What the Urologist DOESN'T tell you about "wait and see

ugbandtulsa · Regular Joined: 28 Nov 2006 Posts: 11

My dear fellow cancer victims and families,

I'm not sure if what I'm about to divulge is or has already been discussed in the Forums. If not, I hope it enlightens you a little. Many of you, or someone you love may have been recently diagnosed with Prostate cancer. Many (if not most) Urologists recommend treatment with a drug named Lupron. At a staggering $2000 per dose, given QUARTERLY, it's not only expensive, but eventually becomes INEFFECTIVE at controlling the spread of the disease. What the doctor does NOT tell you, is that for each prescription of LUPRON that he writes, he receives a "royalty" of approximately 50%. Yes, I said FIFTY PERCENT!!

Ever wonder how a Clinical Oncologist (i.e., a doctor who does not perform surgery) can make $700-$800k per year performing office visits at $200 per shot? The answer? They don't. Assuming your average Urologist or C.O. makes $4,000 per year off EACH person they put on Lupron, if they have only 100 patients, that's a whopping $400,000 per year!! Now, think about this scenario; in a larger town or regional area, if an M.D. has 500 patients, that's 2 million dollars per year!!! The dollars are staggering!

Fellow cancer victims and families of such, I suggest to you that the modern day Urology and Oncology professions have been tarnished horribly by the practices of the drug companies! Why would a doctor send you out for surgery, (either the old style or the new robotic method) and get a referral fee (I do not know how much this is), or instead take the "wait and see" approach, and make $4,000 dollars per year off you? The answer is painfully clear. Doctors are in this to make money, no doubt about it.

When my father was first diagnosed with PC in about 1994, the new stereoscopic surgery was not perfected like it is now. My father opted for the Urologist's recommendation of "wait and see" only to die a miserable, degrading death 13 years later. Granted, at the time, Lupron was only around $750 per dose (funny how times change, and yes, I have the actual receipts in my hand) as opposed to the OVER $2,000 now.

Bottom Line: Do NOT make the same mistake we did, in listening to the "Doctor". Do WHATEVER it takes to get the $30 or $40k for the surgery, get the cancer OUT of your body, and get on with life. Steal it if you have to. NO excuses, just get it. Yes, there is a chance you might have some nerve damage. BIG DEAL. We all deal with handicaps, but let me assure you, for every person that adopts "wait and see", there are 10 that have died horrible, bone wrenching deaths wishing they hadn't. You DON'T have to die from PC...you just have to do the research, and take my advice. Get the cancer OUT of your body. Now.

I wish every day of my life that Robotic Surgery was available 13 years ago for my father. But then again, I would not be writing this letter to you, and saving your life. If you are young, healthy and have PC now, times will change. Sure, you might look great for 10 or even 15 years, but eventually the "horses will get out of the stable, and start running...fast". When that happens, it's over. Ball game. NO CURE. Get my point here? If you are 50, life will be over by 65. Lupron will NOT hold the cancer forever....It just won't. Not to mention it can make you tired and have hot flashes like my father had. You don't feel 100%. No way to live, my friends.

No doubt there will be many, many people who discredit what I say about the Lupron, and how the doctors get paid. Look your doctor right in the eye and ask him to tell you the truth. I did, and got a straight answer. Many of you will not. Believe what you want, but just THINK about what I have said here. Spread the word, that the "wait and see" approach is bunk, and totally misguided. God Bless you all...

Mike H
OK

chas036

I feel the same as you about how the docs get kickbacks from drug companies. Also I feel the same about PC and getting surgery rather than a wait and see attitude, or even getting radiation. At least with surgery you know where you stand with the cancerr because you will have the pathology report which will tell you if they got it all or not. With radiation, you will never know if they got it all or not.

As to the cost,,,, my robotic surgery cost a total of $20,500 for the hospital stay for one day and the surgeon. It was done in a well known university hospital by a surgeon who has preformed well over 1000 surgeries. People spend more on cars than I paid for my surgery to save my life, so never let money be a issue.
_________________
Biospy 4/2007 - 2/12 <%5 Cancer Gleason 6
RP 9/25/2007 Uni Rochester, NY
Gleason 6, Negative Margins

Otago · Regular Joined: 20 Jan 2008 Posts: 28

[quote="ugbandtulsa"] Many (if not most) Urologists recommend treatment with a drug named Lupron. At a staggering $2000 per dose, given QUARTERLY, it's not only expensive, but eventually becomes INEFFECTIVE at controlling the spread of the disease. What the doctor does NOT tell you, is that for each prescription of LUPRON that he writes, he receives a "royalty" of approximately 50%. Yes, I said FIFTY PERCENT!!

