Re: Re: Erectile dysfunction claims

[Guest guest]

In the video, Dr. Walsh recommends active surveillance for appropriate cases. The big question is 'who is an appropriate case'? Each PC patient has to answer that question and decide on treatment. I used the Memorial Sloan-Kettering Prostate Cancer Nomograms to help make that decision. You enter your information and it gives the probablitiy for each of the following: Indolent Cancer (a type of cancer that grows slowly) Organ Confined Disease Extracapsular Extension Seminal Vesicle Invasion Lymph Node

Involvement This information made my decision to have the prostate removed a lot easier. Charlie D. http://nomograms.mskcc.org/Prostate/index.aspx To:

ProstateCancerSupport <ProstateCancerSupport >; charlie14624@... Sent: Tuesday, June 5, 2012 11:31 AM Subject: Re: Erectile dysfunction claims

Provider statistics on erectile dysfunction after treatments for prostate cancer need to explicitly include their definition.

Although it is seldom stated up front, most doctors are providing statistics for recovery of function after as long as one to two years "with or without drugs or aid of physical devices". Some doctors also don't consider having to use pads for minor leakage to be "incontinence."

Objective reviews continue to indicate that an average of at least 30 to 40 percent of men after surgery will not regain full erectile function. For less skilled surgeons or more advanced cancers up to 60 percent of men are likely to have problems.

If you believe your choice is death or full erectile function, this probably is not an issue of concern.

However, for the vast majority of men diagnosed with prostate cancer by PSA screening, this is a false choice.

Dr. Walsh now is also supporting Active Surveillance for appropriate cases.

This was not discussed in the cited 2008 Charlie Rose interview.

If I decided on surgery and lived in the East, I would certainly consider having Dr. Walsh do it,

However, there is no way I would assume a local surgeon would be likley to achieve the same results as Dr. Walsh.

The Best to You and Yours!

Jon in Nevada

Posted by: "Charlie De" charlie14624@... chuckdejohn

Mon Jun 4, 2012 2:27 am (PDT)

Found an interview with Dr. Walsh on the Charlie Rose Show. He talks about prostate cancer detection and treatment. Near the end of the interview, Dr Walsh states only 2 percent of his younger patients who have a radical prostatectomy have long term incontinence and less than 5 percent have erectile dysfunction.Dr Walsh is a professor at s Hopkins. Along with co-workers, Dr. Walsh was the first to describe the 5 alpha-reductase enzyme deficiency, to develop an experimental technique for the induction of benign prostatic hyperplasia, to demonstrate the influence of reversible androgen deprivation on BPH, and to characterize hereditary prostatic cancer. He is on the editorial board of the New England Journal of Medicine and is a member of the Institute of Medicine of the National Academy of Sciences. For 25 years he was the editor-in-chief of ’s Textbook of Urology, which has been renamed Walsh in his honor. Dr. Walsh was honored as the 2007 National Physician of the Year for Clinical Excellence by America's Top Doctors®, and was the co-recipient of the 2007 King Faisal International Prize in Medicine. http://www.charlier ose.com/view/ interview/ 9016

[Guest guest]

Charlie,Great interview, thanks for posting. I know most from reading but I have not seen it in his own words. I had read he filmed his operations over a long time so that when he retroactively had success he would go back and look at the video tape to see what he did right. This guy is a genius.

Steve

[Guest guest]

" ccnvw@... " wrote:

> Provider statistics on erectile dysfunction after treatments

> for prostate cancer need to explicitly include their

> definition.

>

> Although it is seldom stated up front, most doctors are

> providing statistics for recovery of function after as long as

> one to two years " with or without drugs or aid of physical

> devices " .  Some doctors also don't consider having to use pads

> for minor leakage to be " incontinence. "

....

The definitions are indeed slippery and, I think, biased in just

the ways you indicate.

One of the questions on the last standardized follow-up

questionnaire that I answered asked, on a scale of 1..5, how

satisfying was my sex life.

Well, I get no erections at all, but I still have other kinds of

sex and have a great time.  I answered " 5 " .

The doc totaled up the scores and the 5 put me over the

threshold.  Instead of " severe " ED, I was recorded as only

" moderate " ED.

I have no doubt that the statistics are full of BS like that.

....

> If I decided on surgery and lived in the East, I would

> certainly consider having Dr. Walsh do it, However, there is no

> way I would assume a local surgeon would be likley to achieve

> the same results as Dr. Walsh.

I agree, but I suspect that neither of us would have much chance

of getting an appointment.  If Dr. Walsh does one surgery a day

that's about 240 a year, and people from all over the world, not

just the U.S., are lined up.

But I doubt if he can do anything like one a day.  In addition to

treating patients he does research, writes, appears in interviews

like Charlie Rose, participates in public health panels, and

teaches students.

The bad news is he's probably pretty hard to get.  The good news

is that he's out there training students to do what he can do,

and helping us all out in all of the other ways listed above.

One of the things that patients should know about teaching

hospitals is that the great teachers don't do surgeries by

themselves.  They work with inexperienced interns and residents,

training and supervising them in the procedures.

I'm thinking that's probably not as bad as it sounds.  I'm not sure

that I wouldn't rather have an operation by a very bright Hopkins

intern or resident working under close supervision (I hope it's

close) by Dr. Walsh, than an average surgeon at my local

hospital.

Of course I always liked teachers that let me make mistakes so I

could see the consequences for myself.  But maybe that's not the

best thing in medical school

    Alan