what is a “proton friendly urologist” in regards to prostate cancer and bias?

I saw a patient yesterday who had been treated for prostate cancer by Proton radiation in Florida. His PSA was coming down nicely and some moderated voiding symptoms, managed before treatment with Flomax, had not changed. He was very pleased with his treatment choice in terms of all parameters. He had done quite a bit of research and talked to hundreds of people prior to making his decision and hardly anyone had a bad experience with Proton therapy. His path report had one positive core and it was a Gleason’s 6. He started off with surveillance but do to a strong family history of prostate cancer elected to pursue treatment.

I feel he matched his disease to the treatment…and made his decision the right way. Making a decision the right way doesn’t mean everything will go well, but it will limit negative consequences.

I  also feel that the 6 or so Proton centers do a good job in “selecting” their patients. As a surgeon it is very important to select the right patient for any treatment especially if one is considering a prostatectomy.

Dirty little secret about surgeons…we want our patients to do well and selecting the right patient with the right health and the right body type and the right parameters of the disease will help assure a good outcome and the patient doing well.

The patient yesterday had seen my website and thought that he and I would be a good match…he liked the outdoors, dogs and fishing. As he and his wife were leaving she said, ” It was so nice to meet a “Proton friendly urologist.”

Remember patients can be biased in that they think all of their care-givers are biased. Solution? Go to all of them, listen to them, ask questions and then based on all you know and all you have learned…make a decision. You are big boy now. If you don’t like or trust your doctor or think he is one dimensional toward a viewpoint or treatment…get another one.

I actually enjoy following patients that have treated by whatever method and managing the issues that result from that and discussing all of the options in an “unbiased way” more than performing the procedure. As fewer and fewer patients prefer the open method I commonly refer patients to robotic surgeons who then have the surgery and then return to me for follow up. Because doing the surgery is not a big deal to me anymore I truly don’t care what treatment a patient chooses as long they know the consequences of that decision.

I like doing second opinions because not having a “dog in the fight” makes both my and the patients more at ease to discuss issues without the baggage of thinking someone is pushing “his specialty.”

Proton friendly urologist…in other words open to all forms of treatment if the disease fits the patient and the treatment…I like it!