I tend to agree with you. In many cases it's dictated by the patient and not the doctor. If a patient is dead set on surgery even though it is not appropriate, the doctor may feel he has to do it or the patient will just go down the street to his competitor.
I know Dr Scholz got into AS because some of his patients absolutely refused any type of treatments.
I also think that the very good surgeons know their limitations, and are more apt to refuse treatment, whereas a less experienced surgeon is over confident.
These are just my opinions and not supported by any facts.
I think that the 25% positive margin rate is fact, and is unacceptable. Most of this could be reduced by better prescreening and selection which is rarely done.
Scardio did a study of surgeons at MSK and Baylor; the best surgeon achieved an 11% positive margin rate and the worst achieved a 48%; most were in the 24% range. This difference could be due to skill or selection or both, but the difference is very real.
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.