The "Doc says he got it all doctrine"......any comments or debates?

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/31/2009 6:37 AM (GMT -6)   
I have heard this line sooooooooooooo many times from patients whom were told such face to face by their surgeon, yep I got it all!!!   Maybe next time a doc says such a blanket statement you could whip out your prewritten warranty or contract, then you could say well then Mr. Expert you wouldn't mind signing right here then, would you? Or you won't mind being respondsible for my PCa future issues and billings, should they come to exist and be needed. He just gave kind of warranty statement to you the patient....'hey I got it all'....Insane statements I just had as replies(?), they are comparitive to the statement the docs may make on many patients.
 
Problem is many or most patients tend to believe what ever expert doc happens to say or mention as total fact and never should go challenged or disbelieved.
I will save my opinion on this gig till later in this possible discussion.
 
redface  
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4833
   Posted 1/31/2009 8:23 AM (GMT -6)   
So what you're saying is that since my doc said that, I should start making funeral arrangements...or are you saying I should eat the barrel of my 9mil now and get it over with smhair
Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/31/2009 8:46 AM (GMT -6)   
Zufas, you love to alarm, lol. My dr/surgeon never said anything that blatant. He did wide margins, and he said based on post surgery pathology, it looks good, looks like it was contained. He also followed up by saying we will have to watch the post surgery psa numbers closely for several years. Couldn't imagine many doctors talking as if it were a certainty or guaranty.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/31/2009 9:52 AM (GMT -6)   
Steve not meant to upset you or others, the 'alarming' is meant to open eyes on what did he just say(was that a warranty)....how does he know??????  Maybe someone can explain it more clearly to me.  I have been on forums over a number of years, seen and witnessed many times this 'doctrine' theme.. it is very common it appears, just an observation I noticed.


 

Post Edited (zufus) : 1/31/2009 8:04:04 AM (GMT-7)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/31/2009 10:31 AM (GMT -6)   
I think the vast majority of most patients and their families want to hear that, or at least hear some estimation of the success of surgery that they have just endured. It's human nature and expected, in my opinion. I think you place too much emphasis on what doctors should and shouldn't say, in a strict legal and medical sense, and forget that we consider our doctors as a partner in our treatment, not an adversary. I know I wanted to know and was glad to hear, in my case, the surgeon say "I felt and examined the tissue when I removed it and I think I got it all" Yes, the pathology may say different later, but the surgeon is speaking and using his years of experience and observation of past surgeries. They do know what cancer looks like, if it is visible. The fact that a microscope and and a pathologist may find cancer later doesn't discount the surgeons statement. Just as many times, I have heard of surgeons seeing cancer spread beyond the gland and stopping surgery right then, as contuining wasn't protocol for the procedure. I have confidence that if a surgeon can be relied upon to recognize cancer during surgery and stop, then I can put confidence in their words that they think they got it all. Just my opinion.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 1/31/2009 11:06 AM (GMT -6)   
That is where confidence in your surgeon comes in. I was up front with my doc and expressed to him that if, upon getting in, the cancer was more involved than suspected, make a good decision for me and my family based on his professional experience and practicality. I too have known of many occasions where a surgeon would find advanced disease, either prostate, lung, colon, or whatever kind, and simply close and help the pt find alternative therapy with the pts best interest at heart. I have also seen less talented, more aggressive surgeons make a mess of someone in an attempt to be a hero or play God, and do far more than the pt could tolerate. Again, you must rely on the honesty and integrity of the surgeon, he is the only one that can make a real time decision for you, he must know your desires as well. I truly don't think most surgeons will tell you they got all of your disease if in fact he/she knows some was left behind. JMHO
46 you when diagnosed, now 48
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01, 9 Month PSA 0.01
One Year PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Occasional Success with Oral Meds
Success with BiMix


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/31/2009 11:14 AM (GMT -6)   
James C - what you wrote was well said, I applaud you for that post, and Lungman, good post too.

A stupid person could never become a doctor, I have always said that, even the lesser of doctors is still a highly trained individual. Are they gods? Of course not, despite the best training and many years of experience, it is only fair to say that, they too, are human and not perfect.

