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Dr Joseph Smith at Vanderbuilt (What are his stats)

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Posted 7/9/2013 5:30 PM (GMT -5)
Hello,

I am looking at setting up a consultation with Dr. Joseph Smith out of Vanderbuilt for robotic surgery.  Does anyone have any good information and experience with him.  It seems he has done both open and robotic prostectomies but what is his percentage of positive margins historically?

Also what percentage of his patients have major incontinence/impotence issues after robotoc surgery?

Does he have the stats like this?

Also since this is a teaching hospital is he the one behind the console or does he train others and just oversee's the surgery.

What about pathology.  Does the surgeon get a quick pathology report on the removed gland prior to sealing the patient up?  I have heard that some get a quick pathology report while the patient is under and if the margins are clean they will stop there but if any positive margins are found then the surgeon can remove additional tissue or lymph nodes to further diagnose?  Not sure if this process is a common occurance.

Thanks In Advance

Posted 7/9/2013 5:39 PM (GMT -5)
The "on-site" path for me was only the lymph nodes. The prostate would have to be really nasty to show to a visual exam, I would think.
Posted 7/9/2013 5:48 PM (GMT -5)
kdeinv - have you looked through Vanderbilt's website? There are CVs for their docs if you dig into the pages, but I don't think they post stats like that.

I'm being treated at Vandy, and am generally pleased with their services.

Are you anywhere near Nashville?
Posted 7/9/2013 5:57 PM (GMT -5)
I am actually in Atlanta, GA and have been looking at robotic surgeons with great stats (Low positive margins, low impotence and incontinence)

I know Vanderbuilt is the closest teaching hospital to me besides Emory University which I am not sure how specialized they are with prostate cancer. (Vanderbuilt seems like they have more focus in this area of cancer)

Also looking at Dr Tully out of Birmingham, AL which many have commented on.  Their Urology group has performed over 6,000 radical prostectomies.

Thanks

 

Posted 7/9/2013 5:58 PM (GMT -5)
By any chance did you ask the doctor what his stats are?
Posted 7/9/2013 6:03 PM (GMT -5)
No I have not talked with the Dr as of yet.  Would like to get these stats before driving the 4 hours for a consult.  Thought someone that had used him for surgery had already received that info and could share.

Thanks

Posted 7/9/2013 6:14 PM (GMT -5)
kdeinv
I was a patient of Dr Joseph Smith in April 2010. I drove up to Nashville from Huntsville, AL. I had a very positive outcome with Dr. Smith. My incontinence lasted about 4 weeks and have been leak free pad free since then. My ED was also short lived. I was prescribed the vacuum assist device and Cialis. I regained function within 6 months using Cialis. I now do not need any meds although I do pop a Cialis on occasion if I know I am going to get lucky. I suspect that my Cialis use is just an insurance policy for me. As you can see in my signature there was a positive margin at the apex. As I recall from my initial consult with Dr. Smith he was an open RP surgeon for many years and did thousands of open RP. He converted to Da Vinci method and has since done several thousand surgeries. When I was in his office he always had a young intern there with him. Also the morning of my surgery he introduced a young female doctor that was training under him. He assured me that HE would be performing the surgery. I would highly recommend Dr. Joseph Smith.

One last note, I have since moved to Los Angeles, CA and I do my followup PSA testing at City of Hope Cancer Research Hospital.  Should I need any followup treatment it will be with City of Hope. When I saw their prostate cancer specialist he commented that Dr Joseph Smith was one of the very well respected Da Vinci prostatectomy surgeons in the US.  So I consider myself fortunate to have been a patient of Dr. Joseph Smith.

Posted 7/9/2013 7:10 PM (GMT -5)
Those are all excellent questions to ask in your consultation. Unless they have published results in a medical journal, you are unlikely to find them anywhere else (e.g. on the Vanderbilt website)

A quick Pubmed search (www.ncbi.nlm.nih.gov/pubmed/?
term=Smith+JA+Jr%5BAuthor%5D+prostate) shows that Dr. Smith is an author of a large number of papers but few seem to be freely available.

Here is one that provides positive surgical margin rates for the last 200 consecutive robotic and open prostatectomies performed before August 2006 at Vanderbilt: www.ncbi.nlm.nih.gov/pubmed/17936849

....................Robotic.....................open
pT2:.............16 of 171 (9.4%)..... 33 of 137 (24.1%)
pT3:.............14 of 28 (50%).........36 of 60 (60%)
Overall:........15%..........................35%

Robotic results are not so great. open are downright poor. But these are institutional rates, so it is possible Dr. Smith's are significantly better.
Posted 7/9/2013 7:55 PM (GMT -5)
Dr. Smith is very well known in Kentucky.  We have 2 very prominent physicians with prostate cancer that chose Dr. Smith over local surgeons who are also well known prostate cancer surgeons.  I know of 4 patients that have gone to him with remarkable results.  If I would have chosen surgery, it would have been him.

Unfortunately, I do not have any numbers to share.

Thanks

paul

Posted 7/9/2013 8:26 PM (GMT -5)
kdeinv if I were you I'd simply ask (by calling his office) for the doctor's stats for the questions you want answered. I apologize if you've already tried that (I didn't see it in your comment above).

All doctors treating PCa, with any modality, should be able to share their stats with us.
Posted 7/9/2013 10:09 PM (GMT -5)
You could try sending him an email (his email address can be found here: onlinelibrary.wiley.com/doi/10.1002/cncr.21352/pdf) stating that you are interested in potentially coming from Atlanta for a consult, briefly explaining your particulars and asking what expectations a patient with your stats could have in his hands for likelihood of PSM, continence and potency.
Posted 7/10/2013 6:57 AM (GMT -5)
Thanks for the info.  I just set him an email asking those questions.

 

Posted 7/10/2013 7:40 AM (GMT -5)
kdeinv,

Have you also done your research on non-surgical treatments? I am in Atlanta and we have world class clinics for brachytherapy, both permanent seeds and High Dose Rate. I used HDR brachytherapy and have done great.

My surgeon wouldn't operate on me so I didn't research surgeons in the area.

Jack
Posted 7/10/2013 10:22 AM (GMT -5)
Hello

I was going to meet with Radiological Clinics of GA and get their opinion as well.  I am one that really wants the organ out of my body so that a detailed pathological assessment can be made.  (PSA should be zero if contained in the prostate and it is removed)

I am just concerned with fallback treatments.  (If radiation fails then Salvage Surgery is an option but not very effective). 

So I would be concerned that not all the cancer was radiated.

I guess it is personal choice as all treatments have side effects.

Thanks 

 

Posted 7/10/2013 10:41 AM (GMT -5)
Recent studies have shown radiation to be as or more effective than surgery for cancer control and with less significant side effects. It would help if you can add your age, PSA, Gleason and biopsy info so we can better comment.

I met with Dr Critz (RCOG-Prostrcision) but ended up using HDR brachytherapy which does not leave the radiation in the body. There are two great clinics in Atlanta for HDR and I would be happy to give you details of my research and treatment for your consideration.

Jack
Posted 7/10/2013 2:11 PM (GMT -5)
Yes, if you have any Dr's in Atlanta I could consult with.

I have read mostly about Urologists and Surgery. Have not really had any discussion with anyone on Radiation therapy.

Thanks
Posted 7/10/2013 2:33 PM (GMT -5)
Hey kdeinv - you're absolutely spot on with wanting to know the specific practitioner's statistics, as it's not only about quantity of treatments done, it also has to be about quality. As a brother of mine out here on HW once wrote, "I've been golfing a couple times a week for 45 years, and I still suck at it!"

IMHO all practitioners should be keeping these statistics, and if they don't have them that would throw up a red flag to me. While nothing of course is guaranteed, it is without a doubt helpful to know their results. Be sure to have them qualify their results as well - for example "continent" to you and I would include NO issues, but to others it could mean "only one pad per day or when straining" - same with ED, "potent" to us is fully able without outside stimulus - others may consider potent to be with chemical or other assists.

Keep on keepin' on - you're doing great!
Posted 7/10/2013 2:44 PM (GMT -5)
Hi Kdienv. You have already received some specifics re your question and I can't add to that. However, I will simply reinforce the comments from JNF re exploration of non-surgical treatments. Even though you are pre-disposed towards surgery, if you want to really educate yourself and do your due diligence you should explore the other options. That means reading, not only Walsh's 'Guide..." but also Scholz' "Invasion of the Prostate Snatchers." Between the two books you should have a broad perspective. Also, take the time to meet with an experienced brachytherapist or two -- perhaps both HDR and LDR. If your PCa is organ contained, either of those choices are as effective as surgery with generally less onerous SE's.

I'm not really trying to influence your decision one way or another but just encouraging you to do your homework before rushing into a decision.

Jim
Posted 7/10/2013 3:38 PM (GMT -5)
kdeinv I'd like to echo everyone else and suggest you do yourself a favor and explore all treatments before deciding on one.
Posted 7/10/2013 5:14 PM (GMT -5)
Well Dr Smith from Vanderbilt replied: (Robotic Surgery)

He said: 2% of his patients have enough incontinence to warrant additional surgery, while up to 10% use at least a security pad. (I guess 90% are continent)

For T2 tumors - His positive margin rate is less than 5%.

For my age and geason of 6 he said 90% of his patients do not have erectile disfunction with or without medicine.

He has performed over 4,000 robotic prostatectomies and almost 2500 open procedures.

I would say he has very good stats.  He did state that different hospitals and/or surgeons may report their finding differently so it is hard to get an apples to apples comparison.  He simply said pick a hospital and surgeon in whom I have confidence.

 

Posted 7/10/2013 5:26 PM (GMT -5)
If anyone can recommend a very good radiation doctor in the Atlanta area (Brachytherapy) I would be interested in a consult visit as well.

Thanks

Posted 7/10/2013 8:54 PM (GMT -5)
It's good that you got a prompt and forthcoming response from Dr. Smith and I agree you should pick a hospital and surgeon in whom you have confidence. He certainly is highly experienced.

Assuming his PSM rate of 5% is for stage pT2 it's pretty good, but is not world class. There probably is significant variation in how some hospitals and surgeons measure, but its hard to say who is being helped or hurt (i.e. could the 5% really be 2% or really be 8%?). In the absence of other information, if you assume all is equal, you could potentially cut it that rate by a factor of 2-3 times going elsewhere (e.g. Hopkins, Cornell).

On the other hand if his 5% PSM rate is for clinical stage T2 patients (i.e. stage cT2, most of which will be pT2 but some of which end up being pT3+), then it is an excellent rate.

I'm not sure about the continence. How good that is depends on how many of the 10% who use a security pad don't really need it. For comparison, the Hopkins results are 98% dry at 1 year with "dry" being defined as possibly wearing a security pad but the pad actually stays dry.
Posted 7/15/2013 8:09 AM (GMT -5)
kdeinv,

I was treated in Atlanta and used a combination of HDR Brachytherapy, IMRT and Hormone based therapy (Casodex, Lupron/Eligard, and Jalyn).   I was too far advanced for surgery.   Here is some information regarding my docs and others I considered.

My uro is Dr Lewis Kriteman at GA Urology.   They are a very large group that includes prostate specialists, surgeons, and oncologists.   Kriteman does open surgery and can refer to robotic specialists and he also specializes in HDR Brachytherapy.   My rad onc is Dr Craig Wilkinson at Atlanta Oncology Center.   He and Kriteman work together performing HDR Brachytherapy which they specialize.  Another rad onc with Wilkinson that performs HDR Brachytherapy is Dr Marc McCord.   Wilkinson also directed my IMRT treatment.   My medical oncologist is Dr Thomas Seay at Atlanta Cancer Care.   He works mainly with hormonal cancers (breast and prostate) and is my wife's oncologist for her breast cancer.

I also looked at Radiation Center of Georgia.   Their prostate treatment is called Prostrcision.   Their founder, Dr Frank Critz, pioneered the use of seeds and IMRT concurrently.   I decided I liked HDR better for several reasons, but was comfortable with RCOG.   My wife used them for her breast cancer radiation.   I also have a friend that was treated at the Prostate Cancer Center at St Joseph's Hospital.   He had HDR Brachytherapy and was very pleased.

Let me know if I can provide more specifics regarding my treatments and doctors. 

Jack

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