Are some docs like car mechanics or such a correlation exist? Dr. Strum's words

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zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 6/6/2010 6:01 PM (GMT -6)   
Hey this may be taken out of original complete context, but Dr. Strums message is resonant and clear. I regard him the most highly in the oncology world via his actions, deeds, knowledge, compassion, free advice on P2P for PCa patients and his books, conferences and sharing of real needed information to patients.  His words recently on a P2P for a patient with some health side effects going on:
 
(Dr. Strum)-
'Stephen Strum, MD>
The most ignored recommendation that I consistently make is for all
patients with any serious illness to realize how the varying levels of
competency amongst physicians impacts the DIAGNOSIS, EVALUATION &
TREATMENT.  Lay people assume that all physicians are alike or similar
in talent, passion, curiosity, competency, compassion and equally
conscientious.  This is a far cry from reality.  We docs are no
different than car mechanics: there are the few outstanding, the 5-8%
good, the 70% average, and the 20% dangerous.  The breakdown regarding
percentages may be different but this is my take of what I have seen
in 40 years of medicine. An expert pathology review of the diagnostic
biopsy or the RP specimen with utilization of biologic information
that can be obtained from IHC (Immunohistochemistry) testing is for me
a FOUNDATIONAL recommendation.'
---------------------------------------------------------------------------------------------------(my words=)
To bad we can't clone such a wise doc for our much needed help for mankind in general.
I am going to agree with his thoughts and what the heck the percentages given, seen a number of docs and other patient histories over  8+ yrs. in PCa forums.  I feel for the ones whom are mislead, over sold, under analyzed and over treated or under treated. These errors and less than great medical services should not happen and especially for the outrageous costs envolved and profits made off of patients in general.  Knowledge and even street smarts are your friend in medical issues and finding your best answers in your particular case.  Like he mentioned maybe 20% are just plain dangerous, hopefully you did not hire such in your treatments.
 
Peace to you  (to our corpus of brotherhood in the fight against PCa)
Youth is wasted on the Young-(W.C. Fields)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/6/2010 6:17 PM (GMT -6)   
zufus,

great piece, thanks for sharing it. that doc is the one we all dream of having. a rare gem among his peers.

david in sc
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, 4/8 .04, next one:  July
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, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 6/6/2010 6:19 PM (GMT -6)   
 I agree Dr. Strum really is a terrific guy.  Hugely knowledgeable, enormously dedicated, charitable, etc.  We need more like him.  Interestingly, I have not seen anyone on this board who has consulted with him (other than perhaps via p2p).  Is there anyone?
 
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/6/2010 6:33 PM (GMT -6)   
Zufus,
Glad you posted it. I saw the same on p2p and thought about posting it. My only contact with Sturm is through his books and articles and his postings on p2p. His postings are really refreshing as he points out things that other docs would never have thought of. I see his former partner, Dr Scholz, and he has Strum's philosphy.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 6/6/2010 6:47 PM (GMT -6)   
What is P2P?

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10.......waiting for post op biopsy


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/6/2010 6:49 PM (GMT -6)   
Agreed, but I thought we weren't supposed to scare the newbies. ???!!!

Zen9

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/6/2010 6:57 PM (GMT -6)   
Zen, I would rather err on the side of the truth, then to be deluded in half-truths or wrong data concerning my health. I believe it was Zufus's original call here, but its true: this is power in knowledge of what we all fight here, and this knowledge goes a lon.g way to abate fear
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, 4/8 .04, next one:  July
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, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/6/2010 8:51 PM (GMT -6)   
Dan,
Prostate pointers p2p is a physician to patient web site where patients post thier stats and questions, mostly relating to advanced pc and Doctors like Strum, Sholtz, Lam and Barkin give their opinions and recommendations free of charge.
There is an archive section where you can review old posts. There is a wealth of information that you will never see anywhere else. I think the biggest value is seeing how these doctors approach and evaluate a patient, and the follow up tests the recommend; it is way more than 99% of patients got from their primary doctors. You can see that there is a vast difference between a doctor that specializes in only prostate cancer vs doctors that do multiple things.
I love Strum's posts as they are so blunt and insightful.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 6/7/2010 6:18 AM (GMT -6)   
Newbies need to know the truth straight up it is a maze and jungle out there, no sugar coatings. Get scared to some degree and study up and know when you are being fed a line vs. frankness and real truths, only the patient lives with the side effects, results and after the deed(s) are done.

