RE: Discussions on open verses robotic

[Guest guest]

I live in Dupage County. I have been very pleased with my urologist from Central Dupage Hospital. He is a young man, who outlined to me several courses of action including AS, surgery and brachytherapy. He didn't try to sway me one way or the other, although he wasn't high on External Beam Radiation. He said if I chose surgery he would like to be the surgeon, but also said I should consider Northwestern. When I pursued brachy, he recommended me to Dr. Moran at Chicago Prostate Center in Lemont, where I received excellent treatment. My urologist maintains contact with Dr Moran, and consulted with him (without any prompting from me) after I had a bounce in my PSA.

Discussions on open verses roboticTo: ProstateCancerSupport Date: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these days, but here I'll reiterate the group maxim.

Don't jump into treatment before you are informed - make the decision yours in consultation with the ones who count in your life.

Some information comes from experience, others come from research projects, some comes from discussion with medics and fellow patients. At the end of the day it is down to personal choice, what is right for you and yours.

It perhaps doesn't mattter too much who invented what and when. It matters that people know what is looks most attractive for them based on what they have found out.

Terry and other experienced members try to flag up possible contrasts between word of mouth and research. Well worth taking into account.

If we listened to the best stories of any procedure, everyone whould use that one, equally if the worst stories of the same procedure were the only ones about no one would use it.

My take on robotic is that in the right hands it can provide a faster recovery period, with less blood loss and gives an expert a better view of the area to be worked on (as does laproscopic) . I think it takes a special surgeon to operate the kit and just maybe then might have the edge on the open surgery but....

[Guest guest]

Thanks, Alan:

I hope you're right, and I believe you are. Just as some of us

choose to live in " the hinterlands " rather than the city, I'm sure

providers of all kinds of services, including doctors, feel the same way. My

last move was something like my 25th in 14 cities, so I've had plenty of city,

suburb and exurb. I'll take the exurbs as long as I can get to the city

for entertainment.

Each of us needs to find those " centers of excellence "

wherever they may be.

Tom Lauterback

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Monday, August 31, 2009 9:42 AM

To: ProstateCancerSupport

Subject: RE: Discussions on open verses robotic

> ... I am starting today with an IMRT course of treatment from a

> radiological oncologist who seems to be on top of his game ...

> So, the question is, is there that much difference between the

> quality of care in the 'burbs (I'm in the Fox Valley, but it

> could be 25 miles out in any big city) and what one would

> receive at a large teaching hospital in the city? I'm sure I'd

> expect some differences, but does that justify having to drive

> 50-60 miles round trip in brutal traffic every day for the next

> 8 weeks?

I don't know the answer to that question. If I had to guess, I

would guess that, on average, patients at the famous teaching

hospitals and cancer centers do better than patients at the small

centers in the hinterland.

However, I would also guess that there are centers of excellence

everywhere. There can be a guy or gal working in a small town

who likes living there and doesn't want to move to Chicago or New

York, but who takes his work very, very seriously and does an

excellent job.

I'm not an expert, but it seems to me that radiation and surgery

are different in the demands they make on the practitioner.

Surgery requires great skill, steady eyes and hands, lots of

practice. Radiation requires serious attention to detail. I

think a klutz with shaky hands could still be a great radiation

oncologist if he takes his time, uses his head and is committed

to his patients.

You said that your rad onc " seems to be on top of his game " . I

suspect that's what counts. I don't see why he can't do just as

good a job as in the big city teaching hospitals.

Alan

[Guest guest]

Thanks, Alan:

I hope you're right, and I believe you are. Just as some of us

choose to live in " the hinterlands " rather than the city, I'm sure

providers of all kinds of services, including doctors, feel the same way. My

last move was something like my 25th in 14 cities, so I've had plenty of city,

suburb and exurb. I'll take the exurbs as long as I can get to the city

for entertainment.

Each of us needs to find those " centers of excellence "

wherever they may be.

Tom Lauterback

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Monday, August 31, 2009 9:42 AM

To: ProstateCancerSupport

Subject: RE: Discussions on open verses robotic

> ... I am starting today with an IMRT course of treatment from a

> radiological oncologist who seems to be on top of his game ...

> So, the question is, is there that much difference between the

> quality of care in the 'burbs (I'm in the Fox Valley, but it

> could be 25 miles out in any big city) and what one would

> receive at a large teaching hospital in the city? I'm sure I'd

> expect some differences, but does that justify having to drive

> 50-60 miles round trip in brutal traffic every day for the next

> 8 weeks?

I don't know the answer to that question. If I had to guess, I

would guess that, on average, patients at the famous teaching

hospitals and cancer centers do better than patients at the small

centers in the hinterland.

However, I would also guess that there are centers of excellence

everywhere. There can be a guy or gal working in a small town

who likes living there and doesn't want to move to Chicago or New

York, but who takes his work very, very seriously and does an

excellent job.

I'm not an expert, but it seems to me that radiation and surgery

are different in the demands they make on the practitioner.

Surgery requires great skill, steady eyes and hands, lots of

practice. Radiation requires serious attention to detail. I

think a klutz with shaky hands could still be a great radiation

oncologist if he takes his time, uses his head and is committed

to his patients.

You said that your rad onc " seems to be on top of his game " . I

suspect that's what counts. I don't see why he can't do just as

good a job as in the big city teaching hospitals.

Alan

[Guest guest]

Ken:

You're the second person who has provided an excellent review

re: Dr. Moran. I had dinner with a friend who's had a long relationship with

Dr. Moran and has had nothing but good experiences, including successful brachytherapy.

I chose to stay local and have regretted it from the urology point of view;

Elgin may have the market cornered on lousy urologists. From the oncology point

of view, hope springs eternal. I just can't stand the thought of being

catheterized again.

