Screening for prostate cancer

The controversy over screening for prostate cancer will continue.

clipped from www.medscape.com Information is not adequate to recommend screening men for prostate cancer with digital rectal examination or measurement of prostate-specific antigen (PSA), according to a position statement by the American College of Preventive Medicine (ACPM) published in the February issue of the American Journal of Preventive Medicine. The American Urological Association recommends that men who are 50 years and older and who have an estimated life expectancy of more than 10 years should be offered PSA screening. The American Cancer Society recommends that men who are 50 years and older and who have a life expectancy of more than 10 years should be offered both DRE and PSA screening. The United States Preventive Services Task Force and American Academy of Family Physicians do not find sufficient evidence to recommend for or against PSA or DRE screening. The Canadian Task Force on Preventive Health Care recommends against routine screening with PSA.

Swiss study shows higher cure rates with surgery for prostate cancer

There have been several studies recently that show a higher cure rate for surgery over radiation for prostate cancer.

clipped from www.renalandurologynews.com Prostatectomy Is Best PCa Option Superiority of surgery is seen at 10 years Ten-year prostate cancer-specific survival was 83%, 75%, and 72% for men treated with surgery, radiotherapy, and watchful waiting, respectively, the researchers reported in Archives of Internal Medicine (2007;167:1944-1950). At 10 years, patients treated with radiation or watchful waiting had a significant twofold higher risk of death from prostate cancer compared with men who underwent surgery. The increased mortality associated with radiotherapy and watchful waiting was observed mainly in men younger than 70 years and in patients with poorly differentiated tumors, the authors noted.

UroToday - AUA 2007 - Cystectomy in the Elderly: does the Survival Benefit in Younger Patients Translate to the Octocenarians?

UroToday - AUA 2007 - Cystectomy in the Elderly: does the Survival Benefit in Younger Patients Translate to the Octocenarians?:

"The authors thus concluded that while all age groups derive an overall and cancer-specific survival benefit following a radical cystectomy, this benefit is smaller in octogenarians than for younger patients."

This is an interesting study that shows the benefit of surgery for bladder cancer decreases as paient's are older.

I actually performed this operation in 6 patients in their 90s. All the patients did well with surgery without major complications, but most died within 1 year. 3 from other causes and 1 from recurrent bladder cancer. 2 were still alive at 18 months the last time I looked into it.

High quality or Low cost doctor?

There was an interesting article I came across on MSNBC:
Doctors angered by insurers' rating systems

It appears that many insurance companies are rating physicians. This "ratings" are then used to compensate physicians that they see as providing better care with bonuses or by having lower co-pays for patients to see these preferred doctors.

The insurance company says:

"We believe consumers should have information and access to all their doctors but we want to (give them incentives) to go to high quality providers," said Dr. Jeffrey Kang, senior vice president and chief medical officer at Cigna. Such products can lower health care costs by 3 percent to 5 percent, he said.

One physician response is:

"We're concerned that as insurers try to maximize profits they are saying that the doctor that charges the least amount of money is the highest quality," said Dr. Jim Rohack, a cardiologist who is an AMA board member.

The problem with the ratings are delineated in the article:
Some physicians were rated poorly for managing diseases that patients did not have.
If patients did not have tests that were ordered done, this would cause negative marks.

Other problems I see with this are the possibility that insurance companies can reward providers for spending less money (generic drugs) or avoiding ordering tests.

They can also lead patients to doctors that they pay less. Many people do not know this, but many insurance carriers pay different doctors different fees. This is different than the government (Medicare) that pays the same to all in a region.

If there were set criteria that were reliable, I would be fine with this system. As it is I doubt this is the case.

I wonder how much weight patients put on these preferred status.

Removing the wrong testicle

All the steps to prevent this wrong-site surgery went awry.

Source: Kevin, MD

This is the second time I remember Kevin MD finding wrong site surgery in my field, urology.

