TV trolling for lawsuits

Sephie said...
Casey, I read the article in your link and my first thought was "oh come on people." The guy was obese and probably wasn't a good candidate for any type of surgery. In addition, the article doesn't spell out the "crippling" effects the surgery had on the poor man's life. And I found the use of the word "crippling" rather over the top...is the article implying that the man was bed ridden for the rest of his life and unable to perform basic human functions?

Good heavens but it seems that those who are all for not treating the alleged 'non' prostate cancers are just as good at using scare tactics as those medical professionals who are alleged to push treatment to improve their bottom lines.

All I can think of is that poor guy who reads this stuff and says "I don't have to treat my prostate cancer because it's really not cancer" and then, 10 years later, is "crippled" because the cancer has spread to his bones. Wonder if those who are pushing for no treatment for these supposed "insignificant" cancers will be willing to stand up in court and explain to the family of this man why their husband/father died from an insignificant disease.

+1

STW said...
I was watching TV the other night when one of those lawyer ads came on trolling for folks who'd been treated via Da vinci surgery. What's that all about?

Casey59 said...
The target may be the promotion of prostate cancer OVERTREATMENT.

Casey59 said...

STW, I'd be interested to hear if my guess was correct (back to your original question). I watch very little TV so I haven't seen this ad, but I have read about some lawyers advertising for prostatectomy patients

Not even close.

There have been some quality issues with the device:

• UPDATE: Intuitive Surgical Sends Note on Defect in Instrument
  
• Intuitive Surgical May Not Have Tested Devices Properly
  
• FDA: Intuitive Surgical Failed to Report Warning

There have also been allegations of overly aggressive / unethical promotion by the device manufacturer: Salesmen in the Surgical Suite

Lots of medical devices are recalled every year and I don't buy into the theories that the device per-se (which is great technology when properly applied in the right hands and cases) is to blame for most poor outcomes.

I do think some of the tenuous benefits ("minimally-invasive" etc.) have been over-promoted by Intuitive Surgical, many Hospitals and many surgeons and this has created an unhealthy (literally) atmosphere with providers trying to out-do each other for business and abandoning proven approaches that, in many cases, may be better for the patients.

Post Edited (njs) : 7/17/2013 8:48:08 PM (GMT-6)

clocknut said...
when it comes to "insignificant disease," my gut reaction is that the degree of "insignificance" is directly proportional to the degree to which the victim of that disease is "not me."

Exactly. The urologist quoted in the article even tacitly admits that treating clinically low risk disease saves lives but then discounts those lives as "insignificant" i.e.: "...insignificant number of lives saved..."

Even assuming the number of lives saved is small, the only way to deem them insignificant is from a macro view where they are weighed against some other societal impact (public health, cost control, etc.). But to those whose lives would actually be saved or lost, they will never be insignificant...

I agree that, unfortunately, there is no way of knowing with 100% certainty whether or not a patient's cancer is "insignificant". However, if I was diagnosed today with a cancer that was suspected of being "insignificant" there are a number of steps that I would take to help determine that and to determine if it stayed that way. Things like:

1. Getting a second opinion on my biopsy from Bostwick or Epstein.
2. Undergoing CDU or MRIS testing to ascertain the location and size of the tumors.
3. Having repeat biopsies at appropriate intervals based on the CDU results.
4. Getting a Prostavision (Bostwick) or bio-marker test to help determine the aggressiveness and prognosis of my cancer.
5. Adjusting my diet to help control cancer growth.
6. Using a physician who had considerable expertise in working with Active Surveillance patients.

The point being that far from "doing nothing" there are many things that the informed patient can do when faced with the possibility of "insignificant" cancer. Do these provide 100% certainty? Unfortunately, no. But they do provide an opportunity for the patient to significantly improve their odds of successfully avoiding invasive treatment.

Jim

Casey59 said...
At the risk of possibly repeating myself, I will point out that what you call "do nothing and see what happens," njs, is what doctors call "Active Surveillance." I won't embellish at length here, but please understand that people who understand AS and the natural history of PC cringe when they hear noobies refer to it as "do nothing and see what happens," since that (let's call it) gap of knowledge is exactly one of the prime objectives that efforts to provide "patient education" in advance of the rush-to-treatment seeks to close.

