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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2005"The Best" - Where and Whom?
To all of the experienced and well-read contributors to this group, I ask: "If your father or son needed 'The Best' PCa care, what hospital and whom would you recommend he see?" Ken...RCOG if I was leaning towards RT, Hopkins, UCSF, Stanford or Memorial Sloan Kettering for surgery. There are other good places too, these just come quickly to mind...Best wishes and good health, Ron > To all of the experienced and well-read contributors to this group, I > ask: "If your father or son needed 'The Best' PCa care, what hospital > and whom would you recommend he see?" Definitely no-one in Australia! >> To all of the experienced and well-read contributors to this group, I >> ask: "If your father or son needed 'The Best' PCa care, what hospital >> and whom would you recommend he see?" > >Definitely no-one in Australia! Which State are you in? -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC >>> To all of the experienced and well-read contributors to this group, I >>> ask: "If your father or son needed 'The Best' PCa care, what hospital [quoted text clipped - 3 lines] >> > Which State are you in? Not that it matters because saying "Australia" means the entire country but I am in NSW. >>>Definitely no-one in Australia! >>> >> Which State are you in? > >Not that it matters because saying "Australia" means the entire country but >I am in NSW. <snip> I'll let you know how I go after my RAD & HDR Brachytherapy @ SCGH Western Australia. Who knows? -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC >>>>Definitely no-one in Australia! >>>> [quoted text clipped - 9 lines] > > Who knows? Beware what doctors tell you in this country unless you definitely have cancer and it is inoperable or you have a heart problem. On both those fronts under those conditions we are top class but in no other area (other than in-vitro) are our medical conditions anything above 3rd world class. We may have more comfortable waiting rooms and so on but the outcome of your medical visit is on par with 3rd world except in cases mentioned above. I have, in fact, a very life threatening problem of another nature and after 7 years of it being diagnosed and suffering it and being on a small income for that time from an insurance company, I was sent to a hired gun who then attempted to charge me for the insurance company sending me while billing them as well. It is not a healthy health system in this country and it isn't getting better. > To all of the experienced and well-read contributors to this group, I > ask: "If your father or son needed 'The Best' PCa care, what hospital > and whom would you recommend he see?" Ken, I would recommend Dr. Leibowitz or Dr. Tucker out of Los Angeles. If you are concerned with early stage prostate cancer(PCa), they have been doing it since 1991 with 0 deaths due to PCa (except 1 patient who was misdiagnosed by others). If you are concerned with late stage PCa, then they have a 92.6% disease specific survival rate for 42 months. This compares very favorably with the 50% survival rate for 60 months quoted by others in this newsgroup not too long ago for doctors doing more traditional treatments. When you consider that their patients on average have cut their PSA in half for that 42 month period, it is very doubtful that there will be any more PCa deaths in that group by the 60 month mark. Ed Friedman I just got back from RCOG in Atlanta and am very pleased with the quality of treatment there. Http://www.rcog.com will get you more information. Dr. Critz just reviewed the most recent statistics: 88% cure overall. With respect to those who have a Gleason of 6.0 or below, PSA of 6.0 or less, and a T1c (nothing felt on the DRE), then the rate is 95%. This is with the "gold standard" definition of "cure" as essentially zero PSA at ten years -- same as Patrick Walsh uses at Johns Hopkins. Best, J. Manley >> To all of the experienced and well-read contributors to this group, I >> ask: "If your father or son needed 'The Best' PCa care, what hospital [quoted text clipped - 16 lines] > > Ed Friedman > I just got back from RCOG in Atlanta and am very pleased with the quality of > treatment there. Http://www.rcog.com will get you more information. Dr. [quoted text clipped - 9 lines] > > J. Manley Jim, I'm a bit confused about your statistics. In the best scenario that you presented, there is a 5% chance of dying of prostate cancer within 10 years. How is that better than the 0% chance that occurs when one goes to Dr. Leibowitz for treatment? Ed Friedman Ed Friedman wrote...snip... > I'm a bit confused about your statistics. In the best scenario that you > presented, there is a 5% chance of dying of prostate cancer within 10 > years. How is that better than the 0% chance that occurs when one goes > to Dr. Leibowitz for treatment? > > Ed Friedman Hi Ed...Is your "0% chance" statement based upon Dr. Leibowitz's paper in The Oncologist, Vol. 6, No. 2, 177-182, April 2001? That's pretty old and Dr. Leibowitz even states in the paper that the median follow-up is only 36 months, and calls the results very preliminary. No one with stats like the people in the group treated by Dr. Leibowitz would die from PCa within 3 years even if they did nothing. I see from his website that he has enrolled about 75 more patients into this study over the last 5 years. Did you once mention that he has a newer paper coming out?..Best wishes and good health, Ron > Hi Ed...Is your "0% chance" statement based upon Dr. Leibowitz's paper > in The Oncologist, Vol. 6, No. 2, 177-182, April 2001? That's pretty [quoted text clipped - 5 lines] > over the last 5 years. Did you once mention that he has a newer paper > coming out?..Best wishes and good health, Ron Ron, They have updated that paper and presented it to the February, 2005 First Annual Multidisciplinary Prostate Cancer Symposium in Orlando, Florida. A copy of this presentation can be seen at: http://www.prostateweb.com/pdfs/ASCO_PCF_02_2005.pdf Basically, they are now reporting on 183 men, with a median of 75 months and a range of 48-156 months (4-13 years). They still count the one death in their statistics, although it turns out he had ductile adenocarcinoma and not primary adenocarcinoma of the prostate. I discount that death when I refer to 0% chance. I should also point out that they have 0% distant metastases. When you compare this to the Swedish study in the NEJM from 2002, where the starting PSA was about the same, but the Swedish patients were only stages T1 and T2, instead of the T1, T2, and T3 that Dr. Leibowitz and Dr. Tucker accepted, then you can appreciate their results much more. The Swedish study had 4.6% PCa deaths and 10.1% distant metastases after 74 months for patients undergoing RP. For watchful waiting the results were even worse, with 8.9% PCa deaths and 15.5% distant metastases. I am at a loss to explain why anyone would voluntarily choose to play "Russian roulette" with RP or WW, when they have the option of 0% Pca deaths and 0% chance of distant metastases (and keep an intact prostate as well, with higher levels of T after treatment than before treatment is started). Ed Friedman |
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