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Prostate Cancer Surgery: You Need to Know This Before You Say Yes · Intellectual Medicine

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  Somewhere in this country there is the worst urological surgeon
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  and somebody's getting operated on by next week.
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  Let that not be you. The urinary incontinence rate is
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  from zero to 80%. What does that tell you?
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  Right. Yeah.
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  The surgeons matter. What doctors don't tell you
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  before surgery? The surgeon, what is he not
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  sharing with you? You can pretty much guarantee
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  that they'll check your insurance and tell you a date to
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  show up. Beyond that, good luck.
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  But here are some things that you should reflect upon.
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  Not reflect upon. You should know.
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  You should ask these questions Now, you know, I don't advocate
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  surgery and I don't advocate biopsies, but it's your
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  prerogative. There's no path of certainty in
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  this arena, men. There's no superiority of one
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  over the LK. My protocol is better to the
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  extent that we know it's not going to hurt you.
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  But how about your outcomes in 10 or 20 years, right?
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  So I understand why some men will opt for surgery, either
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  psychologically they can't live with a thought of prostate
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  cancer or for other reasons. They judge it to be in the best
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  interest. Now here's what you need to
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  know. One thing, the urinary
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  incontinence rate is from zero to 80% in the studies analyzing
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  that outcome. Think about that zero to 80% and
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  the erectile dysfunction is around 12 to 80%.
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  What does that tell you? Right.
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  Yeah, the surgeons matter that the techniques can be different
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  that the outcomes. It's not like a pharmaceutical
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  intervention where you can standardize it.
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  I mean, think about it, somewhere in this country there
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  is the worst urological surgeon and somebody's getting operated
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  on by next week. Let that not be you.
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  So here's some questions that are tough to get answers to.
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  Doctor, what is your rate of urinary incontinence one year
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  post operative? And if they tell you, well, I do
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  pretty good, there aren't that high.
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  OK, that's not an answer. That's shuffling.
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  I mean, I would think if if I'm the surgeon, I'm keeping stats,
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  I know how many I did. I know how many of them had
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  incontinence. I know how they're doing.
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  I think they owe it to you to get that information.
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  Next question is about erectile dysfunction.
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  Same question. Next question.
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  Here's an important one, guys. If you're contemplating A
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  surgical intervention, what is your rate of biochemical
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  recurrence? They should know that and you
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  should know that biochemical recurrence refers to after the
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  gland is removed. The PSA goes down close to 0.
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  Remember, PSA is made in other spots besides the prostate, so
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  sometimes it doesn't go all the way down to zero.
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  So the PSA level goes very low and then it starts to creep up
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  again. You feel fine, no symptoms, but
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  the blood level, the PSA goes up.
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  The doctors perceive that as a call to arms, as a need to
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  treat, as a biochemical recurrence. 50% of people who
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  have prostatectomies, up to 50% end up with biochemical
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  recurrence. I mean, that's a failure rate of
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  one out of two. That's dismal.
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  But you should know what your surgeon's track record is.
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  And oh by the way, you should have absolutely seen more than
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  one surgeon. This is not an emergency guys.
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  If they say oh great, I can get you in next week.
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  They pause, talk to another surgeon.
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  This is the rest of your life. Another thing, doctor, what did
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  my PSMA PET scan show you? If you look to you with a blank
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  stare and said he didn't get one, find another surgeon.
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  This should be a preoperative study for every man.
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  Why? If you have cancer outside of
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  the prostate gland and it can be identified on a PSMA, PET scan,
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  prostate specific membrane, androgen PET scan and IV dyes is
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  injected and it connects to the prostate tissue in the prostate
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  cancer, that is wherever it may be.
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  If there's anything outside the gland, forget about it.
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  Surgery is harmful and of no value contraindicated.
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  Even so, you have to know that is there anything outside the
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  gland? The next thing that we want to
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  know about from our surgeon, infection and complication rates
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  should know that heart attack, blood clot, things of that
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  nature. It's worth knowing and also find
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  out about the anesthesiologist in the hospital.
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  This is tough information to get.
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  There is a website. This is new to me.
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  Actually, a patient alerted me to it and their objective.
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  I haven't actually used them, but I think it's worth you
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  looking into if you're contemplating any kind of
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  surgery where they can look into the surgeon's outcomes and
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  report it to you. Kind of cool.
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  This patient of mine had knee surgery done.
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  He had a knee replacement and he found out that the surgeon he
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  was thinking of using had a 25% reoperative rate after the knee
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  replacement was done and he found those that had a 5% rate.
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  Perhaps in no other area of medicine is the selection of the
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  doctor more critical than in surgery.
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  The the website isgarnerhealth.com, GARNER,
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  health.com, all one word. I can't vouch for them
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  personally, but I like their focus and the ma'am merit.
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  So another question asked your doctor, Doc, what did you think
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  of the PIVOT study and tell me your impressions about the
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  outcome. Now, the PIVOT trial looked at
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  men who had the prostate gland removed and compare them to men
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  who did nothing. 20 years later, both groups had the same death
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  rate, all cause and prostate cancer specific. 20 years later,
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  surgery made no difference. Now, some surgeons will say to
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  you, well, yeah, I'm aware of that study, but here's why I
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  don't think it applies to you. That's actually an OK response.
