Marketing therapies for prostate cancer – what is fair comment?

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Terry Herbert
Regular Member


Date Joined Sep 2010
Total Posts : 92
   Posted 6/4/2011 6:39 PM (GMT -6)   
There is a page on the Dattoli Center website which lists and compares virtually all available therapies for prostate cancer at TREATMENT REFERENCE CHART

The relevant entries about surgery clearly make the point that surgery was at one time regarded – erroneously - as the best method of dealing with prostate cancer, but with failure rates up to 80% and surgery commonly leaving cells behind causing spread to the bloodstream it seems to be pretty poor choice. Here are the extracts from the page for ease of reference.

Surgery: The old “Gold Standard." Previously perceived as best method to eradicate any cancer. Misconception of guarantee that all cancer is gone. Many, however 40 – 80% of cases found to have more cancer after surgery is completed, requiring additional treatment. Pierorazio PM, et al, "Long-term Survival After [RP]...", Urology 2010 Mar 27, shows an 80% failure rate with high risk patients

Radical Prostatectomy: Surgical removal of bulk of the gland by incisions either retropubic or perineal. Physically removes the tumor from the body. (A psychological benefit.) Most aggressive surgery to be performed on the patient’s body but least aggressive treatment to the cancer. Commonly leaves microscopic tumor cells behind, may spread cancer cells to blood stream. Results have been reported for many years, as this was the only treatment for decades. Moul, J Urol,Vol 163, 2000 “30,000 men per year will develop recurrence after radical prostatectomy.”

Robotic “da Vinci” Laparoscopic: Uses “sophisticated” robotic equipment to remove gland tissue through small openings in the abdomen. Possibly easier to tolerate than major open surgery. Still surgery with similar outcome and side effects of open surgical procedure. Success very dependent on operator’s level of experience. Recent studies report a 3-fold failure rate at only 6 months, with increased complications compared with standard prostatectomy. Blute, J Clin Onc, (Mayo Clinic, Rochester MN) Vol 28, No 14, 2008 “patients have been led to believe ..outcomes are better, but is not the case.” Just another way to extract the prostate.

What about radiation therapies then, or the newer ones like Cryotherapy or HIFU (High Intensity Focused Ultrasound). Not so good – here are some extracts:

Cryotherapy: Cryosurgery: Cryoablation: As primary treatment, uses the process of freezing and thawing to destroy cancer cells. No cutting; performed on outpatient basis. Recent methods reduce risk of rectal injury. Can be repeated. Highest risk of permanent erectile dysfunction; some risk of incontinence, rectal fistula, and urethral sloughing. Cancers return and are frequently more aggressive after recurrence. Not recommended for cases where cancer is known or suspected to have spread beyond the prostate. Very few studies. Despite dating back to the 80s, there is still a lack of long-term data on cryosurgery. Long JP, Bahn D, Lee F "Five-year retrospective, multi-institutional pooled analysis of cancer-related outcomes after cyrosurgical ablation of the prostate." Urol 57:518-523, 2001

Proton Therapy: Uses Proton beams to kill cancer cells. Non-invasive, excellent treatment for tiny tumors of the eyes/brain. However advantages become disadvantages when treating large areas, i.e. prostate plus margins and lymph nodes. Risks of radiation “scatter,” not effective for targeting large areas (such as the prostate), a likely risk of secondary tumors from proton by-product – neutrons. Unable to adjust targeting to account for organ motion; unproven, expensive, limited availability No studies longer than 10 years and most are devoted to protons combined with photons. Hall, IJ, et al "Intensity modulated radiation therapy, protons, and the risk of second cancers," IJ Rad Onc Biol Physics, Vol 65 No 1, 2006 "When compared to photons, a 10-fold increased total body dose is delivered to the patients by neutrons."

Cyberknife® : Fancy name, actually a method of external radiation therapy. This involves what is known as “hypo-fractionated” dose delivery (fewer sessions but higher doses of radiation). Treatment usually delivered in only 5 fractions (treatment sessions). All extreme radiation hypofractionated studies to date reveal a high risk of significant complications including high incidence of urethral/rectal fistula, bladder damage, ulcerations, bone necrosis. No long-term results published (should be reserved for non-curative cases; patients who will not live long enough to suffer harsh complications). King CR, et al Stanford Univ.Sch of Med, "Stereotactic body radiotherapy for localized prostate cancer: interim results of a prospective phase II clinical trial," Int J Rad Onc Biol & Physics, 2009 Mar 15; 73(4): 1043-1048.

