Medical Forum / Diseases and Disorders / Prostate Cancer / April 2008
Checking on doctor
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Dwight - 17 Apr 2008 22:32 GMT I just had a consultation with Dr. Harcharan Gill at Stanford. Said he's done about 200 RPs, and does two per week.
Anyone been worked on by him?
He said I had an 80% chance of being cured, and 100% chance with radiation. In the context of the conversation, it seemed he meant radiation after surgery. Does this make sense to anyone?
Dwight (Doofy)
ed@math.uchicago.edu - 17 Apr 2008 22:52 GMT > I just had a consultation with Dr. Harcharan Gill at Stanford. Said > he's done about 200 RPs, and does two per week. [quoted text clipped - 6 lines] > > Dwight (Doofy) Dwight,
In my opinion, you should run away from any doctor that claims a 100% cure rate. For a doctor to claim that 100% has already been achieved shows total ignorance of the literature. No study has ever shown that. If you check old posts to this group, you will even find (on rare occasions), some men having an undetectable PSA for 10 years or more until it suddenly started to rise.
Also, his figures make absolutely no sense. It is generally acknowledged that early detected PCa's are cured by surgery at a rate of over 90%. For him to quote an 80% cure rate would indicate that your cancer is more advanced than the ordinary early detected PCa. If that is that case, there is no way for radiation to jump the cure rate from 80% to 100%, since that would only be true if all of the PCa cells that have escaped the prostate are located in close proximity to the prostate. Once PCa escapes the prostate, there is no test that can rule out the possiblity that some cancer cells have travelled far away from the prostate. Obviously, radiation would have no effect on any such cells.
Ed Friedman
Steve Jordan - 17 Apr 2008 23:29 GMT > I just had a consultation with Dr. Harcharan Gill at Stanford. Said > he's done about 200 RPs, and does two per week. [quoted text clipped - 4 lines] > radiation. In the context of the conversation, it seemed he meant > radiation after surgery. Does this make sense to anyone? I'd be very reluctant to accept such absolutes when trying to outguess this beast.
Regards,
Steve J
BH - 17 Apr 2008 23:34 GMT >I just had a consultation with Dr. Harcharan Gill at Stanford. Said >he's done about 200 RPs, and does two per week. [quoted text clipped - 6 lines] > >Dwight (Doofy) 100% chance of being cured? I'd suggest following Ed's advice!
Best wishes, Dwight.
Burney RP in 1995 (age 52) RT in 2000 ADT (Casodex) 10/06 - 8/07 Latest PSA - 0.18
jloomis - 18 Apr 2008 14:58 GMT Dwight, I am curious why you did not see Dr. James D Brooks. Stanford Medical University: RP 1999 (Brooks) jloomis
>I just had a consultation with Dr. Harcharan Gill at Stanford. Said > he's done about 200 RPs, and does two per week. [quoted text clipped - 6 lines] > > Dwight (Doofy) Dwight - 18 Apr 2008 20:17 GMT > Dwight, > I am curious why you did not see Dr. James D Brooks. > Stanford Medical University: > RP 1999 (Brooks) This is who Stanford recommended to my doctor for the robotic. Doesn't Brooks only do open prostatectomy?
jloomis - 19 Apr 2008 02:10 GMT Yes, Dr. Brooks is a master at his craft. He would rather do RP by hand. very skilled. He has done 1000's and several here on this news group. He is a skilled surgeon, professor, cancer specialist. Will not operate unless the lab results are promising, and will sew you up if cancer is found to have spread. Best of wishes, jloomis On Apr 18, 6:58 am, "jloomis" <jloo...@ocean.net> wrote:
> Dwight, > I am curious why you did not see Dr. James D Brooks. > Stanford Medical University: > RP 1999 (Brooks) This is who Stanford recommended to my doctor for the robotic. Doesn't Brooks only do open prostatectomy?
Dwight - 18 Apr 2008 16:15 GMT > I just had a consultation with Dr. Harcharan Gill at Stanford. Said > he's done about 200 RPs, and does two per week. [quoted text clipped - 6 lines] > > Dwight (Doofy) Thanks everyone, for your feedback. The 80% sort of shocked me.
Has anyone had surgery from this guy?
Steve Kramer - 19 Apr 2008 01:28 GMT >I just had a consultation with Dr. Harcharan Gill at Stanford. Said > he's done about 200 RPs, and does two per week. [quoted text clipped - 6 lines] > > Dwight (Doofy) Never heard of him. But, I don't care if he's Patrick Walsh. No one has a 100% chance of cure with RP and/or RT. The best you can guarantee you'll not die of PCa is if you have RP, then RT, then get hit by a bus.
