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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2007Unethical and sleazy Urologist
I had a most unpleasant experience yesterday and would appreciate any reactions and feedback: Diagnosed in mid-August with Prostate Cancer: Age-59-good health T1c stage Gleason score 6 (3+3) PSA 3.17 as of August, 2007 PSA doubled in 22 months I have gotten several opinions and have decided that if Insurance won't pay for the Cyberknife I will go with either the lo-dose or high-dose brachytherapy. Upon the urging of a close friend who has a Urologist friend on the staff at St. Barnabas Medical Center in Livingston, N.J. the former told me to contact the Urologist who as a "professional courtesy" to him , would review my numbers. I emailed a letter to the Urologist explaining that I appreciate his offer and would like a few minutes of his time "by phone" to review my biopsy numbers and very simple CT and Bone Scan reports which I attached to the email. I then called the Urologist a week later and he claimed he never received the data and that he wanted me to come to see him in his office saying that he needed to see me in person for among other things to "see what 'body type you have". I reiterated that I simply wanted him to look at the "numbers" and to give me some feedback based upon this information and nothing else. I had a Radiation Oncologist do this by phone a few weeks before. The Urologist however insisted I come in and not wanting to appear to be an ingrate , (remember I was led to believe this opinion was as a favor to our mutual friend and on my behalf) I made an appointment and saw him the other day. He ran through some tests (none of which I thought were necessary inasmuch as I recently had them taken). Tests were urine sample, DRE, took some ultrasound gel and put it on my lower belly and used the ultrasound head to determine that I wasn't retaining much urine. That test took about 30-45 seconds. He then gave me a cursory check of my lymph nodes by palpation all the while racking up CPT procedure codes as far as I can tell. Then we went into his office and he proceeded to give me a very aggressive and unseemly "sales pitch" for the DaVinci Robot at St. Barnabas for radical prostatectomy. This was not a "medical opinion" in any lucid understanding of that term. It was a naked and shameless "sales pitch" to get me to leave my currently affiliated-with hospital (Overlook in Summit, New Jersey) and get me to come to St. Barnabas to undergo the most aggressive procedure, robot or not. I told him at the outset that I had no interest in the rad. pros. inasmuch as I am interested in the less invasive procedures such as CyberKnife or a type of Brachytherapy and I am a perfect candidate for those. The Urologist then insisted on conference calling his friend -a Radiation Oncologist all the while telling him I told him not to bother with the call but he went ahead and got the Radiation Oncologist on the phone who then proceeded to badmouth the CyberKnife and by implication my hospital. This was nakedly unethical and simply very sleazy. Bottom line: I spent about an hour with this jerk and was presented with a bill for $530.00. What could I do but sign the credit card form? My sick mother and father were waiting for me in the waiting room and it was no situation in which to cause a ruckus. He does not accept insurance but his office will transmit the billing information to my insurance carrier and they will pay whatever they decide to pay, which is probably next to nothing. I believe he reeled me in like a fish with no intention but to try to pull me over to his hospital and to rack up an unconscionable fee. I intend to dispute the charge with my Visa card company for starters. I would appreciate any feedback on this and how I might address this ripoff. Thanks, Sy > I had a most unpleasant experience yesterday and would appreciate any > reactions and feedback:... Sy, like any other professions, you've come accross one that needs to be posted on the internet, so that others in the future (those that used the internet to do their initial research) can hopefully see your post and experience. You need to name him. My numbers and age are very similar to yours and I was diagnosed mid-2006 and had my RT in February this year. The Uro that did my biopsy recommended surgery. Second opinion was also by a surgeon who suggested surgery and he LOST INTEREST when I said I am leaning toward RT. Third opinion was by an RT Onc who just started his own IMRT business, so he was very eager get me to sign up. Fourth opinion was also a surgeon, but he had an open mind and gave me options in both surgery and radiation, even referred me to another Rad Onc there. I keep on looking and a 6-7 months later decided on SBRT, which I am quite happy with, so far. So my advice is, take your time, and research, research, and research. Although you do have a G3+3, I'd also consider looking into EPCA-2 and HCA-2, just to get an additional confirmation that you have the beast. Hello Sy, I can relate to your predicament in some ways and understand the emotional roller-coaster ride you are on. Since insurance will not pay for CyberKnife.......Will it pay for DaVinci? I am not sure if that means the same? Seems to me Cyber and Da Vinci are the same? I would base my decision as to treatment not on what insurance believes....... I do understand that it is important that insurance pays........ Dr.s do like "in house visits" If you take a car for instance, and a mechanical problem say, most all mechanics would rather see the car in person than do a diagnosis and treatment plan via phone. I found that Dr.s like anyone do try to sell their treatment options also. It is only understandeable that one would push their service over anothers.... When I went to several Dr.s for diagnsosis and treatment options all "sold" me their plan in some form or another. I also paid for the visit.......... I was diagnosed with prostate cancer when I was 49..... The Urologist was very cold and hard to deal with and feel comfortable with also. He told me I was going to die......(we all do anyway....but this was do to the prostate cancer) He said the best option was External Beam radiation...... I swallowed that and looked forward to 45 trips (one-way @ 75 miles.....that is round trip....150miles) He gave me a Lupron Depot shot in his office......not medical room, 1500.00 per shot......Take down your pants....bang. The shot apparently made the prostate smaller, as well as caused many differing bodily ailments etc.....He never told me nada about what the shot would do.........I learned on-line....Thats it. I went to his Dr. friend for the visit(oncologist) He told me the benefits of radiation also.........and did try to sell his services..... I learned later many of the aspects that radiation could do and would do, on-line........ I did get a very cold feeling about the direction I was headed for, and felt very sick inside........What is going on??????? I decided to take my knowledge, (minimal and all learned on-line and from this news group) to see other Dr. in the "Big City" I was so glad I did this..............I did meet yet another Urologist and did pay for a visit fee and did get the DRE and, and.........I was not too happy with his speech either.......hum...... Finally I headed for Stanford Medical Center....... I met a wonderful Dr. that studies prostate cancer....... I did have the in office visit, and the inspection of all lab work. He was a Surgeon......Urologist.... He looked me over like he was sizing me up, also......my personality, body size, etc. I think this is a way for a Dr. to feel if he can help you...... I expalined what I had done, where I had gone and how I ended up here..... He said, "I can help you" Anyway, he looked at his book and said, I have an opening on thurs....... Do you want that? I said yes.....he shook my hand and I felt a warmth go over my body like no-other........I mean that! I had surgery, RP in 1999. I just had my last PSA and it is undectible....2007 Anyway, sorry for the long story, and realize the hardship you have with Dr.s and insurance, and decisions. Prostate Cancer specialists are the best Dr.s to see. They do require in house visits.... Either it be Radiation or Surgery. We all have to decide, and hopefully do not have to go thru too much making that choice. John Loomis > I had a most unpleasant experience yesterday and would appreciate any > reactions and feedback: [quoted text clipped - 72 lines] > > Sy > Hello Sy, > I can relate to your predicament in some ways and understand the emotional > roller-coaster ride you are on. > Since insurance will not pay for CyberKnife.......Will it pay for DaVinci? > I am not sure if that means the same? Seems to me Cyber and Da Vinci are > the same? John, FYI, DaVinci is robotic laparcopy radical prostatectomy (meaning surgery with robot/computer assisted) Cyberknife is an EXTERNAL beam radiation machine, not surgical procedure. It is more like IMRT (intensity modulated radiation therapy). [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] > Hello