Tall Allen said...
Halbert, I don't agree. Do you think if you lock up a surgeon and an RO in the same room, and let them duke it out they will somehow reach consensus? I know "tumor boards" do just that - but I think that does a disservice to the patient. The patient should be able to hear the various POVs and make his own decision based on what's important to him. The patient also has the responsibility to filter out the doctor's judgments that are outside of his expertise. If my radiation oncologist says "the nerves can't be spared," I smile and nod and ask the surgeon instead. If a surgeon says, "radiation won't cure you," I smile and nod and ask the radiation oncologist instead. As patients, we have to assess the validity of the information we are receiving. It's a tough job, but no one can do it for us.
That last sentence is the key. We must somehow research it and figure it all out for ourselves, a super difficult task considering what is at stake, the emotion involved and sometimes the sense of urgency especially for the more advanced/aggressive cases.
Now sure, you can only believe what the RO tells you about
RT and not the surgeon, and no need to ask the RO about
nerve sparing. But either way, you are very often still dealing with a strong bias, and will often get conflicting info. "If a surgeon says, "radiation won't cure you," I smile and nod and ask the radiation oncologist instead.", that's fine. But once you have asked the most likely biased RO about
it, where are you? With ether surgeon or RO, when you ask them "which should I do", there is going to be a huge financial (and other types of)incentive to at least hint that the service they offer is the best. Each time a surgeon is asked by a patient if he should let that surgeon do surgery on him, thousands of dollars are on the line for that surgeon. (and probably vice versa for RT). If a surgeon gives too many patients advice to seek RT, well, you can see that extra vacation homes on the Gulf Coast and a Mercedes for each family member and sending the wife and daughters on a plane to NY for shopping trips/Broadway plays 2 or 3 times a year(and don't forget girlfriends! LOL!) are not paid for by significantly decreasing the number of surgeries done daily.
And the same could probably be said by the oncologist. Unless a man is just unusually saintly/altruistic, surely it must be admitted that such considerations could work on a man/woman even if only down at the subconscious level. Now I by no means am saying that they don't actually believe that it is the service they provide which is the best choice. I am not saying they are not worth the money. I'm just saying their opinion might be influenced by something other than the final scientific word on the matter, if that can even be known. I'm sure some overcome these biases, but I'm not sure how we are to know who they are.
PSA 10.9 ~112013
Bx on 112013 at age 64 yrs 11 months, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, but SV+, still G9 but down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.1 on 4/7,
PSA <.01 on 6/11, 8/20/14 and 3/4/15
Post Edited (BillyBob@388) : 5/29/2015 1:26:24 PM (GMT-6)