Which treatment is best?

[Guest guest]

While looking for something else kin my files I came

across a very interesting piece concerning the rather arbitrary way in which the

medical world decides on treartment modes. The article is a long one and covers

all sorts of conditions, but is well worth reading, I think. It is at http://www.businessweek.com/magazine/content/06_22/b3986001.htm

The section of major interest for us reads as follows:

Take prostate cancer. Doctors now routinely

test for levels of prostate-specific antigen (PSA) to try to diagnose the

disease. But there's no evidence that using the test improves survival. Some

experts believe that as many cancers would be detected through random biopsies.

Then, once cancer is spotted, there's no way to know who needs treatment and

who doesn't. Plus, there is a plethora of treatment choices -- four kinds of

surgery, various types of implantable radioactive seeds, and competing external

radiation regimens, notes Dr. Klein, head of urologic oncology at the

Cleveland Clinic. " How is a poor patient supposed to decide among

those? " he asks. Most of the time, patients don't even know the options.

" Because there are no definitive answers, you

are at the whim of where you are and who you talk to, " says Dr. M.

Kirsh at the Urology Group in Cincinnati.

Kirsh does many brachytherapies -- implanting radioactive seeds. But " if

you drive one and a half hours down the road to Indianapolis, there is almost no

brachytherapy, " he says. Head to Loma

, Calif., where

the first proton-beam therapy machine was installed, in 1990, and the rates of

proton-beam treatment are far higher than in most other parts of the country.

Go to a surgeon, and he'll probably recommend surgery. Go to a radiologist, and

the chances are high of getting radiation instead. " Doctors often assume

that they know what a patient wants, leading them to recommend the treatment

they know best, " says Dr. E. Wennberg, president of Health Dialog

Analytic Solutions.

More troubling, many doctors hold not just a

professional interest in which treatment to offer, but a financial one as well.

" There is no question that the economic interests of the physician enter

into the decision, " says Kirsh. The bottom line: The conventional wisdom

in prostate cancer -- that surgery is the gold standard and the best chance for

a cure -- is unsustainable. Strangely enough, however, the choice may not

matter very much. " There really isn't good evidence to suggest that one

treatment is better than another, " says Klein.

All the best,

Terry Herbert in Melbourne,

Australia

Diagnosed ‘96: Age 54: Stage T2b: PSA 7.2:

Gleason 3+3=6: No treatment. August '06 PSA 27.4

My site is at www.yananow.net

As a physician, I am painfully aware that

most of the decisions we make with regard to prostate cancer are made with

inadequate data: Dr “Snuffy”

Myers.