Sy, > I can relate to your predicament in some ways and understand the emotional > roller-coaster ride you are on. > Since insurance will not pay for CyberKnife.......Will it pay for DaVinci? They are totally different. The CyberKnife is a computer controlled linear accelerator which delivers high-dose radiation in an extremely precise manner to spare healthy tissues. It also has the ability to compensate for patient/target movement while on the table which is very important so that any movement doesn't cause the powerful radiation beam to hit a healthy area. The DaVinci Robot is a device which assists the surgeon by allowing more precise control of the surgical tools used for very invasive procedures like a radical prostatectomy but with somewhat less cutting. The surgeon controlled robotic device compensates for ill-advised hand movements which the surgeon might make if he had tremors from a drinking binge the night before :) but the DaVinci Robot is nevertheless cutting into tissue, causing blood loss and the usual surgical hazards. If it were NECESSARY for me to go that route I would certainly consider it but I don't want that invasive a procedure and the good possibility of nasty sequellae. The Urologist I saw ther other day, Hannibal Lecter said that virtually all insurances pay for it inasmuch as it isn't performing a "new" procedure but is replicating conventional rad. pros. surgery with the alleged extra precision of the robotic device. I do believe he slipped and made a truthful statement. You'll have to excuse my sarcasm but this situation certainly warrants it. B.t.w., I have contacted my Visa card company and they have temporarily reversed the charge until this gets settled. I will be sending them documentation to corroborate the facts involved. Sy > I am not sure if that means the same? Seems to me Cyber and Da Vinci are > the same? [quoted text clipped - 138 lines] > > > > Sy > Since insurance will not pay for CyberKnife.......Will it pay for DaVinci? Insurance paid for my DaVinci surgery, no questions asked. > Hello Sy, > I can relate to your predicament in some ways and understand the emotional > roller-coaster ride you are on. > Since insurance will not pay for CyberKnife.......Will it pay for DaVinci? > I am not sure if that means the same? Seems to me Cyber and Da Vinci are > the same? Not at all. See earlier posting. > I would base my decision as to treatment not on what insurance > believes....... > I do understand that it is important that insurance pays........ > Dr.s do like "in house visits" > If you take a car for instance, and a mechanical problem say, most all > mechanics would rather see the car in person than do a diagnosis and > treatment plan via phone. Good analogy. However I brought the "car" in (me) and he proceeded to do "unathorized work" on this car. If you have a problem of any magnitude with your car that required "work" the mechanic would call you to authorize the repairs after giving you an estimate as to the cost. This jerk did not get "authorization" for his "work" on me nor did he provide any "estimate" of the cost. And why should he not have provided the same level of professional consideration on these matters as one would have expected from their auto mechanic? I have never been one of those people who were "doctor bashers": the type who complains if they received "too" many tests or complains if they didn't receive "enough" tests. The type who expect a doctor to cure everything and cause you to live to be 125 years of age. Sy > I found that Dr.s like anyone do try to sell their treatment options also. > It is only understandeable that one would push their service over [quoted text clipped - 129 lines] > > > > Sy > This jerk did not get "authorization" for his "work" on me nor did he > provide any "estimate" of the cost. And why should he not have > provided the same level of professional consideration on these matters > as one would have expected from their auto mechanic? Authorization? You walked into his office and requested his professional services. Approval? You sat still while he poked and probed you and you peed into his cup. Estimates? Most doctors have no clue what $$$ those codes translate to. You want free medical care? Not even soldiers get that, but that IS an option you have to get lower bills. I.P. From: stuttgart6@lycos.com (Sy) I had a most unpleasant experience yesterday and would appreciate any reactions and feedback: Diagnosed in mid-August with Prostate Cancer: Age-59-good health T1c stage Gleason score 6 (3+3) PSA 3.17 as of August, 2007 PSA doubled in 22 months I have gotten several opinions and have decided that if Insurance won't pay for the Cyberknife I will go with either the lo-dose or high-dose brachytherapy. Then we went into his office and he proceeded to give me a very aggressive and unseemly "sales pitch" for the DaVinci Robot at St. Barnabas for radical prostatectomy. This was not a "medical opinion" in any lucid understanding of that term. It was a naked and shameless "sales pitch" to get me to leave my currently affiliated-with hospital (Overlook in Summit, New Jersey) and get me to come to St. Barnabas to undergo the most aggressive procedure, robot or not. I told him at the outset that I had no interest in the rad. pros. inasmuch as I am interested in the less invasive procedures such as CyberKnife or a type of Brachytherapy and I am a perfect candidate for. Bottom line: I spent about an hour with this jerk and was presented with a bill for $530.00. What could I do but sign the credit card form? Thanks, Sy ====> hi sy - given your age, stage and psa, the general rule - and notice - i said - general rule.... is surgery as the main line of defense. this way, radiation could be used as a second chance of a cure if the surgery option failed. with radiation, surgery normally is not an option in a failed treatment. of course, the final decision should always be that of the patient and that is what we are discussing here. as to the robot surgery - when the hospital is spending a million bucks a pop for these units, they want it in use 24 hours a days if they could. if the robot was not in use, then, it's costing them money and hospitals aren't in the business to lose money. so, that means that the doctors who are signed on with that hospital have to recruit patients for this procedure. so, that brings us up to your decision. you decided not to have the robot surgery to begin with and told him so up front. was it wrong to push the sales pitch? there's two ways to look at it. 1. to make you aware that this was an option. 2. to push you into an option you didn't want. the answer lies in what you said about the bill. that is an expensive bill that you didn't ask for and tends to make you believe that you are getting ripped off. as to your insurance. just flat out ask them what different types of treatments will they pay for and how much..... then, choose from that. this way, there's no hidden surprises when the final bill is due. all the best on whichever treatment you decide, ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc > I had a most unpleasant experience yesterday and would appreciate any > reactions and feedback: Sy, that doc has his kingdom, and you have to play by his rules when there. We all need to be very proactive and agressively speak out, especially when we assume we're getting something for free. "Doc, I had the understanding that this was a free consultation to get your opinion on my numbers ONLY, is that correct"? It's not that I'm saying you're wrong and he's a wonderful guy, it's just that the burden of understanding is always a 2 way street. By the way.... I vote for surgery. Get it out of your body forever and be cured when you wake up is my feelings on your numbers. I'm 5 years post RP. JMHO  SignatureJK Sinrod www.SinrodStudios.com www.MyConeyIslandMemories.com [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] Thanks for your feedback but it's my understanding that the rad. prost. does not guarantee that "you get it out of your body forever". It may increase long term survival by a few percentage points but at what quality-of-life costs? What type of problems did you have post op? Thanks, Sy > > I had a most unpleasant experience yesterday and would appreciate any > > reactions and feedback: [quoted text clipped - 8 lines] > forever and be cured when you wake up is my feelings on your numbers. I'm 5 > years post RP. JMHO Hello, Sy: I've been reading this all with interest ... sounds like you got quite an education about the interaction between you and your docs. Also seems like the uro bought himself a lot of ill will. He's got your $530, but you've got his name and a story to tell all your male buddies when it's their turn to decide what uro to use. You seem to imply that surgery SEs are worse than those from radiation. You'll get all kinds of stories here. I had an LRP and I'm fine: temporary incontinence and impotence. I'm just one story, of course. But if you're assuming that radiation treatments are free from potential SEs then you need