My dr/surgeon has 26 years of hard time experience, well versed in open RP, has seen lots of stuff over the years, stays up on the current trends and thinking, and has inpecable patient skills and concerns. Perhaps I am lucky. But most surgeons I have had over the years are similar in caliber to him.

Of course patients/families want hope after going through all that. But a good and caring dr/surgeon isnt going to automatically blow smoke up someone's tush just to make them feel good. That would not be typical in my opinion. And only a fool would guaranty someone that there is no chance cancer could return, again, not typical for someone that highly trained.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 1/31/2009 12:17 PM (GMT -6)   
OK Bob another interesting post. I will take the human aspect of this. If the doctor feels in his or her best estimation that they got the cancer, then yes I would like to hear those words "I got it all". In the event a recurrence happens I will be more confident the second time around knowing that they got it the first time. In my guess I got just the opposite, Dale we tried but we just couldn't get it. That is the last thing I wanted to hear. I still feel as though you have an ax to grind with the medical community. I would say that most people on this forum trust and love their medical team. If we are told they got it, then by gosh they got it. When something else happens you just deal with it. I refuse to spend an ounce of energy wondering if my doctor was right or wrong. I made a decision and I put my faith and trust in the physician. Well I put my faith in God for giving me courage and wisdom, I know that is taboo here but it is the truth.
Love your views brother and as always I truly do enjoy your post.

peace and grace
dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .06
Testosterone keeps rising, the current number is 156, up from 57 in May
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/31/2009 12:46 PM (GMT -6)   
My doctor said he didn't get it all. He was neither insane nor lying? But we were fortunate enough to begin a period of remission soon after. In my case, my doctor also said that in his experience this will come back. When I started out, after my positive biopsy, I was hearing that "you are most likely to die with prostate cancer than because of it". They stopped saying that after my surgery revealed a different perspective. Now not even the so called "kings" of prostate oncology can say that with any surety. But when my current oncologist told me his goal is to get me to 80 I was willing to start living to 80. To me my experience was with great doctors.

The fact is that when a favorable pathology is acheived after surgery that doctors usually say that the cancer was contained in the prostate. And what that means is there is no evidence that the disease had spread. It promotes a positive cannotation that "we got it all" and we don't mind hearing that, usually. And in these cases, the disease usually (98%) does not return. I would look pretty silly pulling out that contract in those cases. The warranty on my truck doesn't work that well. And besides, why would I want to scare 120,000 men a year that have successful prostatectomy pathologies in telling them differently when in fact less than 2,500 will fail. Cynical would be to perpetuate the notion that most doctors are lying to you or are incompetant when they try to deliver good news. I created a motto to move forward with in my turn with cancer ~ "Stay Positive". I would rather help people with the experience I gained than criticize their doctors good intentions.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 1/31/2009 10:52:59 AM (GMT-7)


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 1/31/2009 1:08 PM (GMT -6)   
I am not sure I understand the intent of this - the closest we can come to the idea of "getting it all" is the pathology report. Obviously, that is not fool proof either as cancer cells can be in the blood. However, statistically the best reports are negative margins. My doc never made a broad comment that "he got it all" or indicate you will never have a problem. He did show me some stats and I took those not with confidence, but with some comfort that at least they were in my favor. I also take everything with some skepticism as there are no absolutes associated with this disease.

I can only state that we must be careful not to make more of our troubles than they are than we should make any less of them then they are! We thankfully live in a time when there are a lot of good doctors, and good therapys to cure, or extend life. For that I am happy and say keep your chin up!

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.1 10/30/2008


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/31/2009 4:57 PM (GMT -6)   
Tony and Dale, liked both your responses, sound balanced and reasonabe to me. The "bad" doctors are in the extreme minority in my opinion. And it is a team effort with your medical team, yourself, your family, hospital if used, etc. After I had my 3rd and hopefully final bout of my original cancer fight (porocarcinoma) 9 years ago, my very skilled oncologist told me, that despite a wide margin operation and all the radiation I endured, that over one million cancer cells would fit on the point of a pin with room to spare. No doctor in his right mind would be that absolute that there is no chance its ever coming back. From a patient point of view, that is neither logical or fair to assume such a thing. I believe in being fair and balanced with such matters. Personally, I am glad to be living somewhere with the high quality of medical that is available to most, and have the range of options to choose from.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/31/2009 5:18 PM (GMT -6)   
I have somewhat to agree with Zufus. As RBinCountry said, if you have prostate cancer then simply by the fact that it is in your body, it has had exposure to your blood stream and lymphatic system. Therefore the words "I got it all" should not be uttered. This is obvious as seen in the small number of relapses that occur after no evidence of PCa for x number of years. Rather as Purgatory said, a comment such as "the tumour looked like it was confined to the prostate and I feel you will be fine, but we need to carefully monitor your PSA over the years." Give a patient confidence but without pronouncing what is a false certainty.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 1/31/2009 5:25 PM (GMT -6)   
Excellent discussion. This is what makes HW so great we can all agree to disagree at times. No wonder I check this sight several times per day. Love all you guys.

