Re: Medical Beliefs was....Post Brachytherapy problems

[Guest guest]

Which reinforces the need to select really experienced doctors....

To: ProstateCancerSupport Sent: Monday, 22 February, 2010 20:07:23Subject: Medical Beliefs was....Post Brachytherapy problems

Alan says:

<snip> I always hate it when a doctor can't explain why he recommends something, or just says, "It's my experience that ..." It makes you wonder if he's making it all up. <snip>

Many decisions made by doctors are based on what I term ‘medical belief’ because there are no good studies to guide them – merely a mix of good and bad, big and small, biased or straight published experiments. So they do what they think is best, based on their personal beliefs and what they have learned – sometimes by trial and error.

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow. net and www.prostatecancerw atchfulwaiting. co.za

Dr “Snuffy†Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

From: ProstateCancerSuppo rtyahoogroups (DOT) com [mailto: ProstateCancerSuppo rtyahoogroups (DOT) com ] On Behalf Of Alan MeyerSent: Tuesday, 23 February 2010 2:06 AMTo: ProstateCancerSuppo rtyahoogroups (DOT) comSubject: Re: [ProstateCancerSupp ort] Re: Post Brachytherapy problems

copanahoy <copanahoygmail (DOT) com> wrote:> As I said in my original post, inasmuch as my prostate gland> was successfully irradiated (based upon post op CAT scan> analysis) I am really questioning the need for the planned 25> low dose (40 Gy) EBRT treatments scheduled for about 6 weeks> from now.I'm not certain that the seeding is done exactly the same waywhen performed as a monotherapy as when performed in combinationwith EBRT. You have to ask your radiation oncologist about this.If you have lost confidence in him, then you may want a secondopinion from another rad onc, but you'll need to get a completecopy of your treatment plan to take to him.> My disease was "organ confined" and I have no desire

to look> for more problems.How did you find that out? When EBRT is prescribed in additionto brachytherapy, I thought it was because the doc thinks it'suseful to treat the area just outside the prostate?> This is all a statistical probabilities issue anywayVery true I think. If there was no _evidence_ that the cancerwas outside the prostate, the only thing anybody can base adecision on is statistics. There is some percentage of patientswith no evidence of capsular penetration who nevertheless haveit. There are nomograms that can give you some roughprobabilities based on PSA, Gleason score and stage. See theMemorial Sloan Kettering website.> and I'd like to find some empirical data on people like myself> who had the seed implants but did not continue with EBRT> (though it might have been recommended) .I think you'll get more information from the nomograms

than fromanecdotes.> I don't see why I couldn't continue without EBRT but with an> "Active Surveillance" approach with quarterly PSA tests, DREs> and other monitoring by my Urologist.This is a question for the rad onc. Ask him how long you canwait for the EBRT. Ask him if there is a specific time period,or a specific indicator (like PSA rise) that limits the time.Ask him to explain why.I always hate it when a doctor can't explain why he recommendssomething, or just says, "It's my experience that ..." It makesyou wonder if he's making it all up.Let us know what you find out.Good luck.Alan

[Guest guest]

Speaking of brachytherapy I wondered if there is any data on when advanced PCa occurs with Brachy... versus radiation. I just wondered since the seed is usually left and may project a wider and longer radiation. Hypothesis.

I had radiation and it is obvious I know nothing about brachy..... My doctors found an inflamed lymph node near my veins that split to the legs. I asked if they can place a brachy... in the prostate-a specialized lymph why they could not do that to my lymph node. The response since it is out of the prostrate then it is all over my system and would do not good. If they can detect it in my blood at lower levels then it would be all over my system at lower levels as well. sooo?

Wondering about,

Tom W

To: ProstateCancerSupport Sent: Mon, February 22, 2010 2:12:04 PMSubject: Re: Medical Beliefs was....Post Brachytherapy problems

Which reinforces the need to select really experienced doctors....

From: Terry Herbert <ghenesh_49@optusnet .com.au>To: ProstateCancerSuppo rtyahoogroups (DOT) comSent: Monday, 22 February, 2010 20:07:23Subject: [ProstateCancerSupp ort] Medical Beliefs was....Post Brachytherapy problems

Alan says:

<snip> I always hate it when a doctor can't explain why he recommends something, or just says, "It's my experience that ..." It makes you wonder if he's making it all up. <snip>

Many decisions made by doctors are based on what I term ‘medical belief’ because there are no good studies to guide them – merely a mix of good and bad, big and small, biased or straight published experiments. So they do what they think is best, based on their personal beliefs and what they have learned – sometimes by trial and error.

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow. net and www.prostatecancerw atchfulwaiting. co.za

Dr “Snuffy†Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

From: ProstateCancerSuppo rtyahoogroups (DOT) com [mailto: ProstateCancerSuppo rtyahoogroups (DOT) com ] On Behalf Of Alan MeyerSent: Tuesday, 23 February 2010 2:06 AMTo: ProstateCancerSuppo rtyahoogroups (DOT) comSubject: Re: [ProstateCancerSupp ort] Re: Post Brachytherapy problems

copanahoy <copanahoygmail (DOT) com> wrote:> As I said in my original post, inasmuch as my prostate gland> was successfully irradiated (based upon post op CAT scan> analysis) I am really questioning the need for the planned 25> low dose (40 Gy) EBRT treatments scheduled for about 6 weeks> from now.I'm not certain that the seeding is done exactly the same waywhen performed as a monotherapy as when performed in combinationwith EBRT. You have to ask your radiation oncologist about this.If you have lost confidence in him, then you may want a secondopinion from another rad onc, but you'll need to get a completecopy of your treatment plan to take to him.> My disease was "organ confined" and I have no desire

to look> for more problems.How did you find that out? When EBRT is prescribed in additionto brachytherapy, I thought it was because the doc thinks it'suseful to treat the area just outside the prostate?> This is all a statistical probabilities issue anywayVery true I think. If there was no _evidence_ that the cancerwas outside the prostate, the only thing anybody can base adecision on is statistics. There is some percentage of patientswith no evidence of capsular penetration who nevertheless haveit. There are nomograms that can give you some roughprobabilities based on PSA, Gleason score and stage. See theMemorial Sloan Kettering website.> and I'd like to find some empirical data on people like myself> who had the seed implants but did not continue with EBRT> (though it might have been recommended) .I think you'll get more information from the nomograms

than fromanecdotes.> I don't see why I couldn't continue without EBRT but with an> "Active Surveillance" approach with quarterly PSA tests, DREs> and other monitoring by my Urologist.This is a question for the rad onc. Ask him how long you canwait for the EBRT. Ask him if there is a specific time period,or a specific indicator (like PSA rise) that limits the time.Ask him to explain why.I always hate it when a doctor can't explain why he recommendssomething, or just says, "It's my experience that ..." It makesyou wonder if he's making it all up.Let us know what you find out.Good luck.Alan