Tom Lauterback

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of

Bissett

Sent: Monday, August 31, 2009 9:46 AM

To: ProstateCancerSupport

Subject: Re: Discussions on open verses robotic

I

live in Dupage County. I have been very pleased with my urologist from

Central Dupage Hospital. He is a young man, who outlined to me several

courses of action including AS, surgery and brachytherapy. He didn't

try to sway me one way or the other, although he wasn't high on External Beam

Radiation. He said if I chose surgery he would like to be the surgeon,

but also said I should consider Northwestern. When I pursued brachy, he

recommended me to Dr. Moran at Chicago Prostate Center in Lemont,

where I received excellent treatment. My urologist maintains contact with

Dr Moran, and consulted with him (without any prompting from me) after I

had a bounce in my PSA.

-----

Original Message -----

From: Tom Lauterback

To: ProstateCancerSupport

Sent: Monday, August 31,

2009 9:01 AM

Subject: RE:

Discussions on open verses robotic

:

From a " neighbor " in the

Chicago 'burbs, congratulations and continued good health. Your essay was a

breath of fresh air and opens up a line of dialogue to which I have not been

exposed or at least participated. Apparently I'm one of those patients who's

gone to the docs who treat the obese 70 year olds with diabetes in the 'burbs.

I want to be quick to point out that the substandard treatment I've received

has been from urologists only. I am starting today with an IMRT course of

treatment from a radiological oncologist who seems to be on top of his game,

and, I pray, is. The urologists , on the other hand, have been significantly

less than professional. I've ticked off enough of my sad story on these pages

and choose not to bore the reader again, but, from a botched TUMT to a blatant

effort to insist that my treatment options have been misguided and everything

in between, I've received some truly awful care.

So, the question is, is there that much

difference between the quality of care in the 'burbs (I'm in the Fox Valley,

but it could be 25 miles out in any big city) and what one would receive at a

large teaching hospital in the city? I'm sure I'd expect some differences, but

does that justify having to drive 50-60 miles round trip in brutal traffic

every day for the next 8 weeks? I've started on my path to cancer-free

existence, but I raise the question on behalf of those who haven't and may be

sitting 25 or 30 miles from downtown somewhere and wondering whether to stay

local or go into the city. Perhaps I sound naive, but is the bar set that much

higher at a Northwestern, Illinois or U.C.? It might be illustrative to those

who haven't chosen a " final step " or even those who've just been

diagnosed to kick this question around.

Tom Lauterback

From:

ProstateCancerSupport [mailto:ProstateCancerSupport ]

On Behalf Of Carroll

Sent: Monday, August 31, 2009 8:16 AM

To: ProstateCancerSupport

Subject: Re: Discussions on open verses robotic

As

I write this, I am awaiting the results of a PSA test from a sample drawn last

week.

Two

years ago this month I had a robotic laparoscopic RP at Northwestern

University Medical Center in Chicago. The surgeon who performed the

surgery had performed about 300 such procedures per year for a few years

prior to accepting me as a patient. I say " accepting " because

he and Northwestern track surgical outcomes for 5 years and I am convinced

that they will reject cases that are predicted to have poor outcomes in order

to elevate their statistical performance. My suburban urologist who performed

my biopsy said as much when he advised, " IF they

take you downtown, you will do great. They only take good

patients. I get stuck doing the 70 year old obese patients with

diabetes. " I know one can read a lot into that comment and I will

leave you to your interpretations, but I agree with the sentiment that a

major med center with a well recognized specialty program is, shall we say,

conscious, of their results.

Anyhow,

I had the surgery and, although I was in the OR for 6 hours, was

released from the hospital to return home the day following the

procedure. Catheter for 10 days. When the catheter came out I was

prepared with a box of adult diapers (48 count) and heavy duty pads. I

used a couple of the diapers and then wore a pad for a few days while at work

just in case I had an accident. I didn't. Within a few weeks of

the surgery I had zero leakage and disregarded incontinence as an issue.

I

did go on a Muse/Cialis/Viagra rehab program with little results for the

first several months. My surgery was full nerve sparing and I believe

my surgeon prolonged the surgery (remember, it was six hours long) in a very

dedicated effort to minimize disruption/damage to nerve and vascular bundles

that he and I discussed at length before the surgery.

By

the one year mark I was recovering function rather well but was not

completely satisfied. I made an appointment to see Jeff Albough, ED

specialist at Northwestern, in month 13 following surgery. Due to

schedule problems, I was unable to see him until month 16. My intent

was to get right into injections, but by month 16 I was doing very well with

Cialis/Viagra (has anyone EVER benefitted from Muse?) and getting stronger

and stronger without any meds. Jeff urged me to be a little more

patient and not change anything I was doing. I followed his advice and

by month 18 I was using meds more for recreational use than necessity.

Today, at 24 months, I can take them or leave them.

Through

it all, my PSA post surgery has vacillated between 0.0 and 0.1 which I believe

is statistically the same. I have no reason to believe my test taken

last week will be any different.

In

sum, I am very pleased with my choice of surgeons, medical center and

procedure based on the outcomes. At Northwestern's invitation I have

joined their list of reference patients who are available to talk to

prospective patients about the process and program at Northwestern.

When I receive a call at home from someone who is where I was two years ago,

I am very careful to point out the " Your Mileage May Vary "

considerations but, if I had it to do over, I would not change a thing.

Could the outcome have been the same with open RP? I am certain

it could have been but not at all certain that it would have

been.

I

do agree with another poster who pointed out that these forums tend to be

overpopulated with cancer patients who are seeking input to assist

them with their decision making or are having problems and are seeking

direction. It is unfortunate because it may give the impression to

newly diagnosed readers that there are no patients with satisfactory

results. It would be great if people who went through the process and

recovered very nicely remained in touch with the forums but that is not

the way of the world. As time passes I find myself viewing

my summer of 2007 " ordeal " as no more or less eventful than an

appendectomy I had in " 84. Yep it happened and now it's

behind me.

