I have a consult scheduled with Dr Amar Kishan for SBRT and looking for other RO recommendations who specialize in SBRT as well as surgeons to consult with at UCLA and UCSF.
I am looking for doctors who are well beyond learning curves, are patient advocates, and who follow-up to see how effective their treatment had on their patients months and years after the treatment has completed.
Perhaps this is a unicorn, but I hope this is not the case.
Kishan is the best! At UCSF, Alexander Gottschalk.
For surgery in LA, I like Timothy Wilson at St. John's.
In general, ROs give more time to patients and more follow-up than surgeons.
If I had it to do over, I would ask the surgeon candidates the following: Of their patients on whom they operated who were judged to be good prospects for nerve sparing prior to surgery, what is the percentage for whom nerve sparing was attempted, and of those, what percentage recovered potency similar to prior to surgery without any additional oral drugs (e.g. Viagra or Cialis), and what percentage recovered similar potency with the aid of oral drugs.
My own decision might have been the same, but I should have known ahead of time that the typical success rate is reportedly approximately 33%.
Best wishes!
Dr. Gottschalk for sure! And he has the best team.
Hi 'Blue. I consulted with Gottschalk at UCSF for SBRT last summer and was impressed with the conversation and references. I don't think you could go wrong there, IMHO. Ultimately, I chose to go to Swedish Hospital in Seattle and Dr. Robert Meier. It was logistically easier for me living in Oregon than to go to San Francisco. I did ask Gottshalk about Meier and he said, "(he) would have no qualms about recommending Meier" and "they (UCSF) are only interested in the patient's well being."
Bob Meier is also a research-oriented RO and frequently writes and presents papers on result outcomes. I liked that, thinking such participation in the field keeps one current on the state of art for treatments. Curiously, when asked, it appears that Meier/Swedish does about 5x the number of SBRT treatments as Gottshalk/UCSF per year, but again, I think both would be great options for you. Good luck!
~Christopher, 6 weeks post-SBRT and feeling good!
Thank you all very much for your valued insights and recommendations. I am strongly biased toward SBRT over surgery, but I thought I would ask for a really good surgeon recommendation for at least a consult.
Since you are in California, and you want to explore surgery, and I assume you have high risk cancer since you are talking to Kishan, you might consult w Rana McKay at UCSD. She has a protocol which combines surgery with systemic adt treatment for high risk but localized prostate cancer
I am NCCN low risk right now. PSA keeps rising pretty quickly though, at 8.01 right now, so maybe I will fall into the favorable intermediate category by the time my treatment begins.
Have you had a DECIPHER? Kishan will likely request one if your insurance pays for it, so you will know what your risk really is.
I will be agreeable to getting one. I do want a Decipher test but haven’t focused my efforts on it because I am going to get treatment now rather than AS due to PNI detected on one low grade tumor at the base.
BTW - I did talk with Decipher about their test and learned that their results are dependent on the one sample that is sent to them. For example, if a biopsy missed the most aggressive area in the prostate but the most adverse sample is sent to them, still, the decipher results will not reflect actual risk. Meaning, a patient’s Decipher result may not be his real risk because the biopsy didn’t hit the worst area or the worst area was not sent to them.
I asked Decipher the above out of concern because my MRI fusion guided template needle biopsy results showed my PI-RAD4 assessed lesion to be benign. With two radiology opinions being PI-RAD4, I am biased towards the targeted tumor being missed altogether by the 4 tissue samples taken in that area.
With this above perspective, Decipher became desirable but nonessential in my decision making.
Weird situation. You got an MRI that showed where the cancer was but its not there. Its somewhere else. apparently.
Dr Amar Kishan at UCLA treats all NCCN prostate cancer patient stage categories as of this writing (Stage I, II, III, IV). I talked with his study coordinator as well as the appointment coordinator to confirm.
Robert Reiter at UCLA is a good robotic surgeon.
For the cure: surgery or SBRT?
hernia surgery & SBRT 
