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Evaluating Surgeons/Radiation Oncologists

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Posted 5/9/2021 7:20 AM (GMT -5)
The questions about evaluating surgeons seems to appear here regularly. I was dx. in 12/2009 and I had to choose my form of tx. with a biopsy result of G4+3. I did my due diligence. Epstein confirmed my dx. and I met with surgeons and RO folks. I weighed my choices and ultimately chose surgery. In those days, surgery was the "gold standard." In my particular case, I had BPH real bad (very close to ER visits on at least 2 occasions). Surgery offered me a BPH cure and it did do that!

But, on to my topic. I found it very easy to evaluate surgeons. Generally, their websites (or their offices) had specific information in terms of number of surgeries, complications/SEs, etc. I was able to quantify matters. I ended up choosing Mani Menon at Ford Hospital, 110 miles away. When I visited Ford in the inquiry stage they had quite a presentation and I got to meet with him and his team. My research showed that he offered the supra pubic catheter (much more tolerable than the Foley). Also, in my research on a few other surgeons, it said in glowing terms "studied under Mani Menon." I figured I might as well get the teacher, especially since he wasn't that far away (Ford had cut-rate apartments for use by patients through the pathology report/catheter removal).

Unfortunately, I was unable to get that kind of information from ROs. Now, this was in 2009. While there were many additional reasons why I picked surgery, I know the lack of getting data certainly figured in my decision. I guess my question is this: has anything changed in the last 12 years in terms of data availability? One would expect that surgeons and ROs would have data readily available to the same degree. That was not the case in 2009. But with radiation becoming just as mainstream as surgery (isn't that the case?), what about the aforementioned information?

Mel
Posted 5/9/2021 11:22 AM (GMT -5)
Mel,

I don't know if there is a listing such as you're seeking. Periodically, various articles will be published about the "best doctors in Michigan", for example...but do they really mean anything?

It's unfortunate, but true.
Posted 5/9/2021 11:24 AM (GMT -5)
Both ROs that I consulted with showed extensive treatment reports in terms of the years of experience, treatment volume and results. One has publicly published results for more than 30 years and was the first RO to report treatment results following men for 15 years.

However, it is completely up to the surgeon or RO to report about the practice and there is little people can do to verify except for looking at the publicly available information. For instance, if the doc is board certified you can find when certification began and match that with the doctors reported experience. If there is a mismatch, then you may not be getting good information from the doc or clinic.
Posted 5/9/2021 3:03 PM (GMT -5)
Mel,
I would look for a RO who specializes in treating PCa. I think you’re more likely to find that at one of the centers for excellence. At our small regional hospital the RO’s treated most everything without specializing. Clearly more convenient; but, since I had only five fractions the travel was not as important as seeking out one of the best practitioners. Terry
Posted 5/9/2021 3:23 PM (GMT -5)
Mel, you are close to one of the most renowned PCa radiation oncologist, Dr. Alvaro Martinez at Beaumont in the Detroit area. He is one of the HDR brachytherapy pioneers having developed the mono-therapy methods and on a pure outpatient basis. Now most all HDR specialists follow his protocols. He also uses external beam. His primary area of practice is PCa work for both initial and salvage treatment. He is highly regarded and has authored hundreds of research and treatment studies and papers.
Posted 5/9/2021 11:55 PM (GMT -5)
I'm skeptical of doctor-reported success rates. It has been three years since I finished my radiation treatment and I have had no contact with my RO since then. If I have a recurrence, I won't see the RO about it so he might never know my cancer came back. Surgeons might keep better track of their patients, but they might not. My surgery failed, but I had no need to tell the surgeon about it since he's in NYC and I'm in Virginia. I discussed my recurrence with my local urologist and the surgeon may know nothing about it. There's another problem with selection of patients. Imagine an unethical urologist who diagnoses a lot of non-dangerous 3+3 prostate cancer and persuades his his patients to have surgery to "get it out." Such a surgeon could have the best success rate in the world.
Posted 5/10/2021 6:06 AM (GMT -5)
fiddlecanoe, exactly. There is one notable PC surgeon who proudly says he does as many as 6-10 RALPS a day, with an astounding success rate. He literally goes from OR to OR and 'removes the prostate' where his staff has done 99% of the operation, and he definitely screens for low risk patients.

There are overall efficacy stats for different treatments--but they don't include information about the location (Mayo? MDA?), and especially not about individual practitioners.
Posted 5/10/2021 6:13 AM (GMT -5)
Good points Fiddle. Your last point sounds somewhat like a very famous surgeon whose institute touted their surgical success rate. When I asked my uro about him I was told that the famous surgeon would not operate on a high risk man as it would hurt his success rate. Without G6 surgery I doubt there would be so many very successful high volume PCa surgeons so gifted at curing cancer.

