Medical Beliefs was....Post Brachytherapy problems

[Guest guest]

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.prostatecancerwatchfulwaiting.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: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of Alan Meyer

Sent: Tuesday, 23 February 2010

2:06 AM

To: ProstateCancerSupport

Subject: Re:

Re: Post Brachytherapy problems

copanahoy <copanahoygmail>

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 way

when performed as a monotherapy as when performed in combination

with EBRT. You have to ask your radiation oncologist about this.

If you have lost confidence in him, then you may want a second

opinion from another rad onc, but you'll need to get a complete

copy 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 addition

to brachytherapy, I thought it was because the doc thinks it's

useful to treat the area just outside the prostate?

> This is all a statistical probabilities issue anyway

Very true I think. If there was no _evidence_ that the cancer

was outside the prostate, the only thing anybody can base a

decision on is statistics. There is some percentage of patients

with no evidence of capsular penetration who nevertheless have

it. There are nomograms that can give you some rough

probabilities based on PSA, Gleason score and stage. See the

Memorial 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 from

anecdotes.

> 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 can

wait 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 recommends

something, or just says, " It's my experience that ... " It makes

you wonder if he's making it all up.

Let us know what you find out.

Good luck.

Alan