Sources: Duke Medical School, International Journal of Radiation Oncology, Biology, Physics, Vol. 82, Issue 5, 1 April 2012, p. 781; NCCN Guidelines for Prostate Cancer; National Institute for Health & Clinical Excellence; James Buchanan Brady Institute at Johns Hopkins Memorial Hospital; Sloan Kettering Memorial Hospital
Editorial
After 30 years of Medical Malpractice Litigation, I have come to recognize that medicine has patterns of treatments falling in and out of vogue every 10-20 years. Over 20 years ago, women were almost routinely given hysterectomies for a wide range of post menopausal symptoms including bleeding and cramping. Women with Breast Cancer invariably underwent radical mastectomy, the standard of care in the 1980’s. Did our Mothers, Sisters, Wives and Girlfriends require these surgeries? The emergence of a number of non-surgical treatment options that have been just as effective lead one to question the wisdom of the times. I used to think it was a function of women utilizing medical services 3x more than men or that it was simply bad luck to have been born a woman in modern society. Perhaps there was simply way too much money involved in surgeries, operative times, anesthesia times and inpatient postoperative stays for the US healthcare system to slow itself down and reflect?
Lately, a good portion of my practice, has focused upon men and their healthcare experiences. It has been my observation that there is a significant amount of prostate surgery, stemming from the overly agressive approach to prostate cancer treatment. All too often surgeries are scheduled for men with prostate cancer at such an early stage that it does not represent a life-threatening condition. Add to this the reports of misread biopsies, mis applied PSA scores and overly read scans and the results are a staggering amount of radical prostatectomies. Of course there are those who will blame the Medical Malpractice trial lawyers for creating a climate of fear among physicians, leading them to suggest surgery. This argument makes little sense. Cancer is a lot like being pregnant, either you’re positive or you aren’t. And why is there a disproportionate amount of surgery in the male 50 to 80 years of age group? If one lives long enough, they will get prostate cancer -currently affecting 1 out of 6 men. This is actually more prevalent than breast cancer, which affects 1 out of 8 women. However, studies following autopsy have demonstrated that even where prostate cancer is present, it has not been the cause of death in 90% of men. Prostate cancer tends to be slow growing (indolent) and non-recurrent.
So why all the surgery? And what does this mean for men age 50 and older? First, be very careful with your choice of a Urologist. A competent urologist is most likely to obtain a good biopsy sample of the prostate. Be aware that the Pathologist who interprets the biopsied tissue may make an error as well leading to our Second recommendation. Get a second opinion. In most cases you will basically feel healthy. Make sure you aren’t being misdiagnosed or overly diagnosed. Look at the stock market lately. The company which pioneered robotic sugery, originally for women and now for the prostate, is at an all time high. The Global Market for surgical robotics is expected to exceed 5 billion by 2015. Most metropolitan and now suburban hospitals have invested considerable amounts of capital in robotic and minimally invasive surgeries to bring more patients through their doors and into their operating rooms. This is not a train that is easily derailed.
I am certainly not against new technology and constantly push hospitals and physicians to move toward more state-of-the-art practices in the cases I bring on behalf of my clients. I am simply warning that not all surgeries are indicated and that prostatectomy -no matter how robotic or “minimally-invasive” involves the disconnection and reconnection of vital structures and nerve endings which can and does result in temporary (and sometimes permanent) loss of sensation, erectile dysfunction and incontinence. Consider your options carefully and make well informed choices.
Have you or a loved one been diagnosed and treated for prostate cancer? Contact the Lewis Law Firm for a free consultation.
Posted by: Gayle R. Lewis, Esquire