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Archive for October, 2011

FROM THE PHYSICIAN’S HEART…

I have never been told of a Domino or Card party, where a group of men got together to discuss their health issues, such as the stage of their Prostate Cancer when they were diagnosed, the reason they chose the treatment they did (surgery vs Radiation Therapy) and the side effects they experienced from their treatments.  During my seminars in the community, it was no surprise that many did not know the ribbon color or the month selected as “Prostate Cancer Awareness” month.

Men need to talk about their HEALTH issues and visit their physicians more often…and it is just not happening.

Prostate Cancer Ribbon

With the known battle of trying to get male patients to see their physicians, I was quite dismayed when the U.S. Preventive Services Task Force (USPSTF) set forth a draft in OCT 2011, stating  – “…USPSTF recommends against prostate-specific antigen (PSA)-based screening for prostate cancer. This is a grade D recommendation. This recommendation applies to men in the U.S. population that do not have symptoms that are highly suspicious for prostate cancer, regardless of age, race, or family history…”

Of course, the draft went on the describe the rationale, harms of detection and early intervention, the population under consideration, harms of screening and treatment, etc., very valid and persuasive argument set forth in ~15pages.  However, majority of the population will not, and did not get past the first paragraph, or the sentence which states, “This recommendation applies to men in the U.S. population that do not have symptoms that are highly suspicious for prostate cancer, regardless of age, race, or family history.”  Now I have young men telling me they do not need to be tested for Prostate Cancer!

A blanket statement as the above is a great disservice to men, and especially to the men in the African American/Black communities who are at a higher risk for the more aggressive type/stage of Prostate Cancer.  I have seen many patients with high risk prostate cancer who had no “symptoms” –  some had abnormal digital rectal exam (DRE) with PSA’s in the “normal” range, others had high PSA’s and normal DRE’s…but one thing remained constant – majority had NO symptoms that would be considered indicative of Prostate Cancer.  Are they assuming the population at large knows the difference between signs vs symptoms? (Sign = abnormal DRE, high PSA, etc., things a doctor can detect; Symptoms = changes in urination, etc., things a patient detect and tells the doctor). For the sake of clarification, the article did go on to say that PSA testing in males over 75 years old is inappropriate. What say you?

Important DRE

Feeling for Cancerous Nodule on the Prostate

It is true, that Prostate Cancer can be a slow, indolent disease. It is true, that the treatments for Prostate Cancer has side effects that must be taken into consideration. It is true, that some males over the age of 75 would not benefit from any treatment, either because they will die from some other disease process (such as Cardiac Infarction/Heart attack) or they have many other comoridities (illnesses) that are more life threatening than Prostate Cancer.  It is also true, that symptoms for Prostate Cancer are very rare and therefore cannot and should not be used as a marker for testing. It is also true, that age, race and family history plays a large role in Prostate Cancer screening, and it is also true, that most treatments for Prostate Cancer has improved over the years with a decrease in  much popularized side effects; albeit, the side effect of most concern, erectile dysfunction (ED), will occur with increase in age, with or without treatments.

A blanket age is also difficult to uphold. I recently saw a competitor on the X-Factor who at age 60, looks fabulously well and better than most 40 yo men I have seen.  Men are taking better care of themselves. They are living longer and maintaining very active life styles.  If only they would talk amongst themselves…more…

The USPSTF meant well and did a great job in the statement draft presented.  However, a blanket statement as that presented in the first paragraph, inadvertently made the physicians job more difficult, because they are steering away patients that would benefit most from treatments.  Quite a few “low percentage” numbers are used in the article. But I tell you the truth, statistics becomes inconsequential, when the number is ONE and that number is YOU.

It is my humble opinion, that a biopsy should be made available to patients if signs of an abnormally high PSA or abnormal DRE is present. If low-risk cancer is detected, then the options can be presented and discussed with the patient, one of which is to do nothing (i.e., no treatment).

The decision of when to stop testing for Prostate Cancer, is not just an age/number, it should include the patient overall well being, and their desire and concerns should be taken into consideration. Therefore, it is my opinion that the decision to stop testing for Prostate Cancer should occur during a conversation between a patient and his physician….be it at 60 or 80 years of age.

***Support Prostate Cancer Awareness Month in September 2012! Wear a blue Ribbon! ***

For more FREE information on Prostate Cancer visit www.LegacyEducators.com for questions to ask your doctors, videos on treatment available for Erectile Dysfunctions, Tabular form of treatment options, and so much more!

USPSTF full DRAFT article is located here:   http://www.uspreventiveservicestaskforce.org/draftrec3.htm

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FROM THE PHYSICIAN’S HEART…

OCTOBER! It is Breast Cancer Awareness Month and Pink Ribbons are everywhere! Corporation are sponsoring walks, 5k runs, 10k runs, golf tournaments, heart warming TV shows, concerts and myriads of support and survivorship display gives ALL a sense of hope…and so it should be.

Then I step into the Radiation Oncology world. The real battle field.

I recalled many instances during my training, observing how other physicians handled delivering “worse” news (bad news was the initial diagnosis). I was told I would get use to it and that it would get easier. I never did…and I hope I never will.

What do I tell a young woman battling breast cancer with known disease spread to the bones that was stable for a while but no longer responding to chemotherapy treatments? A battle won, another battle lost, a battle won…and now this battle? The ultimate goal – stay alive for her preteen child. This scenario, ask any Oncologists, unfortunately describes too many. Are there any words? No. But a listening ear, a compassionate touch, an understanding nod … allowing the silence to be…present. Acknowledging in and through silence and a gentle touch, while looking into her their eyes, understanding of their fear….their pain…of mortality.

I do not allow myself to cry, but my heart bleeds…and I pray for my patients.

http://www.LegacyEducators.com

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Welcome to Legacy Educators & Consultants, LLC!

Weekly blogs will alternate on articles “FROM THE PHYSICIAN’S HEART…” and “DISPELLING THE MYTHS IN CANCER EDUCATION.”   Questions are welcomed and some will be answered each week!

Be sure to visit http://www.LegacyEducators.com and learn about Cancer the easy way…VISUALLY!!

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