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U.S. senator announces he has PCa and will be getting RP for it

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Posted 3/29/2021 5:03 PM (GMT 0)
No politics here, just reporting that U.S. senator Thom Tillis (Republican, North Carolina) has announced that he had a PCa DX and will be getting RP for it.

I imagine a good many of our lawmakers at multiple levels, the majority of them being older men, could be making similar announcements, if they chose to do so.

https://abcnews.go.com/health/wirestory/sen-thom-tillis-hell-surgery-prostate-cancer-76749409?cid=clicksource_4380645_3_heads_hero_live_headlines_hed
Posted 3/29/2021 6:00 PM (GMT 0)
Sounds like he was doing all the right things, age 60, annual physicals and PSA’s. They spared the details but sounds like he will do ok.
Posted 3/29/2021 6:29 PM (GMT 0)
Mumbo,

"I went to my annual physical and received a PSA test, which led to a biopsy and eventually my diagnosis."

I would hope that the "annual" refers to the PSA test as well, but I wouldn't put money on it, given the "let's negotiate" PSA climate. For all we know, this could have been his first PSA test.

Djin
Posted 3/29/2021 9:16 PM (GMT 0)
True, I am possibly jumping to a conclusion. The way it was written seemed to be quite positive and it discussed routine screenings that seemed to imply that is what he was doing. Of course, believing anything politicians say is not a good policy either.
Posted 3/29/2021 11:53 PM (GMT 0)
Why is it that just about every celebrity or politician under age 75 books into surgery, usually within a few weeks of diagnosis?

That predictable pattern is so opposite the general population, which the massive government SEER database shows only 36 percent of men choosing surgery.

My guess is that high-level Urology professors push what they do, which is railroading men into surgery without any reasonable effort to consult providers of other treatments.
Posted 3/29/2021 11:59 PM (GMT 0)
First thing that went through my mind was does he have one core of G6. Hopefully it all works out well enough for him.
Posted 3/30/2021 12:35 AM (GMT 0)
ASAdvocate, I believe the SEER government database uses only Medicare (and Medicaid) info, so that limits the age to 65 and above. So, I think the 36% number you mention is low. I could be wrong, but the SEER does not have access to private insurance and private pay data.
Posted 3/30/2021 1:05 AM (GMT 0)

ASAdvocate said...
Why is it that just about every celebrity or politician under age 75 books into surgery, usually within a few weeks of diagnosis?

That predictable pattern is so opposite the general population, which the massive government SEER database shows only 36 percent of men choosing surgery.

My guess is that high-level Urology professors push what they do, which is railroading men into surgery without any reasonable effort to consult providers of other treatments.


ASA, we don't know what his Gleason score is. I believe your stat about roughly equal numbers choosing AS, RT, and RP applies only to G6 men. For those needing treatment (for whom AS is not an option), the figures I've seen based on SEER weigh in favor of choosing RP over RT for primary treatment, with that trend increasing.

If you cite your stats, I'll track mine down.

Djin
Posted 3/30/2021 2:39 AM (GMT 0)
Senator Tillis has decided on his treatment. Surgery is a reasonable treatment option for a 60 yr old. I can only wish him the best, a speedy recovery and limited side effects. I’m sure he will do fine.

Glad to hear that he was having PSA testing during his physical. Many of my friends no longer have this test. Also glad that he announced his PCa to the public. PCa is not often in the news, especially in the year of the COVID
Posted 3/30/2021 5:31 AM (GMT 0)
"Why is it that just about every celebrity or politician under age 75 books into surgery, usually within a few weeks of diagnosis?"

they just want it out and their uro is glad to oblige.
Posted 3/30/2021 10:56 AM (GMT 0)
Why do so many on here assume that any man who has surgery for PCa does it because their urologist is unethical? Especially when we know nothing about the patient and his diagnosis?
Posted 3/30/2021 11:55 AM (GMT 0)
For men (like me) who had a biopsy diagnosis of G 9 or 10 PCa, current opinion is that treatment with EBRT, Brachytherapy, and 12 months (average) ADT (dubbed MAXRT) provide similar survival outcomes to Surgery + Adjuvant treatment (RT and/or ADT afterwards), dubbed MAXRP. However, the surgical route has an advantage: MAXRP is an upfront commitment to the combo therapy, whereas after surgery, approx. 25-30% of men have an outcome with no adverse features and an undetectable PSA, which means that there may be no need for radiation and/or ADT at all, or that this therapy may postponed until needed for a rising PSA.

My uro/surgeon was totally ethical, presenting equivalent survival stats for my status with RT vs RT. I was the one pushing for surgery. Why does everyone assume that celebrities and politicians all have a G6 diagnosis? By no means do I doubt there are some men who are pushed into surgery, but to think that all men are is absurd.

Djin
Posted 3/30/2021 12:46 PM (GMT 0)
Djin,

My basic opinion is that most urologists are ethical, and are willing to suggest to their patients that they could consult with a radiation oncologist if they choose for low to mid-risk PC. However, most men aren't interested in digging through options and having multiple consultations for uncomplicated cases. It's more of a guy thing than a doctor thing, IMO.
Posted 3/30/2021 12:46 PM (GMT 0)

halbert said...
Why do so many on here assume that any man who has surgery for PCa does it because their urologist is unethical? Especially when we know nothing about the patient and his diagnosis?

