First off - do you have medical insurance?  If so, then your actual out of
pocket should be reasonable.  If not, then it's going to cost a lot no
matter where you have the surgery done.  Second - FYI - I was fortunate
enough to have Dr. Scardino perform my surgery.  My brother, 5 years older
than me, was diagnosed with PCa right after I was diagnosed.  We both live
in NJ, Sloane is only a 45 minute ride from my home - so it seemed to be a
reasonable option for me.  My brother chose NOT to go to Sloane for
treatment - he went to Morristown Memorial.  Guess what?  His surgery &
hospital stay was charged out at exactly the rate same as mine.  The
insurance companies have made arrangements with the various medical centers
around the country and seem to have set consistent rates across the board.
Don't want to travel?  Fine - I'm am sure that there are many good doctors
near where you live - just find one that has had a lot of experience with
the procedure your husband is going for.  You may want to check with the
Prostate Cancer Foundation to get recommendations for docs local to you.  Do
what is best for you & your husband.  BTW - although my brother & I had
different surgeons and different post-operative treatment -we're both doing
fine.  I just felt more comfortable going to Sloane - it was the right
choice for me.

Best of luck to the both you,
Sandy K.

You don't have to bankrupt yourself by travelling to New York or
Baltimore to be treated.   Perhaps if you would tell us what kind of
insurance or resources you have available, and what doctors are
available to you,  we could give you more explicit advice.  You can also
check out local doctors' qualifications.  Look them up on the web and
see where they did their training.  Also ask them about their experience
in the relevant procedure and what sorts of results they have, including
side effect, for a case like your husband's.    There are lots of
retirees in Arizona, so there certainly is a market for doctors treating
prostate cancer.   I would be very surprised if there weren't several
urologists trained at major medical centers under the stars you can't
afford.  At one point, it was possible to call Dr. Walsh's office and
ask for a referral to a local doctor they know.  Sloan Kettering may
also provide a similar service.

When I was diagnosed with prostate cancer, I was covered by a Humana
HMO, and unless I wanted to pay for it myself, I was restricted to local
physicians.  Fortunately,  I was in an area well supplied with good
doctors, and at the time Humana included some of them in its network.  I
just went to the doctor recommended by my primary care physician.  I
checked where he was trained and questioned him about his experience.
I was satisfied that he would do about as good a job curing my cancer as
anyone else.  I was convinced that with him doing the surgery, the
chances of permanent incontinence were too small to be concerned about.
  Impotence was another matter.  He told me that, given my age, the
chances of not being permenently impotent were about 50 percent.   Had I
arranged to have Patrick Walsh of some other star doi the surgery (at my
own expense), I estimated that I might increase the likelihood to
perhaps 60 percent.   Given all the undertainties, it didn't seem worth
the effort.  I understood that I might be impotent, but that it also
could be treated.  So I stuck with him.  As things turned out, I was
impotent for 18 months, during which time I used a pump with
satisfactory results, and I regained erections, albeit not up to what I
had before surgery, after that.

At the same time, a friend who lived in California, was diagnosed with a
case similar to mine is several ways and different in others.  the
surgeons avilable to him through Kaiser, his health plan,  wern't at all
optimistic about doing nerve sparing surgery.   At our age aat the time,
67, the choice between radiation and surgery is close.  It turned out
that he has access through his inurance plan to a very good radiation
oncologist, so he chose radiation.  He seems to be doing pretty well also.

Hello Juniper,
   I am sorry for your problems with financing RP.  Does your work, or
husbands work provide insurance?
   I have Blue Cross Insurance and I am self employed.  It is very
expensive.  I just figured it cost about 11,800 per year, with part pay,
etc.......and is going up.
   So, I imagine you do not have insurance and that is why you have a
problem financing RP.
   I was diagnosed in 1999.  I was 49 then.  Scared yes, seeing a local Dr.
yes.  He was a Urologist.  That Dr. frightened the heck out of me and was
already set to have external beam radiation at a local hospital.  I started
reading and found this news group.  I decided to go to "The Big City"  San
Francisco..I went to see 2 prostate cancer specialists.....I ended up @
Stanford Hospital with Dr. James D. Brooks.  He is a wonderful Dr. and said
he would help me out.  They did take my insurance and see that may be where
you are having problems.  So, I can ask my Dr. James D. Brooks if he knows
of a goo RP surgeon in Arizona.  He may know one close by or within driving
time.  Did you look up prostate cancer specialist....Arizona? on the
internet?  The hospital stay is 2 days, the surgery is for 3 or so hours.
You drive home in 2 days.  You may be able to work out a payment schedule
with a Dr. you choose also.  I hope I have helped a bit.
If you want to ask any questions feel free.
Wish You the Best John Loomis

