Who really decides upon which treatment is appropriate? In today’s world, there is a plethora of information, the majority of which is inaccurate, on the Internet regarding diagnosis and treatment options for prostate cancer. Unfortunately, it is not uncommon that patients are given advice based on bias or financial considerations.
This morning, I performed 7 prostate seed implants. Every patient was discharged within 90 minutes. None of them complained of pain. There was no blood in the urine and their treatment is now complete. Other options they could have pursued would include surgery, 8 ½ weeks of external beam radiation therapy or other types of radiation such as hypofractionated or proton beam. I no longer consider cryotherapy a viable option for prostate cancer treatment. There was, in the past, enormous enthusiasm regarding this modality, however, it has quickly fallen out of favor because of the high failure rate and complication rate. Therefore, exercise caution if you are advised to have cryotherapy.
If I were Obama and had access to information regarding prostate cancer, the various treatment options, the associated costs with each, and most importantly, the outcomes, brachytherapy would without question be the treatment of choice nationwide. For instance, there is no data to show superiority of any one treatment over brachytherapy. However, there is definite data regarding the cost of brachytherapy to Medicare, which is approximately $8,000 plus seed cost. IMRT anywhere between $35,000 – $55,000, surgery which will range again between $35,000-$55,000. Finally, proton beam can well exceed $100,000. There should really be no confusion. I am amazed that with all this discussion of healthcare, that such a simple demonstration goes unnoticed.