For all the talk of overtreatment, what are your suggestions to curb it? Part 1

in a court of law doctors would be found culpable for overtreatment.  doctors are the learned experts, the paid professionals.

so if doctors are responsible for "overtreatment" why is the burden being placed on the patient? 

my answer is it's not on me to come up with a solution it's on the doctors who profit from the so-called overtreatment.

ed

 

David - I answered the question based on what I thought you asked. I certainly wasn't jumping all over you.

I already answered this question twice in other threads recently.

I think you need to create better communication between patient and doctor and if you're so worried about potential SEs you need to train practitioners to generate better results. There is a disparity in results between great docs and and less than great ones.

The bottom line is that you have men here and many well respected docs who think it's better to waste some lives in order to potentially avoid SEs in many more men. As long as people think that is the problem you will always have over treatment regardless of what you do.

PDL17 said...
Overtreatment is a huge problem. I agree with Purg...I said so on another post. Standardize biopsies to a minimum of 18 cores or more. If less than 3 are positive with low volume, G6 cancer, than only AS is covered by private insurance or Medicare.

There is coming a time that the system is going to implode. We spend 3 times more in all forms of treatments than what we put into Medicare. The truth is we have incredible technologies that cost incredible amounts but "bottom-line" have little impact on life-expectancy. IMO, we need to promote prevention and pay for that research, and spend less treating the diseases we should have prevented in the first place. I don't think this applies so much to prostate cancer, but it truly does for heart disease and adult onset diabetes.

I also believe that PSA screening for patients like davidg, has to continue. If David had an initial PSA of less than 1, than maybe not pay for another test until 5 years later. But to quit testing when the test is so inexpensive, makes little sense to me. It is overtreatment that is draining our resources and decreasing our quality of lives.

paul

Man, if I had a PSA of less than 1 I would have walked barefoot to the Vatican. I took that test three times before doing a biopsy hoping that t would go down. I did a course of antibiotics, stopped having sex, stopped working out. I went to a different urologist hoping he'd tell me the recommendation to biopsy by the first urologist was overkill. My PSA was close enough to not requiring a bipsy according to a lot of the literature I had read (4.0) and even my urologist. He kept telling me 2.2 is a little high with a smirk on his face and told me he'd want it at 1. Even in Rome when they screwed up my 12 month PSA reading by forgetting a zero they reacted to my shock by saying "don't worry, you're well below 4.0"

If my doc hadn't ordered a PSA at 40 there is a good chance I still wouldn't have tested for it as I didn't really have symptoms and I was only given the test when I went in for a very bad reaction to now banned anti Malaria medication that created a host of symptoms, some of which possibly seen as potentially linked to a urinary issue.

I ended up with a G7 and wasn't over treated, but the only reason I was treated is because I was tested. Otis Brawley, some at the AUA, and some here essentially think that someone like me was worth losing because of all the people that could face SE for being treated with a G6. I actually understand their logic but don't agree with it, and not because it involves me.

So what do you do? explain to all men, as was explained to me, what all the possible SEs are, what the dangerous of biopsies are, of surgery itself. Then let the men make their own decisions. Finally, in all honesty, even if I was a G6 I would have sought treatment given my age.

Sephie, don't go.

Don't anyone "answer" that. Just think about what has been posted.

Its actually getting better, I sense….. steady as she goes. We just need to get to the point that we see that we our only hurting those we love, hence ourselves. This is a dynamic community with intelligence abounding, amazingly so. We are just a microcosm of the world. But have the advantage, due to the "tightness" to really solve our problem with our collective, independent wills[ not a contradiction] in my view, think mosaic, to get thru these slights. Thats all they are , slights, not life or death, gargantuans. Go look at F8's beautiful pics, they are to live for. Sephie, don't scare us like that, Sephie……...

Not another threat to leave. I was frustrated, because the first 3 people in a row falsely assumed it was another thread about overtreatment or no overtreatment. I clearly stated that since most felt there was overtreatment, then lets talk specifics from the lay people, like us, what could be done to curb overtreatment. I thought it was very clear. Have no interest in re-hashing the subject in general.

Moving on, in the hours since I was last here, got a lot of great answers and possible solutions out there. The only one I don't agree with, and just my opinion, is the renaming of G6 to a non-cancer term or name. But we have recently had a huge thread on that subject. But no reason it couldn't be on the list of possibilities.

Going back to my original thought, why not make the criteria for invasive treatment, i.e. surgery, a bit tougher to approve. Do most men with 1-2 cores, G6, let's say 5-10%, really need more than AS?

I think with more accurate testing tools, as far as indolent or no indolent, such a distinction could be made safer and easier to enact.

The only problem I have with our standard 10-12 core biopsy tool, is that it can miss some or all of a tumor, so it might be misleading. However, with some of the more advance saturation biopsies, little would be missed, and it might be more exact. My uro told me about a year ago, of them working on 200+ microscopic core saturation biopsies. That could be interesting.

Keep em coming. Lots of good thoughts out there.

david in sc

Post Edited (Purgatory) : 5/24/2013 9:20:51 PM (GMT-6)

When I first came to this site 2 years ago, there were numerous posts where davidg and david (purgatory) would fight about davidg's love affair with Dr. Samadi. It's nice to see them fighting about something else 2 years later.

I understand davidg's obsession with PCa and men in their 40's. He was dealt the tough hand of having PCa at such a young age. But, as one getting the bad news at 53, I can tell you that men in their 50's feel the same. I'm looking forward to seeing my kids marry, graduate and have kids of their own.

I would rather know my diagnosis and make my own decision about treatment. I don't need davidg telling me that the answer is better doc skills or david (purg) telling me that my treatment shouldn't be covered by insurance. I need the best information available and I will make my own decision about treatment.

FrackMe said...
When I first came to this site 2 years ago, there were numerous posts where davidg and david (purgatory) would fight about davidg's love affair with Dr. Samadi. It's nice to see them fighting about something else 2 years later.

I understand davidg's obsession with PCa and men in their 40's. He was dealt the tough hand of having PCa at such a young age. But, as one getting the bad news at 53, I can tell you that men in their 50's feel the same. I'm looking forward to seeing my kids marry, graduate and have kids of their own.

I would rather know my diagnosis and make my own decision about treatment. I don't need davidg telling me that the answer is better doc skills or david (purg) telling me that my treatment shouldn't be covered by insurance. I need the best information available and I will make my own decision about treatment.

I have no idea where that came from. Is it residue from a few days ago? Let's see if Tony intervenes this time. Doubt it...

I don't see a fight now and I didn't see a fight then. You really think this is a fight? And why bring up Samadi? you trying to create drama again? I told you, email me if you want drama.

Of course you should make your own decisions about your own treatment, that's exactly what my position is. But you need to be tested in order to make that decision.

Post Edited (davidg) : 5/24/2013 10:05:23 PM (GMT-6)

Frackme, lighten up, can you not see what you just did??????

Purgatory, whats important here above all, as I have discovered, is relationships, not " who shot John " It ain't easy, nothing worth wild is. We all gots to transcend ourselves somehow. Can,t we just try, the other ain't working……..

logo,

What do you think I did? I think I posted what I think.

Davidg:

I agree.

Pretty transparent attempt, too

Mel

 

Mel.

You agree with davidg about what?