And on the page goes dismissing therapy after therapy, so what’s a man do do?

Why! Buy New Improved DART!! DART now with 4D IG-IMRT. True Dynamic Adaptive Radiation Therapy made possible only by numerous components of 4D image-guided intensity modulated radiotherapy (4D IG-IMRT)

New improved DART provides the most exquisite control of photon beams through SonArray, respiratory gating, cone beam helical tomography, on-board imaging and the "exact couch" functions.

Where can I get New Improved DART? This new level of technology in its most advanced "true" state is currently available at only one center - Dattoli Cancer Center.

Where can I see the long term results of New Improved DART? Evolutionary – in process, since 2008 (yet already “time-tested” since this is a dramatic improvement upon previous successful technology). There is a study, authored by our very own Dr Dattoli and Nurse Practitioner Cash, published in the prestigious Journal of Radiology Nursing – see Cash, J; Dattoli, M et al Radiology Nursing, vol 28, # 3; 87-95; Combined Modality Treatment for Prostate Cancer with Dynamic Adaptive Radiation Therapy. 2009

Is this good marketing? Are the options fairly presented to help a newly diagnosed man to decide what his best option might be? Or is this a marketing ploy focussing on the negatives for all but one therapy, a therapy that apparently does not have a long history or any independently published studies in peer reviewed journals?
Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony Metastasis: Aug '07: Intermittent ADT: PSA 2.3 Aug '10

It is a tragedy of the world that no one knows what he doesn’t know, and the less a man knows, the more sure he is that he knows everything. Joyce Carey

brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 6/5/2011 5:05 AM (GMT -6)   
Reads like a snake oil commercial to me. Numbers games are sneaky. JMO.
72 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. RALP July 2009
PSAs 0 since

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 6/5/2011 6:27 AM (GMT -6)   
They sure twisted the numbers.
I like this one: Many, however 40 – 80% of cases found to have more cancer after surgery is completed, requiring additional treatment. Pierorazio PM, et al, "Long-term Survival After [RP]...", Urology 2010 Mar 27, shows an 80% failure rate with high risk patients.
What a ridiculous comment. What's the "failure rate" for other treatments of high risk patients? Define failure. Define high risk.

Every statement they made is carefully worded to hide the good side of that particular treatment.
Here's some balance for you. A recent study by Jeff, et all, indicates the application of the Improved DART 4D shows a 100% failure in the treatment of broken arms and legs, and has no any effect in shortening the duration of flu symptoms.

The brief sounds like it was written by a lawyer and his marketing manager wife. Watch out.
Jeff

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 6/5/2011 7:02 AM (GMT -6)   
What total horsecrap. Reading it just pissed me off, can't believe any sensible person would fall for it, and all it does it make me resent that clinic, and it's advertising and marketing scheme. It would also make me never want to go there or use their method, if they are so willing to be deceptive on the front end of their operation. Reminds me of the some of the same marketing b.s. that a couple of big name surgeons that get passed around here play.

It's simple not in the patient's best interest at all.

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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 6/5/2011 8:44 AM (GMT -6)   
Interesting post and comments. There is always a certain amount of "puffery" in marketing materials. One would hope that it was limited in such a situation as medical treatment for a potentially deadly disease. However, that is not always the case. In the medical practice in question are any of the statements patently false? Or just stated in a way that bolster their particular point of view? There is so much conflicting information and contradiction in studies in the medical field that a patient is at a disadvantage without honest evaluation and discourse with the professionals. One must keep in mind that medicine is, afterall, a busness and not a charitable endeavor. Hopefully we find a physician who puts the patient's best interest above those of the business interest.
 
Don
 

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 6/5/2011 9:14 AM (GMT -6)   
You may recall that recently I was in search of differing scans that could help me identify the cause of my rising PSA.

The subject of Feraheme MRI-CT scans was found to be the latest thing since the failure for approval of Combidex.

The scan is conducted in Orlando (my home) and only takes patient referrals from two doctors, Myers and Dattoli. The Dattoli dr that contacted me was slick on the phone and totally glossed over the fact that I would have to pay for the drug personally while the insurance industry would pay for the scans.

They are in fact skirting the FDA clinical trial and drug approval process. This dr and the Scan Center had no problem whatsoever with conducting business this way.

The dr went on to say that if cancerous nodes where found they could be radiated at their center. But, went on to say that HT would most likely be required and they could oversee that as well.

Since my discussion with Dattoli I have received follow up phone calls at least once and sometimes twice a week wanting to know when I want to schedule my consult with the dr.