Laurel,

I had my RP done by Dr. Lipson in Canandaigua, NY.  Never heard of him?
That's the point.  He is an excellent urological surgeon, half of a two doc
practise, who has done a large number of RP's with excellent results.  I was
continent within 48 hours and, despite losing one of my nerves, have
erectile function.  I personally spoke with a number of his RP patients and
all but one were continent and functioning (some with the help of Viagra) in
the other way.  The point of this is that there are *lots* of excellent
urological surgeons all over the country, not associated with Johns Hopkins.
Experience in the procedure is the key.  And if you have one of the locals
do it, rather than one of the big names, he (or she) will likely be the one
wielding the knife, not a resident.  I also liked having the surgery done in
our local hospital, a 10 minute drive from my home.  Though my margins were
not clear, I am presently almost 4 years past the surgery and still with
undetectable PSA's.  Your right--This you *gotta* have a big name is
bullshit.   Claude

"juniper" accurately lamented

I've got health coverage coming out my wazoo. Surgeries cost me less out of
pocket than shoes or milk on an annual basis, no matter where I get it. On
top of that, I don't think my wife and I will be ABLE to outspend our
pensions and savings before we die. But did I even CONSIDER Scardino or
Walsh Lange or S-K or Mayo Clinic? No. I did what I'll bet is 1)98.648% as
good and 2) FAR simpler overall: I 3) picked a nearby teaching and research
hospital, 4) checked out its emphasis on prostate cancer, 5) found a
surgeon/ onc/ researcher/ medical professor I liked and who said all the
right things, 6) rejected his offer of my choice of any physician on the
staff, and said, 7) "Let's do it."

Why?

1. I doubt a surgeon who's done thousands of RPs is inherently better than
one who has done merely a thousand or two. Innate skill counts, too, and if
you can't get it right after one thousand, the next thousand ain't gonna
overcome your ineptitude.

2. We considered all the visits before and after surgery in choosing a
hospital. We have a high-end cancer RT center 10 minutes from home and three
very good hospitals within 20 minutes, but we're also just three hours from
Seattle with its huge selection of medical centers for more depth and
breadth. We've driven to Seattle (220 miles each way) 6-8 times now, for all
sorts of consultations. We're down to occasional long phone calls now to
discuss my case, relevant trials, new adjuvant tx options, etc., with more
face-to-face visits lined up the minute my PSA resurfaces or just any time I
want to talk face to face. It's also very reassuring to know that a whole
team of oncologists is STILL discussing ME every time my situation or
adjuvant treatment technology changes, thanks to my doc who's on that team
and still calling me at home 15 months post-op. Is Walsh or Scardino gonna
do that?

3. Teaching hospitals are the cream of the crop. One of mine's specialties
is PC, there are several other related highly rated medical centers in
Seattle, and they often work together. If I want a CT/PET scan to rule out
mets before accepting adjuvant RT, a state-of-the-art CT/PET scanner is
right down the road. Last time my doc phoned me, Caller ID said he was at
that center. Big-name new cancer meds? They're made and tested "down the
block". I'd have no reservations about walking in their door and asking
whether my case warrants trying out their latest promising med. I presume
most big cities have that depth and breadth of facilities available.

4. You local doc or some website clicks should indicate how active and
reputable a particular hospital is in PC treatment, and what collateral
facilities may be available if necessary. Similar checking into my
particular candidate surgeon's background also told me a lot, such as
experience (several RPs a week and teaches the procedure), reputation in the
uro community, education (S-K internship and post-doc for , and attends
national medical seminars), etc.

