The “art of getting away with it” is a favorite medical saying of mine. If I remove a ureteral stone and don’t place a stent and risk extravasation of urine into the patient’s retroperitoneum and the patient does just fine….what does that mean? Does it mean that I was brilliant, used seasoned medical judgement, or did I just “gamble with the patient’s money” and just “got away with it?” Did Mr. S just “get away with it?”
Submitted to Prostate Diaries on 2011/03/26 at 10:53 pm
I am the above referenced Squarf. My health is perfect, my urologicals are so splendid that I shall leave them to the National Bureau of Standards when I keel over. My Dr. Doom will die of sclerosis of his personality before anything takes me down. Prostate cancer is the biggest boondoggle in the history of medicine. You may quote me.
-Lorenzo Q. Squarf, Flamekeeper of Western Civilization
After I wrote my book I began to explore fun ways to promote it using social media. In my twenty years or so of practicing urology I had never gone on the internet to search anything related to urology, much less prostate cancer. I have a subscription to the Journal of Urology and that is my usual resource for researching something. I have found over the years that the articles there often legitimize something that I have already been doing for years. An example would be the transobturator sling. We had been doing them for years with very nice results for stress incontinence in women and then I see an article saying that slings are effective.
So when I search around the internet I was surprised to find so much angst out there about urologists (money hungry will only operated and make you leak urine and impotent), the PSA how it has ruined patients lives and made the drug companies rich (Mr. Richard Albin), and people who are so angry about doctors, PSA’s, prostate biopsies that they “threw out the baby with the bath water” and totally went “naked.” There is an interview with the head guy of the American Cancer Society and he said something to the effect that he disagreed with prostate screening and then asked if he’d had a PSA , he said no and that ” I won’t be getting one.” Nihilism comes to mind.
Now to Mr. Squarf…I like him but I don’t know him. He’d be a caricature in my book on the types of prostate patients and how “who they are” determines which treatment, or lack thereof, they choose. You really need to read his thoughts on PSAs, urologists, and prostate biopsies. I did re read his stuff, but as I remember he had an elevated PSA and elected to not follow the value closely or to have a prostate biopsy. (He was not going to let the system us him for their financial gain or play into a urologist’s sadochistic tests. The little knowledge is a dangerous thing mixed with the clever by half patient. That’s going to be a tough caricature for my wife to draw. )
- The most common symptom of prostate cancer is…no symptoms. So Mr. Squarf recommendation to wait until symptoms I would disagree with rather strongly.
- Repeat PSA’s with a rectal exam and pursue a biopsy if it changes with time…is reasonable.
- Mr. Squarf story is what we call in the business “an anecdotal account.” We know that about 20% of elevated PSA’s result in the diagnosis. Not all of those diagnosed need to be treated, some do. That’s where research and “who are you factors” come in. At age 65 a lot of what Mr. Squarf recommends makes sense. It might not to a 60 year old in better health.
- Mr. Squarf “got a way with it” his PSA was high and elected to do nothing and he did not have prostate cancer. He was the 80%. Good for him…but to advise that all do what he did and a say, “don’t let them biopsy you unless you have symptoms” may be harmful to certain patients.
- His decision seems to driven more by angst at the system than a smart medical choice-reminds me of Otis Brawley….making a medical stance to make a point.
- Mr. Squarf was I wrong to have a biopsy and then have my prostate removed. I was 52, 3 of 16 positive, and there were elements of Gleason’s 7. Was I foolish? Was I duped by my self? What was going to be the pathologic future of my cancer? At what point does an elevated PSA associated with known prostate cancer change from being local or confined to the prostate and the point when it moves to a lymph node (metastasize).
- Mr Albin’s father presented with symptoms, just like you suggested he do, he could not void and had prostate cancer in his bones. He died about a year later. Is this perfect scenario that your recommendations allude to?
- Did Frank Zappa play it just right? He waited for symptoms to occur he. He died about three years after diagnosis at age 54 or so.
- Do you feel that the American Urological Assoc recommendations regarding PSAs and screening are driven solely by the love of money?
- Do you what would have happen to me if I had done what you did? I mean…do you know for sure?
So….these are just questions. That’s all, just questions. Mr. Squarf made a decision, based on research and suspicion of the medical community, and he was right. He gambled with his money and ” he got away with it.”
I love his irreverence, humor and those big words. And now he’s kinda rubbing his decision in our faces….be careful Mr. Squarf….you just might influence someone to do what you did and he was not the 80% but the 20%. He also may be that prostate cancer patient (and I have had many, including a close friend of mine) in whom the gland remained normal, the elevated PSA did not change and yet a biopsy showed every core of the prostate positive for prostate cancer. He was 58 or so and I think that finding his cancer and treating it made a difference. (This is anecdotal as well.)
Mr. S…..great to hear from you and I eagerly await a concise rebuttal of sorts in a mildly vociferous fashion.