Thursday, November 02, 2006

Choices (for men only)

You learn you have prostate cancer, and you have been told that you need to have a radical prostatectomy to remove the diseased gland. You have a choice of an "open" procedure or a laparoscopic procedure. (By the way, we offer both at BIDMC.) How do you choose? What are the pro's and con's?

I attended a recent seminar of this topic -- yes, you get to do this kind of thing when you run a hospital -- and I was surpised to learn from our Chief of Urology that the case is not at all clear cut. I had thought that the laparoscopic procedure would be a clear winner on many counts, but there are arguments to be made on both sides.

I am giving my layperson's interpetation of what I learned, so please don't rely on this. Check with your doctor or the literature for a more accurate reading on the matter. Medicine being an inexact science, there are bound to be lots of opinions.

Since men only are reading this posting -- hold on, maybe some women readers joined us and are interested in this question, too -- I know that your first question will be about potency rates after the surgery. The answer: Similar results.

OK, what about effectiveness in removing the cancerous tissues? Similar results.

What about returning to regular life activities? With open surgery, doesn't the open incision mean a longer recovery time? No, postoperative pain is comparable in the two cases, and men can return to activities just as quickly despite an incision.

And so on, and so on. Are you surprised like I was?


Anonymous said...

Hi Paul,

For me, this post brings up a TON of questions. I think it's clear that even experts in medical fields disagree on many issues, often because there is not a right answer. How, then, do doctors and patients decide on treatment methods? Does the hospital have regulations regarding new treatments and drugs? How do you make sure your physicians are up to date on current research? With all the advertising out there, how can doctors ensure that patients are making informed decisions? If a patient doesn't have a biology background, how are they to understand all the options and risks?


PS. I don't expect you to have the answers to all those questions!

PPS. A long time ago, you interviewed me when I applied to MIT, and you used to take the NSHS kids to Mary Chung's. I was so impressed with your sincerity, and this blog only reinforces that. Thanks.

Anonymous said...

Hi Nishla! It is great to hear from you.

Let's see if others can offer some answers . . .

Anonymous said...

This post is interesting, but men have more choices than just the two surgical procedures. I work with a company that manufactures radiation therapy seeds (just happened to stumble across your blog when I was searching on another topic), so it is surprising that your post doesn't mention the multitude of treatment options--from external beam radiation therapy and brachytherapy to cryotherapy and watchful waiting.

Anonymous said...

Right. This was just about surgery. We work with patients on all those other options as well.

Sorry, I can't always cover everything in one posting! If I did, every posting would be a medical textbook . . .

Anonymous said...

I'm mildly surprised that the more invasive incision doesn't have a longer impact on returning to normal daily activities. But only mildly. During my lifetime I've seen enough huge improvements in sophistication of surgery that I can believe this.

To answer Nishla's question about "how do we decide," I've accepted that there will always be a leading edge with questions that haven't been answered yet. That was true 25 and 50 and 100 years ago and will be 25 and 50 years from now.

Sometimes I look at it this way: I think about my parents' or grandparents' generation. I imagine being around 50 years ago, with the options available then, and wishing I had better options. I fast forward to today, where I may indeed have not one but two options that just didn't exist back then. And I'm at peace with my ability to choose.

Nishla's other question (a major one) is how we make sure our physicians are up to date. I feel very strongly about this. There's no way I can check this out in detail, so I've chosen to get my care at a place where the individual workers are empowered and motivated, and the place isn't run by a bureaucracy.

My previous primary MD was great but he was in a big-name institution where most people at desks looked and acted half dead, and would answer questions by saying there wasn't anything they could do.

I don't mean to sound too much like a commercial, but that's why I travel ~50 miles to go to the BIDMC. I don't have any major problems today, but someday when I do, I want to be in a climate where people know they DO make a difference. In that climate, people tend to keep themselves well informed and share their knowledge with peers.

Patient Dave