Met with my surgeon for my first follow up post RALP last month, uPSA <0.006, great!
… Decipher test showing "aggressive tendencies" and he is suggesting I speak with the RO again soon to hit it hard and to be on the safe side.
Same large Uro Group but different offices in different towns.
All I want to say is that you should continue
to be your own best advocate.
I believe that the Decipher is a good test, but you should get the actual results (let us know when you find out) and study-up on the ranges and interpretations. But moreover, be aware—nothing more than that...be aware, and be your own best advocate—of the presence of a "loophole" which is currently allowing the types of within-private practice "self-referrals" you have described, and that this is a debated topic on whether this is resulting in a new form of "over-treatment." It's an ethics question: from the patient's perspective, it risks unnecessary additional side effects; from a public health perspective, it drives up health care spending without clear benefits to the patients
Federal law, Ethics in Patient Referrals Act, prohibits physicians from referring patients to medical facility in which he or she has a financial interest. The law is intended to protect patients—to ensure that medical decisions are made in the best interest of the patient, without influence or conflict of interest of financial gain by the treating physician. The law, however, includes a loophole for In-Office Ancillary Services (IOAS)...and self-referrals of IMRT radiation therapy in urology clinics is currently allowed through the IOAS. There have been urology offices who have been cited and fined for breaching fine-line which the loophole allows for the obvious financial gain. (Imagine the amount of patient follow-through needed for those cases who were eventually cited and fined, especially considering the patient "trust" that most men initially placed in their surgeon). Not saying this is the case here, but be aware of this contemporary ethics issue which generally flies below most patient's radar
. Ultimately, I'm just saying that in my opinion informed, empowered patients tend to have the best satisfaction with their treatment decisions. Be your own best advocate.
Besides those cited/fined cases, as a numeric guidepost be aware that compared to men seen by urologists employed by NCCN cancer centers, men seen by private practice self-referring urologists were 6.18 times as likely (or 518% more likely to undergo IMRT for their prostate cancer (p<.001), according to a study by Georgetown University's School of Public Policy.
Post Edited (Blackjack) : 12/12/2018 12:35:55 PM (GMT-7)