Ever wonder how a Clinical Oncologist (i.e., a doctor who does not perform surgery) can make $700-$800k per year performing office visits at $200 per shot? The answer? They don't. Assuming your average Urologist or C.O. makes $4,000 per year off EACH person they put on Lupron, if they have only 100 patients, that's a whopping $400,000 per year!! Now, think about this scenario; in a larger town or regional area, if an M.D. has 500 patients, that's 2 million dollars per year!!! The dollars are staggering! [/quote]

500 patients, ALL on Lupron. Now that would be an unusual practice.
You seem misinformed about prostate cancer treatment. You seem to think a huge percentage of patients who do not do surgery all end up on Lupron. This is not true. Your math example is running wild.

Would you please cite your source that the Clinical Oncologist makes $1,000 "royalty" of the $2,000 for each Lupron dose.
And what about oncologists who practice in larger HMO's like Kaiser in California. What are we to think about THEIR motivations when they prescribe Lupron? After all, they make no money from patients drugs or shots, AND Kaiser makes separate contracts for their drugs.
So are their treatment choices influenced by the folks who make Lupron?

[quote="ugbandtulsa"] Bottom Line: Do NOT make the same mistake we did, in listening to the "Doctor". Do WHATEVER it takes to get the $30 or $40k for the surgery, get the cancer OUT of your body, and get on with life. Steal it if you have to. NO excuses, just get it. Yes, there is a chance you might have some nerve damage. BIG DEAL. We all deal with handicaps, but let me assure you, for every person that adopts "wait and see", there are 10 that have died horrible, bone wrenching deaths wishing they hadn't. You DON'T have to die from PC...you just have to do the research, and take my advice. Get the cancer OUT of your body. Now. [/quote]

Now, here, you seem to insist that surgery is the best choice for almost everyone and that longevity is better with the surgery choice.
I seriously doubt you have statistics or studies to back up that opinion.
The number of studies that indicate surgery is a better choice versus EBRT, or seeds, or even watchful waiting (active surevillance, etc) is very limited.
There is a substantial body of evidence that NO particular treatment has been shown to be [u]substantially[/u] superior to the others. No one likes to think its all clear and every individual's case if different, but when you look at a 100,000 men you simply don't find overwhelming evidence that following one path versus another is going to lead, (in large studies) to vastly superior outcomes.
Some small differences to be sure, but nothing as definitive as you seem to suggest.
Every treatment has its risks. Many men who get the best treatment still have their lives cut short. Many other men who do nothing don't lose one day of life from their prostate cancer.
Even after getting treatment, you can never be sure if that is what extended your lifespan.

[quote="ugbandtulsa"] I wish every day of my life that Robotic Surgery was available 13 years ago for my father. But then again, I would not be writing this letter to you, and saving your life. If you are young, healthy and have PC now, times will change. Sure, you might look great for 10 or even 15 years, but eventually the "horses will get out of the stable, and start running...fast". When that happens, it's over. Ball game. NO CURE. Get my point here? If you are 50, life will be over by 65. Lupron will NOT hold the cancer forever..
OK[/quote]

I personally know men who have NOT had surgery, diagnosed in their early 60's and lived til their late 80s. BTW, all men who choose other than surgery do not take Lupron.
Perhaps you don't realize this, but if you walked down the street and chose random men over the age of 70, and gave then all multiple biopsies, you'd end up with about half of them having prostate cancer, all previously undiagnosed. How come their "horses" are not out of the stable, "running...fast"? They're not on Lupron and they're not getting surgery.

I'm sure you mean well, but you are way off base on surgery being the only sensible choice. Also their is limited evidence that robotic surgery is superior to regular surgery as it affects longevity and recurrence.
I'd still like to see your source that Oncologists make 50% "royalty" off the $2,000 for Lupron. Realize of course that more than just giving an injection may be included.

A calm reading of the true facts and data is what is needed. Every doctor likes to think his treatment is superior. Anecdotal reports of success and failure are not the way to judge the value of a treatment.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 271

Robotic prostatectomy is not a universal treatment. (and I HAD a Da Vinci procedure. ) It's not for everyone. No single treatment is right for everyone. And as Otago points out--prostate cancer can be found in most men of a certain age, autopsy studies show: http://www.protectingourhealth.org/newscience/prostate/2003-04peerreviewprostate.htm
but only a tiny portion of those will ever be bothered by the disease, because most of the malignancies are very slow growing.

If you have PCa, and don't have surgery, it doesn't mean you go on Lupron. Maybe you take a wait and see approach, or maybe you have brachytherapy, HIFU, IMRT, IGRT, or protons..or maybe you DO need hormone therapy (ADT) if the cat's out of the bag.

If you have distant disease at diagnosis, surgery MIGHT buy a little time by debulking the tumor but the main effects are likely to be some combination of incontinence and/or impotence. And make no mistake, even laparoscopic surgery is major surgery with all the inherent risks of such. I was on the table for around 8 hours.

My father got diagnosed with prostate cancer over a decade ago. He didn't have a prostatectomy, he didn't have radiation, he didn't take a wait-and-see-approach, and he most definitely did not go on Lupron. His PSA has remained undetectable after his treatment. He had cryoablation.

There are many choices with this disease, and no certainties.

