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Questions for Dr. Jennings (on two different subjects)

Doctor,

In response to my post entitled "Trusting your PCa Physician's Advice", you had this to say:

"I disagree. Your doctor has, or should have, far more knowledge of the medical information relevant to your case. This is not to suggest that you should trust your doctor blindly, as some of my posts have made clear. However, if you have concerns about your doctor's judgment, by all means get a second medical opinion. This might well involve consulting with someone with a different specialty; if your first doc is a surgeon, ask a rad-onc, or vice versa. Then decide which doctor made the most sense, and go from there".

My question to you is this: and what happens when the radiation oncologist also gives you questionable advice? For example, what if you are too old or too ill to live another 10 years, and both the surgeon and the radiation oncologist recommend treatment (as so many of them did in the M.D. Anderson study). Likewise, what if you are a very low risk patient who meets the strict Epstein criteria for AS, and both doctors fail to mention it as an option. What do you do then? Well, if you have not researched your cancer and educated yourself, then you are likely to become one of the millions of over-treated men around the world.

So, I suggest that we do not get hung up on whether or not you should have more knowledge about your disease than your PCa doctor. As you say, your physician should have far more medical knowledge about PCa than you do, but unless you want to be yet another victim of the existing over-treatment problem, then you should, at least, be educated enough on the subject to know if your doctors’ recommendations are in your best interest.

Next topic. In one of your previous posts, you mentioned two different radiation protocols for intermediate risk PCa, and a third if you are at high risk. From your survivor story, I got the information on the high risk protocol, and I want to congratulate you on your success in fighting your Gleason 9 tumor. I am not sure why you didn't provide any details on these protocols in your post, and I am surprised that nobody looking into treatment options asked for them because I, for one, would like to know. Even though I am currently practicing AS, I still consider it useful information to store away in case I happen to need it one day. So, could you please explain the intermediate risk radiation protocols to me, and the other forum readers, and tell us why one of these two options should be your preferred method of treatment. Thank you.

Respectfully,
Alan M in the USA

Re: Questions for Dr. Jennings (on two different subjects)

"My question to you is this: ...what happens when the radiation oncologist also gives you questionable advice? For example, what if you are too old or too ill to live another 10 years, and both the surgeon and the radiation oncologist recommend treatment...?"

I hope it would be unlikely for one patient to find two doctors more interested in making money than providing optimal care, but, regrettably, it is possible. Should this happen, my advice would be a third opinion.

If you are likely to live a few years, it might still be advisable to treat it to slow it down. In this case, EBRT alone would be the least invasive, with the least side effects, and would probably hold it off for five years. If the tumor recurred, it would probably be a few more years before it became painful or obstructive.

"Likewise, what if you are a very low risk patient who meets the strict Epstein criteria for AS, and both doctors fail to mention it as an option. What do you do then? "

I'm not familiar with the abbreviation "AS". I'm guessing it is another term for watchful waiting. If this is the case, you might still want a competent doc to follow subsequent PSAs with you and provide advice.

"... unless you want to be yet another victim of the existing over-treatment problem, then you should, at least, be educated enough on the subject to know if your doctors’ recommendations are in your best interest."

I agree.

It is a fact that better educated patients have better health and better outcomes than the less educated. This is because the better educated can understand their illness and participate in its treatment. This difference has sometimes been attributed to class or racial bias; these regrettably sometimes occur, but in my experience, the advantage is usually due to educational bias.

"... you mentioned two different radiation protocols for intermediate risk PCa, and a third if you are at high risk.... I am not sure why you didn't provide any details on these protocols in your post..."

A full explanation would have meant a longer post. I thought it was already probably longer than many would want to wade through.

For intermediate risk patients, the superior protocols are HDR and EBRT+Seeds. For high risk patients, the highest cure rate is provided by EBRT+Seeds+ADT. This would also be suitable for intermediate risk patients.

"... tell us why one of these two options should be your preferred method of treatment."

They provide the highest cure rates. If cure is not a priority, as with men with shorter life expectancies, other treatment options may suffice, such as EBRT alone. Or, for masochists, surgery.

Re: Questions for Dr. Jennings (on two different subjects)

AS - Active Surveillance - Regular and frequent PSA testing, & biopsies as required.
(I thought I was on AS but my oncologist said I wasn't since the PSA testing was neither regular or frequent; I think he called it watchful/hopeful waiting)

"For intermediate risk patients, the superior protocols are HDR and EBRT+Seeds. For high risk patients, the highest cure rate is provided by EBRT+Seeds+ADT. This would also be suitable for intermediate risk patients."

I think you meant HDR or seeds?

Re: Questions for Dr. Jennings (on two different subjects)

Actually, I meant that the two effective treatments are HDR, and EBRT+Seeds. I didn't mean to imply that both treatments should be combined.

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