Best regards

to all.

Subject: Discussions on open verses robotic

To: ProstateCancerSupport

Date: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these days, but here

I'll reiterate the group maxim.

Don't jump into treatment before you are informed -

make the decision yours in consultation with the ones who count in your life.

Some information comes from experience, others come

from research projects, some comes from discussion with medics and fellow

patients. At the end of the day it is down to personal choice, what is right

for you and yours.

It perhaps doesn't mattter too much who invented

what and when. It matters that people know what is looks most attractive for

them based on what they have found out.

Terry and other experienced members try to flag up

possible contrasts between word of mouth and research. Well worth

taking into account.

If we listened to the best stories of any procedure,

everyone whould use that one, equally if the worst stories of the same

procedure were the only ones about no one would use it.

My take on robotic is that in the right hands it can

provide a faster recovery period, with less blood loss and gives an

expert a better view of the area to be worked on (as does laproscopic) . I

think it takes a special surgeon to operate the kit and just maybe then might

have the edge on the open surgery but....

[Guest guest]

Ken:

You're the second person who has provided an excellent review

re: Dr. Moran. I had dinner with a friend who's had a long relationship with

Dr. Moran and has had nothing but good experiences, including successful brachytherapy.

I chose to stay local and have regretted it from the urology point of view;

Elgin may have the market cornered on lousy urologists. From the oncology point

of view, hope springs eternal. I just can't stand the thought of being

catheterized again.

Tom Lauterback

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of

Bissett

Sent: Monday, August 31, 2009 9:46 AM

To: ProstateCancerSupport

Subject: Re: Discussions on open verses robotic

I

live in Dupage County. I have been very pleased with my urologist from

Central Dupage Hospital. He is a young man, who outlined to me several

courses of action including AS, surgery and brachytherapy. He didn't

try to sway me one way or the other, although he wasn't high on External Beam

Radiation. He said if I chose surgery he would like to be the surgeon,

but also said I should consider Northwestern. When I pursued brachy, he

recommended me to Dr. Moran at Chicago Prostate Center in Lemont,

where I received excellent treatment. My urologist maintains contact with

Dr Moran, and consulted with him (without any prompting from me) after I

had a bounce in my PSA.

-----

Original Message -----

From: Tom Lauterback

To: ProstateCancerSupport

Sent: Monday, August 31,

2009 9:01 AM

Subject: RE:

Discussions on open verses robotic

:

From a " neighbor " in the

Chicago 'burbs, congratulations and continued good health. Your essay was a

breath of fresh air and opens up a line of dialogue to which I have not been

exposed or at least participated. Apparently I'm one of those patients who's

gone to the docs who treat the obese 70 year olds with diabetes in the 'burbs.

I want to be quick to point out that the substandard treatment I've received

has been from urologists only. I am starting today with an IMRT course of

treatment from a radiological oncologist who seems to be on top of his game,

and, I pray, is. The urologists , on the other hand, have been significantly

less than professional. I've ticked off enough of my sad story on these pages

and choose not to bore the reader again, but, from a botched TUMT to a blatant

effort to insist that my treatment options have been misguided and everything

in between, I've received some truly awful care.

So, the question is, is there that much

difference between the quality of care in the 'burbs (I'm in the Fox Valley,

but it could be 25 miles out in any big city) and what one would receive at a

large teaching hospital in the city? I'm sure I'd expect some differences, but

does that justify having to drive 50-60 miles round trip in brutal traffic

every day for the next 8 weeks? I've started on my path to cancer-free

existence, but I raise the question on behalf of those who haven't and may be

sitting 25 or 30 miles from downtown somewhere and wondering whether to stay

local or go into the city. Perhaps I sound naive, but is the bar set that much

higher at a Northwestern, Illinois or U.C.? It might be illustrative to those

who haven't chosen a " final step " or even those who've just been

diagnosed to kick this question around.

Tom Lauterback

From:

ProstateCancerSupport [mailto:ProstateCancerSupport ]

On Behalf Of Carroll

Sent: Monday, August 31, 2009 8:16 AM

To: ProstateCancerSupport

Subject: Re: Discussions on open verses robotic

As

I write this, I am awaiting the results of a PSA test from a sample drawn last

week.

Two

years ago this month I had a robotic laparoscopic RP at Northwestern

University Medical Center in Chicago. The surgeon who performed the

surgery had performed about 300 such procedures per year for a few years

prior to accepting me as a patient. I say " accepting " because

he and Northwestern track surgical outcomes for 5 years and I am convinced

that they will reject cases that are predicted to have poor outcomes in order

to elevate their statistical performance. My suburban urologist who performed

my biopsy said as much when he advised, " IF they

take you downtown, you will do great. They only take good

patients. I get stuck doing the 70 year old obese patients with

diabetes. " I know one can read a lot into that comment and I will

leave you to your interpretations, but I agree with the sentiment that a

major med center with a well recognized specialty program is, shall we say,

conscious, of their results.

Anyhow,

I had the surgery and, although I was in the OR for 6 hours, was

released from the hospital to return home the day following the

procedure. Catheter for 10 days. When the catheter came out I was

prepared with a box of adult diapers (48 count) and heavy duty pads. I

used a couple of the diapers and then wore a pad for a few days while at work

just in case I had an accident. I didn't. Within a few weeks of

the surgery I had zero leakage and disregarded incontinence as an issue.

I

did go on a Muse/Cialis/Viagra rehab program with little results for the

first several months. My surgery was full nerve sparing and I believe

my surgeon prolonged the surgery (remember, it was six hours long) in a very

dedicated effort to minimize disruption/damage to nerve and vascular bundles

that he and I discussed at length before the surgery.