Actually, Casey, I understand AS and the natural history of PC pretty well and AS its not really what I had in mind when posting, although if you prefer to replace "do nothing and see what happens" with AS that's fine -- it won't change my point.

Casey59 said...
You have (perhaps unintentionally) solidified the point here that "patient education" is needed, and has a long way to go.

The need for patient education, so that each patient can make an informed decision appropriate for his own personal values and priorities was precisely the point I was intending to make (I thought pretty clearly).

Patient education, which is a core mission of this forum, is the only axe I have to grind. I am not advocating for or against AS, surgery, or any other treatment option.

(Flame sentence deleted by Mod Tudpock18)

If you want to provide information about PCa overtreatment or the potential benefits of AS there are plenty of respectable sources (e.g. Dr. Carter from Hopkins) you could provide...

Post Edited By Moderator (Tudpock18) : 7/18/2013 5:33:07 PM (GMT-6)

  njs said... If you want to provide information about PCa overtreatment or the potential benefits of AS there are plenty of respectable sources (e.g. Dr. Carter from Hopkins) you could provide... I know you are still a noobie here, but stick around and you will see me referencing Carter regularly.  Like I did here:   https://www.healingwell.com/community/default.aspx?f=35&m=2759290&p=2 And here:   https://www.healingwell.com/community/default.aspx?f=35&m=2385204 And here:   https://www.healingwell.com/community/default.aspx?f=35&m=2077283 And here:   https://www.healingwell.com/community/default.aspx?f=35&m=2141606 No specific mention of Carter in specific by me (he was mentioned earlier in the thread by someone else), but I called out the AS program at JHU which Carter runs:   https://www.healingwell.com/community/default.aspx?f=35&m=2574187&p=2   Dr Laurence Klotz from Sunnybrook is much more prolific, though...        

Casey59 said...

I know you are still a noobie here, but stick around and you will see me referencing Carter regularly.

That's great Casey. I didn't claim that you hadn't ever provided good information, only that the article you put forth in this thread was a bad choice...

Post Edited (njs) : 7/18/2013 4:31:40 PM (GMT-6)

I'm sure you mean well Casey and I think you are on the right track with those prior posts you quoted.

However, while I do think there is some overtreatment as a whole, I reject the apparent notion that all men diagnosed with clinically low-risk PCa should not be treated non a non-deferred basis, which seems to be based on the premise that there is no risk in deferring treatment.

My view is there are unique risks (and benefits) attendant to both treatment and non- (or deffered-) treatment and that there is no one-size-fits-all answer but that each patient needs to make an informed decision appropriate for his own personal values and priorities. For some low-risk patients (e.g. me) that is non-deferred treatment.

Post Edited (njs) : 7/18/2013 4:48:37 PM (GMT-6)

Ok, njs. We are getting somewhere. And thank you for the civil and constructive tone.

I agree that one size does not fit all... Another of my frequently used phrases.

Can you please help to describe a low risk case which should not follow active surveillance as the first step? I'm always open to new ideas.

Post Edited (Casey59) : 7/18/2013 5:12:18 PM (GMT-6)

Sure, my own case...

• 40 years old in excellent health and expecting to live another 50 or 60 but wary of cancer in general and PCa in particular (father was GS 9; mother died of lung cancer).
  
• Already had young kids but not planning to have any more.
  
• GS 3+3 but PNI-positive and already palpable.
  
• Was not comfortable waiting given the ~30% chance that there are already some pattern 4 or 5 cells that were just missed on biopsy.
  
• Knowing that, in all likelihood, I would eventually need treatment, which would likely be more difficult and less likely to succeed if put off for years.
  
• Top priority was to maximize the likelihood of a cure.
  
• Believed lasting side effects were unlikely.
  
• Wanted to put it behind me ASAP vs. living with uncertainty and worry.
  