to research some more. What makes some of us nervous about the Cyberknife is that the information that turns up is long on marketing and short on hard facts. Yes, the Cyberknife has been approved for use throughout the body, and many docs want to begin using it on PCa. There's bound to be a learning period, and the men who get it now are possibly the subjects in that learning. If that's what you want to do, then my hat is off to you, as you are much more courageous than I. But please have your eye open about this. --charlie Signature6/2006 PSA 5.2, DRE suspicious 7/2006 Biopsy: 2 of 10 positive, Gleason 7(3+4) 11/2006 LRP: Clear margins PSA < 0.01 on 1/2007, 3/2007, 6/2007, 9/2007 so far, so good ... > I intend to dispute the charge with my Visa card company for starters. > I would appreciate any feedback on this and how I might address this > ripoff. Your credit card company will demand proof that the merchant failed to deliver the product or service you paid for, plus a copy of your written appeal to the merchant and proof he received it prior to your CC charge dispute. It won't matter to VISA whether you're buying a used car or a life-saving procedure. Maybe the best place for your protest is the state medical board. I.P. I should add that many, maybe most, insurance companies approve and thus fund second opinions. >> I intend to dispute the charge with my Visa card company for starters. >> I would appreciate any feedback on this and how I might address this [quoted text clipped - 9 lines] > > I.P. Sy, I don't think any reputable medical professional would give a medical opinion or assessment of ones condition or make a recommendation without first seeing the patient and doing an assessment for himself and never over the phone. I believe the Rad Onc was the one pushing his treatment option without a proper assessment. It sounds like the urologist was the one that had your interest more at heart than did the Rad Onc. I believe you made a decision of what treatment you wanted and were looking for confirmation. It's your body and your life and if you choose to gamble and have your cancer treated with new unproven technologies so be it. But with your age and assuming you expect to live another twenty five years more or less, you will find that the majority of the experts in the field will recommend surgery. Studies have shown that radiation is not as effective as surgery for long term survival. You need to do a lot more research as you have plenty of time considering your numbers. Don't be in too big a hurry. You may regret it. Ron S. In article <ef87a8eab37d656cafed49eda4993ed4@localhost.talkaboutsupport.com>, I really do appreciate eveyone's feedback on this but let me underscore the following: I had made it crystal clear both by emails and by phone and in answer to his question "What is it that you are looking for"? that: "I would appreciate a few minutes of your time (by phone) to take a look a my Biopsy results and CT scan & Bone Scan and give me his general opinion based upon those particular pieces of data. In fact I went out of my way to underscore that I was not looking for any type of comprehensive medical evaluation whatsoever and would appreciate a look at my results which he had told my friend he would provide to me gratis. He says he needs to see me in person so he can assess my "body type". I then go to his office to satisfy his pretext to "assess" my "body type". Sounds like something from the 19th. Century. Anyone here aware of research showing "body type" assessment as a tool in Prostate Diagnosis & Evaluation? I don't think so. What he should have done if he were a responsible and ethical person would have been to say "Sy, the data (Biopsy report etc.) you showed me is insufficient for me to make an assessment and it's necessary for me to perform certain tests for which there will be additional fees". Fine. I then can decide whether I want to continue or not. Instead, he makes a completely self-serving unilateral determination to give me this exam and than hits me with a $530 bill. I guess he could have run more tests and charged me $900. Why stop there? Am I not a party to this transaction? Am I not the one who will be paying for this? Those are rhetorical questions of course. Can you think of any other type of transaction where someone performs services at their whim and at whatever price they decide and then demands payment for it without having received your consent in the first place? I think that's the Sopranos' business model. This whole thing was just so manipulative and so flagrant. My friend (the one who told me to see Dr. Lecter in the first place) is furious with him inasmuch as he was told that the visit (whether by phone or in person) was complimentary inasmuch as the two of them do business together. He called the Doc the other day and insisted that he not charge me but the guy refused to budge even a little, When any of us step into a Physician's office we don't forfeit our brains or our autonomy. Because of the nature of the "relationship" we are relying on good faith to a certain degree. If that's broached then we have to protect ourselves. This guy broached the principle of "good faith" and not slightly but egregiously in my opinion. If I get the credit card charged reversed permanently (and I do believe there's a chance of that) I still believe he's entitled to some payment but whatever it turns out to be it will be based upon a mutually agreed upon number and not his whim. Thanks for listening. Sy > Sy, > I don't think any reputable medical professional would give a medical [quoted text clipped - 15 lines] > > Ron S. ... > Thanks for listening. ... Thanks for reporting all this. For what it's worth, I think you're doing the right thing. We shouldn't let people bully us and rip us off, even if they have M.D. credentials. Good luck with it. Alan Sy, Even though you didn't think it was necessary to have an examination, you did agree to go forward with the doctor. It seems to me that you should have made it "crystal clear" to the doctor that you were expecting these services at no charge before submitting to the exam and tests. In any event it seems quite reasonable to me that the doctor would want to examine you before giving his opinion. Especially a DRE. My suggestion is to chalk this up to a learning experience and pay the bill. It really isn't worth $500 to get worked up by this. You have more important things to do. Bert > In article > <ef87a8eab37d656cafed49eda4993ed4@localhost.talkaboutsupport.com>, [quoted text clipped - 80 lines] >> >> Ron S. > ... > I intend to dispute the charge with my Visa card company for > starters. I would appreciate any feedback on this and how I > might address this ripoff. Based on your report of your experience, I'm inclined to agree with you that you were badly treated. However, as others have pointed out, it may not be easy to refuse payment. To begin with, the person was who told you that you would be seen as a "professional courtesy" may well have been talking out of his hat. Do you have any reason to believe that he had permission from the urologist to say such a thing? You should ask him. If he didn't, then the urologist is an innocent party as far as the "courtesy" consultation is concerned. He never offered you free advice and it is a perfectly reasonable expectation that he should demand that you come into his office and that he charge you. He is, after all, running a business. He might give free advice to friends and family, but it's a little unreasonable to think he would he do such a thing for a perfect stranger who happened to be a friend of a friend. Doctors hate doing that, and for good reason. Give a guy a free consultation and he starts calling you back every time he has a headache. Maybe you wouldn't do that, but a lot of patients would. Then the guy starts telling his friends that they can call Dr. Jones and get free advice. It's a slippery slope. Nevertheless, there were still two kinds of bad treatment in my view: 1. Insisting on expensive tests that you didn't need. Since you emailed the test results to the doctor, and since you have evidence that he received the email, his denying that he saw the data sure looks to me like he was just trying to rip you off. If I were the doctor and I didn't recall the email, I'd at least make a quick search through my emails, or ask my office manager to do it rather than repeating tests that were already done. 2. Aggressively pushing his services instead of giving you objective advice. If I were a doctor and you came to me for advice, I'd tell you what I thought were the potential advantages of surgery vs. radiation, and of laparoscopic vs. open surgery. I'd say what my specialty was and how I could help you if you decided you wanted what I do. If I thought that surgery was a better option for you than radiation, I'd say so. If I thought that brachytherapy was better than CyberKnife, I'd say that and explain why. But I wouldn't try to "sell" anything to you. I wouldn't try to minimize the risks of what I could offer. I wouldn't have done that strange thing