Public kept in dark about best cancer centers

Newsweek magazine makes a case for more transparency in cancer treatment won-loss scorecards among doctors and hospitals.

The article, "What You Don't Know Might Kill You," says there can be a wide disparity in success of treatments of cancer, for instance, depending on where the patient goes.

" ... at Fox Chase Cancer Center in Philadelphia, to pick one top site, the five-year survival rate for patients with stage II prostate cancer is 93 percent, compared with 88 percent nationwide."

A 5 percent difference doesn't sound like much, unless you are one of the 5 percent.

The Newsweek investigation found wide differences between the results of top cancer centers and community settings (local hospitals and private practice oncologists) where 90 percent of cancer patients are treated.

"Five years after surgery for prostate cancer, for instance, 72 percent of men treated at leading hospitals are alive, compared with 62 percent of those treated elsewhere. Scrutinizing data from specific cancer centers reveals even greater gaps. Five-year survival for stage IV prostate cancer is 71 percent at Fox Chase, for instance, but 38 percent nationally."

Often the issue isn't which hospital has the best machines, it's which hospitals have the best doctors. Those are usually found at the major cancer centers.

But good luck finding out the track records for particular cancers at various cancer treatment centers. They usually don't release this data. So if you want to find the best cancer center for treatment of prostate cancer, you can't find out.

In fact, according to Newsweek,

"And although the National Comprehensive Cancer Network (NCCN) of the nation's 21 top cancer hospitals collects data on how well its members adhere to treatment guidelines, it will not release the information on specific centers."

Ask for surgeons' track record with ED and incontinence

Media blogger Jeff Jarvis has written a detailed and insightful piece about the aftermath of his prostatectomy -- "Small c: the penis post."

Warning readers that this might qualify as too much information, Jarvis goes into some of the specifics of incontinence and erectile dysfunction.

Those are two big problems for men who undergo prostate surgery or radiation treatments. It seems we're so intent of getting rid of this cancer -- be it slow or fast growing -- that we don't worry about the side-effects until after we start to heal and things ain't what they used to be.

Everything I read leading up to my surgery suggested that patients should find out the doctor's success rate at curing the cancer. In a recent report on minimally invasive surgery, a researcher suggested that patients who choose the da Vinci robotic method ask the surgeon how many he's performed. Apparently the success rate improves with "hands-on" experience.

While those are good ideas, something else patients should ask is the surgeon's success rate regarding incontinence and erectile dysfunction following the operation.

Based on experiences of men in a prostate support group I joined, too few surgeons pay much attention to those statistics for their patients.

They should. Removing the cancer is only half the battle. Ensuring the prostate cancer survivors can live full lives is an important part of the cancer cure.

If your surgeon doesn't seem to know how his patients fared with incontinence and ED after the surgery, it's time to start looking for a new surgeon.

More confusion about prostate cancer treatments

A new study raises more questions than it answers about the serious, long-term after-effects of surgery for prostate cancer.

The study finds that men who undergo the less invasive, laparoscopic surgery tend to have a greater chance of impotence and incontinence than those who have surgery by traditional methods.

Published this week in the Journal of the American Medical Association, the prostate surgery report finds that men who choose minimally invasive surgery had a lower rate of blood transfusions and internal scarring, as well as shorter hospital stays.

After 18 months, however, the men who had minimally invasive surgeries reported a high incidence of incontinence and erectile dysfunction.

The minimally invasive surgery includes, but is not limited to, the da Vinci robotic system that is gaining widespread support. Other types of laparoscopic surgery is performed by hand.

It's unfortunate that the researchers lumped all types of minimally invasive surgery together in the report, rendering it totally useless for anyone trying to make an informed decision about what route to take for cancer treatment.

Many doctors tout the da Vinci system as superior to other forms of hands-on laprascopic surgery; this study does nothing to prove or disprove that.

The study by Dr. Jim Hu of Brigham and Women's Hospital in Boston also did not take into account the several forms of radiation or hormone therapies that are used in cancer treatments.

According to the AP, Hu analyzed the Medicare data for nearly 9,000 prostate cancer patients who had surgical treatment from 2003-07. Of those, 1,938 patients had minimally invasive surgery and 6,899 patients had standard surgery. Note that since these were Medicare cases, the age of the men involved was probably older than the average age of men who undergo prostatectomies.

