Feeds:
Posts
Comments

Posts Tagged ‘john c mchugh md urologist gainesville ga’

2005_12_14_15_52_33_706

If you have had a MRI would you comment for me on how much it cost…both the procedure and the radiologist reading it. Don’t get me wrong. I think the MRI will be very helpful for all…but weren’t we just talking about costs of psa, biopsies, treatment, etc and etc. Where is the outrage? USPSTF where are you? Issue a statement and recommendations regarding the use and payment of the MRI. You picked on Mr. Psa but is Mr. MRI too big a boy for you? You talked about the “risk” of having a Psa drawn…now let’s hear about the “risk” of having an MRI…you know…the expense and inconvenience of the MRI, the finding of a “spot” but the spot when biopsied, oh yes that terrible biopsy, but the spot has no cancer because the spot was a false positive, and oh yes the patient became septic because of the biopsy and had to be admitted to the hospital and etc and etc. Someone please…speak out about the risks of an MRI. As they say, “the silence is…deafening.”

Ps…I’ll find out the cost of a prostate MRI and the cost of reading it and I’ll compare that to the cost of a Psa, urologist office visit, prostate biopsy, and the reading of it by a pathologist-all combined and I’ll wager that the latter is much cheaper than the former. Have you read anything about the costs of an MRI? HmmmmmmmInvestigative report by pepe the prostate

Do you have a “naive” prostate?

 

Pts Who Are Biopsy Naive Can Benefit From Prostate MRI

Urology – May 30, 2016 – Vol. 34 – No. 2

Prostate MRI improved the detection of significant prostate cancer in patients undergoing initial prostate biopsy.

Article Reviewed: Presence of MRI Suspicious Lesion Predicts Gleason 7 or Greater Prostate Cancer in Biopsy Naïve Patients. Weaver JK, Kim EH, et al: Urology; 2016;88 (February): 119-124.

Background: The use of MRI has become more common in patients considering prostate biopsy after a prior negative biopsy. However, for patients who are biopsy naïve, the role of MRI has not been established.

Objective: To conduct a study of patients undergoing prostate MRI prior to prostate biopsy.

Design: Single-institution retrospective study of the records of 100 patients undergoing prostate biopsy after MRI at Washington University, St. Louis, Missouri, between 2012 and 2014.

Methods: The study evaluated prostate MRI and other factors to identify predictors of Gleason ≥7 prostate cancer (G7+) on prostate biopsy. Patients with MRI-suspicious regions (MSRs) underwent cognitively targeted biopsy. Those without MSRs underwent a 48-core template biopsy.

Results: On multivariate analysis of biopsy-naïve patients, presence of MSR was the only significant predictor of G7+. However, for patients with prior negative biopsy, MSR was not a predictor. PSA density >0.15 was predictive of G7+.

Conclusions: Patients who are biopsy naïve can benefit from prostate MRI if a MSR is identified that can be used to guide prostate biopsy.

Reviewer’s Comments: The use of MRI and guided biopsy has become increasingly common. Several studies have shown an increased detection rate of significant cancer in these patients. However, the use of prostate MRI in biopsy naïve patients is less well studied. This was a retrospective study evaluating prostate MRI in men undergoing prostate biopsy at Washington University in St. Louis, Missouri. All patients underwent an extended template biopsy (48 cores), but patients with an MSR underwent cognitive fusion biopsy with 4 to 6 directed cores. Multivariate analysis was conducted to identify factors associated with G7+. Patients were evaluated as biopsy naïve or prior negative biopsy. For patients who were biopsy naïve, presence of MSR was the only significant predictor of G7+ on biopsy. However, for patients with a prior negative biopsy, only PSA density was predictive of G7+. Prostate MRI and fusion biopsy have become increasingly utilized in patients with a prior history of negative biopsy and those undergoing active surveillance. However, use of prostate MRI in patients who are biopsy naïve is less well known. The potential cost implications could be prohibitive. However, improved detection may ultimately benefit patients. In this study, prostate MRI improved G7+ detection in biopsy-naïve patients but not patients with a prior negative biopsy.(Reviewer–Kelly L. Stratton, MD).

 

Author: Weaver JK, Kim EH, et al
Author Email:  uropro2012@gmail.com

Read Full Post »

if you are young and not a liberal you don't have a heart....if you are old and are not conservative you don't have a brain....Churchill

Otis Brawley

The Wit and Wisdom of Don Berwick.