• Still studied like crazy and talked to half dozen doctors before making decision.

njs, thanks for your reply, and sorry I’m not responding until this morning…I’m usually not online (at least not at HW/PC) in the evenings.   And thanks again for the civil discourse.   I’ll admit that I was not prepared for your reply.   I will give particularly thoughtful consideration to my response. I wouldn’t normally answer a question with a question, but I want to be sure to establish a common foundation for the ensuing dialogue.   I know that you previously stated that you were familiar with the “natural history” of prostate cancer; but that is atypical of someone diagnosed only a few months ago and so I want to ask if we have the same basic understanding.      PC is unlike almost any other cancer in it’s near omnipresence.   Autopsy studies of men who died accidentally of other causes found roughly 40% of men in their 40s had at least a clinically detectable amount of prostate cancer.   In a conference room with 10 of your male work colleagues all your age , or in a bar, or at a ball game…from a broader statistical perspective, three others (besides you) are already carrying around at least the same amount of PC has you had, and you are the only one that knows it.   In fact, from the perspective of you knowing about it, it’s not just that 1 (you)-in-10, but the age-adjusted SEER Incidence Rates for PC among men under 50 is less than 10:100,000 (year 2010), and specifically about 100:100,000 for men in their 40s.   The fact that you stumbled across the set of circumstances which led you to a biopsy at age 40 is somewhat of a statistical anomaly , but the fact that your biopsy was positive is far from an anomaly . This data is not, based solely upon my own observations, widely known by most 40-year olds.   I did not know it when I was diagnosed at age 49, either.   It’s taken me several years for me to not only learn it, but also to understand the meaning and impact of it in this context…   The other aspect that not all newcomers know about is how tipping-point decisions by 3 rd parties caused an incredibly rapid change in the profile of typical RP candidate/patient…in the span of only about one generation.   If you don’t mind, I will simply copy/paste from one of my postings (from HERE) which was dated about a year ago (7/9/2012). Twenty years ago, it was mostly older men (the Medicare population) who where diagnosed with PC (not the typical low-risk diagnosis of today's era). After the introduction of the PSA test, the rate of radical prostatectomies nearly tripled between 1989 and 1992. In 1992, Medicare changed the fee structure for PC treatment services, and launched an investigation into RPs performed on high risk men over 75 (especially performed on comorbid men) because of the high attributable 30-day postsurgical death rate and high complication & re-hospitalization rates. This corresponds directly to the point where PC-reported deaths began to decline...there were lots of older, unhealthy (comorbid) guys dying on the operating tables in 1992. As Medicare reimbursement rates started dropping in 1992 for the RP surgery (as a result of the fee structure changes), the rate of the surgery among the medicare population dropped by 1/3 between 1992-1995. However, private insurance continued to pay high rates for RPs, and the rates of diagnosis, and guess what, surgery among younger men started rising…and the actual numbers of RPs performed continue to rise with younger-and-younger populations of men.      So, sorry to answer a question with a question, but I wanted to ask first if we are on a common foundation with this background?   If you are online today, perhaps we can have some continued dialogue on this topic…although I am leaving today shortly after lunch to go to a Sheryl Crow concert!  ( added in an edit later in the morning :  I also post here infrequently on weekends...I have been very busy preparing for an upcoming wedding.  But if we don't cross paths today, I will get back to you, njs, in this thread with more of a reply.  Looking forward to your comments.)           BTW, Buddy Blank, I have also read about men using the RP as (essentially) a diagnostic procedure to gain a clearer (albeit not perfect) picture of their prostate pathology.     edit :   fixed a couple typos…there are probably a few more still needing to be fixed Post Edited (Casey59) : 7/19/2013 12:06:49 PM (GMT-6)

Casey59 said...
I wouldn’t normally answer a question with a question...

I don't believe I asked one, Casey - I was trying to answer yours, but that'ts quite alright anyway.

My understanding of the natural course of PCa, including the often indolent and virtually never metastasizing nature of GS6, came from closely studying the topic, which, at my doctor's advice, I began doing before I elected to go ahead and be screened and which I did a lot more of after I was diagnosed.

To answer you question, no, I don't think we share a common understanding with regards to PCa prevalence or the Medicare reimbursement issue. With respect to the latter, I was not previously aware of this but I'll take your word for it.

With respect to PCa prevalence, my understanding is that, while fairly common, PCa is significantly less prevalent than you state for men aged 40-50 and especially in men my age (40). Moreover, even if it were as prevalent as you say, your assertion that the other 3 guys out of 10 besides me would be expected to have "at least the same amount" of disease as me would still seem to be a huge stretch as my tumor was already palpable, was visible on MRI and ultimately reported to be of moderate extent.

All that said, even if I shared your understanding of these two issues 4 months ago I guess I don't see what bearing that would have had on my decision. But I am interested to see where you are trying to go with it...