Kudos to Otago for addressing the issues raised in the initial post.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

ugbandtulsa · Regular Joined: 28 Nov 2006 Posts: 11

My sources for the "kickback" are as follows:

1. The Doctor told me personally, to my face. Please re-read the post carefully.
2. A drug rep confirmed (in the waiting room, I might add).
3. The ex-wife of another urologist confirmed.

Good enough for me. Just do the math. Look at what the average clinincal Oncologist makes per year. I did, and it's WELL over $600,000 and that's without performing surguries. You can't do this on $200 office visits, sorry.

As far as the Lupron, I didn't say that every single patient the doctor had was on Lupron. Fortunately, many decide to get surgery. I only said that IF he had that many patients, he would make THAT much. Please re-read carefully.

The only reason that you believe that surgery does not work or that it's not better than hormone therapy is because you've never seen anyone go through the full cycle from onset to death from PC. Sure, you're fine for awhile, sometimes many years (my father was fine for over 13).

But you're missing the point here. The point is, is that eventually ALL PROSTATE CANCER becomes hormone refractory. Which means, that it finds a way around the Lupron, Casodex, (substitute any hormone blocker you want here). It mutates, and becomes more agressive. By this time, it's too late. My father's PSA was also very stable and low, until it started quadrupling every month. Then it was too late. And therein lies the problem. You don't know when it will happen, but it WILL happen. What does the research say on the prognosis of people that get diagnosed with PC after 15 years? 20 years? What IF you don't die from something else, and you are only 75 and healthy, and you die from PC? Should you have gotten surgery then? Hindsight is always 20/20, but you just can't gamble like that.

And if you get PC at a younger age, chances are that your cancer WILL be the source of your death. After all, PC is the biggest killer of men in terms of cancer, so plenty of people are dying from the "wait and see" method. What's your response for that, gentlemen?

Replicant · Moderator Joined: 01 Nov 2006 Posts: 271

Surgery works.

Surgery does not work.

Both statements are true. I "believe" both.

In my case, for example, surgery alone was not curative. Radiation was required. It may have cured me. Maybe not.

For surgery to work, the cancer must still be localized. Optimally, it needs to be confined within the prostate, but at least it must not be distant disease. If it is distant surgery will not cure the patient. If it is distant, or if it is metastatic, the cancer cannot be cured (as of this writing, of course).

For some patients, surgery is not the best option, even if the cancer is localized. It might be external radiation, or watchful waiting, or ADT. It might be high-intensity focused ultrasound, or protons. Consider a 70ish man with heart problems, asthma, and a fear of going under the knife...

I have an aquaintance who shares some of my medical history--not too far apart in age, and we both chose surgery. In both cases, our PSA came back. He went to Loma Linda and had proton beam therapy, just before I started IMRT. He was so happy with it that he told me if he had known about proton therapy he would have chosen it as his primary treatment.

As to cancer becoming hormone refractory--that is true. It will always happen, given enough time--but since prostate cancer primarily affects older men, it can often buy enough time for them to die of other causes. Is ADT an attractive option for a younger man? No. But in some cases, it's all they've got.

Take a man I know, who was diagnosed in his early 60's with metastatic prostate cancer--his first sign was leg pain. It was already in his bones. He had surgery, all right, and it has given him several years free of any more pain or concern from prostate cancer. But the surgery was castration--which does about the same thing as ADT. A prostatectomy would have done little to help him and could have made him miserable from incontinence.

Prostate cancer will probably kill him. If he doesn't crash his truck first. But cancer was killing him 8 years ago and his version of hormone therapy has bought him a lot of life and a lot of time doing things he likes.

The choice he made is a choice men *still* have. Even if there is some nefarious kickback scheme in place, men don't have to get Lupron shots. They can simply have an outpatient surgical procedure and be done with testosterone. For many men, surgical castration is unacceptable for many understandable reasons. Thank goodness they have a choice in the form of ADT.

And maybe, just maybe, some men undergoing ADT will open up their papers next month, next year, or 5 years from now and read that a cure for advanced prostate cancer has been found.

As to watchful waiting (expectant management)--it is a viable option for certain patients, for example, those who will probably die of something else way before prostate cancer gets them.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

goruck

the poster, ubagodo...i forget the name made some great points, but the points are no longer accurate.

Medicare placed a big change into effect regarding the lupron injectable market.
Yes the margin was 50% and that was a government mandated margin which was ridiculous and placed undue renumeration for such service, while a prostate resection paid a surgeon only 700$.

however, the margin now is only 6%!
It is a complicated issue which i will devote an entire entry for my blog.

peace
_________________
George Rucker
Urology/Urologist
http://prostateconcerns.blogspot.com/
www.urology-partners.com
http://www.cornellurology.com/past-res.html
http://www.lakewoodranchmedicalcenter.com/index.php?&PageID=1088

ugbandtulsa · Regular Joined: 28 Nov 2006 Posts: 11

That's great news, that at LEAST the docs are only getting 6 % now, as opposed to almost $1000 per shot.

And that was exactly my point about Wait and See, is that for younger to middle age men, it's suicide. