Yes, statistically speaking, an experienced surgeon is an important
consideration. However, there are several centers of excellence in the
country. I chose UCLA in California based on their experience and
reputation. A lot of people, however, are very restricted in their
choices due to HMOs or other health insurance limitations.

JohnG
Many patients require procedures after the original operation. I didn't
want  to have to travel if there were post op problems. Plus, there is
more to me than my prostate, and I know who the good doctors are here.
Staying local with Dr.Joseph Wagner at Hartford Hospital in Connecticut
worked well for me. He does Lap RP using the DaVinci Robotic
system.Among the things that impressed me about Dr.Wagner were:
1.)He has kept a database of survey results about how all his patients
have done. Every visit includes a written survey about relevant quality
of life issues.
2.)At the initial consultation he gives out a list of patients who said
they are willing to talk about their experience. Any patient who is
willing is eligable. He doesn't limit it to guys with good results. I
called about 15 guys. They all liked him, and said they would chose him
again. Now I'm on the list. I'm a year months post op, and very
pleased with my results and with him.
3.) Relatively large series of cases using DaVinci. He was a pioneer
starting this technology at Beth Isreal in NYC.
Steve U

   I may be flamed for this post, but here goes.  Most men who have RP's
have successful surgery.  Most men have their surgery done at hospitals
other than Johns Hopkins and famous hospitals like it.  There are many, many
excellent urological surgeons out there who don't write books, who don't get
quoted in the papers, who don't operate on celebrities.  They practise in
big cities and in smaller communities.  They quietly and competently perform
successful surgeries on large numbers of men with prostate cancer.  They are
out there, and most PCa sufferers are operated on by them. If you do your
research on urologists available to you, you can find such a competent
surgeon, and your result will be as good (or as bad) as it would be at Johns
Hopkins.
   I live in a town of 12,000 people 30 miles from two large teaching
hospitals in Rochester, NY.  The main urological surgeon in our town is a
man who has a reputation as being an excellent urological surgeon (He is
humorless and doesnt have much of a bedside manner, but I don't care about
that.).  He was on the faculty of a large teaching hospital in Chicago, but
left it to take up a surgical practise in our town where, as he puts it
(totally in character), "I didnt have to clean up residents' mistakes."  In
20 years of surgery, he has done over 500 RPs, most of these in the more
recent years.  He loves surgery, studies it, and keeps up to date on
procedures.  He practises nerve-sparing surgery, and 3 years ago went to the
Cleveland Clinic to learn  the laproscopic procedure.  I spoke personally
with 5 patients of his, all of whom spoke glowingly about their surgical
results.
   I did my research on him and felt comfortable with him being my surgeon.
I decided that there was also a great advantage in being treated in our
local hospital, 10 minutes away by car.  So I didnt even go the 25 miles to
one of our two big teaching hospitals in Rochester.  I stayed here and had
him do the surgery.  That was on May 1, 2002 when I was 64 years old.
   What have been the results?  Unfortunately I did not have clear margins
and my post-surgery Gleason went up to a 3+4 from a 3+3 presugery.  He could
only spare one nerve. But all other results have been excellent.  My PSA is
still undetectable (I am also superstitious and hoping I didnt jinx myself
by saying all this---my next PSA is end of April and I get as nervous as the
rest of you.)  I was continent within 48 hours.  Erections were back in 6
months---OK, but better with 25 mg of Viagra.  I can't say what long range
results will be, but the shorter range ones are very good, and I'm very
pleased with my decision to have him do the surgery *here*.
   This is a long and rambling way of saying that there are lots of good
surgeons and hospitals all over the country.  *If* you do your research, ask
the proper questions, and talk with former surgical patients,  chances are
you can find a good surgeon and hospital near you.  You don't have to go to
Johns Hopkins.

Yeah, I thought about all that. But I figured hassle counts, too, and I'm
just 3 freeway hours from an excellent university teaching hospital which
does prostate surgery (and RT) every day, but 2,000 miles from J-H/W. I
figure the difference between -- say -- one surgeon's 68% and another's 70%
track record is not worth tearing out much hair over. Even here, I could
have chosen the author of "PC for Dummies" as my surgeon, but it turns out
that the whole staff wrote the book, my surgeon teaches other surgeons how
to do RPs and does hundreds himself, he promised he'd be doing all my actual
RP work once my abs are opened up, it's all free, Seattle has some great
food, and I'll be going back to the docs many times over the next 5 (30?)
years, so what the hell? The big factor was the 68 vs 70 % business (those
numbers came out of a hat, but you get the idea); we're talking decimal
points here, and my doc is very sharp, takes hours to talk with me face to
face and over the phone, discusses my case every week with a the whole
oncology staff, trained at Sloan-Kettering, plans and authors many clinical
trials, follows the research, came highly recommended by other urologists,
etc. Ya gotta look at the whole picture, topped off by confidence in the
surgeon.

I.P.

Hi, John.

I took the words of a trusted friend, my gen prac doc.  The same man
that helped me to give up smoking (after more than 40 years [4 packs
per day]).  He is the same doc that gave me a physical once a year for
the past 25, and he is the person who found my tumor (through DRE).
He recommended a doctor and his partner that were practicing the nerve
saving technique (this was nine years ago!), and it was at a local
hospital in Concord, MA (Emerson).  

Life is full of choices and chances.  There are many doctors out there
that are doing first rate jobs with PCA and they don't all practice in
Chicago and Baltimore.  What is "the best?"  My doc, Stephen Schloss,
cured me and I have only minimal after effects from the surgery.  As
far as I am concerned, *Schloss* is the best doctor out there!  I had
a Gleason of 5 + 4 (the same as Bill Bixby who died two years before
my RRP) and  a PCA of 3.4.  The tumor was termed "lethally
aggressive", so I think old Steve did a bang-up job.     d;o)

Dave

hi john - there are stats that show that big hospitals have lower rates
of complications due to the high volume of RP's done.  that is a plus.

but i think the bottom line is this.  i'm happy with my choice of
surgeon and that really the bottom line.  is the surgeon capable of
providing you with the desired outcome you are seeking.

i'll use my wife as an example.  she had a heart attack and open heart
with three major blockages left.   they said this one heart doctor was
good and he ended up giving her the second heart attack in a failed
attempt angioplasty.  

now, we get the word three months later, that they want to do it again.
how's that make you feel?  only this time, it's a different guy that is
suppose to do all the complicated cases.  so, we go through it and it
was successful.  ok, now, something happen a year later and she needs to
have another stent put in right where that one was.  used same doctor
and no problems.

it is now another year later and symptoms are popping up that are heart
related and after a week of extensive tests, they find that the one
stent has body trash in it.  only this time, they use a different doctor
we never heard of.  he goes into the same artery and does a bang up job.
so, what am i saying?

there are a lot of surgeons who know what they are doing.  it is up to
you to interview them and decide which one you feel comfortable with and
then have it done.  after all, you've done all the work and the day that
the operation is done, you have the least worry of all because you've
done the best that you could.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

There are about 200,000 cases of prostate cancer diagnosed every year in
the US.  Not all of these are treated with RRP, but a sizeable number
are.  Clearly one medical center can't even come close to treating all
of them or even a substantial fraction.

When I had my RP,  my Medicare HMO would not have paid me to travel out
of state.  In fact, I was largely limited to local physicians who were
associated with the HMO.  Fortunately, my area is well supplied with
highly qualified physicians and the urologist I was referred to turned
out to be one of the better ones in the area.   In principle,  I could
have paid for the surgery myself and tried to have it done at Hopkins
or, more likely, in St. Louis, where Dr. Catalona was as the time.  But
aside from the large dent it would have made in our savings,  I wasn't
too enthusiastic about having the surgery done far from home and then
travelling back and having some other urologist deal with post surgical
care and any possible complications.  I realized that my chances for
potency would be higher with a more skilled surgeon, but not by an
enormous age.  At age 67,  I had a substantial risk of being impotent no
matter who did the surgery.  And, I figured impotence could if necessary
be treated.  It turned out that I was impotent for 18 months and used a
pump with reasonable success.   Since then erections have returned, so I
guess I lucked out.  I am still PSA free after almost five years, and I
am quite content with the choice I made.

Since I had my surgery, I've changed my insurance arrangement.  Humana
withdrew from my area, and although they were okay when I was in their
plan,  I won't be lured into joining a Medicare HMO again.  My insurance
options are better, but although Dr. Catalona has since moved to the
Northwestern Medical School, and I am a retired Northewstern faculty
member,  his medical group doesn't presently accept patients insured by
any of the Northwestern plans.  so even today, I would have to pay for
it myself to be treated by Dr. Catalona.

Walsh and others like him have trained many urologists. And by now,
nerve sparing surgery is pretty well understood There are many highly
qualified surgeons out there today, particularly at major medical
centers.   Your chances with one of those would be very good.
Unfortunately, there are still quite a few who don't do nerve sparing
surgery or who do only a few each year and are not up to par.  but if
you do some research about  potential surgeons' qualifications and you
question them about their track records, you ought to be able to find a
good surgeon closer to home.

If you're in the Mpls/StPaul Mn area I can give you a couple of names.  
One of them is my own surgeon.

Dale j.