with the phone call to the rad onc, and I wouldn't have tried to pad my bill. So you were treated to an unpleasant, useless, and expensive service but, in spite of your protestations, at no point did you say "No, I won't come in" or "No, I won't take that test". Does that mean you shouldn't try to refuse payment? Well, why not try? It might not work, but you don't exactly owe the sleaze ball any better treatment than he gave you. Good luck, and let us know how it comes out. Alan > 2. Aggressively pushing his services instead of giving you > objective advice. [quoted text clipped - 7 lines] > thought that brachytherapy was better than CyberKnife, I'd > say that and explain why. Alan, after my DX, the fourth opinion doctor was the one that gave me the responses you outlined in statement #2 above. He did not pressure me one way or the other and the final decision for course of treatment was my own. Thanks for your supportive comments. Let me underscore that even if my friend the intermediary, the doctor and myself ALL misunderstood the nature of this consultation, I am not trying to get away with a freebie and am in fact quite willing to pay him a mutually agreed upon fee, but will not let him call all the shots in this matter. The whole doctor-patient relationship is completely assymetrical and nowadays I think we better face the fact that it's as much a business relationship as anything else and as such, we "customers" deserve no less "informed consent" than we'd get from our auto mechanic. Sy > > ... > > I intend to dispute the charge with my Visa card company for [quoted text clipped - 67 lines] > > Alan Is Cyber Sexy? About six months ago I heard a commercial on the radio about a state- of-the-art treatment for prostate cancer called "Cyberknife." It was being offered at a hospital in Long Island (a suburb of NY) that I had never heard of. Well, I sat up straight, and to quote Anatole Broyard, "my mind became immediately erect." But my gut reaction was negative: concern, even fear. I thought, not knowing anything at all about the "Cyberknife," that folks in the PC community were going to fall for it in a big way regardless of its merits. That's because anything healthcare-related that has the word "cyber" in it is "sexy" these days. Same for "robot". If you're a clever marketer, you're going to find a way to slip those words into your promotional materials. Then it occurred to me that, if this Cyberknife is so good, why is it not being introduced by a topnotch hospital? There are loads of them here in New York. And they can afford the technology. So I did a brief search online and came up with very little info about Cyberknife, none of which suggested that it was superior to current PC treatments. Seemed that it was indicated for brain tumors. I'm not against technology, just the way it's hyped. "Cyber" doesn't necessarily mean better. Same goes for "robot". Dr. Mani Menon, robotic surgeon par excellence, once wrote the following: "There is a fundamental question to be asked of a technologically advanced society, which is: "Once a machine has been designed to perform a task, should man be removed from the equation?" "The painful and unequivocal answer to this question whether it be in folk song of John Henry and the steam engine or the economical practicalities of the automobile industries, is a mournful but unwavering, "Yes." Recently a friend sent me an article about a robot which makes rounds for a particular doctor when he is unable to be at the hospital in person. So the next time you go for a check-up, you may hear the words: "Have a seat. The robot will see you now." I wonder: When we feel those cold hands roaming over our bodies, will we long for John Henry? Leah prostatecancerblog.net Sy, With all due respect, I can't help but feel this diagnosis has added another level to your emotional stress causing even more confusion than is already out there in cyberworld. From your characterization of the doctor and your treatment by him, one can't help but question why you didn't walk out of his office. You state that he did "unauthorized exams" on you. Did he force himself on you, " a 59 year old man"? Your compliance would be construed as authorization. Also, what did you really expect from a urologist? I doubt you could find one in this country that would recommend anything other than surgery with your numbers let alone cyberknife. You state that you have done a lot of research. My question is who recommended the CT-Scan and bone-scan? I think you will find that with your low numbers that neither scan would probably be effective in finding anything anyway. You subjected yourself to unnecessary radiation exposure for nothing but padding a rad-oncologist bottom line. It is my opinion that since you have only been diagnosed within the last seven weeks that there is no way you could have done an effective job researching this topic. Most of us here on this forum have done our research after we had our treatment. We did like most and rushed into a treatment from ignorance and fear. Afterwards, we decided to learn more and did our homework. I suspect that a lot of your research is from articles that promote a particular treatment regime and are biased by nature. You need to be very careful in determining when the article was written and who authored the article. Also, a gleason 5 is preferable to active surveillance. A gleason 6 is marginal and should be monitored more closely. But you still do have enough time to do more research and become more comfortable with your decision as once you make it there is no turning back. You will then have to cross the bridges as you come to them. Best wishes, Ron S. [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] You ask some good questions, the same ones I asked when I was told about the CyberKnife. HI Leah, I appreciate your questions as well as your literary bent. The Hospital you are referring to is Winthrop University hospital in N.Y. The name "Cyber-Knife" is clever but accurate inasmuch as it is a computer guided linear accelerator which certainly warrants the "high tech" name . You can say the same thing of the "Gamma-Knife" or "DaVinci ROBOT". I have my own medical products company and am quite familiar with the industry and the marketing, some of it quite sleazy in fact. Spend a few hours listening to WABC or WOR (NYC area) and you will hear countless ads many from second rate hospitals touting their "Center for Advanced and Comprehensive Laser Bunion Therapy" and such. > Then it occurred to me that, if this Cyberknife is so good, why is it > not being introduced by a topnotch hospital? T Good question and here is the answer. The CyberKnife was developed at Stanford about 15 years ago. They will be getting their second one soon. Their are dozens of CyberKinife facilities in the U.S.A. at places like Georgetown University, Baylor Univ, U. of Texas. Med. Ctr., etc., etc.. It was originally "approved" by FDA for inoperable brain lesions and having been successful in those applications the FDA cleared it incrementally for other body systems. It has been used for several years for Prostate treatment. It is also approved" by Medicare. If a treatment is given the "green light" by the Federal Medicare Program the private insurance industry follows thereafter in most cases. Many private insurance carriers will pay for it but some don't because the treatment is very expensive. The longitudinal data is less out in time for the CyberKnife as it is a newer technology but it is certainly not "experimental" in any rational sense of the meaning of that word and that not withstanding I'm convinced enough about it's technology that I would do it in a heartbeat for my particular Dx.. My problem is that my carrier, Oxford Health Plans has been refusing coverage the last few months. The data to date is at least as compelling as for other types of sterotaxic radiosurgery but the CyberKnife has the advantage of being able to compensate for patient/organ movement while on the treatment table in order to not inadvertantly hit healthy tissues. Another benefit is that because it delivers very high-dose highly targeted radiation the treatment is completely "bloodless" and consists of 5- 1 hour or so sessions. Also, there has never been any shortage of chauvanism concerning NYC and the hallucination that they have the "best" of everything. I don't exactly live in Borneo and am in Central, New Jersey where many of the M.D.'s have been trained in NYC or even better schools (Duke, Stanford , Harvard etc) but it's really a distinction without a difference. I would not go running into NYC or anywhere else for that matter because I have the most garden variety type of Prostate Cancer (PSA 3.17, Gleason 6 (3+3) stage T1c) and as someone said recently on this board my type of case for the average Urologist is as common as "cutting fingernails". If you do a Google you will find lots of objective data (as "objective" as one can get in this field altogether) about the CyberKnife. Sy I asked the doctor why didn't say "Sloan-Kettering in NYC have one". The reason is that