution, where I subsequently completed all of my (ADT+radiation) treatments. They were a renowned facility (I believe they rank in the top 5 or 6 in the nation), and yes, the travel and extended (8-week) absence from home were both difficult, not to mention 'lonely' (because daily unattended residence there was required in my case), but I enjoyed 8-years of remission, until just recently receiving notice of the cancers recurrence.

So yes, I would highly recommend doing your research, scrutinizing the published records and reputations of physicians and their facilities, and going wherever you need to go, to obtain the best care possible. In today's world, money is money, and when it comes to treatments like these, it becomes really 'big' money, real quick, regardless of which doctor or facility you choose, so why not choose the very best that you can?

Best of luck to you.

I've not had any treatment yet still on the roller coaster of tests but I believe that ride is ending soon. I think there are great doctors in a lot of different places. My GP convinced me to go see a urologist, and I live in a community where there are two great (competing) health care groups, each with expertise. My urologist was reassuring and ordered an MRI. When the MRI came back PIRADS-5 and we then had the consult. Any search shows PIRADS-5 indicates a 95% chance of cancer, she was reassuring and really walked through what that meant, it doesn't mean that it's horrible, it means you need to have a biopsy. That was when research mode turned on, watching videos, going to PCRI.ORG, using AI...and on and on and on...you can drive yourself crazy. However I really felt going to Center of Excellence as Jeff indicated was the right place to go. I am relatively close ~200 miles from Mayo Clinic in Rochester MN. I have been extremely impressed by the thoroughness, it's not been here is our standard and that is what we are going to do, it's we will do this, then we will meet. I also feel like I'm dealing with the experts, the people who are doing the trials, the people who are doing the leading practices and procedures.

With all of that said and looking at all the questions and comments I feel having a Center of Excellence from NCI at least for me gives me confidence in the recommendations.

Maybe an analogy. If you have a Ferrari and you purchased it from a dealer 500 miles away and that's the only authorized dealer who can repair it. You probably can have your local mechanic fix some of the easy things but you might need to go to the Ferrari specialist for any complicated. Yes I'm comparing all us to Ferrari's!!!

The one caveat to all of this.....is it's sometimes difficult to get all of your appointments scheduled on the same day so there is a travel expense. Also not knowing what treatment I'm going to have it might become a larger travel expense/burden.

Very important, the best doctors+the best facilities=the best results. Even if you have to travel a distance, get a doctor and facility that are very experienced in the procedure. I mean hundreds of times experienced. I had removal surgery done 11 yrs. ago at University Hospital Siedman cancer center in Cleveland, still undetectable today.

Dave 3+4

@sorensend58
It sure would be interesting and useful to know what the biopsy results are. It seems you have not had it done yet, but you have picked a great place to get it done.

If it turns out that you have a very aggressive case, you should try to get an appointment with Doctor Heath at Mayo. She’s one of the top oncologist in the country. She may not be available unless you have metastasis, Or if you have an aggressive case with aggressive issues.

There are groups that will give you free lodging if you are having prostate cancer treatment. Check with the American Cancer Society and just do a search on the web for free lodging for cancer patients and you will find more than one option.

If you chose to stay local, consider use a COE that has a 2nd opinion/telehealth option. Dana Farber and MSKCC both have that option and its covered by health insurance.