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surgery choices & feedback on a couple of doctors in particular
Hi all -
I'm recently diagnosed (Jan 12) and thanks to family who have been through this & sites like this, have quickly become much more informed (and much less anxious vs. those first few hours after the news broke).
My stats are PSA 3.3, 3-of-12 positive cores, Gleason 7 (one was 6, two were 7), relatively young (46). I'm a T1c - in fact, I joke that the book title is already set -> "How High Cholesterol Saved My Life" as I wouldn't have been watching my PSA as diligently without the 2x year blood tests required while on cholesterol medicine.
So I have a couple questions for now...
I think I've considered the range of treatment options and arrived at surgery being the one for me. Obvious question now is "which type" (robotic vs. open).
I've met with several doctors, for open surgery the absolute best meeting was with Dr Eastham at MSK (outstanding visit!). If I do open, he's definitely the guy.
After meeting with several robotic surgeons "locally", I decided that I should meet with Dr. Fagin in Austin TX (still to be scheduled).
So two-fold question - for those that traveled a similar path, what swung you to do one vs. the other (open vs. robotic)? And for the doctors I mention in particular, would you mind sharing your experience with me?
Re: surgery choices & feedback on a couple of doctors in particular
Dave,
I hope you get a good response to this, but can I suggest a better way of finding out a bit more about Dr Fagin?
If you go to the Website link at the top of the page and then click on the Search Engine link on the page you come to and enter fagin you will find ten stories from men who have had dealigns with him. Read their stories and correspond directly with them if you have any further questions.
Re: Re: surgery choices & feedback on a couple of doctors in particular
Thanks Terry (and Dan).
I had tried the search options within the forum with limited results - hadn't thought of doing a site-wide search, that (as you said) provided more feedback.
Re: surgery choices & feedback on a couple of doctors in particular
Hi Dave;
I was faced with the same situation; I was diagnosed at 53, with a PSA of 14, and Gleason of 7. It was very strange times for sure, and I was (and am) very fortunate to have a great wife to support me. When faced with something like this, we're not as stable and strong as we like to think we are :) Anyway, I chose the robotic surgery for it's accuracy. I had one of the top surgeons in the Tampa area take care of me, and it worked out great. Dr Mastandria was very informative (he has a website if you google his name) Anyway, I was out of work for about 6 weeks, and after the initial "stuff" you have to go through, I was ultimately glad I chose that route. One note of caution - take your time recovering - and you will fully recover - I pushed it a little, and tried to play golf....nothing more than embarrassing with all the leaking, but still. I will be more than happy to share any experiences if your curious. Again, you'll be fine.
Re: surgery choices & feedback on a couple of doctors in particular
Dave,
I can definitely recommend Dr Eastham and everyone at MSKCC very highly. He did my open RRP two years and a few weeks ago (I just had my two year visit there last week with undetectable PSA). I was 40 at the time, Gleason 3+3, PSA 3.1, one core in 10 with 5% positive.
Although everyone is different in terms of their recovery, I believe having the best possible surgeon can make a huge difference. In my case...
Surgery was delayed due to a tied up OR so my surgery started at around 3:30 on a Wednesday afternoon (instead of 11AM). It was apparently done around 6 or 6:30 and before midnight I was in a room. Dr Eastham came by to see me very early the next morning (I think around 6) as well as his fellow who assisted in the surgery. By that time I had already been up and walking a lap or two around the floor. By that night laps were no problem (relatively speaking). Both Drs again came to visit me before 6AM the next morning and by noon on Friday I was on my way home.
I had no complications over the next ten days and on the following Monday the catheter came out. I had very little leakage (within a few days I was using an Always overnight pad and even before then I was using the same pad for several days at a time since it stayed dry). I was back at work after four weeks and within a few weeks after stopped using the pad altogether - at that point it was just a security blanket.
Impotence took a bit longer, and it's not always where I want it to be (although with 25mg of Viagra a better than 6 erection is guaranteed and it's usually in the 8-10 range). Dr Mulhall at MSKCC is excellent and I highly recommend meeting with him.
It's worth mentioning that when I went back to MSKCC for my various follow-ups, Dr Eastham always called me personally to give me the results of my PSA. To me it speaks volumes about the level of care that everyone there shows for the patients.
Feel free to e-mail me if you have any questions, concerns, etc.
Dan
Re: surgery choices & feedback on a couple of doctors in particular
Hi Dave,
Just thought I'd say hello. My situation is nearly the same as yours. I'm 47 with T1c. I was also having cholesterol blood test when the doctor caught my high PSA.
I'm here in Austin, TX and have also been referred to Dr. Fagin. Just curious as to how you were referred to him, especially given that you're in NY?
I've been researching other doctors/hospitals.
The University of Texas MD Anderson hospital in Houston is supposedly the 2nd best hospital in the US for cancer treatment, so I would think if you're coming all the way to Texas, you would be referred to Houston. Anybody mentioned Anderson to you?
Thanks,
Tom
Re: Re: surgery choices & feedback on a couple of doctors in particular
Hi Tom -
Welcome to the "mid-40's" club. I guess lucky for both of us the cholesterol thing was looking over our shoulder...
Yes, I did consider MDA (especially when I was thinking proton therapy might be a choice). I met with 5 surgeons (I eliminated the non-surgical options fairly quickly) including Jean Joseph/Rochester NY, Angelo De Rosalia and Po Lam in Syracuse, NY, James Eastham at MSK/NYC and had an electronic exchange with Randy Fagin/Austin.
It was Dr Lam in Syracuse that added Dr Fagin's name to the list. Dr Lam is the "local expert", having done >350 robotic surgeries (if I wasn't willing to travel, Lam would be my choice). According to him (Lam), Fagin is in the top tier of robotic surgeons in the country (he recommended Ahlering/UC Irvine, Guillonneau/MSK, Vip Patel/Orlando, Fagin/Austin & Jim Porter/Swedish Hospital Seattle). The connection between Lam & Fagin? Fagin actually studied at a local hospital a few years ago, I'm sure they crossed paths there (University Hospital, Syracuse NY).
I was *very* direct in questioning each of the doctors on my list (I had a 3-page list of questions for each of them. Their answers/numbers will be different! If there's any doubt, make sure you have them qualify their answers!)
Ultimately, it came down to this for me:
- the decision weight of technology (open vs. robotic) evaporated over time; more important is the choice of the quality & experience of the surgeon - I frankly didn't care if he used hammer & nails if he was good (well - kind-of - you know what I mean...)
- if you have a short-list of "thumbs-up" candidates, then allowing locality to play a role is OK
- As many other's have said (including an Uncle who has been a HUGE help in this process - he was diagnosed & treated last year) - meet with as many surgeons as you can. ONE of them is going to feel right in your gut. Follow your gut.
I can drive to MSK in about 4 hours - AND my local urologist was a fellow with Dr Eastham's group. Dr Eastham has done over 2,000 open surgeries & over 200 robotic surgeries. He's the chief of urology at one of the leading cancer centers in the world. Add to that the meeting with Dr Eastham was "way out in front" in terms of his conversational manner & patience (very comfortable to speak with, he stayed with us answering all of our questions way over an hour until 6:30PM one rainy NYC night). I'm having open surgery with him in <1 month and feel VERY comfortable I've got the right guy for the job.
If there's anything I can do to help you along in your process please let me know. It looks like we are almost "in-stride", but would be happy to help. I do have a friend who works at MDA (administrative) so if you need logistical help let me know (unfortunately they didn't have contacts we could leverage for PCa, but they live there & know the hospital well).