they have already invested their millions in "high tech" devices. > Is Cyber Sexy? > [quoted text clipped - 49 lines] > > prostatecancerblog.net That is a great line and apropos especially here :) > Anatole Broyard, "my mind became > immediately erect." > I am not > trying to get away with a freebie and am in fact quite willing to pay [quoted text clipped - 5 lines] > relationship as anything else and as such, we "customers" deserve no > less "informed consent" than we'd get from our auto mechanic. My head is reeling. Would you expect to go into a garage, watch them replace your water pump and wax your car and overhaul your frammis, charge it to VISA, drive away, and then decide you don't want to pay for it? Did you not notice those needles, that finger, that foamy cup of warm urine you filled up, or that cold gel and wand on yer tum-tum? You're darn tootin your arrangement with your physician is a business; just ask his billing department in some skyscraper 2,000 miles away, who bills you based solely on those codes he punched into his computer. So you expected a "courtesy" visit? Well, was he not courteous? Why on earth would you expect a guy who spent a fortune and a decade on med school to spend his time, facility, manpower, instruments, expertise, and cold hard cash (for the urinalysis) on you, then just wave, say "Thank you for your time", and wave in the next freeloader? And did you actually think any business is going to open an e-mail attachment these days? I haven't opened an attachment from my niece's old baby sitter in years, and her name is now Melinda Gates. No way in *hell* am I going to open an attachment from my Mom, and I don't even have a business on my computer. Sorry to sound so harsh, but a little head-slap might alert you to watch out for yourself as you navigate the perils and pitfalls of any medical system, especially with a problem as ill-defined as prostate cancer. I.P. > I had a most unpleasant experience yesterday and would appreciate any > reactions and feedback: You certainly are justified in complaining about the guy who tried to sell you on a DaVinci robotic procedure. But I wonder if you are going too far in deciding for yourself. Not only have you decided on radiation in preference to surgery, but you've even decided which radiation method to use. What you need to do is to go back to the urologist who was willing to openly discuss all possible methods of treatment and make sure you understand the relative risks of each of them with respect to the likelihood of curing the disease in the long term and of side effects. From what you say, it is likely that radiation is a possible choice for you, but you don't want to exclude any treatment out of hand. I was diagnosed with a Gleason 7 cancer at age 67, and my urologist told me I could choose either surgery or radiation. I chose surgery, but had I been five years older, I would have chosen radiation. As best I could tell the marginal advantage, for a man my age, of radiation over surgery with respect to side effects such as impotence was not worth the greater uncertainty about a long term cure. After another five years, the calculus would have been different. I'm not an expert, but my guess is that if you have access to a highly qualified surgeon, the odds of side effects for surgery and radiation for a man your age are pretty similar. On the other hand, if you have access only to "average" practitioners, you may be better off choosing radiation. I would be surprised if the cyberknife procedure has any established advantage over IMRT. > Diagnosed in mid-August with Prostate Cancer: > [quoted text clipped - 69 lines] > > Sy I have spent a lot of time researching the options and based upon my age and numbers precluded the rad. prostatectomy right from the start. I don't find the risk/reward ratio compelling enough for me to go that route. I have given some consideration to "active surveillance" (the term "watchful waiting" is really misleading) also inasmuch as there is new data on younger patients like myself (59) and with numbers (T1c, PSA 3.17, Gleason 6 (3+3) ) that seems compelling. I believe that I could live with the "uncertainty" and would be scrupulous about getting my PSA checked every few months and getting a yearly biopsy if warranted. I have not totally ruled it out especially now that I am leaning towards either high-dose or low dose Brachytherapy (my Insurance will not pay for the Cyberknife). I have been told that 2 months prior to Brachytherapy I would be given a drug called "Eligard" or "Lupron" both of which reduce adrogen production which allegedly "feeds" the cancer. Some of the side effects can be: Hot flashes weakness weight gain muscle loss and possibly causing me to go shopping at Nordstrom (just kidding!) This doesn't sound too appealing to me. I am also of the understanding that I'd have to be on it for about 1 year -post Brachytherapy. Regarding the efficacy of the Cyberknife it established it's effectiveness originally with inoperable brain lesions in the mid 90's and has been incrementally cleared by FDA for use in all body systems at this point in time. It is true that the longitudinal data is not as far out in time as with other treatments but there is no rational reason to believe it would not be very effective at killing cancer cells and and sparing healthy tissue especially because it can correct for patient/organ movement on the table during treatment. I would take whatever "chance" there might be in a heartbeat as I am convinced that it (or similar stereotactic radiosurgery) is "generally" as effective and less toxic than other interventions. > > I had a most unpleasant experience yesterday and would appreciate any > > reactions and feedback: [quoted text clipped - 99 lines] > > > > Sy >I don't find the risk/reward ratio compelling enough for me to go that >route. I have given some consideration to "active surveillance" (the [quoted text clipped - 4 lines] >my PSA checked every few months and getting a yearly biopsy if >warranted. From my amateur perspective, your modest PSA and gl6 are good pointers for WW (or AS if you prefer) but your tender youth puts you more at risk; if you've a long life ahead of you then the wisdom of WW is shrouded in increasing uncertainty with the passing of time - I'm sure you already know this. As you rightly say, the impact of 'living with the uncertainty' is the propellant for action. If your regular PSA checks show little or no change you could perhaps become quite relaxed about it all. I found my own results - at any point in time suggesting a 2 year doubling - became increasingly difficult to live with. But in the short term, WW could be profitably used to become more certain in your own mind of the choice you're about to make. Good Luck. I Hi "rosbif", Love that name. Inferring "roast beef" I'd guess? If so it's quite a fitting name for someone in this group if you catch my drift :) I would have my PSA checked every 2 to 3 months. My cancer is localized and "slow moving" if it moves at all. From what I've read frequent PSA tests would probaly catch any upward trend. Moreover it would alow me to "buy time" regarding future approval for CyberKnife treatment or anything else that would be available in the next few years. To reiterate my numbers "almost" perfectly fit "active surveillance" almost perfectly. Statistically suppose I opted for 40 15 minute EBRT radiation treatments. I would be willing to bet that the possibility of getting into a car accident driving to the hospital for all those treatments might very well offset the "almost" in the previous statement. I have no statistical proof of that of course but given the statistical nature of this whole "prostate treatment/risk/reward ratio" decision making I don't think I'm too off the mark. Sy > >I don't find the risk/reward ratio compelling enough for me to go that > >route. I have given some consideration to "active surveillance" (the [quoted text clipped - 19 lines] > > Good Luck. >I >Hi "rosbif", > >Love that name. Inferring "roast beef" I'd guess? If so it's quite a >fitting name for someone in this group if you catch my drift :) I hadn't thought of that - I was in France at the time of posting and rosbif is a gently perjorative label the french give to the english in return for being called 'frogs'...it's a misleading take on our respective staple diets...:-) >I would have my PSA checked every 2 to 3 months. My cancer is >localized and "slow moving" if it moves at all. From what I've read >frequent PSA tests would probaly catch any upward trend. Should do, barring anomalies and mixing your labs. In another post you mention a 22 month doubling time, which I think is fractionally on the wrong side of the borderline for what is currently believed to be acceptable for AS. So, emphasis on the 'active' of AS. >Moreover it would alow me to "buy time" regarding future approval for >CyberKnife treatment or anything else that would be available in the [quoted text clipped - 4 lines] >for all those treatments might very well offset the "almost" in the >previous statement. Unless your PSA