peace to you
Dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .06
Testosterone keeps rising, the current number is 156, up from 57 in May
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 1/31/2009 5:36 PM (GMT -6)   
Zufus, in my husband's case, the doctor said "I believe I got it"(all was not mentioned). He told me that he cut a wider margin than he needed to but believed that the cancer that could be surgically removed was removed...the path report proved he was correct with negative margins, bladder neck and seminal vesicles. Does this mean that my husband will never be bothered by PCa again...no. But it does mean that he has a very good to excellent prognosis.

Our doctor went on to say that my husband needed to be very diligent with his follow up over the next 4 or so years. In fact, he wants my husband to have PSA tests every 3 months for the first 2 years (the standard is every 3 months for the first year) because there was a miniscule extension into the capsule.

Your post raises a very good point as there are many out there who would believe that their cancer was "cured" after surgery and might figure they don't need further PSA tests since the doctor said it was all gone.

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/31/2009 5:45 PM (GMT -6)   
And that Sephie, is a very good point.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/31/2009 5:55 PM (GMT -6)   
Good point from you BillyMac and to you too Sephie.
Dale - agreeing to agree to disagree is always a good basis for inteligent learning and opinions, hat off to you.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4833
   Posted 2/1/2009 6:13 AM (GMT -6)   
As I recall, my surgeon said it looks like we got it all and that there was approx 92% chance it wouldn’t be back.
 
The ninety something percent was the same number I had read about way before surgery so it was 100% good news to me smhair
Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/1/2009 8:54 AM (GMT -6)   
Steve, what you said is exactly the point. My best to you.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


mozart250
Regular Member


Date Joined Jan 2007
Total Posts : 102
   Posted 2/1/2009 4:50 PM (GMT -6)   

Question: Can the doctor really know whether he "got it all" after surgery anyway?

Isn't this really what the pathology report tells you anyway?  And the pathology report only tells you whether there was any evidence of cancer on the margin or outside of the prostate.  Can the pathology report even indicate that "he got it all".

Yeah, I know what the doctor means to say is that he saw no evidence of cancer on the margin of the prostate or outside the prostate during surgery.  But that is not the same as "got it all".

 


53 Year Old DBA by profession; amateur pianist by passion.
 
June and Aug 2006:  PSA 4.6.  DRE prostate enlarged.  Second opinion
Sep  2006:  Biopsy results positive one lobe.  Gleason 3+3.
Nov  2006:  RPA performed at Fletcher Allen in Burlington VT.
Nov  2006:  Pathology report: Stage T3a and Gleason 3+4.
Dec  2006:  PSA 0.1
Feb, May  2007:  PSA 0.0 (under 0.1)
Aug, Nov  2007 and Feb 2008:  PSA 0.1
Mar-May  2008:  IMRT Radiation..completed May 1, 2008 
Sept 2008, Jan 2009: PSA still 0.1.  Dang. 
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/1/2009 4:57 PM (GMT -6)   
hello, stranger. When you don't post in a couple weeks, we guys with memory defects forget you have been around... wink

You make a good point about 'got it all' and visual detection, vs pathology labs and such.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, July 17, 2018 2:40 PM (GMT -6)
There are a total of 2,982,487 posts in 327,008 threads.
View Active Threads


Who's Online
This forum has 161827 registered members. Please welcome our newest member, Robert A.
448 Guest(s), 10 Registered Member(s) are currently online.  Details
Kent M., torontolyme, vminas01, JAS01, ashleylynn, Syon, RandyJoe, BillyBob@388, OriolCarol, Robert A