By

the one year mark I was recovering function rather well but was not

completely satisfied. I made an appointment to see Jeff Albough, ED

specialist at Northwestern, in month 13 following surgery. Due to

schedule problems, I was unable to see him until month 16. My intent

was to get right into injections, but by month 16 I was doing very well with

Cialis/Viagra (has anyone EVER benefitted from Muse?) and getting stronger

and stronger without any meds. Jeff urged me to be a little more

patient and not change anything I was doing. I followed his advice and

by month 18 I was using meds more for recreational use than necessity.

Today, at 24 months, I can take them or leave them.

Through

it all, my PSA post surgery has vacillated between 0.0 and 0.1 which I believe

is statistically the same. I have no reason to believe my test taken

last week will be any different.

In

sum, I am very pleased with my choice of surgeons, medical center and

procedure based on the outcomes. At Northwestern's invitation I have

joined their list of reference patients who are available to talk to

prospective patients about the process and program at Northwestern.

When I receive a call at home from someone who is where I was two years ago,

I am very careful to point out the " Your Mileage May Vary "

considerations but, if I had it to do over, I would not change a thing.

Could the outcome have been the same with open RP? I am certain

it could have been but not at all certain that it would have

been.

I

do agree with another poster who pointed out that these forums tend to be

overpopulated with cancer patients who are seeking input to assist

them with their decision making or are having problems and are seeking

direction. It is unfortunate because it may give the impression to

newly diagnosed readers that there are no patients with satisfactory

results. It would be great if people who went through the process and

recovered very nicely remained in touch with the forums but that is not

the way of the world. As time passes I find myself viewing

my summer of 2007 " ordeal " as no more or less eventful than an

appendectomy I had in " 84. Yep it happened and now it's

behind me.

Best regards

to all.

Subject: Discussions on open verses robotic

To: ProstateCancerSupport

Date: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these days, but here

I'll reiterate the group maxim.

Don't jump into treatment before you are informed -

make the decision yours in consultation with the ones who count in your life.

Some information comes from experience, others come

from research projects, some comes from discussion with medics and fellow

patients. At the end of the day it is down to personal choice, what is right

for you and yours.

It perhaps doesn't mattter too much who invented

what and when. It matters that people know what is looks most attractive for

them based on what they have found out.

Terry and other experienced members try to flag up

possible contrasts between word of mouth and research. Well worth

taking into account.

If we listened to the best stories of any procedure,

everyone whould use that one, equally if the worst stories of the same

procedure were the only ones about no one would use it.

My take on robotic is that in the right hands it can

provide a faster recovery period, with less blood loss and gives an

expert a better view of the area to be worked on (as does laproscopic) . I

think it takes a special surgeon to operate the kit and just maybe then might

have the edge on the open surgery but....

[Guest guest]

Hi Tom,

Sorry to hear of your tribulations.

I also live in the Fox River Valley. My Primary Care Physician is an internist who has an office in Batavia and has admission rights at Delnore. The urologist who did the biopsy did it at Delnore.

I have no reason to believe that the urologist who did the biopsy is anything other than competent in the services he provides generally. While meeting with him to review my biopsy results he honestly reviewed the full range of treatment options and said I could take my time researching and deciding what course of action to take but encouraged me, without alarming me, to come to a decision within 6 months. He did not advocate watchful waiting with good justification.

He did say that he performed open RPs. I asked him how often he performed the surgery and he said he did about a dozen a year. My wife and I exchanged glances almost by reflex. All of our reading had warned us against getting an RP from a doctor who did one once a month; bingo, our doc averaged EXACTLY that.

To me, the trip downtown was well worth it. I am not saying Delnore or other area hospitals are inept or incapable of delivering very good care. I am just happy with the treatment and care I recd at Northwestern. My surgeon at Northwestern is a board certified urologist by education/training.

On your general question regarding the standard of care, I can only express my opinion at the decided risk that it may be controversial. For several years I lived in Cleveland. It was well known, and often reported in the press, when dignitaries from around the world were in town for treatment at the Cleveland Clinic. Closer to home, I met people from around the country who spent weeks in Chicago while receiving treatment at Northwestern at the same time I was there for tests, classes etc. etc.. Now, having lived in the Fox Valley for the past 8 years, I do not know anyone who has traveled more than 20 miles to be treated at Delnore, a state of the art, modern hospital. Certainly the PERCEPTION is that certain regional medical centers are far superior to suburban hospitals. I was lured to investigate UC, Rusch and Northwestern based on that perception, and ultimately chose to be treated at Northwestern. The

true size of the gap between perception and reality? Not sure.

I know the decisions are very, very tough. My primary guy, who I like very much, gave me information but was reluctant to give me advice on my choices. I finally had to plant myself in his office at about 1900 hrs one evening and sorta block the door to get him to openly discuss what he would do in my shoes or what he would recommend for his father or brother. In the end, he was great, but I had to do a little arm twisting.

Best regards and good luck in your progress,

From: Metcalf <bryan.metcalf@ virgin.net>Subject: [ProstateCancerSupp ort] Discussions on open verses roboticTo: ProstateCancerSuppo rtyahoogroups (DOT) comDate: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these days, but here I'll reiterate the group maxim.

Don't jump into treatment before you are informed - make the decision yours in consultation with the ones who count in your life.

Some information comes from experience, others come from research projects, some comes from discussion with medics and fellow patients. At the end of the day it is down to personal choice, what is right for you and yours.

It perhaps doesn't mattter too much who invented what and when. It matters that people know what is looks most attractive for them based on what they have found out.

Terry and other experienced members try to flag up possible contrasts between word of mouth and research. Well worth taking into account.

If we listened to the best stories of any procedure, everyone whould use that one, equally if the worst stories of the same procedure were the only ones about no one would use it.

My take on robotic is that in the right hands it can provide a faster recovery period, with less blood loss and gives an expert a better view of the area to be worked on (as does laproscopic) . I think it takes a special surgeon to operate the kit and just maybe then might have the edge on the open surgery but....