velocity slows I suspect you're a bit too young for the long-haul AS, but your figures look comfortable enough to justify spending some more time looking at the alternatives. If you've any uncertainty at all that would make sense even if you decide to come back to the cyberknife. >I have no statistical proof of that of course but given the statistical >nature of this whole "prostate treatment/risk/reward ratio" decision >making I don't think I'm too off the mark. > >Sy > I have given some consideration to "active surveillance" (the > term "watchful waiting" is really misleading) also inasmuch as there > is new data on younger patients like myself (59) and with numbers (T1c, > PSA 3.17, Gleason 6 (3+3) ) that seems compelling. At 59 I planned, and was working hard on, living another vital, active 30 years. I don't think anyone claims AS offers acceptable odds of that. > Regarding the efficacy of the Cyberknife it established it's > effectiveness originally with inoperable brain lesions I've had one surgery near my brain and four in my lower belly. FLASH: they're at opposite ends of the vital section of my body. I wouldn't let my brain surgeon near my prostate, nor my urologist near my brain. And don't forget that nerve-sparing RP is considered by many [probably all urologists '-) ] as the toughest surgery in the book. > there is no rational > reason to believe it would not be very effective at killing cancer > cells and and sparing healthy tissue especially because it can correct > for patient/organ movement on the table during treatment. Here's one rational reason to consider: the surgeon, whether she's up to her elbows in your crotch or siting at a console down the hall, must 1. Determine which cells surrounding the prostate are cancerous and which are not, 2. Remove the former, and 3. Leave the latter. Now realize that the two lie just tens of thousandths of an inch apart throughout your inner crotch, and tactile feel is still one of the best ways to distinguish cancerous meat from healthy meat. You asked one of us a couple of days ago about his experience following an RP. Mine was this (RRP three years ago @ 61): I'm healthier and more fit than I have been in over a decade, am still a very active full-time "extreme-sport" athlete, may die from a meteor strike 25 years from now, and still have the option of some form of radiation treatment if my PC returns. The rest is just minute details, IMO. I.P. >>> I would appreciate any feedback on this and how I might address this ripoff. The doctor may be sleazy, but you are the one shortchanging yourself by pursuing one ill-advised course of action after another. This isn't about $500, it's about your life. You have access to the best doctors and hospitals in the world, but you choose a small, no-name community hospital because "it is 15 minutes from where you live." And apparently because there is a "yes- man" of a doctor there who will do anything you want. During the course of my husband's illness, I came across a number of guys from Central Jersey who came to Manhattan for treatment. My husband's "rad pal" at Sloan K. was from Morristown, and a guy I met at the surgeon's office at NY Hosp was from Jersey "horse country." And I know for a fact that Sloan has "branches" in NJ. Finally, if you want to stay within the state, there is an excellent teaching hospital in Hackensack. I often see it recommmended in the "Top Doctors for Cancer" book from Castle Connolly. You may be a candidate for treatments other than surgery. For example, my husband's radiation oncologist, Michael Zelefsky, who is head of Brachytherapy at Sloan K, recently wrote that he has been getting very good long-term results by treating even medium-and high- risk PC patients with IMRT alone. You should be consulting doctors of this caliber. Who knows, you may be pleasantly surprised about the treatment recommendations. You should also read on my blog, "Straight Talk for the Newly Diagnosed." It consists of step-by-step instructions from Johns Hopkins for finding the best doctors and treatments for PC. Hopkins is the top-rated hospital in the country, with the top-ranked Urology faculty (although your focus should be cancer). And what they advise patients to do is right, even if it is painstaking. Fortunately for you, treatment is not an emergency. I also have on my blog, "How to Find a Good Doctor", which offers excellent tips not only on finding top doctors but also top hospitals. There are some wise people here, but I haven't heard anybody endorse the decisions you've made. I must tell you that dying of prostate cancer is a very unpleasant business. My husband says I am wasting my breath, but I think your life is worth saving. Best of luck. Leah prostatecancerblog.net Hi Leah, Once again, I appreciate your comments and concern but it appears your expertise may be more in the Literary field than in Medicine or Marketing. >And I know for a fact that Sloan has "branches" in NJ. Yes they do and there's a branch in Basking Ridge 10 minutes from me which is even closer than Overlook Hospital. I never even considered going there. You may not be aware of the fact that the name "Sloan-Kettering" is a "brand" these days, just as is Kellogg's or Nabisco. Savvy hospitals have been selling their "brand names" the last few years (their are "Mayo" clinics in South Florida, "Johns Hopkins" clinics outside of Baltimore) "Joselyn Diabetes Clinics' which are essentially franchisees in a sense. Of course the name granting institution will do their best to insure that the doctors operating under their brand are "ethical and competent" but they are still mainly comprised of local doctors which is ok, but let's not get too hung up with a "brand name" to begin with. A "name" is not what it used to be. Finally, if > you want to stay within the state, there is an excellent teaching > hospital in Hackensack. I often see it recommmended in the "Top > Doctors for Cancer" book from Castle Connolly. There was an article in New York Magazine (or was it the "New Yorker") published about a year ago exposing these "rating outfits" like Castle Connely" and how much bunk is involved in their assessments. The ratings or ranking game has itself become a big business and companies like J.D. Power & Co. have made millions on assessing non-sensical criteria like "Voted best Urinary Tract Infection detector" by J.D. Power & Company to a gullible public. U.S. News & World Report is less about "U.S News and World Reporting" than it is about "Voted best College Cafeteria" by U.S. News & World Report and other such nonsense. Once reputable institutions and publications have "sold out " in many respects. CAVEAT EMPTOR squared. Sy > >>> I would appreciate any feedback on this and how I might address this > >>> ripoff. [quoted text clipped - 49 lines] > > prostatecancerblog.net > I had a most unpleasant experience yesterday and would appreciate any > reactions and feedback: [quoted text clipped - 3 lines] > told me to contact the Urologist who as a "professional courtesy" to > him , would review my numbers. No where do I see the word "FREE". > I reiterated that I simply wanted him to look at the "numbers" and to > give me some feedback based upon this information and nothing else. However............... > I made an appointment and saw him the other day. He ran through > some tests (none of which I thought were necessary inasmuch as I > recently had them taken). .............Did he hold a gun to your head and force you to pee? Did he grab you by the balls and tell you to bend over for the DRE? Were you bound and gagged for the ultrasound test? Or did you submit to the tests on your own free will? > I believe he reeled me in like a fish with no intention but to try to > pull me over to his hospital and to rack up an unconscionable fee. > I would appreciate any feedback on this and how I might address > this ripoff. Sounds like you were trying to rip him off with a free appointment. Was there any reason you couldn't have stood up and walked out at any time after you realized he wasn't going to give you feedback on those "numbers"? Before he performed even one test? [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] > > I had a most unpleasant experience yesterday and would appreciate any > > reactions and feedback: [quoted text clipped - 5 lines] > > No where do I see the word "FREE". Nor did I expect it for free. > > I reiterated that I simply wanted him to look at the "numbers" and to > > give me some feedback based upon this information and nothing else. [quoted text clipped - 10 lines] > > Or did you submit to the tests on your own free will? I submitted to the test based on the principle of a "good faith assumption" and just like if he had given me an injection I wouldn't expect it to be an injection of botulism. What he should have done (and I've repeated this several times already) was to say that "your request for my interpretation of your results can't be done by just the test paperwork you showed me" (which is all I had requested in the first place) and I have to give you the following procedures. That