NEJM -- Management of Prostate Cancer

[Guest guest]

This is a very interesting discussion. You can vote on what procedure you think this patient should get. after reading a short essay by a physician. They have three options AS, Radiation and surgery. be sure to read all three essays.

http://www.nejm.org/clinical-decisions/20081211/#commentbox

[Guest guest]

I read all three essays and voted for AS for the 63 old patient. I did

note, not surprisingly, the very different messages sent by all three

essays. I lifted the following paragraphs as an example. By the way,

the seed doc claims that his form of treatment offers cancer control as

good as surgey. The surgeon claims that surgery provides better control

rates.

As usual, controversy is alive and well in the world of prostate cancer.

Dr. Scardino (surgeon)

" In a multi-institutional longitudinal study of the quality of life

after radical prostatectomy, 2 years after the procedure, 20% of

patients reported incontinence requiring the use of one or more

incontinence pads daily, but urinary obstruction and irritation

improved significantly, and overall distress from urinary symptoms was

less than at baseline. Sexual function, especially the quality of

erection, deteriorated substantially in the first 3 months but had

improved at 2 years, especially in young men with low PSA levels who

had undergone nerve-sparing surgery. Although these side effects are

troublesome, they can be mitigated through treatments that, albeit

cumbersome, are widely available. " (but often are not covered by your

health insurance)

And what about the older? men with higher PSA levels? who did not have

successful nerve sparing surgery?

Dr. Roach (radiologist)

" In a recent, large, multi-institutional series involving a validated

quality-of-life instrument to assess urinary incontinence 1 year after

treatment, 85% of men reported having " no problem or [a] very small

problem " with urinary incontinence after permanent prostate seed

implantation as compared with 76% after surgery. With regard to sexual

function 1 year after treatment, 53% of men reported having " no problem

or [a] very small problem " after permanent prostate seed implantation

as compared with 29% after surgery. If erectile dysfunction does occur,

it is typically responsive to phosphodiesterase type 5 inhibitors such

as sildenafil. " (again, often not covered by health insurance)

Laurel

>

> This is a very interesting discussion. You can vote on what procedure

you

> think this patient should get. after reading a short essay by a

physician.

> They have three options AS, Radiation and surgery. be sure to read

all three

> essays.

>

> http://www.nejm.org/clinical-decisions/20081211/#commentbox

>

[Guest guest]

I read all three essays and voted for AS for the 63 old patient. I did

note, not surprisingly, the very different messages sent by all three

essays. I lifted the following paragraphs as an example. By the way,

the seed doc claims that his form of treatment offers cancer control as

good as surgey. The surgeon claims that surgery provides better control

rates.

As usual, controversy is alive and well in the world of prostate cancer.

Dr. Scardino (surgeon)

" In a multi-institutional longitudinal study of the quality of life

after radical prostatectomy, 2 years after the procedure, 20% of

patients reported incontinence requiring the use of one or more

incontinence pads daily, but urinary obstruction and irritation

improved significantly, and overall distress from urinary symptoms was

less than at baseline. Sexual function, especially the quality of

erection, deteriorated substantially in the first 3 months but had

improved at 2 years, especially in young men with low PSA levels who

had undergone nerve-sparing surgery. Although these side effects are

troublesome, they can be mitigated through treatments that, albeit

cumbersome, are widely available. " (but often are not covered by your

health insurance)

And what about the older? men with higher PSA levels? who did not have

successful nerve sparing surgery?

Dr. Roach (radiologist)

" In a recent, large, multi-institutional series involving a validated

quality-of-life instrument to assess urinary incontinence 1 year after

treatment, 85% of men reported having " no problem or [a] very small

problem " with urinary incontinence after permanent prostate seed

implantation as compared with 76% after surgery. With regard to sexual

function 1 year after treatment, 53% of men reported having " no problem

or [a] very small problem " after permanent prostate seed implantation

as compared with 29% after surgery. If erectile dysfunction does occur,

it is typically responsive to phosphodiesterase type 5 inhibitors such

as sildenafil. " (again, often not covered by health insurance)

Laurel

>

> This is a very interesting discussion. You can vote on what procedure

you

> think this patient should get. after reading a short essay by a

physician.

> They have three options AS, Radiation and surgery. be sure to read

all three

> essays.

>

> http://www.nejm.org/clinical-decisions/20081211/#commentbox

>

[Guest guest]

I read all three essays and voted for AS for the 63 old patient. I did

note, not surprisingly, the very different messages sent by all three

essays. I lifted the following paragraphs as an example. By the way,

the seed doc claims that his form of treatment offers cancer control as

good as surgey. The surgeon claims that surgery provides better control

rates.

As usual, controversy is alive and well in the world of prostate cancer.

Dr. Scardino (surgeon)

" In a multi-institutional longitudinal study of the quality of life

after radical prostatectomy, 2 years after the procedure, 20% of

patients reported incontinence requiring the use of one or more

incontinence pads daily, but urinary obstruction and irritation

improved significantly, and overall distress from urinary symptoms was

less than at baseline. Sexual function, especially the quality of

erection, deteriorated substantially in the first 3 months but had

improved at 2 years, especially in young men with low PSA levels who

had undergone nerve-sparing surgery. Although these side effects are

troublesome, they can be mitigated through treatments that, albeit

cumbersome, are widely available. " (but often are not covered by your

health insurance)

And what about the older? men with higher PSA levels? who did not have

successful nerve sparing surgery?

Dr. Roach (radiologist)

" In a recent, large, multi-institutional series involving a validated

quality-of-life instrument to assess urinary incontinence 1 year after

treatment, 85% of men reported having " no problem or [a] very small

problem " with urinary incontinence after permanent prostate seed

implantation as compared with 76% after surgery. With regard to sexual

function 1 year after treatment, 53% of men reported having " no problem

or [a] very small problem " after permanent prostate seed implantation

as compared with 29% after surgery. If erectile dysfunction does occur,

it is typically responsive to phosphodiesterase type 5 inhibitors such

as sildenafil. " (again, often not covered by health insurance)

Laurel

>

> This is a very interesting discussion. You can vote on what procedure

you

> think this patient should get. after reading a short essay by a

physician.

> They have three options AS, Radiation and surgery. be sure to read

all three

> essays.

>

> http://www.nejm.org/clinical-decisions/20081211/#commentbox

>