NPR's "Science Friday" Scholz & Brawley interview/transcript

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Casey59
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   Posted 9/12/2010 8:13 AM (GMT -6)   
The National Public Radio (NPR) show "Science Friday" featured Dr  Mark Scholz, co-author of "Invasion of the Prostate Snatchers: No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency" and Dr Otis Brawley, medical director of the American Cancer Society.
 
You can listen online, or read the show's complete transcript, by going to this link:
 
 

Post Edited (Casey59) : 9/12/2010 11:12:38 AM (GMT-6)


NEIrish
Regular Member


Date Joined Aug 2010
Total Posts : 245
   Posted 9/12/2010 8:47 AM (GMT -6)   
I caught a good part of it Friday, Casey. As I mentioned on another thread, it put me back on the "shoulda-woulda" rollercoaster, since I was the one leaning a bit towards AS. Hate feeling like the surgery was overkill, since despite all our reading, we were still unprepared for how compromised he'd be. Luckily, my husband doesn't look back. If nothing else, the NPR show puts the disease out there. It mentioned how underfunded the research is for PCa.
Husband 60yrs., no symptms: PSA 10/04 2.73, 12/06 3.64, 5/09 3.9, 10/09 4.6, 1/10 5.0w/ free PSA 24
6 core biop 4/1/10 path rept: rt mid: adnocarc. G=3+3, 5% of core; R apx v. susp. minute ca, R base bnign w/ mod. atrophy, L side atrphy only; 2nd opnion JH confrmd
MRI - 15mm nodule
BiLatRP surg 7/6/10, path: T2c, nodes, sem.ves, extra caps. neg., adenoc both sides G=3+3 cntinent, Viagr-8/27 ED

John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 9/12/2010 11:40 AM (GMT -6)   
One thing that struck me is that three controlled trials comparing the effectiveness of radiation vs surgery were cancelled due to lack of participation from both doctors and patients. It seems that surgeons don't want to particiate and men patients also didn't want to participate. With breast cancer there were many women that participated in effectiveness studies with out a problem.
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


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/12/2010 11:52 AM (GMT -6)   
John T said...
One thing that struck me is that three controlled trials comparing the effectiveness of radiation vs surgery were cancelled due to lack of participation from both doctors and patients. It seems that surgeons don't want to particiate and men patients also didn't want to participate. With breast cancer there were many women that participated in effectiveness studies with out a problem.
JT
 
 
Yes, but I could see that being the case.  I will admit that while I absolutely see the benefit of participating in most clinical trials, I don't think that (with the knowledge I had at my treatment decision making time) I would want to have my treatment choice randomly selected.  I felt that I knew, without a doubt, what was right for me.
 
So, I could see this being the case...

Fairwind
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Total Posts : 3892
   Posted 9/12/2010 1:00 PM (GMT -6)   
That's probably the case alright..after you have read the ten pages of legal forms you must sign to participate in these trials, then find out YOUR treatment program will be randomly selected and you will be locked into it whether you like it or not, most men head for the exits..Men who have choices are seldom willing to give those choices up.

A Much better source of subjects might be long-term prisoners or those completely without financial means or insurance who are hard-pressed to find ANY treatment. These groups can be carefully controlled and the results easily monitored..

There may come a day when high-risk men who are cancer free simply opt to have their prostate removed as a preventative measure..This mass production would drive the "fine-tuning" of the surgical procedure reducing the expense and side effects to more acceptable levels

Fairwind
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Date Joined Jul 2010
Total Posts : 3892
   Posted 9/12/2010 1:38 PM (GMT -6)   
"Dr. BRAWLEY: If I could, I'd go one step further. We need to recognize that we need to do the scientific studies to develop the tests to be better than PSA, to develop the test that will tell us the cancers that kill versus the cancers that don't kill. "

Dr Brawley needs to get up to speed.. The Four Gene Signature Urine Test has been licensed for commercial application by Abbott Labs and is being used to pin-point the existence of PC. It does not tell the GRADE of the cancer, a biopsy STILL must be relied on for that information..

When the truck driver, Emmanuel. called in, he let a lot of the steam out of Brawley and Scholz arguments..His cancer was NOT indolent as originally suspected, his surgery resulted in NO impotence or incontinence, two side effects the Brawley and Scholz present as being commonplace...

John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 9/12/2010 1:42 PM (GMT -6)   
I understand how you feel and I feel the same way, but why don't they have a problem with women enrolling in controlled studies for BC?
We also can't critize the lack of controlled randomized studies on treatment effectiveness when we ourselves would not submit to them and our doctors will not perform them. I guess the best we can hope for is retrospective studies that everyone finds fault with unless they support his point of view.
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


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/12/2010 1:54 PM (GMT -6)   
John T said...
We also can't critize the lack of controlled randomized studies on treatment effectiveness when we ourselves would not submit to them...
 
True, and while I have never criticized the lack of such a study, I have lamented it's absence.  I don't know enough about the BC situation (similarities/differences) to commment.
 
 

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/12/2010 2:01 PM (GMT -6)   
Fairwind said...
"Dr. BRAWLEY: If I could, I'd go one step further. We need to recognize that we need to do the scientific studies to develop the tests to be better than PSA, to develop the test that will tell us the cancers that kill versus the cancers that don't kill. "

Dr Brawley needs to get up to speed.. The Four Gene Signature Urine Test has been licensed for commercial application by Abbott Labs and is being used to pin-point the existence of PC. It does not tell the GRADE of the cancer, a biopsy STILL must be relied on for that information..

You reinforced what Dr Brawley said; you both said the same thing:  We need a test that will tell us the grade of prostate cancer; we don't have that today.  This is, of course, something we can all agree emphatically upon.
 
 
The Four Gene Signature seems like a good tool (another good tood) to help avoid unnecessary second biopsy tests for those who have had one test with no findings.  In that regard, its sorta like PCA3 or a number of other existing tests.  I have not had a Four Gene Signature test, but this is what I understand from the readings.  As you and Dr Brawley point out, it does not tell the grade of cancer.
 
 
edit:
added color later as an edit to highlight that these comments were essentially one-in-the-same; worded differently

Post Edited (Casey59) : 9/12/2010 1:12:22 PM (GMT-6)


Fairwind
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Date Joined Jul 2010
Total Posts : 3892
   Posted 9/12/2010 2:03 PM (GMT -6)   
The whole thing might be taken from our hands John.. Lets say China or India or G.B. wants to find out, for sure, what works best.. They will just say "You 2000 guys go through THAT door and you 2000 guys go through that door over there. No arguments, no lawyers, take it or leave it..Very few other countries have the free enterprise based medical system that we have...

We have over a million people in prison, mostly males, many for long terms..Here is a ready-made study group. These men are in no position to argue about treatment choices. Most of them are on Watchful Waiting regardless...I know for a fact that drugs are routinely tested on prisoners to make sure they are safe during clinical trials.. Prisoners volunteer to test the drugs in exchange for enhanced privileges and living conditions..

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/12/2010 2:06 PM (GMT -6)   
Fairwind said...
A Much better source of subjects might be long-term prisoners or those completely without financial means or insurance who are hard-pressed to find ANY treatment. These groups can be carefully controlled and the results easily monitored..

 
That statement troubles me.  Dachau, Buchenwald, the Philippine prisoners, and even Tuskegee comes to mind. 
An underlying premise of ethical medical testing is the principle that human experimental subjects must be volunteers.  (check testimony at Nuremberg war crimes trials)
 

Fairwind
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Date Joined Jul 2010
Total Posts : 3892
   Posted 9/12/2010 2:20 PM (GMT -6)   
They can still be volunteers...And yes, careful controls would be needed with outside oversight to prevent abuses..
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G6,7, 9
RRP performed Sept 3 2010

geezer99
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Date Joined Apr 2009
Total Posts : 990
   Posted 9/12/2010 4:54 PM (GMT -6)   
We have to live with medical science as it exists not as we hope it will exist in the future. So you don’t like “eye of newt and toe of frog” come back in one hundred years and see if we have something better. The Doctors on the NPR program are probably right, but they are unable to offer any option except “take your chance.”

OK, I underestimated just how hard the effects of ED would be. Who should I blame except myself? Even knowing what I have learned since my surgery I am not sure I would have done anything different. Life deals you a hand and it is up to you to play it.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/12/2010 7:05 PM (GMT -6)   
Well I finally had time to read this, and I thank you Casey for posting it.

And I have the final score: Scholz 1, Brawley 0. And Mr. Emmanual, the phone in caller, get's 1 also.

Brawley was articulate enough but you could see areas that he and Scholz disagree. And I side sided with Scholz on all they were divided on.
--------------
Case and Point #1:
Dr. Brawley wasted no time in his comments about screening and he disdain for it. Brawley feels that National Prostate Cancer Awareness month should be about the pro's and con's of screening.

And Scholz:
"There has to be selectivity for my thing for Prostate Cancer Awareness Month would be that prostate cancer is different from other cancers and that we need education prior to screening, and then of course if people are screened, or if they're diagnosed with prostate cancer, they need a lot of education before they select treatment."

Later Brawley says: "Well, I agree first off, I agree with almost everything that's been said here." when asked another question and he digressed back to screening again.

Tony's opinion: Clearly I agree with Mark Scholz about educating men before screening. And I think that the ACS can really help here. And after the educated caller chimed in, Scholz acknowledged if more men were like him we would not be having as big an issue with screening. I want to mention, it was the ACS lobbyist in nevada that helped our chapter of UsTOO get a grant for screening....talk about a confusing message?

----------------------------------
Point 2: Is Screening is the problem or is Funding is the problem...
Mark Scholz touched on how little spending there is in prostate cancer research and education. Brawley alluded to the unsuccessful trials that John T points to. I think the ACS is not a best option for conducting studies especially when their medical director is at odds with the medical community. If they would appropriate more funding to educating men about prostate cancer, catch them in their 20's, 30's, 40's..etc. Then perhaps we can lose the bad image of screening for prostate cancer that Brawley portrays. Remember, I was diagnosed with a late stage of prostate cancer at age 44 by a random screening. I can't imaging what I would have to have dealt with if that was still sitting inside me unscreened, untreated. It's in my DNA to disagree with Dr. Brawley in this interview, and in my heart.

-----------------------------------
Point 3: Why Emmanual get's a point and Brawley does not.
We see Mr. Emmanal here at HealingWell. People newly diagnosed who figure things out.

Mr. Emmanual is a PhD but not in medicine. he took 6 months to educate himself about treatments and about how to choose a great doctor. He was articulate and handled his diagnosis well.

Brawley and scholz both seemed impressed by his knowledge and how he dealt with his diagnosis. But Mr. Emmanual get's the point here because he proves that with education, screening is not a bad thing at all. Here is an interesting exchange:

<Snip>
Dr. SCHOLZ: Excellent point about the variability in surgical skill. And if all the men out there were as thorough and did as much research as Lyle, we'd have a lot fewer problems.

Dr. BRAWLEY: Yeah, I would agree. Now first, I would say that men need to first make a decision whether they want to be screened or not. Because many men, the answer is: I don't want to be screened.

If they choose to be screened, they need to do as Lyle did and they need to do research, they need to ask questions.

FLATOW: All right.

Dr. BRAWLEY: ...they need to find a doctor who's good.
<End Snip>

I think that what Lyle did was common here at HW. It seems like the ACS would first like to put the scare into screening. Scholz is a much smarter man because he recognizes there are a lot of very reachable Lyle Emmanual's out there.

And that's what we should be stressing about during National Prostate Cancer Awareness Month...

That's my two cents worth...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 9/12/2010 6:14:12 PM (GMT-6)


Casey59
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Date Joined Sep 2009
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   Posted 9/12/2010 7:44 PM (GMT -6)   
TC-LasVegas said...
And Scholz:
"There has to be selectivity for my thing for Prostate Cancer Awareness Month would be that prostate cancer is different from other cancers and that we need education prior to screening, and then of course if people are screened, or if they're diagnosed with prostate cancer, they need a lot of education before they select treatment."

