How to Get Unbiased Advice -- Inside Info?

Dear All,

I saw this in another forum and thought it was interesting.

Date: Mon, 25 Dec 2006 17:53:14 -0800 (PST)
From: Keith Hilton <sunstone4gems@yahoo.com>

My son-in-law, who is an MD, an Internist, and is in training to become
a cardiologist, gave me this advice: Anyone diagnosed with Prostate
Cancer (and I suppose, any other cancer) should make an appointment
with a Medical Oncologist. Unlike specialists, who all seem to believe
(or want you to believe) that thier way of doing things is best, a
Medical Oncologist does not do the radiation, or the prostate surgery,
or other options; they stay abreast of the most recent research in the
area of cancer (an often specialize in certain types) and will give the
pros and cons of each type of treatment, without having to "sell" any
particular one.

My son-in-law was First in his class at George Washington University,
trained to be an internist at New York Presbyterian, and
Sloan-Kettering, Had the best research paper of his graduating class,
(Harvard University asked him to come down to present the paper
there.),
and he, while in Med school, worked for the Center for Disease
Control, and was among those taken to the White House for briefings on
bird flu. In short, he is top-notch. Oh, did I mention, he was the
top choice of the Director of Cleveland Clinic's Cardiology Department?

He said that the Medical Oncologist can be like a quarter-back
directing the over-all treatment program.

On January 4, Leah wrote, in pertinent part:

> My son-in-law, who is an MD, an Internist, and is in training to
> become a cardiologist, gave me this advice: Anyone diagnosed with
> Prostate Cancer (and I suppose, any other cancer) should make an
> appointment with a Medical Oncologist. Unlike specialists, who all
> seem to believe (or want you to believe) that thier way of doing
> things is best, a Medical Oncologist does not do the radiation, or
> the prostate surgery, or other options; they stay abreast of the most
> recent research in the area of cancer (an often specialize in certain
> types) and will give the pros and cons of each type of treatment,
> without having to "sell" any particular one.

Bingo!

I'm glad to see this support for my oft-repeated rant that PCa patients
should consult a real live honest-to-God *cancer specialist* when
considering tx
options. Unless a uro is one of those few who are thoroughly trained in
*cancer* treatment, he will almost always urge surgery. That's how he
pays for his lifestyle.

Unfortunately, we all too often see pts here who have proceeded with a
surgery which was not (as advertised) curative. IIRC, Strum has written
(on P2P) that med oncs frequently are consulted by pts whose clinical
situations have deteriorated significantly because they were not
properly txd by urologists. So med oncs find themselves confronted by
pts who present with awful clinical records and who hope that the med oncs
are able to help them.

We also often see pts who are receiving ADT from uros who have no idea
what they are doing, but are mindlessly following a recipe. It's called
(by medics) "cookbook medicine." It bears little or no resemblance to
science. Especially the science of learning about the individual pt's
unique clinical record. Too much labor, not enough time.

Yes, it's true that I go on and on about consulting an onc when/if the
uro's surgery fails to cure (AIUI, about 30% of the cases). That's
because folks who post here are too often post-RP and wondering what to do.

No one should conclude that I am against RP of whatever type. Not that
my opinion should control anyone's tx selection. It can be curative but
it is all too often not.

> He said that the Medical Oncologist can be like a quarter-back
> directing the over-all treatment program.

Exactly.

Regards,

Steve J

"We must tailor the treatment to the nature of the disease. We must
listen to the biology."
—Stephen B. Strum, MD

Hello Steve,

Steve Jordan wrote:
> On January 4, Leah wrote, in pertinent part:
>
> > My son-in-law, who is an MD, an Internist, and is in training to
> > become a cardiologist, gave me this advice:

Please attribute this correctly!! I don't even have a son-in-law.

I said that A person in another forum who I don't even know from Adam
posted this message (in prostate pointers RP mailing list). Below is
the date of the post and the person's name. Only reason I thought it
might be reliable is that the son-in-law seems to have excellent
credentials. But remember, he is not a cancer specialist but a doctor
in training.

This is one man's opinion, keep that in miind.

Date: Mon, 25 Dec 2006 17:53:14 -0800 (PST)
From: Keith Hilton <sunstone4g...@yahoo.com>

Leah

On January 4, Leah wrote, in pertinent part:

> Please attribute this correctly!! I don't even have a son-in-law.

Correction noted.

Regards,

Steve J

callalily wrote:
> Dear All,
>
> I saw this in another forum and thought it was interesting.
>
> Date: Mon, 25 Dec 2006 17:53:14 -0800 (PST)
> From: Keith Hilton <sunstone4gems@yahoo.com>
>
> My son-in-law, who is an MD, an Internist, and is in training to become
> a cardiologist, gave me this advice: Anyone diagnosed with Prostate
> Cancer (and I suppose, any other cancer) should make an appointment
> with a Medical Oncologist. Unlike specialists, who all seem to believe
> (or want you to believe) that thier way of doing things is best, a
> Medical Oncologist does not do the radiation, or the prostate surgery,
> or other options; they stay abreast of the most recent research in the
> area of cancer (an often specialize in certain types) and will give the
> pros and cons of each type of treatment, without having to "sell" any
> particular one.

You're right that the med onc has broad cancer tx expertise, and thus
often directs a pt's tx. But since her primary hammer is medicine --
i.e., drugs, aka ADT in our case -- we need to closely examine her
impartiality if she recommends . . . ta daaaa . . . treatment by
medicine. I considered, justifiably I believe, the published research/
teaching/ practicing med onc I consulted before deciding about ADT to be
just another leg of my treatment stool, along with the rad onc and the
uro (surg) onc.

I.P.

Oh were it that simple. Unfortunately, as I noted recently in another
thread, there doesn't seem to be many med-oncs who specialize in PCa.
Perhaps one reason is because PCa cells divide relatively slowly,
traditional chemo that targets fast-dividing cancer cells (and hair)
has not worked well on PCa. I.e. med-oncs really haven't had anything
for us. And it has been customary for uros to treat through the ADT
stage. I'm afraid that unless you find a med-onc specializing or at
least having an interest in PCa, you will get the same "cookbook
medicine."

Strum is one of the few people I hear talking about futile primary Tx.
The fact is that no man wants to hear that he missed his chance for
cure, and the "cut-it-out" mentality prevails. It is perceved that
having RP, RT, etc. is being aggressive, is doing something, acting,
addressing the problem, etc. How many men here, in the absence of
documented systemic disease, would forego ablation in one form or
another as primary Tx? W/ a PSA of 33 I was on the borderline but
everyone I knew, including doctor-friends, said you've got to take the
one chance you have at cure. It's human nature - the survival instinct.


I am not arguing against med-oncs - you should have one on your team
from the outset; but when you recur, you absolutely need one.

Bill Denton
RP 2/12/02
PSA 1.10
Memphis

WANTED: MEDICAL ONCOLOGIST SPECIALIZING IN RECURRENT/ADVANCED PROSTATE
CANCER. MUST BE ABREAST OF ALL CURRENT
RESEARCH/DEVELOPMENTS/TREATMENTS. SOUTHEAST AREA. CONTACT ABOVE.

PLONK

Don't these stupid SOBs understand that they're pissing their very
target audience?

I.P. on Jon Bilec