What the doctors say

[Guest guest]

A recent posting on another List quoted Dr Catalona

(the developer of the PSA test) as saying that he believes that the prostate

should be removed, when one has prostate cancer - even if it has already

spread..

No doubt this is are a valid view, but this quote

prompted me to look at what other doctors had to say and I thought I’d

share these with you:

H. Ballentine , M.D., Professor of Urology and

Oncology at the s Hopkins School of Medicine and lead author of a recent

study which looked at men enrolled in the university's expectant management

program from 1995 to 2005, estimates that overall, perhaps 30% of newly diagnosed

men could be managed with watchful waiting.

Dr. Scardino is reported at the European Association of

Urology strongly stating his view that traditional treatments may be

“overkill” in cancer with very low malignant potential. In support

of this view, he described in detail such factors as the risk of perioperative

complications, long-term issues with ED and incontinence for radical surgery,

and ED, bowel, and urinary side effects associated with radiotherapy.

Dr Israel Barken has said " The overall approach

I believe in is doing the Minimal Intervention that the patient feels

comfortable about combined with the Maximum Surveillance that medical science

allows. "

Dr Logothetis, a leading expert in

advanced prostate cancer was asked a question at a US-TOO meeting in Texas. He had been

commenting on the relative inaccuracy of the diagnostic process. The question

was: " Does this mean that a lot of people who are diagnosed as having

cancer really don't? His answer was: " Yes, if one accepts the diagnosis

that the cancer is a disease that is potentially lethal……. One of

the problems with prostate cancer is definition. They label it as a cancer, and

they force us all to behave in a way that introduces us to a cascade of events

that sends us to very morbid therapy. It's sort of like once that cancer label

is put on there we are obligated to behave in a certain way, and its driven by

physician beliefs and patient beliefs and frequently they don't have anything

to do with reality. And they are only worrisome because the pathologist has

decided to call it a cancer.

Dr Stamey: " I believe that when the final

chapter of this disease is written, which is unlikely to be in my lifetime,

never in the history of oncology will so many men have been so overtreated for

one disease. .........Clearly we are overdiagnosing this disease. "

Dr Strum: " The most bothersome aspect of

what goes on in the world of PC today is that few (less than 5%) of physicians

(mostly urologists) bother to spend the 10-15 minutes to use the literature

published in urologic journals and oncology journals to calculate the

individual's risk for OCD (organ confined disease) vs non-organ confined

disease. This is like going to sea on the open ocean and not checking out

your ship or the weather but just " doing it " . Physicians are

not behaving as scientists and moreover, they are not translating what we know

into what is done with the patient. Unfortunately, we appear to be living

in a time when physician income is more important than patient outcome. "

Dr “Snuffy” Myers.: " As a

physician, I am painfully aware that most of the decisions we make with regard

to prostate cancer are made with inadequate data. "

And finally a quartet from Dr Willet Whitmore:

" The current state of prostate cancer may not be

good medicine but it sure is good business. "

" There are more people making a living from

prostate cancer than there are dying from it. "

" Is cure possible? Is cure necessary? Is

cure possible only when it is not necessary? "

" Growing old is invariably fatal while prostate

cancer is only sometimes so "

Dr Whitmore was himself diagnosed with prostate

cancer, chose not to have conventional treatment and to go for Watchful

Waiting. He eventually died of the disease, allegedly saying " Perhaps I

waited too long. "

What to make of all these divergent views? Very

difficult for all of us.

All the

best

Terry Herbert

in Melbourne Australia

Diagnosed

‘96: Age 54: Stage T2b: PSA 7.2: Gleason 3+3=6: No treatment. June '04:

TURP. Aug '06 PSA 27.4

My site

is at www.prostatecancerwatchfulwaiting.co.za

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