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  It tells you that they're aware of the study, they've considered
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  it, and they are. They are acting against the
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  conclusion of the study because they feel it's in your best
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  interest, and they should be able to explain why that's an OK
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  position. I still don't advocate surgery,
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  but I respect your prerogative. Now if you have a surgery done,
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  prostatectomy or focal therapies where they cut out part of the
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  gland, you should still consider what are you going to do
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  afterwards. And that's another question I'll
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  ask. Hey doc, what's your plan after
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  surgery to help make this cancer not come back?
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  What do you advise to reduce the risk of biochemical recurrence
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  if you get the Bambi in the headlight?
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  Look, guy hasn't put my OR gal hasn't put much thought into it.
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  These are the things that are not covered.
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  They don't go to these in detail.
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  They're uncomfortable to talk about the failure rates of the
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  prostate surgery, the prostatectomy, but things you
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  need to know about biochemical recurrence post operative
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  infection. When they give you generalized
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  comfort like, well, that happens, but the rates are low,
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  not good enough. I want numbers.
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  I think if you generalize well, my outcomes are better than, you
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  know, the studies show. All right, tell me, what are
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  they? So take your time.
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  Get a couple of opinions at least.
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  Two, You can't undo surgery. It's permanent.
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  It's guaranteed to cause harm. That's unequivocal.
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  Surgery causes harm. I don't care what kind.
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  But especially prostatectomy, that's an irreversible
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  amputation of a critical part of your anatomy.
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  OK, Don't go lightly down that road, guys.
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  What else do they not tell you? Very few.
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  I in fact, I've done many consults of patients who who
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  have talking to urological surgeons.
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  Never do they bring up the PROTECT T trial, the PIVOT
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  trial, these trials that show futility of outcome with surgery
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  not brought up. It's not good for business, it
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  deserves consideration. So erectile dysfunction rates,
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  urinary incontinence rates, biochemical recurrence rates,
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  perioperative infection. How many of your patients doctor
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  end up with an extended hospital stay, All worthy of attention.
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  And then find out the pedigree of the anesthesiologist.
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  Oh, by the way, find out about insurance coverage.
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  I mean, I've seen people whacked because the hospital's in
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  network, the doctors in network, the anaesthesiology group is not
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  in surprise. Three months later, you get like
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  a whacking bill. So everybody should be in
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  network and everybody should be working kind of collectively as
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  a team. Here's a great question to ask
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  your surgeon if you're contemplating surgery.
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  Doc, if you had prostate cancer, who would you go to for surgery?
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  If you had the ability to go anywhere in the country and see
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  anybody, who would it be? Now, if that surgeon is 3 states
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  away or across the country and you look him up and he glows in
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  the dark and they're not covered by your insurance, find out how
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  much it cost out of pocket. This is the rest of your life if
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  you let insurance reimbursement be the rate determining step or
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  I should say the only clinical path you're willing to consider
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  that may not be prudent. Listen, if you if you're in dire
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  financial straits, you may have little choice, but you might
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  have the reserve, the capacity to pay out of pocket.
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  And often times if you tell the doc that, you know, they look at
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  the global bill, it can be, could be less, can be less than
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  the sticker price. I mean, I see folks dropping,
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  you know, hundreds, 10s of thousands on plastic surgery.
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  Shoot, I don't begrudge them that.
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  Some of them I'm really happy to get it done.
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  But this is your life. So investigate it thoroughly.
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  Check out that website, ask a lot of good questions.
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  It's never a rush. Contemplate the non operative
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  path. But if you choose surgery to not
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  be lulled into believing it solved the problem, it just had
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  an impact, but you got to have another plan, a post operative
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  plan, and you should be prepared for managing the not only
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  complications of surgery guys, but the biochemical recurrence.
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  One other thing you got to know about, you got to know about
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  this, what role does radiation play in that doctor's protocol?
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  Is it immediate or delayed? Now, some surgeons like to do
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  radiation shortly after you recover from surgery.
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  They irradiate the pelvis just in case some of the cancer cells
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  escaped. See, they're acknowledging that
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  the surgery itself doesn't wipe it all out.
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  Radiate the pelvis. What we have found, what has
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  been found out through studies, is you don't need to do that.
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  You can wait. You can wait.
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  And the outcomes are no worse if you wait even years and all of a
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  sudden the PSA is creeping and then you do the radiation.
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  I don't think radiation should be done ever.
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  So let me be clear. In my protocol, in my pathway,
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  my research, and in in my hypothesis and philosophy of
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  treatment, it's never done. However, in the conventional
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  pathway, it is part of what they do.
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  And it is OK if you choose it with good informed consent, but
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  delay it. Do not get it done right after
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  surgery. I hope these tips help you.
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  And I hope that you take notes, Write them down when you go in
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  there. It's it can be unnerving.
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  Sometimes the surgeons get a little impatient if you're just
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  asking questions other than yeah, what time do I show up?
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  Well, guys, it's your body. It's your life.
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  Take command of the space. Be polite.
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  You know, after all, these surgeons worked hard to get
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  where they are. We want to be nice to them but
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  be affirmed. You don't need to do something
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  because someone else tells you to do it.
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  It's got to be right for you, in your heart, in your mind.
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  So good luck out there, right Fight, cancel like a man.
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  Talk to the urologist like a man, right?
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  You're as equal, her equal. You don't happen to be somebody
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  that has to just be like a cork floating in the stream.
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  All right, gang, till next time, by the way, leave comments, ask
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  questions. We love to hear from you.
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  Makes me happy. And we know how important that
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  is. All right, see y'all later.
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  Bye.