[Guest guest]

:

After all my complaining about substandard treatment, it's

refreshing to hear of people who have received excellent care in the 'burbs AND

at a well known teaching hospital such as Northwestern. I'm not sure the board

certification is key, however, since every urologist I've gone to was board

certified. Apparently those boards don't certify honesty and ethics. Certainly

the Cleveland Clinic, especially in the past few years, has gotten wide

acclaim. Delnore, Sherman and St. Joe's here in Elgin, and dozens of other

suburban hospitals obviously do the best they can and no doubt do their best to

attract the best staffs they can, but I'm sure there's something to be said for

having your business card say Northwestern (and that's tough for me to say; one

of my degrees is from Illinois, and I bleed orange and blue).

Continued good health, and thanks for your kind words.

Tom Lauterback

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Carroll

Sent: Monday, August 31, 2009 10:38 AM

To: ProstateCancerSupport

Subject: RE: Discussions on open verses robotic

Hi Tom,

Sorry to hear of your tribulations.

I also live in the Fox River Valley. My Primary Care

Physician is an internist who has an office in Batavia and has admission

rights at Delnore. The urologist who did the biopsy did it at

Delnore.

I have no reason to believe that the urologist who did the

biopsy is anything other than competent in the services he provides

generally. While meeting with him to review my biopsy results he

honestly reviewed the full range of treatment options and said I could take

my time researching and deciding what course of action to take but encouraged

me, without alarming me, to come to a decision within 6 months. He did

not advocate watchful waiting with good justification.

He did say that he performed open RPs. I asked him

how often he performed the surgery and he said he did about a dozen a

year. My wife and I exchanged glances almost by reflex. All of

our reading had warned us against getting an RP from a doctor who did one

once a month; bingo, our doc averaged EXACTLY that.

To me, the trip downtown was well worth it. I am not

saying Delnore or other area hospitals are inept or incapable of delivering

very good care. I am just happy with the treatment and care I recd at

Northwestern. My surgeon at Northwestern is a board certified urologist by

education/training.

On your general question regarding the standard of care, I

can only express my opinion at the decided risk that it may be

controversial. For several years I lived in Cleveland. It was well

known, and often reported in the press, when dignitaries from around the

world were in town for treatment at the Cleveland Clinic. Closer to

home, I met people from around the country who spent weeks in Chicago while

receiving treatment at Northwestern at the same time I was there for tests,

classes etc. etc.. Now, having lived in the Fox Valley for the past 8

years, I do not know anyone who has traveled more than 20 miles to be treated

at Delnore, a state of the art, modern hospital. Certainly the PERCEPTION

is that certain regional medical centers are far superior to suburban

hospitals. I was lured to investigate UC, Rusch and Northwestern based

on that perception, and ultimately chose to be treated at Northwestern.

The true size of the gap between perception and reality? Not sure.

I know the decisions are very, very tough. My

primary guy, who I like very much, gave me information but was reluctant to

give me advice on my choices. I finally had to plant myself in his

office at about 1900 hrs one evening and sorta block the door to get him to

openly discuss what he would do in my shoes or what he would recommend for

his father or brother. In the end, he was great, but I had to do a

little arm twisting.

Best regards and good luck in your progress,

From: Metcalf <bryan.metcalf@ virgin.net>

Subject: [ProstateCancerSupp ort] Discussions on open verses robotic

To: ProstateCancerSuppo rtyahoogroups (DOT) com

Date: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these

days, but here I'll reiterate the group maxim.

Don't jump into treatment before you

are informed - make the decision yours in consultation with the ones who

count in your life.

Some information comes from

experience, others come from research projects, some comes from discussion

with medics and fellow patients. At the end of the day it is down to

personal choice, what is right for you and yours.

It perhaps doesn't mattter too much

who invented what and when. It matters that people know what is looks most

attractive for them based on what they have found out.

Terry and other experienced members

try to flag up possible contrasts between word of mouth and research.

Well worth taking into account.

If we listened to the best stories of

any procedure, everyone whould use that one, equally if the worst stories

of the same procedure were the only ones about no one would use it.

My take on robotic is that in the

right hands it can provide a faster recovery period, with less blood

loss and gives an expert a better view of the area to be worked on (as

does laproscopic) . I think it takes a special surgeon to operate the kit

and just maybe then might have the edge on the open surgery but....

[Guest guest]

:

After all my complaining about substandard treatment, it's

refreshing to hear of people who have received excellent care in the 'burbs AND

at a well known teaching hospital such as Northwestern. I'm not sure the board

certification is key, however, since every urologist I've gone to was board

certified. Apparently those boards don't certify honesty and ethics. Certainly

the Cleveland Clinic, especially in the past few years, has gotten wide

acclaim. Delnore, Sherman and St. Joe's here in Elgin, and dozens of other

suburban hospitals obviously do the best they can and no doubt do their best to

attract the best staffs they can, but I'm sure there's something to be said for

having your business card say Northwestern (and that's tough for me to say; one

of my degrees is from Illinois, and I bleed orange and blue).

Continued good health, and thanks for your kind words.

Tom Lauterback

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of Carroll

Sent: Monday, August 31, 2009 10:38 AM

To: ProstateCancerSupport

Subject: RE: Discussions on open verses robotic

Hi Tom,

Sorry to hear of your tribulations.

I also live in the Fox River Valley. My Primary Care

Physician is an internist who has an office in Batavia and has admission

rights at Delnore. The urologist who did the biopsy did it at

Delnore.

I have no reason to believe that the urologist who did the

biopsy is anything other than competent in the services he provides

generally. While meeting with him to review my biopsy results he

honestly reviewed the full range of treatment options and said I could take

my time researching and deciding what course of action to take but encouraged

me, without alarming me, to come to a decision within 6 months. He did

not advocate watchful waiting with good justification.

He did say that he performed open RPs. I asked him

how often he performed the surgery and he said he did about a dozen a

year. My wife and I exchanged glances almost by reflex. All of

our reading had warned us against getting an RP from a doctor who did one

once a month; bingo, our doc averaged EXACTLY that.

