Having decided on treatment the next step was picking the surgeon. This was harder than I thought it would be. All of the data on prostatectomy suggests that successful outcomes are highly correlated with the skill of the surgeon so I was hunting for a prostate ninja. I talked with a local surgeon who was recommended by my urologist and then paid a visit to a Mayo Clinic surgeon who had helped a friend. Both doctors were very experienced (> 1,000 procedures) with impressive outcome data but the Mayo mystique won in the end. I chose to have the surgery as soon as possible but it is necessary to wait at least 6 weeks after a biopsy to allow the prostate to recover. My surgery (a robot-assisted radical prostatectomy) was scheduled for September 2016 in Rochester, MN.
The surgical experience at Mayo was very positive. The doctor was confident and concerned. The nurses were angelic. Yes, the nurses were amazing. I really can't describe how dear they are to me now. I awoke from my surgery in pain with a catheter (tube running from my bladder to a bag on my leg....through my penis). I'm confident this was the most vulnerable moment of my life. The nurses were so sweet, constantly concerned about me, sharing stories of their families. It was a very difficult evening and my nurse angels got me through it. The next day I was discharged and my wife drove us home.
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- While I loved my Mayo surgical team for their confidence and skill I feel like their attention to my individual situation was less than impressive. For instance, my biopsy showed perineural invasion. Recent studies suggest that "nerve sparing" (attempts to keep the nerves that control erections intact when removing the prostate) surgery is not recommended in that situation but my team did not seem interested in the topic. I had a strong feeling that the surgeon measured himself on the basis of potency outcomes. If my erectile function was good he was successful. The potential risk to my life seemed less interesting to him.
- Prostate cancer treatment options can be quite contentious. Unfortunately, many of the parties to the decision lack objectivity. The surgeon wants to cut. The radiation oncologist wants to zap you. The medical oncologist (well...hopefully you won't meet those guys...they come on board when the disease metastasizes) have other plans. One of the books that helped me see the landscape a little better was this one: Invasion of the Prostate Snatchers. The book has a very shock-prevoking title which you should ignore. It's survey of prostate cancer and options is very helpful.
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