PC specialists favor their specialty treatment

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geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 3/11/2010 8:45 AM (GMT -6)   
This study, published this week, confirms the general wisdom of this board -- doctors favor those PC treatments which they perform. The lesson: learn a lot -- get multiple opinions.

archinte.ama-assn.org/cgi/content/full/170/5/440?home

"Overall, 42 309 men (50%) were seen exclusively by urologists, 37 540 (44%) by urologists and radiation oncologists, 2329 (3%) by urologists and medical oncologists, and 2910 (3%) by all 3 specialists. There was a strong association between the type of specialist seen and primary therapy received."

"Conclusions Specialist visits relate strongly to prostate cancer treatment choices. In light of these findings, prior evidence that specialists prefer the modality they themselves deliver and the lack of conclusive comparative studies demonstrating superiority of one modality over another, it is essential to ensure that men have access to balanced information before choosing a particular therapy for prostate cancer."

Arch Intern Med. 2010;170(5):440-450.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day
9 mo. PSA 0.00 -- 1 light pad/day ED remains


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/11/2010 9:34 AM (GMT -6)   
Interesting stats, but I wouldn't have expected the results to be different. I would expect a surgeon to push surgery and would expect a Radiation or Seed center to push that.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time, 3/6 Cath #13 out - 4 days


Bassguy
Regular Member


Date Joined Mar 2010
Total Posts : 25
   Posted 3/11/2010 10:45 AM (GMT -6)   

As someone who is going through the treatment selection stage right now, I would agree with title of this thread.  And generally it is not surprising.  I think what is important though is that anyone reputable offering you treatment should provide you with good statistics regarding their specialty.  When I met with a radiation oncologist recently she certainly urged me to consider her offering.  Additionally she provided a Nomogram... not sure how well known this is...

http://www.mskcc.org/mskcc/html/10088.cfm

When we input my numbers the calculator painted a pretty good picture, except for the rate of being recurrence free in 10 years.  57% seemed like not a great number to me and started me thinking about surgery again.  

She was pretty straight forward and said, if you don't like those odds you need to do some more investigation, which I thought was a very professional approach.


Age: 49, 49 dx, PSA: 5.65
2nd Biopsy: 1/10 - 1 of 12 cores positive, 5% Cancer, Gleason 2+3=5 by primary care, Upgraded to 3+3=6 by MMSK
Considering entering Johns Hopkins 2nd opinion program to square away pathology issue.
Have not decided on a course of treatment.


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 3/11/2010 2:11 PM (GMT -6)   
When your only tool is a hammer than everything looks like a nail.
The only remarkable thing is that somebody paid to learn this.
Diagnosed at 54
PSA 8.7 Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7 Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09 Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence Pad free week 5
PSA 6/6/09 <0.1 PSA 9/10/09 <0.1

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