Hal, I don't think it's necessarily that the urologists are unethical. Rather many of us experienced urologists who wanted to rush us toward surgery w/o a fair discussion of the alternatives. That may or may not be ethics or the profit motive but more likely is the fact that many of the urologists are surgeons and believe in their craft. We all have anecdotal stories. My ultimate urologist WAS one who fairly discussed alternatives and was the one who assisted during my brachytherapy. But before finding him I ran into more than one who wanted to sign me up for the surgery before I left the office...

Jim
Posted 3/30/2021 1:02 PM (GMT 0)
My Urologist offered both options but when he said he thought surgery offered a possible cure, I jumped at it. And note, I got in for surgery just 4 weeks after biopsy.
And that delay I was told was simple so the biopsy would heal over.
Posted 3/30/2021 1:03 PM (GMT 0)
I agree with Jim. I worked with many urologists and almost all of them truly thought surgery was better than radiation.

Paul
Posted 3/30/2021 1:03 PM (GMT 0)

halbert said...
Djin,

My basic opinion is that most urologists are ethical, and are willing to suggest to their patients that they could consult with a radiation oncologist if they choose for low to mid-risk PC. However, most men aren't interested in digging through options and having multiple consultations for uncomplicated cases. It's more of a guy thing than a doctor thing, IMO.

That's true -- there is a built-in bias-of-convenience because men get their diagnosis from a uro, with whom discussion begins (and may end).

Djin
Posted 3/30/2021 1:13 PM (GMT 0)
As a senator and long term politician he is used to having a staff to perform most everything for him so he can spend time on fund raising and politics........it is just what they do. He simply assigns a staff member to figure out what he should do and then does it. If any of us think he would go see multiple doctors for assessments we would be crazy. I am sure the staff member checked with Walter Reed or John’s Hopkins and spoke with the chief urologist who said surgery would be fine for the Senator....let’s get it scheduled.
Posted 3/30/2021 1:15 PM (GMT 0)
When I was exploring options, one of the two rad ones I saw, prefaced his advice with “keep in mind, that I’m a radiation oncologist, because I believe in radiation as a great option for people in your situation. So naturally, I’m biased towards radiation” and he followed that up with “the fact is, you have an equal chance of cure with either treatment option”

Urologists/surgeons are human. I really don’t think , with exceptions here and there of course, that it’s greed. It’s that they believe in what they do.
Posted 3/30/2021 3:28 PM (GMT 0)
I didn't see anyone on this thread even mention ethics on this thread but for a few who seemed to assume every one else did and then for some reason...the thread went astray into a discussion on defending doctors from being considered unethical...who on this thread ever said they were...ASadvocate made the observation that it seems to him...that the celebs/politico do make that call rather quickly... I noticed that myself over time...measure twice cut once...RTFQT... Amiwrong...Amiwrong...logo...

PS finally a decent south swell of 5-7 tide right...wind right...Off to say yes...yes...thank you Kiwi's
Posted 3/30/2021 3:52 PM (GMT 0)

logoslidat said...
I didn't see anyone on this thread even mention ethics on this thread but for a few who seemed to assume every one else did and then for some reason...the thread went astray into a discussion on defending doctors from being considered unethical...who on this thread ever said they were...ASadvocate made the observation that it seems to him...that the celebs/politico do make that call rather quickly... I noticed that myself over time...measure twice cut once...RTFQT... Amiwrong...Amiwrong...logo...

PS finally a decent south swell of 5-7 tide right...wind right...Off to say yes...yes...thank you Kiwi's

ASAdvocate said "My guess is that high-level Urology professors push what they do, which is railroading men into surgery without any reasonable effort to consult providers of other treatments."

I don't think it's a stretch to use the word unethical to describe "railroading men into surgery without any reasonable effort to consult providers of other treatments" when applied to the doctor-patient relationship. On the contrary, ethics seems to me a very logical consideration within a treatment-decision-making discussion.

Djin

Post Edited (DjinTonic) : 3/30/2021 10:19:41 AM (GMT-6)

Posted 3/30/2021 6:13 PM (GMT 0)

halbert said...
Why do so many on here assume that any man who has surgery for PCa does it because their urologist is unethical? Especially when we know nothing about the patient and his diagnosis?

have you read the tales of woe on this forum regarding surgery?
Posted 3/30/2021 6:14 PM (GMT 0)

PDL17 said...
I agree with Jim. I worked with many urologists and almost all of them truly thought surgery was better than radiation.

Paul

well, they are surgeons

https://www.youtube.com/watch?v=notktagfwda
Posted 3/30/2021 8:13 PM (GMT 0)
Just a single data point:

My urologist is a retired surgeon who now only deals with non-surgical intervention after 25+ years of cutting. He was very careful to explain all my options and gave me referrals to several other types of treatment providers. He ran me thru all kinds of tests prior to telling me surgery OR radiation would be equally beneficial and it was up to me to decide what possible side effects I wanted to risk.

MY (just me!) bottom line was ED and/or minor incontinence (surgery) was a better possible outcome than a 1 in 20 chance of Grade 3 or higher GI problems (radiation). An entirely personal choice well guided by my urologist. As it turned out ED did not happen and a light pad lasts several days.

TRUS 12-core biopsy (25% G3, 20% G4) with PIRADS 3 on 3T-mpMRI. 71-years old at time of diagnosis

Six months after RALP he was pushing SRT when my PSA went from 0.022 -> 0.018 -> 0.023 ->0.028 but now, 32-months later he is telling me just to postpone any further treatment as my PSA wanders around 0.052.
Posted 3/31/2021 9:04 PM (GMT 0)
Djin you are absolutely correct...I should have RTFQT...amiright...amiright...
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