 Signature PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum
Leonard Evens - 19 Apr 2008 05:15 GMT > I just had a consultation with Dr. Harcharan Gill at Stanford. Said > he's done about 200 RPs, and does two per week. [quoted text clipped - 6 lines] > > Dwight (Doofy) I agree with what the others have said about cure rates. The best spin you can put on what he said is that he is speaking figuratively but not quantitatively. If you challenge him on the figures, he may be more forthcoming.
If I were in your shoes, I would certainly be put off by such a cavalier response, but I wouldn't necessarily reject using him as a surgeon. He may in fact be a good choice for robotic surgery. You have to get some information about that.
What I don't see is why you are insisting on robotic when a first rate surgeon like Dr. Brooks is available.
Dedman - 19 Apr 2008 09:19 GMT > What I don't see is why you are insisting on robotic when a first rate > surgeon like Dr. Brooks is available. I can't answer for the OP but from what I understand the recovery time from the surgery is much shorter.
 Signature Dedman
** Posted from http://www.teranews.com **
safire - 19 Apr 2008 11:09 GMT >> What I don't see is why you are insisting on robotic when a first rate >> surgeon like Dr. Brooks is available. > > I can't answer for the OP but from what I understand the recovery time from > the surgery is much shorter. Patrick Walsh claims that robotic can't replace the benefit of direct touch by a skilled surgeon. That may be the point Evens is trying to make, in particular since OP said he's concerned about LT ED. While recovery time undoubtedly is much shorter after robotic surgery, not many long term studies exists showing better results.
Leonard Evens - 19 Apr 2008 16:32 GMT >> What I don't see is why you are insisting on robotic when a first rate >> surgeon like Dr. Brooks is available. > > I can't answer for the OP but from what I understand the recovery time from > the surgery is much shorter. I think it depends on what you mean by recovery. Certainly it takes longer with open RP for the incisions to heal, but, on the basis of the little I know, I doubt if the time to regaining continence or erections is much different.
Claude - 19 Apr 2008 22:03 GMT >>> What I don't see is why you are insisting on robotic when a first rate >>> surgeon like Dr. Brooks is available. [quoted text clipped - 6 lines] > little I know, I doubt if the time to regaining continence or erections > is much different. I wonder if anyone has knowledgeable information about what urologists would cite as the advantages of robotic surgery besides quicker recovery time and therefore, I assume, lower surgical risk. Are there any other advantages to it? Probably we will have to wait until enough of these are done to have a study comparing the two types of surgery in terms of cancer removal, continence and erectile recovery.
He'sDeadJim - 19 Apr 2008 22:25 GMT >>>> What I don't see is why you are insisting on robotic when a first rate >>>> surgeon like Dr. Brooks is available. [quoted text clipped - 13 lines] >study comparing the two types of surgery in terms of cancer removal, >continence and erectile recovery. Many doctors claim they can see better when doing robotic.
Leonard Evens - 21 Apr 2008 17:31 GMT >>>>> What I don't see is why you are insisting on robotic when a first rate >>>>> surgeon like Dr. Brooks is available. [quoted text clipped - 13 lines] >> > Many doctors claim they can see better when doing robotic. And those who do Open surgery claim they can both see better and feel better what they are doing. The argument for seeing better is that the fiber optic probles allow for magnified images on the screen. However, surgeons using the open procedure can, if they choose use magnifying lens, if they need to look closely at detail, so I don't see why there is an overwhelming advantage here with respect to visual inspection of the operation site.
rosbif - 20 Apr 2008 01:24 GMT >>>> What I don't see is why you are insisting on robotic when a first rate >>>> surgeon like Dr. Brooks is available. [quoted text clipped - 13 lines] >study comparing the two types of surgery in terms of cancer removal, >continence and erectile recovery. I think you're right, it's still too early to make reliable comparisons. Even though the manufacturers offered him a 'free' robot, the uro who did my laparascopic RP (basically the same thing but without the robot) decided against training and turned down the offer to get to grips with it, preferring instead the closer physical association he enjoys with his team assembled directly round him (anaesthetist, brow-mopper, instrument-passer, masseur, teaboy etc). This seems to make some sort of sense. The robot-assisted surgeon probably leads a lonely working life in front of his LCD while all those other bods are cosying up together round the patient.
