Beware the siren song of the greedy urologist.

Hi Ranger44 - good to be your own advocate for sure. Radical surgery would not be my choice either. On the longevity remark, once you hit early 80's and reasonably healthy then there could be several more good years ahead. Setting your limits on making it to 80 and/or not going past 85 would not be my vision (I'm currently 83 and I want at least 10 more with quality - God willing). Just an opinion.
Keep chasing the best treatment options. Good luck.

I inherited my dads funky prostate, so i have seen many urologists starting in my 30s.

At first, i realized they were kind of goofy docs. I did some research and realized all they had as tools were antibiotics and their finger.

Time went on. My stepdad died of PCa. I saw more of them. And i saw what they did to my stepdad, and the decisions they made with their heads. Now i conclude they not just funny/goofy, they are kind of dangerous. I realize that anyone that spends too much time with a urologist has a good chance of being DEAD. PSA had come out. I read articles. I started plotting my PSA on a graph.

Then my dad dies of PCa. I see the absolutely F’d up decisions they make for him. I am very cautious of these guys now.

Then me. I get PCa. I quickly study my ass off. In like 3 months i seem to know more than the docs i am seeing. This petrifies me, as im not that smart. And when you are in a room with your doc, HE needs to be the smartest guy in the room!

They routinely quoted me made up statistics designed to get me to proceed in the direction they wanted, which was a LESS CURATIVE route for me.

My PCa experience felt like 2 years of hand-to-hand combat. It was horrible. I still did not get my preferred treatment plan. It was so intense, it was hard to keep my head thinking straight. The pressure. I eventually partially capitulated to the one urologist. Hopefully i survive these stupid greedy men.

I noticed 3 things that make them terrible doctors.
-greed for the money to keep their practice running. Keep you in-house
-most of them want to be the 1000 prostatectomy man, or urolift man. So they want you, even if your survival odds are better down the street.
-Training. Medical Schools are corrupt now just like all of our systems. The docs are not taught all sides of things.
I actually found them good at their “proceedure”, but really bad at risk/reward or strategic planning for patient survival. The schools don’t teach them to think, or to find the truth of a situation. They are taught to follow orders, follow protocols, follow what your software flow chart says. Or else.

PLUS:
Now i sit on the prostate cancer forums and watch. I see man after man after man... offered misguided treatment. And now their cancer has returned, and they come to the forum asking what happened.

Specifically, as im sure you are wondering, they were High Risk category patients. High Risk should NEVER be advised to go the RP route as it is at best a 50/50 shot at cure.

But, those urologist surgeons, in the year 2024, have no reservations advising a poor terrified guy to go that way.

What I keep hearing from other high risk men is that they often refuse treatment because of quality of life. What does quality of life usually mean in these circumstances. We are talking about Libido and sexual function. Everyone has the absolute right to choose what treatment or treatment(s) they are willing to endure. But, I must agree with the last post, these same men refuse treatment and the cancer eventually spreads and in some cases very aggressively. It is at that point, these men want every treatment available to throw everything they can to stop the cancer. Since being diagnosed with de novo metastatic PC I have heard story after story of men refusing treatment. In my opinion, PC should never be treated by a Urologist. You are better served by a reputable Oncologist Urologist that can offer you every treatment possible to treat cancer aggressively.

Here's one other focal treatment to consider. I had the Irreversible Electroporation (IRE) treatment about 7 weeks ago. It was an outpatient procedure. Since my tumors were all within the prostate, I was a good candidate. The doctor said that IRE and cryotherapy would both be effective given the location of the tumors (toward the front of the prostate). This procedure uses electrodes to essentially electrocute the tumor. It was similar to the transperineal biopsy as to the location. It was not particularly painful; I only used tylenol for a few days. I had a catheter for six days. It wasn't as bad as I had imagined. I even removed the catheter on my own without incident. I had blood in my urine for about six weeks, but that was probably longer than usual due to my taking blood thinners due to heart issues. There has been a bit of incontinence, but not too much. I had this done at Moffitt Cancer Center in Tampa. I think some of the Mayo Clinic locations may use this focal treatment also.

Best wishes for a successful outcome.