would have been fine. I could have then elected to proceed or to stop right there, pay for his time and leave. > > I believe he reeled me in like a fish with no intention but to try to > > pull me over to his hospital and to rack up an unconscionable fee. > > I would appreciate any feedback on this and how I might address > > this ripoff. > > Sounds like you were trying to rip him off with a free appointment. Read my earlier postings. I fully expect that he deserves some payment but not based upon his self-serving and unilateral decision to run tests on me and without some clarification of his intentions not to mentione the extravagant cost involved. Is that too much too expect? I suspect you may be a doctor yourself given what sounds like an inordinate sense of entitlement and a lack of understanding as to the asymetry of the doctor-patient "relationship" > Was there any reason you couldn't have stood up and walked out > at any time after you realized he wasn't going to give you feedback > on those "numbers"? Before he performed even one test? > I suspect you may be a doctor yourself given what sounds like an > inordinate sense of entitlement and a lack of understanding as to the > asymetry of the doctor-patient "relationship" "Sense of entitlement"? Darn right! Both parties entered into a contract; he fulfilled his obligation, and is now entitled to see you fulfill yours. High School business law. "Asymmetry"? He has something you want, you have something he wants. You asked him for his product, he provided it, you accepted it, the ball ... er, bill ... is in your court. I.P. Your analysis (there are puns all over the place if you think about :) is certainly commensurate with someone who is versed in "High School Business Law". The matter here is not so "cut and dried"-another pun Let me stop right there. Thanks, Sy > > I suspect you may be a doctor yourself given what sounds like an > > inordinate sense of entitlement and a lack of understanding as to the [quoted text clipped - 9 lines] > > I.P. > Your analysis (there are puns all over the place if you think about :) > is certainly commensurate with someone who is versed in "High School [quoted text clipped - 3 lines] > > Let me stop right there. Maybe I should add that I've performed as a consumer advocate for > 40 years, busting the chops of blue-chip corporations up to and including VISA, General Motors, Datsun, Sears, JC Penney, Dept of Defense, VA, etc., including several credit card purchase disputes as recent as last month, plus local pit bull lawyers who thought they could bluff me into submission because they had law degrees and I don't. Score so far: I.P. about 30, opponents 0, as in Nada ... Zip ... you lose. Turns out we all have to operate under the same set of laws, JD or no JD. The Fair Credit Reporting Act is a huge and very effective club with which to hit errant merchants over the head, but it does have a strict set of compliance rules for both parties. 10th grade business law was just a starting point, leading to the 12-15 reference books on my shelf on this topic alone. Let us know how it all works out. I'd love to know how to legally rip off some merchants and individuals who have screwed me over the years without leaving paper trails. I.P. > I had a most unpleasant experience yesterday and would appreciate any > reactions and feedback: > I reiterated that I simply wanted > him to look at the "numbers" and to give me some feedback based upon > this information and nothing else. I had a Radiation Oncologist do > this by phone a few weeks before. Sure you did - over the phone - I can imagine it now - "Hi, this is Sy, I don't need to make an appointment, I just need some free advice over the phone." "No problem, Sy. We do it all of the time. The doctor is busy with a patient now, but I will give you his cell phone number so you can call him direct." > The Urologist then insisted on conference calling his friend -a > Radiation Oncologist .................. Who was standing by waiting for such a call. You said the "unethical and sleazy" urologist's name was Hannibal Lecter...what was the "unethical and simply very sleazy" oncologist's name, Josef Mengele? > My sick mother and father were waiting for me in the waiting > room............. Why did a sick person have to come to the doctor with you? I know - you still live at home and she is the only one who knows how to drive. > He does not accept insurance but his office will transmit the billing information You said he is "on the staff at St. Barnabas Medical Center in Livingston, N.J," and he doesn't accept insurance? I don't believe it. [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] > > I had a most unpleasant experience yesterday and would appreciate any > > reactions and feedback: [quoted text clipped - 9 lines] > a patient now, but I will give you his cell phone number so you can call > him direct." My friend is an Internist in Virginia. He told me to call his cousin a Radiation Oncologist to give his opinion over the phone based on the Prostate Biopsy data as well as the CAT scan and Bone Scan tests which I'd sent him. There was no reason that I be physically present because he had all the information he needed and very thoroughly interpreted what he saw and what thought. Do you understand the concept that with certain medical conditions quantitative data is of much more importance than my "body type" for example and the patient does NOT require physical inspection. Hence the TNM staging level, the Gleason score, the PSA level, the prostate volume the image and % of core sample adenocarcinoma found etc.. Capiche? > > The Urologist then insisted on conference calling his friend -a > > Radiation Oncologist .................. > > Who was standing by waiting for such a call. You said the "unethical and > sleazy" urologist's name was Hannibal Lecter...what was the "unethical and > simply very sleazy" oncologist's name, Josef Mengele? > > My sick mother and father were waiting for me in the waiting > > room............. > > Why did a sick person have to come to the doctor with you? I know - you > still live at home and she is the only one who knows how to drive. I guess you don't know the correct address for the Groups you should be posting to so I looked them up for you: alt.society.mental-health alt.support.schizophrenia sci.med.diseases.mental > > He does not accept insurance but his office will transmit the billing > > information > > > You said he is "on the staff at St. Barnabas Medical Center in Livingston, > N.J," and he doesn't accept insurance? I don't believe it. He certainly does not accept Oxford Health. Maybe he does accept others. My error. Remember to visit those groups I referenced above as I think you can use them. I think it's time for this thread to end. Sy has made up his mind and apparently didn't really want the input he asked for in the first place. Best wishes and good luck to you on your treatment, Sy. Burney dot Huff at Mindspring dot com Sy, You never responded to my post like you did others. I aggree with you that cyberknife is at least similar to other rad treatments. However, that is where we part. From the few studies that are available comparing surgery to radiation, it seems that radiation starts to fail after approximately ten years on average as compared to surgery. There is a local Rad Onc in my town that does only seed implants and he tells anyone under seventy-five to have surgery rather than seeds. Seeds are reserved for those with a shorter life expectancy. Read this article from Dr. Walsh: http://urology.jhu.edu/newsletter/prostate_cancer56.php Ron S. On Oct 6, 1:11 pm, "ronju99" <jlsp...@nospam.verizon.net> wrote...snip... > I aggree with you that cyberknife is at least similar to other rad treatments. I am not sure how Cyberknife is used to treat PCA, I do not believe there is a standard protocol. When Cyberknife is used to treat brain tumors, a hypofractionated dosing regime is used. This means a much higher dose is applied over far fewer fractions than is commonly used in XRT to treat PCa. Whether hypofractionation or standard fractionation is an active area of investigation in PCa research. Cesium seeds (vs. Pd or I) and high-dose rate brachytherapy represent applications of the hypofractionated approach. A nice paper on hypo- vs standard fractionation in PCa has been written by David Brenner. (HYPOFRACTIONATION FOR PROSTATE CANCER RADIOTHERAPY-WHAT ARE THE ISSUES?; Int. J. Radiation Oncology Biol. Phys., Vol. 57, No. 4, pp. 912-914, 2003) and can be downloaded from his home page http://www.columbia.edu/~djb3/#top > However, that is where we part. From the few studies that are available > comparing surgery to radiation, it seems that radiation starts to fail after > approximately ten years on average as compared to surgery. While I would agree that the addition of XRT to seeds would provide an additional curative buffer for higher-risk men, the gap narrows considerably as we move to lower-risk men. For some data on longer-term brachytherapy outcomes see Radge, et.al (Modern Prostate Brachytherapy - Prostate Specific