Opinion by Don Cooley

To All Patients but particularly new patients.

Now what I am going to say below does not apply to all doctors and certainly not to YOUR doctor but it applies to far to many. Case in point, surgery for someone with a PSA in the twenties, all the sticks positive and large volume of cancer and yes a Gleason 9 to 10. Just surgery no hormonal ablation treatment, no radiation, no chemotherapy. The disease will keep growing and the time it takes to have surgery and the moths later watching the PSA rise may mean the difference in living 3 years or 15 years. But the doctor does his thing and collects his reward and later upon failure the doctor says - well too bad it had already spread I guess but I had no way of knowing. Of course he knew it had with the statistics given, or should have known before the surgery was performed.

Those of you who have been around a while notice that I frequently may express that the only reason the doctor is doing something is that it makes him money. I think we see this big time in the prostate cancer medical community.Not all but far ore than we might think. Even the University doctors who live on income from studies want you to enter a study so the University can get the money. Again money is more important than patient care. But of course this is not all doctors - but far too many.

A man who has just been diagnosed with insignificant cancer is told by his Urologists that he must have a shot of Lupron "to hold it until you make a decision" In this case the treatment is worse than the disease. There is no proven benefit that a shot of Lupron will do anything to extend survival. The patient with insignificant cancer could possibly last a life time with no spread of the disease. Then why that shot of Lupron, BUCKS - BIG BUCKS. Urologists should not be allowed to administer any chemotherapy and hormonal ablation therapy is a form of chemotherapy.

But they are not the only ones.

When your treatment is obviously failing with a rising PSA (and there are other tests that could be done) don't go back to your urologist, your radiation oncologist your Cryo doc, etc. - when you think you are failing you must make the same decision that you did at the beginning and go with the best specialists who treats failing disease and then which Medical Oncologists is best able to treat me and extend my life.

Urologists are not the only ones guilty of this but it is the one we see most frequently. In addition they may order a lot of blood tests and other diagnostic procedures that are going to produce nothing - except money in the pocket of the physician. One might consider a bone scan with a PSA of over 10 - but rarely will it be positive. Since it takes a lot of disease to show on a CT scan there are millions wasted every year on CT scans that will be negative and the doctor should have been aware that it would be negative. Maybe at a PSA of 20 one should order a CT scan. However there are cases where we might do them all when there is something that lights a red flag and tell us to check it our - the most common of which would be a family history of Breast of Prostate cancer. Millions of your insurance dollar are wasted in this manner.

Lets take an example how doctors earn extra cash. Lets say that you go in for a combination of external beam and seeds but you have no insurance. You may pay as much as $60,000 to $80,000 dollars - in cash and almost always up front. On the other hand if you have insurance the company may pay the doctor $20,000 to $30,000. If you are on Medicare the doctor will probably get even less. This goes on in all fields of medicine including the hospitals who will charge you maybe $14.00 for a Ibuprofen pill - that is maybe $112 a day for Ibuprofen.

Now the clinic, doctor, hospital, University may have some agreed on reduction of these fees if you meet certain qualifications, which is kind of them, but they never tell you that they are available unless you dig. We need legislation that controls this kind of rip-offs and say simply that anyone and everyone has to pay the same fee regardless if they are covered by insurance or not and the fees should be posted - the lowest fee prevails.

As it is if you go to a medical facility and ask them how much a procedure is - frequently the doctor will simply say - "I don't know". Of course he has done 5000 of these procedures and he doesn't know??? He does but does not want to tell you because the price may scare you out the door - even with insurance being involved.

The other day a member of one of the groups basically said they had to trust their doctor until he proves differently. My reply to him was that he got it backwards - one should not trust the doctor until he can prove differently. We have been seeped on doctor being a God-like figure that those in this old generation find it hard to accept that he may be taking advantage of you. Whatever the doctors says - goes. And then we see replies that indicate all the other doctors are wrong but not my doctor!

We have seen members in these groups whose doctors have laid out a path for treatment that it totally wrong. They ask questions of the group and with a number of answers, from patient experts, and not one would agree with their doctor. They proceed on with their doctors recommendations, after all he known more than a bunch of patients, and the treatment fails and they can't figure out why. Had they listened it would have been a different story in my opinion. And if the doctor read the studies, worked on the basis of evidence based medicine - the doctor would have known that he was wrong (and may have known anyway). Maybe it was the money to treat by himself, maybe it was stubbornness that he would be treated "his (the doctor) way". But it was wrong and it will cause the early death of the patient. And it happens all to frequently.

And then there are doctors who are so enamored of themselves and their treatment that they think they can't fail and so when the patient begins to have a rising PSA following apparently a failed treatment the doctor tell them not to worry and don't do anything until the PSA gets to 20 because "there is no proof that early treatment with hormonal ablation therapy is any better than later". And he apparently never reads the many studies on the use of hormonal ablation therapy - does not believe in evidence based medicine and sometimes seem to go out of their way to kill the patient. At a PSA of 20 the disease is spreading like gang busters - too late to get any control.

Is there an answer - I could think if a few but there seems to be no cry from the patient community that they are getting ripped off and until there is the costs will rise as will the cost you pay for your insurance coverage. And you will go on thinking your doctor knows it all when it fact he knows little about this disease - and a lot less than many of the patient experts in these groups.

Do doctors lie - of course they do especially when it lines their pockets. To them it may seem like a "white lie" - to use it just isn't the full truth.

There will be a couple thousand patients who will see this post and less that 2% will read it. As the life goes on and one wonders why they are dying from this disease - they are convinced it was something they did - not the doctor - the doctor did the best he could do - pure BS.

One last thing - the size of the hospital makes a difference. Usually the larger hospitals (including University Hospitals) have more selections of treatments, better read doctors, a better selection of doctors, a better team approach to you disease, more and better equipment and more experience. The moral of the story is you are more likely to find better treatments in the larger hospitals/cancer centers.

As in any sale of any product it is "Buyer beware" - big time!!!!

Page Reviewed and/or Updated:

September 20, 2008