Comments on: BEWARE OF INEXPERIENCED PROSTATE CANCER SURGEONS http://prostatecancerblog.net/?p=1861 A Wife's Passion Thu, 26 Aug 2010 02:09:19 +0000 hourly 1 http://wordpress.org/?v=3.0 By: Alvin Chin http://prostatecancerblog.net/?p=1861&cpage=1#comment-8866 Alvin Chin Sun, 22 Nov 2009 00:50:23 +0000 http://prostatecancerblog.net/?p=1861#comment-8866 I realized the side effects were bad in surgery and that is why I chose brachytherapy. I also didn't particularly like the game played by my diagnosing urologist who I felt was not up front with me on how many procedures he had done and was doing per year. It didn't take me too long to conclude that I was not going to let this relatively inexperienced, but mid-career urologist, operate on me. I've always said that one of the reasons that I chose brachytherapy was the "learning curve" need not be that great and you have the help of a whole team to make sure that the doses are done correctly. The simple fact that you have to cut a closed system invites leakage and that was not necessarily the case in radiation, as the side effect rates bear out. There are times when surgery truly is the gold standard but in most run of the mill cases, it is not necessary and radiation, (preferably brachy), will do fine. This leads one to wonder if the over treatment caused by the over diagnosis of PCa is not solely due to the inability of surgeons to provide a clean operation. That is, too many inexperienced surgeons are leaving the impression that there is over treatment because of the detritus that is invariably left behind. It always causese one to wonder whether the treatment was worth it when one is left with incontinence, impotence, and a less than perfect internal system. The final question is why can't they train their surgeons better or require them to obtain special licenses or experience to perform mass prostatectomies just as they require of specialized cardiac surgeons. I suspect that there are still surgeons out there not practicing Nerve-sparing RRP even though Johns Hopkins/Walsh circulated the procedure in the major professional journals a few years ago. Over treatment is a problem caused by the professional gate keepers, not the patients. All they need is more honesty and a will to improve the results. But, evidently is takes more than a desire to make our professionals, more professional. I realized the side effects were bad in surgery and that is why I chose brachytherapy. I also didn’t particularly like the game played by my diagnosing urologist who I felt was not up front with me on how many procedures he had done and was doing per year. It didn’t take me too long to conclude that I was not going to let this relatively inexperienced, but mid-career urologist, operate on me. I’ve always said that one of the reasons that I chose brachytherapy was the “learning curve” need not be that great and you have the help of a whole team to make sure that the doses are done correctly. The simple fact that you have to cut a closed system invites leakage and that was not necessarily the case in radiation, as the side effect rates bear out. There are times when surgery truly is the gold standard but in most run of the mill cases, it is not necessary and radiation, (preferably brachy), will do fine.

This leads one to wonder if the over treatment caused by the over diagnosis of PCa is not solely due to the inability of surgeons to provide a clean operation. That is, too many inexperienced surgeons are leaving the impression that there is over treatment because of the detritus that is invariably left behind. It always causese one to wonder whether the treatment was worth it when one is left with incontinence, impotence, and a less than perfect internal system.

The final question is why can’t they train their surgeons better or require them to obtain special licenses or experience to perform mass prostatectomies just as they require of specialized cardiac surgeons. I suspect that there are still surgeons out there not practicing Nerve-sparing RRP even though Johns Hopkins/Walsh circulated the procedure in the major professional journals a few years ago. Over treatment is a problem caused by the professional gate keepers, not the patients. All they need is more honesty and a will to improve the results. But, evidently is takes more than a desire to make our professionals, more professional.

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