Thoughts on Selecting a Prostate Cancer Surgeon

Prostate cancer has been confirmed with a biopsy, and you have eliminated active surveillance, radiation and other treatment options. You?re now planning to have surgery?but who should you pick? This is the most common situation that I deal with day to day, helping newly diagnosed prostate cancer patients and their families.

The bad news?

• ?We are now faced with cancer, and want the most successful treatment, with the least amount of side effects.?
• With surgery, we are dealing with ?prime real estate,? and the possible side effects concern vital functions, namely going to the bathroom & having sex.

The good news?

• Prostate cancer is not a rare, mysterious disease that would effectively require seeing a renowned expert at a large, distant academic university hospital. Prostate cancer is so common that there are plenty of local experts who can offer the latest technology and have many patients that have successfully been through prostate surgery.
• We find prostate cancer so early, with prostate-specific antigen (PSA) blood test ?& digital rectal exam (DRE) screenings, that our goal in treatment is curative. Most men will not die of prostate cancer, but at least we can eliminate this risk factor with treatment, once found.
• ?Let?s just get rid of this cancer, so we can just get on with our lives.?

?My advice?

I usually advise patients to approach selecting a surgeon, just like hiring a contractor to work on a project for you. You are basically hiring this person to work for you (the project = taking out your prostate!), and follow up with you (usually at least for five years after surgery). So, it is important to consider all the pros and cons, during your ?interviews? or consultations with these surgeons.

Of course, there are clinical aspects to consider (and please see links below for some common questions to ask your doctor):

• Physician?s experience / expertise, as well as of his team (usually includes at least one assistant surgeon, plus a physician?s assistant and/or advanced practice nurse)
• Hospital?s experience with prostate surgery
• Side effects
• Clinical outcomes / success rates

I think the non-clinical aspects are just as important to consider:

• How easy is it to contact the surgeon with questions/concerns? (email option? phone?)
• How clearly are things explained? Is it easy to ask questions at the visit?
• Are there patients willing to share their experience of surgery and recovery with the surgeon, and are they available to help you learn more?
• Do you have a good rapport with the surgeon? Good gut-level feeling?

Statistics

There are plenty of studies out there, covering everything from success rates after surgery, to the various rates of side effects in urinary and erectile function, and it can be very easy to get lost in these numbers (e.g. ?analysis paralysis?).

Statistics can help with big picture issues, but unless the statistic is 0% or 100%, I would not hinge any important decision upon a few statistics alone. The difference between 30% and 90% is inherently significant, but if I?m presented with options that are 89%, 93%, and 95% successful ? all three are viable options.

Making a decision involves looking at all aspects, perhaps using a decision making tool or checklist (see example in PAMF Prostate Cancer Notebook (Chapters 3-4 on decision making) to make sure that you have addressed all the aspects of making such an important decision as selecting a surgeon for your prostate cancer.

Often men meet with more than one physician. Whether it is two physicians or five physicians, once they start hearing the same things again in the answers, I usually tell them they have effectively hit ?data saturation,? and they are probably ready to make that final decision.

Hindsight

Judging from the feedback I?ve received from patients after surgery, the men that are most satisfied with their selection (regardless of the outcome) are those who were very thorough in their consideration of all the options and possibilities. They avoided the dreaded ?woulda, coulda, shoulda? phenomenon! They realized that the priority was getting the cancer out, and any side effects that result can be managed as best as possible with their surgeon.

In the words of one of?my former patients, ?the most important ?side effect? is that you get to live??

Perspective is a good thing.

?Learn more about prostate cancer decisionmaking online:

Prostate Cancer Foundation: Questions to Ask the Doctor

Cancer.net (American Society of Clinial Oncologists): Questions to Ask the Doctor

PAMF Prostate Cancer Notebook (see Chapters 3-4 on decisionmaking)

PAMF Prostate Cancer Survivor Videos

Frank delaRama R.N., M.S., AOCNS, is an Oncology Clinical Nurse Specialist at the Palo Alto Medical Foundation and is a prostate cancer nurse navigator ? a role he created at PAMF in 2004.???Frank was also?instrumental in creating PAMF?s Prostate Cancer Buddy Program. He? is the chair?of PAMF?s??Cancer Patient Advisory Council, and has helped many men and their families along the cancer care journey, from diagnosis, through treatment, and into survivorship.

Source: http://www.pamfblog.org/2011/07/prostatecancersurgery/

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