Surgeons in Idaho

[dwagstaffr]

Hello, I've read a number of posts and have appreciated the information. My boyfriend (47 years old) was recently diagnosed with Prostate Cancer, his second biopsy showed 3 scores containing 3+3 Gleason scores cells. His first with a different doctor) showed 5 cores 3+4 score. He has a low PSI between 4-5 and no enlargement of his prostate or identifiable mass on MRI. The doctor he is currently with is encouraging surgery due to his age and likelyhood of a better recovery now than 5+ years from now. The biopsy has been sent out for genetic testing. So the question is does anyone know of good surgeons in Idaho or close by (with the exception of Washington perhaps travel isn't the best idea right now)? And how we can get consultations or scheduled with those surgeons? Thank you in advance.

[Tall_Allen]

First, you might ask for a second opinion on his biopsy report from Epstein's lab at Johns Hopkins (cost=$275):

pathology.jhu.edu/departmen...

If it doesn't change the diagnosis, surgery is only one of several options. His age means he is likely to have fewer side effects of treatment from any therapy. It also means he will have longer to live with any side effects that persist - such as may happen with incontinence or ED after surgery. Here are some questions he should ask himself:

pcnrv.blogspot.com/2017/12/...

I don't know if there are any prostate surgeons in Idaho who have the experience to do a good job. If you can get to Seattle or Salt Lake City, there are good surgeons at Swedish Medical and Huntsman. Here are questions he might ask:

pcnrv.blogspot.com/2017/12/...

The other good options for him that are equally curative and have lower risk of side effects are SBRT (a quick kind of external beam therapy) and brachytherapy (seeds). They are available at Swedish. He has time to explore all options before deciding.

IMRT and protons don't improve in any way on the outcomes of SBRT, and are more tedious and expensive.

[dwagstaffr in reply to Tall_Allen]

Thank you for you quick reply, the links you provided were very useful. I've read on various forum that the quality of the surgeon makes a significant difference as far as recovery. But when I read studies, stats, and such there is no mention of rating surgeon quality as a factor of the study. I want him to have the best surgeon possible, but I also want to balance being pushy or attempting to own the decisions that are entirely his to make.

[Tall_Allen in reply to dwagstaffr]

Not only does the experience of the surgeon make a difference in the speed of the recovery, it makes a difference in the oncological results achieved. The positive margin rate is a good metric - too high means he is not curing his patients; too low means he is cutting too wide or selecting easy patients. It is up to him to rate the surgeon's quality. I met with several before deciding (in my case, I decided surgery was a bad choice for me, given my youngish age at the time). Those questions will help him compare doctors.

He may also want to read the following articles about finding the right doctor and managing the doctor/patient relationship:

pcnrv.blogspot.com/2017/12/...

pcnrv.blogspot.com/2017/12/...

I think you are wise to stay at arm's length from his decision. Anticipating regret causes much of the stress in making what could be a life-changing decision. There is a kind of regret called "Role Regret" that arises when a patient gives in to pressure from others to change his decision. In my live support groups, I've heard resentment at spouses when the patient felt pressured. They say things like, "She just wanted me to cut it out - no matter what the cost." You may be interested in this article about decisional regret:

pcnrv.blogspot.com/2017/10/...

I think the best you can do is pass on all this info to him (he may feel overloaded at first - but he has time), and let him know that you will support him whatever he decides to do.

[dadzone43]

Check St Luke's in Boise. They claim a whole cancer treatment center; I know nothing of it's quality.

[dwagstaffr in reply to dadzone43]

He is currently with Stephen Brussell a urologic oncologist from St Lukes.

[cpcohen]

Tall_Allen makes the essential point:

. . . There are alternative treatments, that are at least as good as surgery.

Surgery may have been the 'gold standard' when radiation treatment was in its infancy; it's not the 'gold standard' any more.

. Charles

[dwagstaffr in reply to cpcohen]

When we converse about alternate treatment options the concern for radiation induced cancers is the primary hesitation to choosing this option, testicular cancer for example.

[cpcohen in reply to dwagstaffr]

I understand the concern. As I remember it, the chances of getting any cancer, as a result of radiation treatment, is quite low -- but not 0. That has to be balanced-off against the better long-term results of radiation _as a treatment for the prostate cancer_.

. . . . You'll have to do the stats yourself.

I had a prostatectomy 12 years ago. I think, if I were faced with the same situation now, I'd probably pick radiation instead. The tumor was Gleason 6, PSA 8.0, and my PSA doubling time was 18 months. So treatment was probably a good idea.

[dwagstaffr]

The surgeon's name is Stephen Brassells, he ran a Prostate Cancer clinic in Washington DC for 18 years prior to working here in Idaho.

[London441 in reply to dwagstaffr]

Hi there I live in Washington DC but a Boise native. I have the good fortune of being close to Johns Hopkins In Baltimore and thus getting treated there. However surgery was not a easy decision for me, even though I was in a somewhat more advanced stage.

Tall Allen’s advice to have the biopsy slides reviewed at JH is a very good one by all accounts. Very often scores get downgraded as a correction, which can potentially change your treatment decisions.

Urologic surgeons have a general reputation of being overeager to cut when it isn’t necessarily the best option. It’s what they know, and it’s very profitable. Patients are often easily persuaded by the ‘get it all out’ notion, but it doesn’t necessarily do that by any means. Recurrence rates with surgery alone are not encouraging.

Please don’t take my word for any of this. Do your homework! Other treatments are every bit as effective in many cases-especially lower volume, less than 4+3 Gleason, and organ confined.

I especially caution against quickly deciding on surgery (you absolutely have time to decide) because the side effects of incontinence (which is usually temporary) and impotence and penile shrinkage (which are often permanent) can be more than many men can reasonably bear psychologically.

I would not have been easily persuaded to get a prostatectomy in your husband’s apparent condition. Please learn as much as you can and get at least on opinion from someone other than a surgeon or a urologist closely connected with one. Radiation, just for one example, has proven equal cure rates with a very different side effect profile.

[dwagstaffr]

This feels like excellent news, after fully reviewing his options he has decided on Active Surveillance and he has his urologic surgeon's support. Thank you so much every one for your information and comments, they were valuable and assisted the conversations and decisions that were made.

Stay safe out there!