Many practitioners track their patients and then in different ways report results to prospective patients. Some publish the results using appropriate scientific methodology. Two radiation oncologists I have mentioned have done so. Both are brachytherapy specialists. One, Dr Frank Critz, pioneered the combination of concurrent seed brachytherapy and EBRT. He published reports starting in the 1980’s comparing his process to the reports of surgery coming from John’s Hopkins, MSKCC, and others. Dr. Critz has retired and the clinic purchased by a hospital and continues to be a leader in PCa treatment under the trade name Prostrcision. The other is Dr. Jefferey Demanes, the HDR brachytherapy pioneer. He published results as long as 15 years and posts on his website. He has retired and no longer updates the information in that form. Dr. Martinez in Detroit, Datillo in Tampa and many others have published their results. Many top surgeons like Samadi in New York do so. And oncologists like Snuffy Meyers reported treatment experience in videos, papers and even books.

In my situation, my RO saw me at least yearly to track my experience. After the five year mark I no longer meet with them but can continue to report to them regarding side effects. While they don’t formally publish the results the clinic uses the information to help new patients understand the expected long term effects regarding cancer control and side effects based on their actual experience. This also guides them with internal quality control. My urologist practice does this as well. Both are very metric based and use the information in a variety of ways, but they don’t formally publish the information.
Posted 5/10/2021 7:07 AM (GMT -5)
Most likely centers of excellence and those associated with a university may do a better job with tracking and documentation. I meet virtually with the team at Cleveland Clinic every six months and review my PSA. Each meeting starts off with the same questionnaire regarding uninary and sexual function as well as any changes in medical treatments and medications. I’m sure they track.
Posted 5/10/2021 5:29 PM (GMT -5)
My surgeon is probably the same one you guys are talking about. In my case, at least, he was not screening for low risk. I was a pretty high risk 4+3 with PNI and lots of positive cores. But I doubt he includes me in his stats.
Posted 5/11/2021 8:50 AM (GMT -5)
I call/email/text medical professionals for recommendations. That has worked well so far (knock on wood here). Then I interview carefully. Nurses know who has the skills and patience. Anesthesiologists know. Doctors in related fields know.

Example - recently had cardiac cath w/ stents. When I asked the (clearly competent) cardiac nurse practitioner about a cardiologist she recommended the one she'd sent her father-in-law to. Bingo!

My previous PCP recommended a "rock-star" urologist for my prostatectomy. His communication skills were impressive, but when I understood how many procedures he scheduled and that he had music on a headset while operating the Da Vinci I knew he wasn't for me.

I think it's very like finding a good plumber or electrician.

Wilderness
Posted 5/11/2021 9:59 AM (GMT -5)
I will always remember a conversation I had in my pre-surgery workup. I went to the hospital for an appointment with the anesthesia NP, where they went through my anesthesia history, allergies, and so on. The NP said, "I see you're having Dr. Figenshau for your RALP. He's the best. If my husband needed it done, he's the one I'd want to have do it."
Posted 5/11/2021 9:25 PM (GMT -5)
For my hernia surgery last Dec, my doctor referred me to a surgeon. He said he really liked this surgeon and would send his family to him if they ever needed general surgery. He was very solid and did a great job. It doesn’t take much sometimes to help make a choice.

Only problem I have had with some recommendations and referrals are the doctors are in such high demand that they are out months for appointments which can make it hard to take care of a problem that requires prompt attention, at least in your mind.
Posted 5/12/2021 6:42 AM (GMT -5)

halbert said...
I will always remember a conversation I had in my pre-surgery workup. I went to the hospital for an appointment with the anesthesia NP, where they went through my anesthesia history, allergies, and so on. The NP said, "I see you're having Dr. Figenshau for your RALP. He's the best. If my husband needed it done, he's the one I'd want to have do it."

Hal, my anesthesia NP , whom i met with about an hour before surgery, told me the same thing. I think they learn that in school LOL.
Posted 5/12/2021 7:20 AM (GMT -5)
A factor not mentioned so far is the role of the physicists in radiation therapy. At least when I had my IGRT done at Vanderbilt, they had three physicists on staff to design the actual radiation plans. They work with the x-ray machine's software, and the MRI and CT scans of a patient's physiology, to develop the treatment field. I got a copy of my actual treatment plan, a color map of the dosage plan.

We never meet the physicist, don't know their name, know nothing of their background other than it was good enough for the cancer center to have hired them! The RO will decide the photon energy level, dose schedule, what margins there should be, what areas should be treated, which are all quite important considerations. But the unsung hero in this scenario is the physicist who programs the x-ray machine to actually, accurately, precisely, deliver the intended level of radiation while minimizing injury to surrounding tissue.

I suppose that's a recommendation to have high-dose radiation therapy done at a center with significant experience and history. You'd look at facility success rates somehow, and I'm not sure where that could be found. It wouldn't be for a specific RO necessarily, but the overall success of the facility.
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