To me, the trip downtown was well worth it. I am not

saying Delnore or other area hospitals are inept or incapable of delivering

very good care. I am just happy with the treatment and care I recd at

Northwestern. My surgeon at Northwestern is a board certified urologist by

education/training.

On your general question regarding the standard of care, I

can only express my opinion at the decided risk that it may be

controversial. For several years I lived in Cleveland. It was well

known, and often reported in the press, when dignitaries from around the

world were in town for treatment at the Cleveland Clinic. Closer to

home, I met people from around the country who spent weeks in Chicago while

receiving treatment at Northwestern at the same time I was there for tests,

classes etc. etc.. Now, having lived in the Fox Valley for the past 8

years, I do not know anyone who has traveled more than 20 miles to be treated

at Delnore, a state of the art, modern hospital. Certainly the PERCEPTION

is that certain regional medical centers are far superior to suburban

hospitals. I was lured to investigate UC, Rusch and Northwestern based

on that perception, and ultimately chose to be treated at Northwestern.

The true size of the gap between perception and reality? Not sure.

I know the decisions are very, very tough. My

primary guy, who I like very much, gave me information but was reluctant to

give me advice on my choices. I finally had to plant myself in his

office at about 1900 hrs one evening and sorta block the door to get him to

openly discuss what he would do in my shoes or what he would recommend for

his father or brother. In the end, he was great, but I had to do a

little arm twisting.

Best regards and good luck in your progress,

From: Metcalf <bryan.metcalf@ virgin.net>

Subject: [ProstateCancerSupp ort] Discussions on open verses robotic

To: ProstateCancerSuppo rtyahoogroups (DOT) com

Date: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these

days, but here I'll reiterate the group maxim.

Don't jump into treatment before you

are informed - make the decision yours in consultation with the ones who

count in your life.

Some information comes from

experience, others come from research projects, some comes from discussion

with medics and fellow patients. At the end of the day it is down to

personal choice, what is right for you and yours.

It perhaps doesn't mattter too much

who invented what and when. It matters that people know what is looks most

attractive for them based on what they have found out.

Terry and other experienced members

try to flag up possible contrasts between word of mouth and research.

Well worth taking into account.

If we listened to the best stories of

any procedure, everyone whould use that one, equally if the worst stories

of the same procedure were the only ones about no one would use it.

My take on robotic is that in the

right hands it can provide a faster recovery period, with less blood

loss and gives an expert a better view of the area to be worked on (as

does laproscopic) . I think it takes a special surgeon to operate the kit

and just maybe then might have the edge on the open surgery but....

[Guest guest]

Tom --

I've been following this discussion. I have two comments:

1. If you've eliminated brachytherapy as a possibility, _only_ because it may

involve catheterization, I think you're being short-sighted. It's an effective

therapy, with a reasonably low rate of side-effects. My _guess_ is that it has

a better side-effect profile than open-beam radiation therapy, and better cure

rates.

We have a good local brachy group, and they've done a good job on tracking their

patients post-treatment. The long-term cure rates they have are better than

sugical rates. [The results for their own patients have been published; the

comparisons with other treatments haven't come out yet.]

I'm not saying that your uro was right in trying to scare you. But he may have

been right in recommending brachy over open-beam.

2. My ex-wife has multiple myeloma, a rather nasty bone cancer. She was slowly

dying under the supervision (and ineffective treatment) of her local oncologist.

She finally said:

.. . . " You really don't know what to do with me, do you? "

When she got to one of the 'centers of excellence' for that disease (University

of Arkansas), she was treated aggressively and effectively. It took a big team

to do it. She's still alive and kicking.

For _some_ patients, the local oncologist might have been fine. For her, he was

a disaster. He just didn't have the knowledge, or the tools, or the deep

support structure, to treat her well.

>

> :

>

>

>

> After all my complaining about substandard treatment, it's refreshing to

> hear of people who have received excellent care in the 'burbs AND at a well

> known teaching hospital such as Northwestern. I'm not sure the board

> certification is key, however, since every urologist I've gone to was board

> certified. Apparently those boards don't certify honesty and ethics.

> Certainly the Cleveland Clinic, especially in the past few years, has gotten

> wide acclaim. Delnore, Sherman and St. Joe's here in Elgin, and dozens of

> other suburban hospitals obviously do the best they can and no doubt do

> their best to attract the best staffs they can, but I'm sure there's

> something to be said for having your business card say Northwestern (and

> that's tough for me to say; one of my degrees is from Illinois, and I bleed

> orange and blue).

>

>

>

> Continued good health, and thanks for your kind words.

>

>

>

> Tom Lauterback

>

>

[Guest guest]

Tom --

I've been following this discussion. I have two comments:

1. If you've eliminated brachytherapy as a possibility, _only_ because it may

involve catheterization, I think you're being short-sighted. It's an effective

therapy, with a reasonably low rate of side-effects. My _guess_ is that it has

a better side-effect profile than open-beam radiation therapy, and better cure

rates.

We have a good local brachy group, and they've done a good job on tracking their

patients post-treatment. The long-term cure rates they have are better than

sugical rates. [The results for their own patients have been published; the

comparisons with other treatments haven't come out yet.]

I'm not saying that your uro was right in trying to scare you. But he may have

been right in recommending brachy over open-beam.

2. My ex-wife has multiple myeloma, a rather nasty bone cancer. She was slowly

dying under the supervision (and ineffective treatment) of her local oncologist.

She finally said:

.. . . " You really don't know what to do with me, do you? "

When she got to one of the 'centers of excellence' for that disease (University

of Arkansas), she was treated aggressively and effectively. It took a big team

to do it. She's still alive and kicking.

For _some_ patients, the local oncologist might have been fine. For her, he was

a disaster. He just didn't have the knowledge, or the tools, or the deep

support structure, to treat her well.