5. The "right things" for me included number of RPs he's performed as well
as details on that last paragraph.

6. He said I could choose any physician I wanted, including the university
surgery dept head, Lange, who had an RP, and who authored "PC for Dummies"
along with the whole UW & VA oncology staff. I didn't need him; by now I was
duly impressed with my guy.

7. They were ready to operate quite soon, having compacted many
consultations with several specialists into a very short time span. Their
cooperative, eager spirit, from nurses to surgeons, had impressed me from
the very first time I phoned the uro phone number cold and said, "I've got
Gleason 8 PC. What does your hospital have to offer me?" That call got me
the OR nurse who coordinates all PC surgery and lasted over half an hour,
and when the oncologist called back the next afternoon, we talked for
another 45 minutes, checking each other out.

By that time I didn't need no steenkin'  Walsh to feel confident I was in
good hands.

And my entire expense so far? Great Seattle dining and a Super 8 motel for
the wife while I was in recovery. (I could sleep and eat free in the
hospital if I didn't take the wife along, but I ain't eatin' hospital food
in a city like Seattle.)

Which brings up medical insurance. I gather you guys have none? I can't
imagine entering our age brackets without it. My medical jacket runs into
two very thick packages not even counting half a dozen surgeries (my RP was
a low-risk pajama party compared to one of them). Sure, I had military care
for 20 years and remnants of that now, so the cost is low (under a grand a
year), but without that I'd have bought my own insurance at "list price" for
exactly the concerns you've expressed. My medical bills would have probably
hit seven figures by now without medical coverage, and I'm just STARTING to
fall apart.

I.P.

I think you are unnecessarily flogging yourself.  There are plenty of
good urologists all over the country including Arizona, every one of
whom can provide excellent care.  We see an occasional horror story
about some quack mutilating a patient, but many of these are "doctors"
who also do nose jobs, hair transplants, boob lifts, and will cut your
toenails too while waiting for the anesthesia to kick in with their
cousin acting as assistant surgeon.  They often work out of a
storefront "clinica" in a poor part of town.  Any surgeon operating in
a real hospital has the same many years of training as any other
surgeon, has passed the same exams, is board certified, etc., etc..
Sure, some are better than others and a few have to take the exams a
second time to pass but any doctor can (and does) have screwups, even
the gurus.  Usually the best physicians are the ones who truly care
about their patients and who will make the extra effort to do the best
they can do no matter where they ranked in their graduating class or
where they hang their shingle.  What you need to do is get referrals
from other physicians such as your family doctor (who would they go to
if it were their prostate?) and interview at least half a dozen.
People end up going with the one who seems to be the most caring, has
the best "bedside manner", the one who has a busy office, the one who
does many of these surgeries each month, and the one who claims to have
good statistics.  You do the best you can do given your resources -
both financial and emotional.  Our local county hospital (Oakland, CA)
has some of the best doctors around.  They often look a little
hippy-dippy, coming to work in sandals with their hair tied back into a
ponytail (the men that is) but they do damn good work inspite of their
often limited financial resources - just about as good as anybody - so
don't feel you're shortchanging your husband just because your doctor's
name isn't Walsh.

If you have no insurance, you may want to investigate a new phenomenon,
some of the large, brand spanking new hospitals in India and Thailand
that cater to folks just like you from all over the world.  The
facilities are absolute top of the line, all the doctors are American
or European trained, they all speak English (unlike some in this
country), you are given a registered nurse as your private attendant
(you're lucky to see a registered nurse for more than a few minutes
each day around here), and after your hospital stay you spend another
week or so recovering at a nearby resort.  The total cost for two
including airfare and resort is about 20% of what it would cost in the
good old US of A just for the surgery.  Many of our x-rays and MRI's
are already outsourced to someone in Asia and we don't even know it -
with results every bit as good as those from the inhouse radiologists.
I'm not recommending this option, it's a mighty big step to take and
you will really flog yourself if it doesn't turn out well, but you
might look into it and tuck it away in the back of your mind just in
case.

No matter what road you take, it will be a crap shoot with regard to
side effects and possible recurrence.  Most doctors and hospitals hover
around the same statistics, all else being equal (no cherry picking,
for instance).  I saw some figures a few years ago with respect to
major heart surgery where something like 5% of the patients died in the
best hospitals and 10% died in the worst hospitals.  Does that mean the
best is twice as good as the worst?  I don't know, they don't seem much
different to me.  Is 80% erectile function with Viagra as reported by
Walsh better than 50% without Viagra as reported by some other doctors?
Probably not.

