What is happening in increasing numbers and frequency is that a patient will have his biopsy done by his local urologist and then go about finding someone else to do the surgery. The trend has been to look for robotic surgeons and then go there for the treatment. I am Okay with that, I think it is smart to research and talk to people and then make the informed decision that is best for the patient. The thing that prompted this post is the posts by patients on the various support sites for prostate cancer. I read time and time again about having the surgery and then returning for follow-up and seeing a physicians assistant or some other care giver rather than the surgeon. In many cases I am sure these patients have made their decision without the input of the urologist that made the diagnosis. I know this because it has happened to me. For whatever reason after the positive biopsy result, the patient does his research and goes elsewhere. When things don’t go to plan elsewhere they then feel uncomfortable coming back to the original urologist.
Here’s how you handle this: Go back to your “biopsy urologist” and listen to his input and then tell him what you have decided to do. If it is robotic then ask him who he thinks is good, if its him inquire about experience and results. If you have decided to go elsewhere tell you urologist that and then tell him you want to follow-up with him after your treatment elsewhere. There is no reason to have your biopsy and end the relationship. In my situation, the nearest robotic surgeon with a lot of experience is 70 miles away. To continue to go there instead of here just to have PSA drawn or management of incontinence or erection issues is not time efficient.
If you have appropriately handled the situation as I have suggested, then you can easily transition back into the local and convenient follow-up of the urologist that made your diagnosis. I do this all the time. I see myself as a facilitator of your decision-making process. It matters not whether you choose me or not .I would feel most urologists feel the same way. So let’s show the urologist that made your diagnosis (dare I say “saved your life”) some loving.
Prostate Diaries 
Don’t forget the issue of Health Insurance. I really didn’t have a choice who did my vasectomy, but when I subsequently suffered from PVPS and went for reversal, I didn’t care about insurance. I would have sold my entire 401K, if it meant getting relief.
But you’re right, at least speaking to your doctor makes sense, unless you feel that he did you wrong and you no longer trust him.
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i remember buying toad the wet sprocket years ago, it seems i bought big head tod at the same time…i left a note on your blog-that was quite the journey and i am glad you are on your way to recovery. i will mention your site to every vasecotomy i do from now on. patients and people do so much better if they know about potential downside before rather than after. thanks for looking through the site. jm ps i bike as well and spin four times a week usually
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Thank you for your support, I just hope I can be active again when the weather gets better. Still a bit cold here.
Practicing what you preach is important, it is great that you exercise.
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Dear Dr. McHugh,
My GP, a member of the Ohio State Medical Group referred me to Dr. Geoffrey Box, a urologist at the Ohio State Medical Center. Dr. Box, who was quite young, did my biopsy and recommended surgery. I was leaning toward DaVinci LARP, since I had been doing my homework, and I asked him how many DaVinci procedures he had performed. He said 50 in the year since he had finished is training in the method. Talking with another urologist who did not do LARP, he said I might want someone who had done at least 200 such procedures as it took time to build the skills, and a number of others I spoke to said the same and recommended a number of urologists. I eventually went with Dr. Rashmi (Rush) Patel, the partner of the urologist who first suggested 200 procedures as a guideline, who had done well over 200 in four years, and I’ve been very happy with the result, especially as my surgery was somewhat more difficult than the biopsy suggested it would be. It took about 4 hours, rather than the expected two and a half hours, as the prostate was significantly enlarged. I would rate Dr. Patel highly, not only because of the results so far, but because of the level of attention I got from him. I have since been somewhat concerned that the young urologist might have been offended that I left him and your post relieved my concern somewhat. I muust say I was higly impressed with Dr. Douglas Martin, a radiation oncologist at OSU Medical Center, whom I consulted about IMRT while making my decision. He provided me his phone number and email address in case I had additional questions. I did, and he responded promptly to them. If I had chosen radiation, he would have been my man.
Mike C.
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