Tag: breast cancer

Let’s Revolutionize Prostate Cancer

Let’s Revolutionize Prostate Cancer

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A New Approach to Prostate Cancer

It is time.  We need to rationally approach prostate cancer with new tools.  Imaging first — biopsy last.

In 2004 Dr. Thomas Stamey, Chief of Urology at Stanford, published a seminal article, heralding the end of the PSA era.  He was known as the “the father of the PSA.”  This was not greeted with great applause.  He concluded that PSA testing was not an accurate measure of prostate cancer.  In subsequent years, he has admitted the correlation coefficient between PSA testing and prostate cancer is approximately 20 percent.   That is less than even odds that an elevated PSA equals prostate cancer.  (Vigorous sex can raise your PSA up to 40 percent.)

Men are in constant fear of an elevated PSA and its implications.  It’s like watching the Dow.  But the approach has been too slow to evolve.

Let me give you the best example.  Women typically have an annual mammogram — often followed by an ultrasound (it should be the opposite).  If you are diagnosed with a suspicious mass, a wire-guided biopsy is performed.  This is very targeted and limited only to the specific area of interest.   A positive biopsy is now most commonly followed by a lumpectomy.  The story then becomes complicated.

For men, the approach is backwards, and medieval.   A suspicious digital rectal exam, followed by an elevated PSA (greater than 4.0) will inevitably demand a prostate biopsy.  15 years ago this would have been a “4 core” sample.  4 blind stabs.  But over the interval there has been a tendency to increase to 8 cores, then 12 cores and now 16 cores.  Blind stabs through an area that cannot be sterilized.  This can frequently cause infection, bleeding and pain.

It is time for this approach to come to an ignominious end. …

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Trying to Put Genie Back in the Bottle

Trying to Put Genie Back in the Bottle

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We have seen the emergence of “evidence-based medicine” in the last 10 years.  This has been an effort to further legitimize and give scientific basis to common medical therapies.  A medical version of “show me the money.”  I have always thought this was rather inane, since it presumed that all medicine for the last 2000 years has been unscientific and irrational.  Although the reality is medicine is not nearly as scientific as asserted.  Only 10-20% of medical practice is based on sound scientific principles.   This rankles most physicians who believe that conventional medicine is scientifically-based.  The highest form of medicine is the practiced art using scientific principles and technology.

A series of US Task Force recommendations are being rolled out by the Department of Health and Human Services.  These are well-intentioned and rational.  Examining the literature and epidemiology of medical practices in an effort to determine what is safe, sane, practical and effective.   The trap is “effective” as you will see.

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