Antigen Results in 219 Patients with up to 12 Years of Observed Follow-Up; Haakon Ragde, M.D., Leroy J. Korb, M.D., Abdel-Aziz Elgamal, M.D., Gordon L. Grado, M.D., Brad S. Nadir, CIS; CANCER July 1, 2000 / Volume 89 / Number 1, pp 135-141). BTW, regarding late failures, the authors note, "There appears to be little risk of late failures, with 75% of this population's failures occurring within 5 years of the treatment, and no patient failing after 115 months." ...ron In article <63179ecb22f08f35b2fb5701c06bf9d8@localhost.talkaboutsupport.com>, > Sy, > You never responded to my post like you did others. I aggree with you that [quoted text clipped - 8 lines] > > Ron S. I wonder if Walsh would stand by that article today - it was written in 2000, and is way more negative towards seeds than is his more recent book. And seeds only for those with a shorter life expectancy? What nonsense. Check out the Seattle Prostate Institute for their long term results. Hi Bob, I have read the study at Seattle Prostate Institute. I can also give you another biased website to read; http://www.davincisurgery.com/procedures/urologic/prostate/prostate_cancer_treat ment_comparison.aspx Ron S. In article <637ec87031fd8f9800c1da3f621ddcc8@localhost.talkaboutsupport.com>, > Hi Bob, > I have read the study at Seattle Prostate Institute. I can also give you [quoted text clipped - 3 lines] > > Ron S. That site deals with surgery vs "radiation", not just brachytherapy. And it shows good long term (15 year) results - think what a more objective view of the literature on radiation might find! Bob, The problem that I have with these studies and the conclusions from them is that the patients would probably have had similar numbers without any intervention of aggressive treatment. For example; for the low risk group, it takes on average ten years before symptoms of mets surface and another five years before death. Average patient age was sixty-nine. That would put them on average at eighty-four when they died. How many would live that long anyway? I just believe that a lot of these studies are taking credit for the long term survival that would occur naturally. If these treatments were really effective then the curve should increase and not decrease with time. Don't call it a cure if the the disease returns at a later date. I know it is anecdotal, but if radiation was as effective as they proclaim, my cousin wouldn't have died at 62 after EBRT when he had a choice of surgery or EBRT and my brother had T3a cancer and was treated with open RP followed by 36 EBRT treatments. His came back after eight years. One was treated at Methodist Hospital in Indianapolis and the other at a major hospital in Wichita,Ks. Ron S. In article <c5e3bfe6c8f0728c7aceb3628f641e52@localhost.talkaboutsupport.com>, > Bob, > The problem that I have with these studies and the conclusions from them [quoted text clipped - 7 lines] > treatments were really effective then the curve should increase and not > decrease with time. Typically, these studies report on "disease free" rates, not mortality. By disease free they mean the patients dramatically lowered their PSA by their treatment, and it has not risen again. So, no, untreated patients would not have the same numbers, as their PSA will stay the same or increase. But if your point is that many, maybe even a majority of PCa patients will not die from their disease, regardless of treatment (or lack of treatment), then you are probably right. But if you are not willing to take the risk that you will be in the 'lucky' group of survivors, then looking at the disease free rates for different treatments makes sense. > Don't call it a cure if the the disease returns at a later date. > I know it is anecdotal, but if radiation was as effective as they [quoted text clipped - 3 lines] > years. One was treated at Methodist Hospital in Indianapolis and the other > at a major hospital in Wichita,Ks. No treatment has a 100% disease free rate. The highest rates I have seen are for brachytherapy - after 15 years, around 86%-89%. So up to 14% are going to have their cancer come back in 15 years - and it might kill them. Because some may not survive doesn't mean you shouldn't go with the treatment you think gives you the best odds. > Ron S. You said might kill them. That the desease will come back. However, there are many studies that show just because you have a psa return doesn't mean you will die from PCA. Autopsies have shown that most men have PCA at time of death but only about 3% ever die from it. I just believe that we are over treating the disease. Ron S. [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] In article <c5e3bfe6c8f0728c7aceb3628f641e52@localhost.talkaboutsupport.com>, Hi Ron, Though I am not anywhere near being a Biostatistician I think that after the DRE, scans, staging level and Gleason score have been compiled we prostate patients are essentially a compendium of numbers which can be accurately assessed by any Urologist or Radiation Oncologist anywhere on earth. > is that the patients would probably have had similar numbers without any > intervention of aggressive treatment. I am coming to that same conclusion also inasmuch as these studies are perplexingly difficult to perform and then analyze and make sense of. I also seem to come across an inordinate amount of general conclusions stating that various treatment options' results are "about the same". Not to mention that the philosophical inclination here in the States to "do something", sometimes anything. That's part of our national character. My stats: Age 59-Good health & fit in other respects Stage-T1c Gleason-6 (3+3) PSA-3.14 My 8-sample biopsy shows unilateral adenocarcinoma with 40% , 60% and 80% in samples. Of course I have read that if any adenocarcinoma is found there's a very good chance it's also in areas not-biopsied. I would be interested in knowing which study you reference which said: >For example; for the low risk group, > it takes on average ten years before symptoms of mets surface and another > five years before death. Average patient age was sixty-nine. That would > put them on average at eighty-four when they died. I am especially curious as to how "low risk" is defined. Thanks, Sy > Bob, > The problem that I have with these studies and the conclusions from them [quoted text clipped - 16 lines] > > Ron S. > Though I am not anywhere near being a Biostatistician I think that > after the DRE, scans, staging level and Gleason score have been > compiled we prostate patients are essentially a compendium of numbers > which can be accurately assessed by any Urologist or Radiation > Oncologist anywhere on earth. Assuming that all trust the numbers (especially the Gleason), I think I would agree that they "can" be accurately assessed. It is interesting to me, therefore, how you can find so many variations of treatment recommendations (or in some countries treatments forced on a patient) based on the same data, same literature, and fundamentally same organic structures. > Do you understand the concept that with certain medical conditions > quantitative data is of much more importance than my "body type" for > example and the patient does NOT require physical inspection. Hence > the TNM staging level, the Gleason score, the PSA level, the prostate > volume the image and % of core sample adenocarcinoma found etc.. > Capiche? Even if your only interaction had been a phone call, you bought a commercial product: a physician's knowledge. From that point, we can all hear your thought processes: "Wow! You mean I'm going to get all these verifying tests free, as long as I don't open my dumb mouth and mention costs? OK, Sy ... keep it quiet and just bend over. Hey, maybe if I stay *real* quiet this dude'll cut the dang thing out fer free! And if he does that, maybe I can sneak my wife's hysterectomy in here, too. Who sez there's no free lunch?" Do you have any concept how irrational your excuses sound? Do you think you didn't just rack up some serious bad marks with your credit card company, which will bite your credit rating in the butt either by itself or with one or two more similar frivolous disputes? I.P. > I had a most unpleasant experience yesterday and would appreciate any > reactions and feedback: [quoted text clipped - 72 lines] > > Sy I suspect you signed away many of your rights when you signed that receipt. Most of the laws 'protecting' purchasers has to do with merchandize. A phone solicitor fast-talks you into a sale; a shirt is the wrong size; half the pieces didn't come with the wagon; etc. You may be able to irritate him a little bit by challenging him through your credit card company, but I doubt you'll win under these circumstances. Hiring a lawyer and suing is one possibility. It would be prolonged with an uncertain outcome. Your best outcome might be to report him to the AMA and other city or state oversight agencies that may exist where you live. You won't get your money back, but you will have possibly saved another. "Sleazy" is a good description for him. |
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