My guess is that laparascopic (plain or robot-assisted) will gain favour over time and perhaps completely displace the open surgery - but it is only a guess. Significantly less operating time on average, less blood loss, quicker recovery time - whether these advantages are construed as trifles or not, there's little point in not accepting them graciously if all other things - curative, rehabilitative - turn out, after due appraisal, to be broadly equal.
Steve Kramer - 20 Apr 2008 12:08 GMT >>>> What I don't see is why you are insisting on robotic when a first rate >>>> surgeon like Dr. Brooks is available. [quoted text clipped - 13 lines] > done to have a study comparing the two types of surgery in terms of cancer > removal, continence and erectile recovery. Most of my information on RLRP comes from this NG. And, all other things being equal in 2000, if RLRP was available, I would have chosen it over RRP. However, depending on your definition of "surgical risk", I think that open surgery might have the nod on that one. As I recall, RLRP involves a much longer time under anesthetic, which is never good. It also involves a lot more bleeding. However, RLRP also involves a much better look at the prostate and the all-important "margins". But, there is no "feel" whatsoever. So, as to risk, I think it's a toss-up.
As to erectile recovery, I think it might have an advantage as to seeing the nerves and a disadvantage as to peeling them.
As to continence, I don't think there is an advantage either way.
I am fully prepared to be told I'm wrong; which will educate me and others.
 Signature PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum
rosbif - 20 Apr 2008 12:36 GMT > As I recall, RLRP involves a much >longer time under anesthetic, which is never good. It also involves a lot >more bleeding. No Steve, regarding bleeding, exactly the opposite is the case.
Smaller total incision tying in with less bleeding and faster recovery.
I believe laparascopic procedures (robotic or otherwise) are faster too but perhaps less generally, I'm not 100% sure about this. As example only, my non-robotic LRP took 2.5 hours - average according to the uro. I've heard of open RP being something of a marathon haul and I'd be surprised if the average was lower than my 2.5.
Steve Kramer - 20 Apr 2008 13:17 GMT >> As I recall, RLRP involves a much >>longer time under anesthetic, which is never good. It also involves a lot [quoted text clipped - 10 lines] > the uro. I've heard of open RP being something of a marathon haul and > I'd be surprised if the average was lower than my 2.5. That is very good to know. Admittedly, my paradigm was set shortly after RLRP became widespread. Then, I believe, surgeries were taking up to four hours. But, again, I could be wrong.
Leonard Evens - 21 Apr 2008 17:35 GMT >> As I recall, RLRP involves a much >> longer time under anesthetic, which is never good. It also involves a lot [quoted text clipped - 7 lines] > I believe laparascopic procedures (robotic or otherwise) are faster > too but perhaps less generally, I'm not 100% sure about this. I think in fact you are 100 percent wrong about that. It is my understanding that generally laparascopic prostatectomy takes at least twice as long as convention RRP.
> As > example only, my non-robotic LRP took 2.5 hours - average according to > the uro. I've heard of open RP being something of a marathon haul and > I'd be surprised if the average was lower than my 2.5. rosbif - 21 Apr 2008 19:12 GMT >> I believe laparascopic procedures (robotic or otherwise) are faster >> too but perhaps less generally, I'm not 100% sure about this. > >I think in fact you are 100 percent wrong about that. I don't want to be made to appear to be careless with all-important facts. Above I say I am *not* 100% sure.
> It is my >understanding that generally laparascopic prostatectomy takes at least >twice as long as convention RRP. according to;-
http://www.roboticoncology.com/Laparoscopic-Prostatectomy.php
- surgery time is similar.
We were both wrong.
I.P. Freely - 19 Apr 2008 17:59 GMT >> What I don't see is why you are insisting on robotic when a first rate >> surgeon like Dr. Brooks is available. > > I can't answer for the OP but from what I understand the recovery time from > the surgery is much shorter. Yes, but there are other pros and cons. I'd rate the surgery recovery time as the LEAST important factor unless I just HAD to compete in the Olympics next month.
I.P.
Dwight - 22 Apr 2008 00:33 GMT > > What I don't see is why you are insisting on robotic when a first rate > > surgeon like Dr. Brooks is available. [quoted text clipped - 6 lines] > > ** Posted fromhttp://www.teranews.com** And I hear the after effects profile is better with robotic.
I might check into Brooks anyway.
I.P. Freely - 22 Apr 2008 00:52 GMT Some docs say it's important to be able to feel the tissue by hand to distinguish cancerous from healthy tissue.
I.P.
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