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What should a man having a prostatectomy look for in their surgeon?
For me, I think establishing a good patient relationship is extremely important. As a
patient, you need to feel comfortable with your surgeon. You need to understand the disease
that you have, the surgeon should have gone through the disease that you have. So, you
understand the extent of the disease, the Gleason score, the aggressiveness of the tumor
and so on and so forth. You have to feel comfortable with your surgeon and I also think it is important
that you ask the surgeon what their experience is with a given surgical technique. Clearly
from the literature, the more surgery that a surgeon has done, the better he is at performing
that surgery. So, when you look at a surgeon that has done 50 prostatectomies and compare
to a surgeon that has done 800 prostatectomies, one would find that the surgeon that has done
more surgery probably will have better outcomes. Now that is not to say that one needs to have
800 or 1000 prostatectomies to be a competent surgeon. Actually in the literature, it takes
about 20 procedures based on what has been written to be competent with this operation.
But I really believe when you look at the robotic surgeons around the country, the more
experience they have, the better the outcomes they are. So, the surgeons that have done
the most cases will have the best outcomes. So, you need to ask the number of cases that
they have done and you need to ask them their specific outcomes, how many of those patients
are cured with surgery alone, what is the positive margin rate, in other word when the
surgeon does the procedure, does the disease, is the disease contained within the prostate
and will they require additional therapy such as radiation therapy or hormonal therapy.
You should ask your surgeon what their continence numbers are. Knowing how many pads and what
the average length of pad use is extremely important and looking at the quality of life
after surgical intervention. And then for many men, potency is an extremely important
issue and you should ask the surgeon what the potency numbers are. Those numbers with
the continence numbers, with the cure numbers are all important numbers that you as a patient
need to know when choosing a surgeon, but most importantly you have to have the trust
and feel comfortable with your surgeon. You may find the terrific surgeon, but if you
don't trust him, you are not going to have a good outcome.
Some prostate cancers are high risk, aggressive, and more likely to spread. Others are low
risk, least likely to have bad outcomes. The biopsy says cancer, but current diagnostic
tools provide limited information about how aggressive a man's individual disease is,
so most men decide to treat prostate cancer immediately. Once treated, many men experience
serious long-term side effects like incontinence and *** impotence. Immediate treatment
is not always needed, but right now a man can't be sure if his cancer is the kind that
is likely to require treatment or if he is okay to wait for now. What if there was a
test that could determine how aggressive prostate cancer is. Genomic health is developing a
new test to do just that. By reviewing the underlying biology of the tumor and using
genes from multiple biologic pathways, the test can predict the aggressiveness of prostate
cancer when diagnosed, allowing a man to make a more informed treatment decision with confidence,
taking care of himself with more information and greater peace of mind.