Sometimes when you get that queasy feeling that something just doesn't feel right you just have to walk away.

They may be very good a what they do. RADIATION. However they sure seem to be going about it (marketing) the absolutely wrong way.

Just my thoughts and opinion on this topic,

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09 Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
PSA .6 IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9
3/7/11 PSA 4.2
4/10/11 PSA 3.8
5/19/11 PSA 4.9

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 6/5/2011 10:56 AM (GMT -6)   
Sonny, like they say: if it looks like a duck, walks like a duck, and quacks like a duck, its probably a duck. I am real big in trusting those inner gut feelings for the most part.
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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 6/5/2011 11:23 AM (GMT -6)   
This is distrubing to me to say the least. I heard nothing but good things about Dalotti to this point.
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3633
   Posted 6/5/2011 12:20 PM (GMT -6)   
The fact that Dattoli uses these tactics to promote his business, using carefully selected dubious studies to support as negative a picture as possible of competing treatments while selecting equally dubious studies, many written by his own staff, supporting his "DART" linac, which, surprise surprise, is ONLY available at HIS treatment center.....

If he uses these tactics to denigrate his competition then you can be sure he is using equally twisted information to support his treatment outcomes..

By refusing to treat the difficult cases that are likely to have negative outcomes, a treatment center can make itself look very good indeed..His sales pitch comes right out of the playbook of any good carnival barker..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4087
   Posted 6/5/2011 12:25 PM (GMT -6)   
Unfortunately, prostate cancer is a booming business and with that boom comes big marketing.  I don't like Dattoli's approach either but it's not unlike what we see from other prominent practioners.  Dr. Menon touts the "Veil of Aprhodite" nerve sparing technique that allows a 90% return to erectile function (but don't read the small print). Dr. S evidently has former patients out trolling on health forums to tout his excelence. Georgetown University floods the radio airways in Washington, D.C. extolling Cyberknife and the latest and greatest (again, don't read the small print). There are billboards , radio spots and TV commercials galore in South Florida touting da vinci the "minimally invasive" new gold standard, etc, etc, etc, blah, blah, blah.  I won't be long before every lucky 100th patient gets a prize...
 
Are Dattoli, Menon and Samadi bad docs?  I don't think so.  Is their marketing over the top?  I do think so.  This makes it even more difficult for the poor slob who discovers he has PCa to make a decision.  But, it's the world in which we live...so get used to it.  We still don't have to like it but, guess what - this marketing works so it is unlikely to stop.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 6/5/2011 12:35 PM (GMT -6)   
The problem with health care in the US is that the economic incentives pervert medical practice. If MDs make money by doing procedures, regardless of the outcome, well, unscrupulous doctors will advertise so that they can do more procedures. People often don't like University Hospitals, because the staff doesn't always seem eager to please. I bet at the Dattoli Center, they bend over backwards to please you, because they want your business. Maybe it's better to go to an MD that isn't quite so eager for your business.

Somehow, there has to be a change in how doctors get paid. Oh wait, that's "health care rationing", "socialized medicine", "death panels"--maybe we can't have a better health care system in the US because we can't have a practical discussion about fixing it, only a political, ideology driven one.

Terry Herbert
Regular Member


Date Joined Sep 2010
Total Posts : 92
   Posted 6/7/2011 4:32 PM (GMT -6)   
I was taken to task by the Director of Marketing & Development Dattoli Cancer Center & Foundation for my post on the grounds that their site on the grounds that there was nowhere else that supported information on treatment options with references to peer-revidewed cmedical journal citations.

In my response, I suggested that the citations might be regarded as misleading, quoting as an example the RP section where the statement is made:

“Most aggressive surgery to be performed on the patient’s body but least aggressive treatment to the cancer. Commonly leaves microscopic tumor cells behind, may spread cancer cells to blood stream.”

The citation in supprt of this statement is an article written 11 years ago which I cannot access without paying US$30. This would be an excessive amount for me since the Abstract seems to show that the piece is in fact a meta study with the stated intention of providing a comprehensive overview of the definition of PSA only recurrence, staging controversies and the wide variety of treatments to be considered is provided. It seems from the Abstract to have nothing to support the statements made.

I realise people think i am f*rting against thunder, or peeing upstream even, to choose another metaphor, but even though I understand the machinations of the business that is the prostate cancer industry and the importance of maintaining cash flow, it still makes me mad to see what seem to me to be such blatantly misleading statements.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 6/7/2011 9:11 PM (GMT -6)   
tud, i fully agree with your post
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 margin
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, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 6/7/2011 11:20 PM (GMT -6)   
Doctors are salesmen (and I include female doctors here). Like most salesmen, they will stop short of outright lies, but are not adverse to bending the truth ~ especially with a Director of Marketing & Development behind the scenes!

