The patients I see with prostate cancer and who are considering their options have done a whole bunch of research “before” they have seen me and then even more after they have been given the diagnosis. It is hard to imagine that after that research and particularly after speaking to other patients who have been through the process, that they would not know the risks and percentages of the various side effects. Could they be angry? Distrustful of surgeons as biased? I thought the urologist here made a pretty good point and that is that as more and more patients travel to have “the robot” the long-term relationship so valuable between the doctor and patient somewhat erodes and this might explain the “abandoned” remark.
I am sorry…but in the end it the patients job to do due diligence about his care…I don’t completely buy that in this day and time with the internet, availability of a second opinion and all the friends that have been treated for prostate cancer…that a patient goes into a procedure “hoodwinked” and aware of side effects.
Selective hearing, enamoured with the robot or protons, looking for a scapegoat? No I don’t buy it…but it does make for a pretty good NPR story…you kinda want to hear something bad about those money hungry surgeons from time to time.
Were you pushed into a particular treatment? Comment about it.
CONAN: You wrote about one of them, Paul Nelson(ph) of New Canaan,
Connecticut. Tell us about him.
PARKER-POPE: You’ll have to remind me: Is he the wine – he’s, no, tell me
about Paul Nelson.
CONAN: He was – learned he had prostate cancer at the age of 46 and opted for
robotic prostotectomy – I don’t know if I’m pronouncing that correctly – with a
famous New York surgeon who played down the worries of erectile dysfunction.
PARKER-POPE: Yeah, I’m sorry. I’ve talked to so many men about this since the
story. I just – there’s so many that have stories to tell. And what’s
interesting about Paul Nelson is that he – you know, he sat down with a doctor,
a very respected surgeon, who gave him very promising statistics: 98 percent of
men do fine after surgery.
And he went in and had surgery, and he wasn’t fine. He had erectile function
problems after surgery, as the majority of men will have, and when he tried to
talk to his surgeon about it, you know, the response was: Well, you must just
have something. You know, it’s an anxiety issue. You’ve got your own set of
problems. And he was kind of abandoned by this surgeon.
He decided to start, you know, basically a support group for men to talk
about these issues because, as he discovered, that most men – there were more
men like him than those that the doctor was talking about, that 98 percent
success rate – which when you really get behind the numbers, what you learn is
that that’s a very specific, select group of patients under a very sort of
specific set of circumstances.
And while that is real – those are real data, those aren’t data that apply to
the average man who’s diagnosed with prostate cancer.
CONAN: Well, we want to hear from those of you who have undergone treatment
for prostate cancer, and talk about what your life has been afterwards. Give us
a call, 800-989-8255. Email us, firstname.lastname@example.org. But first, we’ll talk with Dr.
Jason Engel, director of urologic robotic surgery at George Washington
University Hospital here in Washington. And he joins us here in Studio 3A. Nice
to have you with us today.
Dr. JASON ENGEL: Nice to be here.
CONAN: And you’re a prostate cancer surgeon. What do you tell your patients?
ENGEL: I’m almost ashamed to say I’m a prostate cancer surgeon after that. It
sounds like I’m one of the bad guys. But I do agree with Tara in the sense that
those interactions with the surgeon and the patient, they’re very different –
it’s a different interaction based on each – different situation.
My approach, I think, has been different than probably many of the patients
that have called Tara and told them her story, in the sense that the recent
article in JAMA that came out, that outlined some of the outcomes and woke
people up as to the reality after prostate cancer treatments in general, are
things that I have been telling my patients for years, really.
CONAN: So this is not really news, what was in JAMA.
ENGEL: It’s not really news to the majority of urologists. And I would say
that we have to really differentiate between the urologist that takes the
approach of saying, I’m going to be the one following you later, I’m going to be
the one helping you later and looking you in the face later and helping you
through this time; from places, maybe larger centers, that have a different
model, where patients are going to travel to them, not necessarily see them
again. And the patient also is looking for a different thing from that surgeon.
They’re expecting better outcomes, in a large part.