In summary, I believe Dr. Claus Roehrborn of UT Southwestern is one of the best five doctors in the country to perform a robotic radical prostatectomy. He has performed over 2,800 of these surgeons. I had one of the most aggressive prostate cancers you can have…a tertiary 5…with a Gleason Score of 8 to 9. The major risks of this surgery are (1) getting all of the cancer, (2) incontinence and (3) restoration of sexual function. My surgery was extremely successful and I fully recovered and my life was totally back to normal in 4-5 weeks after surgery. I am 61 years old and generally in excellent health. I realize others have had this surgery and not ever achieved a full recovery, and for that I thank Dr. Roehrborn and believe I was also very fortunate and blessed.
I visited with 6 different doctors, including two from Plano, TX, two from Dallas, one from MD Anderson and one from Memorial Sloan Kettering in New York. I have had four heart procedures/surgeries at the Cleveland… Clinic, so I am very familiar with and very comfortable getting on a plane and having surgery by the best doctor to perform that surgery. I considered all kinds of treatments, including IMRT (Intensity Modulated Radiation Therapy) radiation, SBRT (Stereotactic Body Radiation Therapy or “CyberKnife”) radiation, Hormone Therapy or Androgen Deprivation Therapy (“ADT”), Proton Therapy, HIFU (High-Intensity Focused Ultrasound), Brachytherapy (seed radiation) and prostatectomy. Frankly, before I considered all alternatives and talked with 6 doctors, prostatectomy was the lowest on my list. I chose prostatectomy because of the serious and aggressive nature of my prostate cancer—it had the best chance of being successful in eliminating the cancer. I realize other patients will choose other options that are dependent upon their particular cancer, their age and health. I decided to be treated by Dr. Roehrborn at UT Southwestern in Dallas, close to where I live. Irrespective of the stage and seriousness of your cancer, I recommend that you be treated by Dr. Roehrborn.
I learned after reading the literature, there is a 35-40% chance of a false negative on a biopsy if you do the “random” kind where a doctor takes 12-15 samples randomly. Basically, the doctor is looking at less than 1% of the prostate, so it is easy to miss cancer. Also, you could get a “false positive”, which is you are told you have a Gleason Score of 6 (usually treated with “active surveillance”), but you really have a Gleason Score of 7 or 8 (which is usually treated with radiation or prostatectomy).
I had an MRI done on a 3T MRI machine w/dye (very important) by another doctor (at my insistence…he did not want to do it…one doctor even told me that my insurance would not cover an MRI…false). I had the MRI sent to Dr. Daniel Costa at UT Southwestern, who works with Dr. Roehrborn and is excellent. The MRI showed the placement of my tumor was on the edge and apex of the prostate, making it very risky to biopsy because of the possibility of “breaking the capsule” and causing my cancer to spread throughout my body and metastasize (which is an extremely bad and usually fatal result). At Dr. Roehrborn’s direction, I did an MRI-guided in bore biopsy with Dr. Costa. That was on a Tuesday around 10 am.
At 5:30 pm on Wednesday (the following day), Dr. Roehrborn calls me and tells me that I have a 4+4=8 (on Gleason scale of 6 to 10). He recommends a robotic radical prostatectomy. I ask him about radiation, and he says he does not think that is the best choice because (a) it has a smaller chance of being successful stopping the cancer, and (b) once you do radiation, it is very difficult and highly unlikely to do a successful prostatectomy, and (c) once you do a prostatectomy, if you have a reoccurrence years down the road, radiation is an excellent additional treatment option (among others), if ever needed.
Also, a word about Dr. Roehrborn’s communications methods and “bedside manner”. He does not wait to call you into his office, give you bad news and give you tissue or his shoulder to cry on. He simply calls you and factually tells you everything he knows as soon as he knows it. Yes, it is traumatic, and he is very business-like and to the point. He does not mince words or soften the bad news. But he tells you EVERYTHING he knows (very different from some other doctors with which I interacted on this issue) and ALWAYS answers all of your questions. He also met with me and my wife prior to surgery to answer all of my questions at my request. He met my us two hours after I requested the meeting. Later, I emailed him at 11 pm one night and he responded to my 6 bullet point questions at 4:30 am the next morning, concisely and straightforward, giving me his percentage opinion (varies from patient to patient) of my prevailing on the three riskiest aspects of the surgery (getting all of the cancer 80%, no incontinence of significance 95%, restoration of sexual function 70% if I follow ALL of his recommendations). If you read the other reviews, many people “downgrade” him for his “bedside manner” and very factual responses. I personally want all of the information so I can make an informed decision—and I also learned that other doctors do not give you all of the information and discuss all the risks. But if you want a doctor to whom you can go and cry on his shoulder, Dr. Roehrborn is not for you.
I had a “bone scan”, which showed the cancer had not yet spread, but is not conclusive (cancerous micro-organisms can be spreading and it would not show up). This result allowed me to have my robotic radical prostatectomy. It is important to walk around as quickly as possible after the surgery and to get your digestive system working. These all really help with recovery. Six (6) days after the surgery, Dr Roehrborn calls me at home
Read More