When we go shopping for a doctor, do we really go for the doctor who is best for us, or is it the one who is backed by the best marketing and who gives us the best sales pitch? I suspect the latter.

As part of building empathy with you the client patient, a good salesman doctor will tell you what you want to hear, and is very good on picking up on subtle clues to that end. You might come out of his office thinking "wonderful doctor", but is it really just "wonderful salesman"?
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but then rose to 0.4, doubling time 7 months
Following diet change, PSA static at 0.4...

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 6/8/2011 5:56 AM (GMT -6)   
Great post Piano. Right on the mark. However, as with anything that we buy. We need to kick the tires, check the reputation and track record of the business. If there are compliants about their product, reputation or service, if they have deceptive sales practices or are dishonest, we shop elsewhere. Aggressive marketing is not, in and of itself, a concern (for me anyway) as long as the product or service is as advertised. If the sales pratcies are agressive, but customers are satisfied with the service, what's the problem. The question is the service. If it is so good, why is there a need for the agressive sales tactics? I think that you need to be more careful in checking out the quality of the product your getting. I know I will be if I am ever in the need of radiation treatment again.
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 6/8/2011 7:29 AM (GMT -6)   
OK, I just can't let all this go by without saying something. First, you are making generalizations about all doctors. That is a common thing with doctors, lawyers, and even preachers. It is always unwise to make generalizations about anything animate or inanimate. Say you buy a blue car, and it turns out to be a lemon. Does that mean all blue cars are lemons? Of course not!

I don't know any of these doctors or organizations mentioned here. Maybe they are ALL charlatans. Maybe some more than others. I do know that in any medical community, it does not take long for a bad doctor to become well know to his peers. It pays to ask around before accepting anything from a given practitioner. If things look like a practice mill, or you hear more than once that something is not on the up and up, then run like the devil. Just don't lump all of any group together.

There are a lot more good docs out there than bad. Believe me, I used to know both.
72 years old (1939) USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0. RALP July 2009
PSAs 0 since

clocknut
Veteran Member


Date Joined Sep 2010
Total Posts : 2649
   Posted 6/8/2011 7:58 AM (GMT -6)   
I've never chosen a physician based on marketing strategy or sales pitch.  In fact, no doctor I've ever utilized has even remotely  had a marketing strategy or sales pitch.  They're just good doctors going about the business of helping people (and, yes, earning a pretty good living doing so, but given the nature of their work, I think that' fair).
 
I agree that the Dattoli propaganda is highly misleading and skewed in their favor, but the doctors I've known are not salesmen and have no reason to be.  To make a blanket statement such as "doctors are salesmen," seems completely foreign and inaccurate to me.  Maybe it would be better to say "some doctors" or "a few doctors," or even "many doctors," but not ALL doctors.  Good doctors in our communities don't need to advertise.  Patients flock to them because of word of mouth recommendations based on their madical proficiency and bedside manner.  Patients shun them if they're not good at what they do. 
 
I would certainly never have made a decision regarding treatment of my prostate cancer based on something I read on the internet or a piece of written advertisiing, anymore than I would buy a car based on a glossy brochure or a TV ad showing the car doing 360's and racing through city streets.
 
All of the procedures listed in this thread obviously have their merits and their disadvantages.  Anyone who thinks that any one of them provides a sure-fire guarantee against recurrence or SE's is surely not doing any critical thinking.  Caveat emptor is an old Latin saying that still applies in 2011.
 
 
 
 

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 6/8/2011 9:21 AM (GMT -6)   
Brainsurgeon has a very fair point. There are good and bad in every profession. While everyone is entitled to make a living, I think most docs want to help patients get well. (They could make a lot more money as investment bankers).

I wonder if advertising such as Dattoli's backfires. I guess not, or he wouldn't do it. Personally, it would cause me to be VERY reluctant to go there, for the same reason I don't eat at restaurants that have a guy standing at the door urging every passerby to come in for a great meal. The best restaurants don't need the door shill. (You don't see Peter Scardino advertising that you need to come to him for surgery because otherwise you will live miserably for the rest of your life - and don't fall for that radiation stuff, which will burn your insides and not remove your cancer).

I went to a speech by a leading Johns Hopkins doctor, who I think gave good advice. As I recall, he said something along the lines of "You should pretty much ignore anything you see on a doctor's or hospital's website, including our own website."
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