>

> :

>

>

>

> After all my complaining about substandard treatment, it's refreshing to

> hear of people who have received excellent care in the 'burbs AND at a well

> known teaching hospital such as Northwestern. I'm not sure the board

> certification is key, however, since every urologist I've gone to was board

> certified. Apparently those boards don't certify honesty and ethics.

> Certainly the Cleveland Clinic, especially in the past few years, has gotten

> wide acclaim. Delnore, Sherman and St. Joe's here in Elgin, and dozens of

> other suburban hospitals obviously do the best they can and no doubt do

> their best to attract the best staffs they can, but I'm sure there's

> something to be said for having your business card say Northwestern (and

> that's tough for me to say; one of my degrees is from Illinois, and I bleed

> orange and blue).

>

>

>

> Continued good health, and thanks for your kind words.

>

>

>

> Tom Lauterback

>

>

[Guest guest]

Alan --

On treatment effectiveness:

I'll e-mail a copy of the group's " own patients " report to you. I'm inclined to

believe the results. Note that the population was composed of " low- and

low-tier intermediate risk " patients. The patients had _only_ brachytherapy,

not brachy + external beam.

Several people treated by that group are in my local PCa support group, and they

are generally happy with the treatment. [Yes, I know -- that would be true for

most patients of most therapies.]

Note that their typical radiation dose (144 Gray) is quite high, compared to

what EBRT supplies.

The paper deals with survival rates, not side-effects.

A " treatment comparison " paper, written by that group, based on previously

published results (_not_ a randomized clinical trial) will be coming out in the

next few months.

On side-effects:

When I said " guess " , I meant " guess " . As for comparing treatments, I agree with

you -- it's tough.

My logic about side-effects is simple-minded:

.. . . In brachytherapy, each seed delivers a dose to its local region, and the

seeds are all located within the prostate. Outside the prostate, the dose falls

off quickly.

.. . . In open-beam therapy (gamma-ray), every beam passes through other body

tissues _before_ it reaches the prostate, dropping energy (and side-effects)

along the way.

What I'd need to really justify my statement (logically, not through clinical

experience) is two radiation-dose diagrams, for the same patient:

.. . . one for brachytherapy;

.. . . one for open-beam therapy

and a comparison of their expected radiation doses _outside_ the prostate, in

surrounding tissues.

That, I don't have.

It would be interesting to compare those dose diagrams to the equivalent dose

diagrams for proton therapy. The Bragg peak is a powerful tool to put radiation

dose where it belongs.

>

> > 1. If you've eliminated brachytherapy as a

> > possibility, _only_ because it may involve catheterization,

> > I think you're being short-sighted. It's an effective

> > therapy, with a reasonably low rate of side-effects.

> > My _guess_ is that it has a better side-effect profile than

> > open-beam radiation therapy, and better cure

> > rates.

>

> ,

>

> Have you seen any published studies to support this? When I

> investigated this six years ago the consensus seemed to be that

> cure rates for brachytherapy and external beam were about the

> same. At that time, if you had an intermediate or high risk

> case, radiation oncologists were recommending that external beam

> always be part of the treatment - either combined with

> brachytherapy or given by itself. The reason was that external

> beam can treat the area around the prostate as well as the

> prostate itself.

>

> > We have a good local brachy group, and they've done a good

> > job on tracking their patients post-treatment. The

> > long-term cure rates they have are better than sugical

> > rates. [The results for their own patients have been

> > published; the comparisons with other treatments haven't

> > come out yet.]

>

> I never know what to make of these kinds of claims. There are

> lots of places that claim cure rates for whatever they do that

> are way higher than national averages. For example, at one time,

> I saw claims that Walsh, the famous s Hopkins

> prostate surgeon, was getting 97% cure rates with his open RP

> procedure. Skeptics believed he was cherry picking his patients,

> taking only the low risk cases.

>

> I saw another study by an HDR brachytherapy clinic that claimed

> over 95% cure rate for HDR. I've also seen reports from people

> on this or other newsgroups that their doctors told them that

> they had 99% cures, or that all of their patients were continent

> and potent.

>

> For me, the gold standard on these kinds of reports is a well

> conducted clinical trial with a peer reviewed publication. And

> even then I add a grain or two of salt.

>

> I have no hesitation in recommending particular doctors or

> clinics. There are good ones and bad ones. But I'm more

> hesitant about recommending particular treatments, at least among

> the well known standard treatments.

>

> Alan

>

[Guest guest]

Alan --

On treatment effectiveness:

I'll e-mail a copy of the group's " own patients " report to you. I'm inclined to

believe the results. Note that the population was composed of " low- and

low-tier intermediate risk " patients. The patients had _only_ brachytherapy,

not brachy + external beam.

Several people treated by that group are in my local PCa support group, and they

are generally happy with the treatment. [Yes, I know -- that would be true for

most patients of most therapies.]

Note that their typical radiation dose (144 Gray) is quite high, compared to

what EBRT supplies.

The paper deals with survival rates, not side-effects.

A " treatment comparison " paper, written by that group, based on previously

published results (_not_ a randomized clinical trial) will be coming out in the

next few months.

On side-effects:

When I said " guess " , I meant " guess " . As for comparing treatments, I agree with

you -- it's tough.

My logic about side-effects is simple-minded:

.. . . In brachytherapy, each seed delivers a dose to its local region, and the

seeds are all located within the prostate. Outside the prostate, the dose falls

off quickly.

.. . . In open-beam therapy (gamma-ray), every beam passes through other body

tissues _before_ it reaches the prostate, dropping energy (and side-effects)

along the way.

What I'd need to really justify my statement (logically, not through clinical

experience) is two radiation-dose diagrams, for the same patient:

.. . . one for brachytherapy;

.. . . one for open-beam therapy

and a comparison of their expected radiation doses _outside_ the prostate, in

surrounding tissues.