The last time was on a kidney:
http://www.njurology.com/RoboticSurgeryBlog/2006/03/removing_the_wrong_kidney.php

I read some of these comments and without taking sides, here are some facts:
The cancerous testicle should have been removed when he first has cancer. I am sure the physicians advised him of this many years ago.

As for all the risks he will be exposed to, they are inaccurate. The main problem with removing the incorrect testicle has to do with infertility. He will not be able to father his own children. He wanted a vasectomy, so this should not be as big of a deal as it otherwise would be.
The other side effects can be prevented with testosterone replacement.

Several of my testicular cancer patients are on testosterone for supplementation since their remaining testicle isn't producing enough anyways.

As for what amount is appropriate for compensating this poor gentleman, I guess that depends on how you look at it.

The last point I had a problem with is the patient saying he did not read the consent. I do not have my patients read the entire consent, but I do read the important points to them. They can read it if they want to.

Grand rounds is up at UroStream

UroStream: Grand Rounds Vol. 3, No. 28

Welcome!

I have the honor of hosting Grand Rounds for the second time! I can't believe it has already been a year since the last time I put all these great medical posts together. Time does indeed fly when you are blogging away.

I thought of many different ways to 'spice up' Grand Rounds. After much deliberation, I finally decided to' stick to the basics' and just present 'the facts', as I did many times before as a resident during our weekly nerve-wracking, anxiety-inducing Urology Grand Rounds.

Why HOT girls are pushing pharmaceutical drugs

Mia Heaston, the current Miss Illinois and one of the 2007 Miss USA
hopefuls, is also a pharmaceutical rep -- one of the many hot girls Big Pharm
hires to push pricey meds onto Doctors and eventually into you. Why?

We have pharmaceutical reps in our office almost daily. Most are attractive/handsome, and some are more knowledgable than others.The 16 cheerleaders that are drug reps was a little surprising.



read more digg story

Clinical Cases and Images - Blog: Blog Advice

Clinical Cases and Images - Blog: Blog Advice: "Every blogger hits a 'writing block' every now and then. Most good bloggers overcome it and just go on, stronger and better than ever. Some other good bloggers get stuck in the 'writing block' and their web sites join the virtual cemetery of dead blogs respectfully maintained by GruntDoc."

Excellent blogging help by clinical cases.

Kevin, M.D. - Medical Weblog: Requiring surgeries to be videotaped

Kevin, M.D. - Medical Weblog: Requiring surgeries to be videotaped:

Requiring surgeries to be videotaped
Believe it or not, there is a bill in Massachusetts suggesting just a thing. A plaintiff malpractice lawyer's dream? Surprisingly, they are against the idea as well.

I read the actual paper. Its amazing, audio and video. I thought we had it rough in New Jersey, but this is worse than anything I've seen here.

Internet changing the way people manage their health - The Cancer Blog

Internet changing the way people manage their health - The Cancer Blog:

62% reported using online health tools.
56% reported improvement in their health management due to personal technology.
2% of patients with chronic diseases thought that online health tools had
improved their management.
One third of patients thought that online tools enabled them to be an 'equal partner with my care providers in making health
decisions.'
62% reported that they would go to their personal physician for information and advice; 44% said they sought information and advice on medical Web sites; 32% said that found healthcare information and advice through an online search.
The Internet ranked as number 3 among the top 5 sources for
medical information.

62% said that their physician did not utilize the Internet to manage their health.
Among ways respondents said that their physicians do utilize the Internet include: direct e-mail communication with patients; scheduling of appointments; offering a way to check on practice and credentials on a Web site.
27% thought their physician fully embraced the Internet.

Only 11% of physicians communicate by e-mail even though 45% of
Americans would like this method of contact.

34% of patients wanted to access lab results by a secure Web site while only 7% stated that they had this option.
33% would like to schedule appointments online but only 7% said that this was currently available to them.
40% of patients had privacy concerns with the use of the Internet. A quarter of patients were concerned that private medical information could be used inappropriately.

Interesting statistics about people's use of the internet and what they would like.
I was surprised that 45% would like to have a physician's email.

I do this only with my major surgical patients.