Among the results, diagnoses of incontinence was 15.9 (minimally invasive) vs. 12.2 (standard) per 100 person years and erectile dysfunction was 26.8 (minimally invasive) vs. 19.2 (standard) per 100 person years. (The rate of "100 person years" is primarily for comparison. It's the rate for 100 people for 1 year, or 1 person for 100 years, or however else you want to divide it.)

Said Hu:

"The take-home message for men is they need to dig deeper than simply the message they might be getting from planted stories from device manufacturers or radio ads or billboards."

Unfortunately, this study itself doesn't dig deep enough.

Neighbor's prostate diagnosis brings back memories

My wife brought home the news yesterday from her bus commute that one of our neighbors has been diagnosed with prostate cancer.
I immediately asked my wife to see if the guy wants to talk with someone about it. I can imagine the shell-shock he must have felt at getting the news.
It has been nearly two years since I got the first hint that I may have prostate cancer. An MD first noticed a spike in my PSA at an annual check up in April 2007. By August it had been confirmed by follow-up tests and a biopsy, and I had my robotic laproscopic surgery in September.
My first reaction was surprise, then shock (my father and a close relative had both died of cancer).
Even though the diagnosis was scary for me, I had a lot of support from my family and medical community. I got busy reading about prostate cancer and its treatment. Luckily, I was "healthy" enough to get surgery that would take the bastard out of there for good.
So what I'll suggest to our neighbor is to listen to his doctor, get a second opinion, read up on the disease, contact a prostate cancer support group and make a decision.
Then I'll warn him that even when the cancer is gone, the side effects of treatment can linger. Men suffer varying degrees of incontinence or erectile dysfunction, but there are ways to deal with those problems too.
The important thing is to take action and not passively accept fate.

NY Times editor blogs about prostate cancer

The battle against prostate cancer is a very public ordeal for Dana Jennings.

The New York Times editor has chosen to blog about his experiences with the disease as he undergoes treatment. Find it at Well.

Although I had the best intentions to do the same with this blog, it has fallen into the occasional update of some cancer treatment news. I really don't have the desire to go into sharing all the trials and tribulations of prostate cancer recovery after surgery. Maybe one day I will.

Jennings also had surgery for prostate cancer, but that's where our stories diverge. My post-surgery pathology report and tri-monthly PSAs come back clean. His didn't.

What followed were hormone injections and now radiation treatments.

He tells very eloquently what it's like to lose his sex drive from the drugs and how he deals with the anger that wells from within.

Statin use may hide prostate cancer

My prostate cancer was discovered because of a spike in my PSA level that was noted during a routine annual doctor's visit. Others are first diagnosed for prostate cancer when their PSA level reaches a certain threshold.
In both cases, a biopsy usually follows.
What's a concern is that a report at Urology Today finds the use of statins lowers PSA levels, thereby giving inaccurate numbers that needed to give an accurate diagnosis of prostate cancer.
Statins are a class of drug used to lower cholesterol levels in people at risk for heart disease. Lipitor, Zocor and Crestor are among the brand names of these drugs.
In a retrospective study of 1,214 men who used statins, researchers found that as LDL (bad cholesterol) dropped so did PSA levels.

"PSA decline was linearly associated with a decline in LDL and for every 10% LDL
decline there was a PSA decline of 1.64%."

Often, a threshold PSA level triggers the need for a biopsy. The reseachers found that the drop in PSA in as many 39% of the cases would have resulted in no biopsy being performed.

As is so often the case, there's a lot of uncertainty regarding statins and prostate cancer. Obviously more study needs to be done.
For instance:
-- A report earlier this summer found that the use of statins for the long term could raise the risk of prostate cancer among obese men.
-- A report in January found that men who were taking statins to lower their cholesterol had a 10 percent greater chance of being cured of prostate cancer by radiation therapy 10 years after diagnosis

Vote yellow on election day

Being an ardent bicyclist, as well as a cancer survivor, I always pay special attention when I hear from the Lance Armstrong Foundation.
The foundation is reminding the LiveStrong Army to get out and Vote Yellow on election day.
That means wear yellow when you vote to make the impression that those committed to battling cancer come out to vote on election day.
Both Obama and McCain pledged on the record that they would fight cancer if elected president. Wearing yellow should remind them of their pledge.
Find out more about Vote Yellow here.