Wall Street Journal on Berwick. 

Who is Donald Berwick?

Meet your new head guy of Medicare and Medicaid. Appointed by your President during a recess and without Congressional debate.

Any health care funding plan that is just, equitable, civilized and humane must – must – redistribute wealth from the richer among us to the poorer and the less fortunate. Excellent healthcare is by definition re-distributional.
Donald Berwick

Competition makes things come out right. Well, what does that mean in health care? More hospitals so they compete with each other. More doctors compete with each other. More pharmaceutical companies. We set up war. Wait a minute, let’s talk about the patient. The patient doesn’t need a war.
Donald Berwick

I think health care is more about love than about most other things. If there isn’t at the core of this two human beings who have agreed to be in a relationship where one is trying to help relieve the suffering of another, which is love, you can’t get to the right answer here.
Donald Berwick

It is, I guess, politically correct, widely believed, that to say that American health care is the best in the world. It’s not.
Donald Berwick

The decision is not whether or not we will ration care. The decision will be whether we ration care with our eyes open.
Donald Berwick

We have really good data that show when you take patients and you really inform them about their choices, patients make more frugal choices. They pick more efficient choices than the health care system does.
Donald Berwick

Death Panels Begin As Reform Takes Shape

Posted 08/18/2010 06:42 PM ET

Medicine: After the recess appointment of a Medicare and Medicaid head, an FDA panel drops its endorsement of a widely used cancer drug. Another FDA-approved cancer therapy may not be paid for. It begins.

It didn’t take long for the health care philosophy of Dr. Donald Berwick, President Obama’s choice to head the Centers for Medicaid and Medicare Services, and an appointee we have labeled a “one-man death panel,” to have an effect.

Berwick is an admirer of Britain’s National Health Service and its National Institute for Clinical Excellence, with the Orwellian-acronym NICE.

“NICE,” Berwick has said, “is extremely effective and a conscientious, valuable and — importantly — knowledge-building system.” But NICE is really a system of rationing, through a bureaucratic formula for “cost-effectiveness,” that has rushed untold numbers of Britons to an early grave.

Avastin, the marketing name for the drug bevacizumab, is the world’s best-selling cancer drug. Used mainly to treat colon cancer, it was approved by the Food and Drug Administration in 2006 after it was found that by cutting the blood flow to tumors, it helped in treating breast cancer.

An estimated 17,500 American women are treated with the drug each year. It is effective, having been shown to extend life by at least 20 months, but it is not cheap.

Under the new “cost-effectiveness” philosophy of this administration, an FDA advisory panel has voted 12-to-1 to drop the endorsement of Avastin for breast cancer treatment. The FDA usually follows advisory panel recommendations, and a final decision will be announced Sept. 17. If approval of the drug, approved for colon, lung, kidney and brain cancer, is revoked for breast cancer, it is likely that insurers would drop that coverage.

In a joint letter sent to the FDA and key congressional lawmakers last week, Susan Komen of the Cure and the Ovarian Cancer National Alliance (OCNA) urged that Avastin continue to be approved for metastatic breast cancer patients and warned of the message this “decision sends about drug development for women with advanced breast cancer.”

Breast cancer, the second most common cause of cancer death among U.S. women, claimed 40,000 lives last year. Komen says the decision to use Avastin should be made between a woman and her doctor after a thoughtful consideration of the benefits and risks. We agree.

The Obama administration’s health care overhaul is all about cost and little about care. Berwick has opined: “We can make a sensible social decision and say, ‘Well, at this point, to have access to a particular additional benefit (new drug or medical intervention) is so expensive that our taxpayers have better use for those funds.”

In other words, the government will decide whether treating you and extending your life is worth it.

OCNA is also concerned whether Berwick’s CMS, the Centers for Medicare and Medicaid Services, will pay for Provenge, a vaccine to treat the recurrence of prostate cancer, and at what rate. The vaccine is made from a patient’s blood cells with cancer cells and an immune-boosting substance. A three-dose course of the immunotherapy is estimated to cost $93,000.

There’s a conflict in mission statements. The FDA is supposed to approve drugs that are safe and effective. The CMS statute says it must pay for treatments that are reasonable and necessary. Provenge is ominously still under review by CMS.

“The decision is not whether or not we will ration care,” Berwick says. “The decision is whether we will ration with our eyes open.”

Well, all our eyes should be wide open by now.

Share

Read Full Post »