I have talked with Dr. Barken years ago and Dr. Strum just a little (via emails) and his co-author Donna Pogliano in various emails(she got me into his book on the inside cover 2nd edition). Andrew (Ohio State) got in touch with Dr. Strum and Leibowitz atleast to get an idea of what that is like. As for treatment, have one guy in our local prostate meeting group whom is under the care of Dr. Scholz and receiving Leukine treatments. He flies to California a couple times a year to see him.

We had one guy on this forum who got a DaVinci surgery apparently by a newbie trained doc, this doc did not even get all of his gland removed, it was botched, covered up by his doc and his doc referred him to friend radiologist for 'salvage' job on his rising psa levels. He found out about the whole scenario and was suing his surgery doc. Hopefully nobody gets that type of wonderful treatment and care. There are other examples and plenty of imperfect assessments on patients, and rushed into whatever treatment protocol. You may have to make a very tough decision in your choices, but get to know all your possible choices and what to expect...hopefully you were told the details.
Youth is wasted on the Young-(W.C. Fields)


April6th
Regular Member


Date Joined May 2010
Total Posts : 264
   Posted 6/7/2010 7:40 AM (GMT -6)   
John T---thanks for the info, I will check it out.

Dan
Here are some of my stats:
Age:54
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10.......waiting for post op biopsy


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/7/2010 8:52 AM (GMT -6)   

Excellent posts, zufus.

If Dr. Strum is correct, then 10% or fewer of doctors are good to excellent.  Not that surprising when you think about it. 

So if you simply go to your local urologist/radiologist - the one with the good bedside manner - for treatment, understand that you are rolling the dice.  That doesn't mean you will necessarily lose, but the dice are stacked against you.  Not every local doctor is in the top 10%.  

I say again, I think there will soon come a time when many fewer men are actively treated for prostate cancer, most urologists will simply monitor men with PCa, but if and when treatment (surgery/radiation/seeds/etc.) does become necessary, it will be done by a relatively few specialists in major cancer centers who do nothing but these treatments.

Zen9 


JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 6/7/2010 1:18 PM (GMT -6)   
Zufus,
 
Thanks for the post. In a recent thread on the quality of urologists (which became a little testy), I made the point that urologists fit the bell curve like most other folks when it comes to ability. My comment was probably not too well received since nobody wants to think about 70% of physicians being average....but Dr. Strum does...and recommends that all his patients consider it carefully.
 
And I agree with your point about newbies (I was one just 8 months ago). They need to know all that we can share, even if some of it is uncomforable. I suspect there are a lot of guys who were like me when I landed here....I didn't know how much I didn't know.
 
Joe
 
 
 
 

Age -67 PSA - 4.5

Biopsy  (9/4/09) - Positive in 5 of 8 cores. In those 5 cores, 5 of 11 samples were positive. Gleason 3+3=6. Stage – T1C  Ct and Bone scans negative.

 

BT performed on 12/11/09. 84 seeds of Palladium 103. Surgery at 7:30 - Home at 12:30 same day with no catheter. Blood in urine for a week. Side effects as expected -  some burning, frequency, urgency.   Resumed daily  1 ½ mile walk after 3 days. 

 

BT followed with 25 IGRT treatments beginning Feb 15 (4500 Gy's). After third week, experienced some fatigue. Now 2 months from last rad treatment - energy level has returned. Burning gone and urgency is much improved.

 

First post treatment PSA (6/1/10) - 0.1

 


Gleason7
Regular Member


Date Joined Feb 2010
Total Posts : 111
   Posted 6/8/2010 6:50 AM (GMT -6)   
Dr. Strum:
Unusual for one professional to suggest others in his / her line of work might be less then superstars BUT alas it's VERY true as "seemingly" evidenced by many of the posts in this forum! Using mechanics as examples was a great idea as when technology advances in vehicles so must the mechanics who have to repair them. With prostate cancer there are a number of treatment / non treatment options available. Take DiVinci for example, almost all major medical centers offer the procedure these days and those who happen to be doing the first few it would seem thoset few patients might not do as well as those who have had the procedure at a facility that has performed thousands. Same goes for radiation, seeds, freezing.

74 years old - third biopsy 12/23/09 found two of twelve cores @ 30% and 70% Gleason 3+4=7. Vatikutti DiVinci @ Henry Ford Detroit - Dr. Peabody 02/10/10. Prostate 106 grams - nerves spared - four hour procedure due to urethra / bladder connect (large prostate issue) - margins etc. clear. Zero pads now. Five week PSA undetectable next one due early July. Henry Ford offers a class for ED and methods for returning function to what's left of the family jewels.
devil
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