I agree with many of the comments above. The treatment you ultimately go with must align with your life expectations. After you move forward with your treatment decision, you must then live with the consequences and should embrace whatever comes your way. Looking back and second guessing your decision will only cause frustration and anger. For me, I was 56 when I was diagnosed with PC (Gleason 7-->4/3). As with most men, I did a lot research to ensure my ultimate treatment decision aligned with my life expectations going forward --> I wanted 30+ years of PC free life to love/support my wife & son, with the best possible understanding of the cancer that was currently in my body. For myself, sexual function was of minimal concern, control of urination was a higher want, and living a PC free life was of upmost concern (#1, #2, #3, ...). I went with a robotic radical prostatectomy at a center of excellence (Mayo-Rochester) and chose the best possible doctor at Mayo-Rochester. Results have been very good - Margins negative, PSA undetectable for over a year (crossing fingers this continues), full urination control, and complete erectile function. As we all know, cancer is tricky, and you never know if it will come back. However, having a radical prostatectomy that removed all known cancer from my body, I feel confident moving forward. For myself, I was unwilling to accept the risks associated with newer technologies that rely on imaging "tools" to identify and treat the cancer. The imaging technology we have is awesome, but is not 100% perfect. For myself, to bet my life on imperfect imaging technology was not an option. I am a big advocate of using the "tried & true" technology that has decades of application. Not to say other treatments are not as good or better, this is just my opinion, based on my personal research/conversations/etc...

Best of luck to all those battling prostate cancer.

Jim

Right on 100%!!

Sorry to hear what has happened. I had my 3tMRI done at UNM University of NM, but I went MD Anderson for my biopsy, but had some issues with their re-read of the slides, as I had a Houston radiologist that only does prostate cancer, disagree with MDA. I ended up firing MD Anderson they were trying to tell me they didn't want reread the images and so on, "they were the best in the World" blah blah, I went to Mayo in Jacksonville, where the MRI was redone, and they had their team of radiologists review both studies to render the final decision, also had by biopsy at Mayo. Bottom line is you have to question these Drs, get second opinions or even 3rd opinions. I sent the Pathology to John Hopkins, where they provided more detail and the findings were more in-depth, the Mayo report vs John Hopkins were like day and night.

I'm kinda of in the same situation and I feel like they have pretty much given up on me. My Urologist had me on ADT for about six weeks before he dropped me and my medication because I questioned his order for a transrectal biopsy. That was it no further discussion and he washed his hands of me. I'm 71 with a PSA of 287 and cancer in my bones and lymph and he still wanted me to undergo a biopsy without ever asking me how I felt about it. Pretty unethical if you ask me but I'm happy I didn't agree to a transrectal without a MRI. I'm in a rather rural area and far from a major city so even finding a Urologist is a problem let alone getting proper care. I probably should have expected such treatment from him when on our first and only visit he was wearing a mask. How can anyone have faith and trust in a health care professional when they won't give up the mask? It's like their badge of honor for their disgusting and inhumane behavior during the so called pandemic in which they acted like complete authoritarians. Power is an insatiable appetite that never finds content.

We’re not doing it right…

Here’s part of the problem...too many people getting paid along the way.

From the excerpts below taken from a major health insurance company’s recent 10-K filing claiming to cover or administer health plans for 18 million people you can see that 86% of the company’s medical customer business is from Administrative Services Only. The idea here is for the health insurance sponsor, that is, your employer, to make money from the company’s health insurance plan. How do you think they do that?

10-K excerpt
“Administrative Services Only or ASO. Plan sponsors (i.e., employers, unions and other groups) self-fund all claims, but may purchase stop-loss insurance to limit exposure. We collect fees from plan sponsors for providing access to our participating provider network and for other services and programs… Approximately 86% of our commercial medical customers are in ASO arrangements.”

Here’s the “stop loss insurance” offered to plan sponsors.
“Reinsurance is ceded primarily to limit losses from large exposures and to permit recovery of a portion of direct losses.” “…Under the terms of the Agreement, the plan sponsor pays a monthly premium based on an established rate per commercial health plan members. In return for premiums paid, the plan sponsor is reimbursed a percentage of costs in excess of a deductible for hospital related services provided to individual commercial health plan members. The required deductible per individual commercial health plan member per calendar year was $150,000...Covered charges over the deductible are reimbursed by the reinsurer at 80% for the years….”

So how do you make health insurance pay? Enter the “Medical Benefit Management Service”. In 2017 the subject company paid $3.6 billion to purchase a Medical Benefit Management Service company which operates as an independent subsidiary that contracts with medical benefit payors and acts as a claims gate keeper standing between the payor, insured and provider. Another10-K excerpt below.
“Medical Benefit Management Services….xxx is a leading provider of integrated medical benefit management solutions that focus on driving adherence to evidence-based guidelines, improving the quality of customer outcomes and reducing the cost of care for our clients. xxx contracts with health plans and other commercial and governmental payors to promote the appropriate use of health care services”

It gets better…ProPublica recently investigated a major healthcare insurer and learned about an AI platform the company uses that allows company doctors to reject claims without having to open the patient file. One company doc rejected 121,000 claims in the first two (2) months of 2022. Early last year another company medical director denied 63,000 claims in two (2) months. The company estimates only 5% of people would appeal a denial resulting from the AI review.