I noted Scholz's agreement with Brawley on this point of education preceding screening.  Would have been a perfect time for Scholz to say screen everyone first, educate them later, if that was what he believed...

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 9/12/2010 7:53 PM (GMT -6)   
Casey,
I respectfully disagree that what Scholz says is the same thing Brawley says. These men disagree about screening. Brawley would like to see less men screened. Scholz would like to screen more educated men. One man's tone is to educate and screen, the other man's tone is to scare some men out of screening entirely.


Tony

Post Edited (TC-LasVegas) : 9/12/2010 6:58:54 PM (GMT-6)


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 9/12/2010 8:00 PM (GMT -6)   
OK...but equally as respectfully, what Dr Brawley actually said in his last comment just before the Scholz quote from above was:
"What should happen is a man needs to be informed and needs to make a decision as to whether he wants to get it because keep in mind, all the major organizations, be it the American Cancer Society or the American Urologic Association or others, say that there are some known harms associated with prostate cancer screening. There can be overtreatment, as well as alarming men necessarily. "
 
 
Brawley said men should be "informed" [he was talking about before screening]; Scholz says "that we need education prior to screening."   I kinda thought they were talking about the same thing.   I did not think that they were on the same page with the screening position, which is why this exchange raised my eyebrows in curiosity.

Post Edited (Casey59) : 9/12/2010 7:16:48 PM (GMT-6)


Fairwind
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Date Joined Jul 2010
Total Posts : 3892
   Posted 9/12/2010 8:40 PM (GMT -6)   
Here in Denver, The urology center where I'm being treated (up to this point) is owned by the 20 or 30 doctors who base their practices there. They are all Urologists, surgeons and radiation oncologists. Frequently, they sponsor free prostate cancer screenings at county fairs, farmers markets, car shows and other public gatherings..You get the standard pee questioner, a PSA test and a DRE..Colorado State University Medical Center occasionally does the same thing..So the upfront presentation is they are doing this as a public service but backstage they freely admit it drums up a lot of business...

In our system, delivering medical services is a business, a very profitable business..

It might be interesting to see how the VA deals with PC when the profit motive has been removed...What treatments do they recommend and provide for their patients?
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G6,7, 9
RRP performed Sept 3 2010

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/12/2010 8:55 PM (GMT -6)   
fairwind, i am still hung on you suggesting using prisoners and the poor for these clinicals? doesn't that strike you a bit on the cold and insensitive side? almost a little bit of **** era thinking there, though i know you never used those words. just seems cold. even the vilest of prisoners are still human, and the poor - they are exploited enough in this world.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 9/12/2010 9:11 PM (GMT -6)   
Wait a minute! Prisoners get PC TOO! No routine PSA or DRE's for them! It's get sick and die! If they were offered to be screened (perhaps with experimental screening methods) and if needed, were offered treatment which might also be experimental but it could be a standard treatment also, (something they would not get otherwise) and they VOLUNTEERED to do this, what's the problem with that??

If the "Standard Treatment" for prisoners is "get sick and die" then almost any active treatment is bound to be an improvement and in no way exploits the prisoners who volunteer..They are heavily involved in drug testing NOW, phase 1 trials where they test new drugs for safety and side effects in humans, not to see if the drug actually works..

The big advantage of using prisoners is you have complete control of the trial. All of the subjects are available for monitoring and testing and treating all of the time, 24/7..

This is NOT **** Germany for God's sakes...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/12/2010 9:15 PM (GMT -6)   
fairwind, you are right in that you could control the trial group that way easier, its more of a situational ethical hangup to me. i think i understand you intent in your view, i would just have problems with the execution of it. i value the importance of trials, its very needed in research of cancers and disease, but i sure wouldn't want to be randomly picked for the placebo, instead of an honest shot for treatment.
there's a lot to think about here, its a good topic
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.
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