How to find a good surgeon for radical prostatectomy
Every article I have read suggests that outcomes post RP are primarily dependent on skill of surgeon over type of RP (laparoscopic, robotic, open). How in the world do you find information on who is a good surgeon? Asking the surgeon doesn’t seem very useful other than how many procedure have they done as rest is subjective (“yup, I’m a good surgeon” response shows confidence more than any sign of surgical competence). We will ask the urologist we are currently seeing more details of their surgical experience level and outcomes when we next speak with him but how do we find out info for other surgeons? Can’t get referral to each one, one by one, to chat. Large volume surgical centers (often at academic centers) are considered to have a better chance of getting a good/experienced surgeon but obviously they will have good and not so good and/or limited experience surgeons as well (doctors are also at those centers to learn and do their first surgeries on someone . . . ). Surgery is a one shot deal and the surgeon’s abilities appear to be the one thing that is associated with better outcomes so we feel this is a critical decision. Any information on how and where to find statistics or other information to help pick a surgeon? Our current urologist can do his surgery but also supports us if we opt for different option or surgeon or location. We are willing to go anywhere. Though waiting a year to be seen elsewhere isn’t a great option as my husband has regional lymphadenopathy so surgery sooner than later is best obviously. Thoughts?
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I can only tell you what I did here. I went to a couple video / zoom events where the surgery was discussed. All of those involved suggested the thing to look for is experience. Look for someone who has done 1,000 of these surgeries. Luckily, the surgeon aligned with my urology practice has that kind of experience. He does a couple per week most of the time.
Next I simply asked around, other doctors I have contact with, and I'm lucky enough to have three sisters who are nurses of various degrees and types. I was able to find out my surgeon had a very good reputation for outcomes. Also, they gave me a couple choices of hospitals, I asked if they had a preference and found out one of the places had a much newer "Davinci" machine, and that was his preference (I felt that was a no brainer…)
All of this is of course anecdotal, but, I'm afraid it's really the best I could do. I'm sure others have their own processes for this.
For my RP, I asked friends who had the procedure. Based on their recommendations, I interviewed three surgeons at different facilities and then chose the one with whom I felt most comfortable. You are correct, the choice of surgeon is critical.
Important to go to a 'center of excellence' for surgery and ongoing care. Their experience is extensive. Best of luck.
Thank you all for your replies. They help to get an idea how everyone approaches the task of choosing a surgeon as it is a bit overwhelming to know that choice can be so critical to the outcomes.
@havhav, I agree with @web265, @edo and @darlynn. I'm sure you will understand that I have a bias towards Mayo Clinic and their top surgeons. If you would like to inquire about care at Mayo, here's how: http://mayocl.in/1mtmR63
I'd also like to hear from others like @alanr @bodeygolfer @budisnothome @dandl48
@juangui @ken82 @kowalski @kujhawk1978 @mrbill @poodledoc
@rxharleydude @sanway @scullrower @stoney @waynen.
What is your criteria for choosing a surgeon?
The first thing I would do is make sure that radiation is not an option. If surgery is the way to go ask surgeons to give you their track record: rate of infections, affect on urinary and sexual function, and most of all cure rate.
A question – do any or all of the Mayo Clinic’s do PSMA Pet scans and if so, which ones? Can they be done with short wait times? Can they be paid for privately? Wondering about traveling to one to have PSMA Pet scan done prior to surgery to:
1. Increase odds of finding distant metastases that could have been missed by CT and bone scan as may change best treatment option away from surgery or add radiation to post surgical plan at earlier date
2. If local lymph node mets present as if can confirm (realizing high specificity if positive) if possible it would give additional knowledge to surgeon for best surgical planning.
I chose radiation treatment because I’m on warfarin and didn’t want to go through the process of getting off warfarin and then going back on it. The cure rate was about the same for radiation as it is for surgery. With radiation you deal with different side effects for a longer period of time. It’s been 2 1/2 years since my radiation treatment and there hasn’t been any sign of cancer. So, if radiation is an option, I’d compare the side effects of radiation vs surgery and determine what you prefer. Looking back, if I didn’t have the warfarin issue, and knowing what the side effects of radiation are ( it takes longer for one’s system to recover from radiation than surgery) I probably would go with surgery. Either way, Mayo is one of the top 2-3 rated centers for dealing with prostrate cancer. To me, that means their surgeons are some of the best in the world in dealing with prostrate cancer. I would request a surgeon that has had many years experience with this type of surgery. I would rely on prayer for the surgery team and then trust that they will do the best job possible. I would be grateful that I am able to have a facility such as Mayo to handle this situation. I have had two open heart surgeries for valve replacement at a different facility and am so grateful for the care I received from them. I am so glad I chose Mayo for my prostrate issue. I believe in prayer and the power of a positive attitude/outlook when dealing with health issues. Wishing you the best. Am willing to discuss further if you want.
Hi havhav, it looks like you've decided on surgery as your treatment. If you are like me, that's probably the toughest health decision you've ever made. The advise you are getting is sound. My decision was to go with proton Beam radiation at Mayo in Phoenix. I was 73 when diagnosed and one criteria that I looked at was that surgery works better with younger patients and radiation is better with older patients. I have several friends in their 70s who chose surgery and had a lot of urinary issues afterwards. One had surgery at Mayo with well respected surgeon who recommended he choose radiation. His PSA was 4+5 and he didn't want to wait on use of ADT before the radiation, although that would've slowed the cancer. It's a tough decision and different specialists may have a bias for their treatment specialty. Finding the right surgeon and hospital is critical for you. If you can, talk to as many people as you can who've been treated at the hospital and by the surgeon. Best of luck. After my treatment, my life has returned pretty much to what it was before, for which I'm very thankful. There is hope