Posted by CLDing on June 13, 1999 at 12:36:44:
In Reply to: Re: Ca Prostate posted by Bjorn Lundquist on June 12, 1999 at 15:13:04:
Thank you for your "by the way" comments. Indeed, we are priviledged to have you on board, as the discussion had been getting too boring with the same characters participating!
Coming back to RRP. There are 3 attitudes towards RRP.
The first is the "good boy's attitude" - do only those cases that you think has a very high chance of cure; in the process this group does a lot of cases which contains pussycats in their prostate whose surgery had actually made no difference to their survival. They are credited with good results until their patient selection criteria are scrutinised and you find that the results were actually predictable.
The second group is the "macho's attitude" - doing RRP for borderline cases, those with the very tiny window of opportunity or those at the window frame. In the process you don't get brilliant results; you get criticised for being too aggressive and the results are also fairly predictable, though much less than the first group. But there is no doubt that this group of urologists have saved some of the borderline cases.
The third group is the "invincible attitude" - carry out RRP whaever the case may be. In other words do everything for the patient and hope for the best, afterall "I" can operate so well and "my" patients do no die or have incontinence or impotence, and the least I can do is to give them local control - (is it true?)!!!!
All of us interested in CaP can identify ourselves with these 3 groups. Personally I would like to belong to Group 1 but that is also the coward's group. Pat Walsh wrote a paper last year suggesting that it is perhaps the borderline group that we should be tackling if we are going to make any further difference to the overall survival of patients with CaP. I tend to agree, even though what you have just said about this group of patient is very true all over the world. However, if our local figures are indeed representative, i.e. the basal or normal level (or the background noise) of our Chinese and Malay PSAs are high, then a PSA of 29 is equivalent to about 19 among the whites - very roughly. That is why I asked for the ethnic group of this patient.
This is a complicated issue and I am sure we have much more to learn. Please continue to contribute.