When it is all over and your husband is fully recovered, you will have
picked the best doctor.

All the luck to you and your husband.  
Dave Perry

Looks like you have no health insurance. Start contacting human resources
at all your area hospitals. Tell them your situation, and let them help you.
Almost every doc in the world does SOME pro bono work. It's tax deductable
for them. Even broke guys get surgery. As to the doc... relax there are
thousands of good qualified Urologists all over the country that can get
this done. It's not like you're going to a blind butcher. Start doing the
legwork, and stop feeling sorry for yourselves. If he was diagnosed early
there's a good chance he'll be just fine.

I'll just second what others have said. You don't need a big name.
There are uros all over who do great work. I live in Georgia and had
surgery 4 months ago locally. I am VERY pleased with the outcome. I
married a RN 3 years ago and have learned a lot about how the medical
community. Primary care docs see patients for years after surgery. They
know who's good and who isn't. If you know anyone in the AZ medical
community have them ask around. If you know someone who knows someone
have them ask around. If you know someone who knows etc. I'll bet AZ is
a great place to find a PCa surgeon. All the best.

Tom

<Remainder snipped>

Laurel, I live in New Mexico, probably in a smaller town than you, and my
surgeon was recommended (on the basis of a 28.4 PSA) by my personal
physician who knew to whom he was sending me.  The PSA was scary enough and
the biopsy was certainly no fun (and confirmed all our suspicions) and
surgery, RRP, performed within the week.  Prior to the urologist's
examination I didn't know this man, but trusted my doctor's recommendation
because I trusted him.

Turns out, this urologist was formerly an army officer who treated many men
at Fort Bliss, Texas, before retirement from the army and he was the most
considerate, compassionate, and knowledgeable surgeon I could have hoped to
find.  He followed up consistently, made further recommendations (radiation
was eventually required), and is still following my case after about four
years.

Maybe it's an advantage for me that I'm a Christian and depend on the kind
of guidance that I receive from God.  It's a discussion I prefer not to go
into right now, but I never even thought twice about accepting what was
being offered.  I hadn't read anything about prostate cancer before this,
never looked at this newsgroup, never even talked with anyone on a personal
basis, and I certainly didn't travel out of town (Las Cruces) to New York or
Los Angeles, or Boston, or any of those other places where the "experts"
live and perform their surgeries.

In short, do you trust your family doctor or personal physician?  What does
he or she tell you?  Is there more than one urologist in your vicinity?  Do
you have an US TOO chapter in your town?  (You can hear valuable stories and
helps in this group.)

There are many posts preceding mine here and I haven't read most of them.
Some may offer similar counsel -- I hope they do.

Don't despair, help is available.  You and your husband are not experiencing
anything that a number of others here are not also experiencing.

Ken Bland

Sorry for what you are going thru.  It's something I'm sure crosses
many peoples minds.  I know I gave it some thought.  I'm in Arizona
(Phoenix metro) but went to Detroit, MI for my robotic lap RP.  I
found that the doctor there (one of the pioneers in RLRP) as well as
the hospital was "in-network" for my health insurance.   Having said
that, there's no way to know that the outcome would have been any
different had I used a local doctor.  I have talked to people who used
local doctors here who had completely great outcomes so its not a
given that a local doc won't be as good.  I did have to find a local
Uro to do my follow up.  I can't vouch for his surgical skills but I
found a local Uro-surgeon who seems very nice who has done 150 of the
same type of robotic LRP here in phx and he may be just as good as
anyone else.  He was agreeable to doing my follow up even though he
knew I was going out of town for the surgery before I went.  I'm not
making any recommendation that he's right for you but if you want to
see if he's on your insurance his name is Dr. Dale Russell.  One of
his partners, whose name I believe is Mitchell Kane, also does the
same surgery but I've never met him.  I believe Kane has done perhaps
200 of the procedures.  From my research at the time (last Dec) they
appeared to be the most experienced at that particular procedure here
in Phx.  

My best wishes to you in this trying time.  Ask if you have any
questions.