That, I don't have.

It would be interesting to compare those dose diagrams to the equivalent dose

diagrams for proton therapy. The Bragg peak is a powerful tool to put radiation

dose where it belongs.

>

> > 1. If you've eliminated brachytherapy as a

> > possibility, _only_ because it may involve catheterization,

> > I think you're being short-sighted. It's an effective

> > therapy, with a reasonably low rate of side-effects.

> > My _guess_ is that it has a better side-effect profile than

> > open-beam radiation therapy, and better cure

> > rates.

>

> ,

>

> Have you seen any published studies to support this? When I

> investigated this six years ago the consensus seemed to be that

> cure rates for brachytherapy and external beam were about the

> same. At that time, if you had an intermediate or high risk

> case, radiation oncologists were recommending that external beam

> always be part of the treatment - either combined with

> brachytherapy or given by itself. The reason was that external

> beam can treat the area around the prostate as well as the

> prostate itself.

>

> > We have a good local brachy group, and they've done a good

> > job on tracking their patients post-treatment. The

> > long-term cure rates they have are better than sugical

> > rates. [The results for their own patients have been

> > published; the comparisons with other treatments haven't

> > come out yet.]

>

> I never know what to make of these kinds of claims. There are

> lots of places that claim cure rates for whatever they do that

> are way higher than national averages. For example, at one time,

> I saw claims that Walsh, the famous s Hopkins

> prostate surgeon, was getting 97% cure rates with his open RP

> procedure. Skeptics believed he was cherry picking his patients,

> taking only the low risk cases.

>

> I saw another study by an HDR brachytherapy clinic that claimed

> over 95% cure rate for HDR. I've also seen reports from people

> on this or other newsgroups that their doctors told them that

> they had 99% cures, or that all of their patients were continent

> and potent.

>

> For me, the gold standard on these kinds of reports is a well

> conducted clinical trial with a peer reviewed publication. And

> even then I add a grain or two of salt.

>

> I have no hesitation in recommending particular doctors or

> clinics. There are good ones and bad ones. But I'm more

> hesitant about recommending particular treatments, at least among

> the well known standard treatments.

>

> Alan

>

[Guest guest]

Sorry for the delay in responding.I have not noticed any change in length. I did notice a reduction in girth during the time I was recovering. I attributed the change to the fact that at times I was not fully erect or, in other words, my penis was not as engorged with blood as it was prior to surgery. That effect is not noticeable now. I am not sure if the original girth has been regained or if I am just used to the new state of "normal". In any event, it is not enough to be a problem.During recovery, I did counter the effect of my observations by trimming pubic hair way back. A significant reduction in the amount of pubic hair gives the optical impression of larger size. I continue to keep it trimmed now. I also have a very flat stomach which I know helps from an optical standpoint as

well. Anyone who has a gut or protuberant belly can make a very noticeable difference in how large their penis looks by reducing the belly fat.

From: Metcalf <bryan.metcalf@ virgin.net>Subject: [ProstateCancerSupp ort] Discussions on open verses roboticTo: ProstateCancerSuppo rtyahoogroups (DOT) comDate: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these days, but here I'll reiterate the group maxim.

Don't jump into treatment before you are informed - make the decision yours in consultation with the ones who count in your life.

Some information comes from experience, others come from research projects, some comes from discussion with medics and fellow patients. At the end of the day it is down to personal choice, what is right for you and yours.

It perhaps doesn't mattter too much who invented what and when. It matters that people know what is looks most attractive for them based on what they have found out.

Terry and other experienced members try to flag up possible contrasts between word of mouth and research. Well worth taking into account.

If we listened to the best stories of any procedure, everyone whould use that one, equally if the worst stories of the same procedure were the only ones about no one would use it.

My take on robotic is that in the right hands it can provide a faster recovery period, with less blood loss and gives an expert a better view of the area to be worked on (as does laproscopic) . I think it takes a special surgeon to operate the kit and just maybe then might have the edge on the open surgery but....

[Guest guest]

Sorry for the delay in responding.I have not noticed any change in length. I did notice a reduction in girth during the time I was recovering. I attributed the change to the fact that at times I was not fully erect or, in other words, my penis was not as engorged with blood as it was prior to surgery. That effect is not noticeable now. I am not sure if the original girth has been regained or if I am just used to the new state of "normal". In any event, it is not enough to be a problem.During recovery, I did counter the effect of my observations by trimming pubic hair way back. A significant reduction in the amount of pubic hair gives the optical impression of larger size. I continue to keep it trimmed now. I also have a very flat stomach which I know helps from an optical standpoint as

well. Anyone who has a gut or protuberant belly can make a very noticeable difference in how large their penis looks by reducing the belly fat.

From: Metcalf <bryan.metcalf@ virgin.net>Subject: [ProstateCancerSupp ort] Discussions on open verses roboticTo: ProstateCancerSuppo rtyahoogroups (DOT) comDate: Wednesday, August 26, 2009, 6:09 AM

It isn't often that I intervene these days, but here I'll reiterate the group maxim.

Don't jump into treatment before you are informed - make the decision yours in consultation with the ones who count in your life.

Some information comes from experience, others come from research projects, some comes from discussion with medics and fellow patients. At the end of the day it is down to personal choice, what is right for you and yours.

It perhaps doesn't mattter too much who invented what and when. It matters that people know what is looks most attractive for them based on what they have found out.

Terry and other experienced members try to flag up possible contrasts between word of mouth and research. Well worth taking into account.

If we listened to the best stories of any procedure, everyone whould use that one, equally if the worst stories of the same procedure were the only ones about no one would use it.

My take on robotic is that in the right hands it can provide a faster recovery period, with less blood loss and gives an expert a better view of the area to be worked on (as does laproscopic) . I think it takes a special surgeon to operate the kit and just maybe then might have the edge on the open surgery but....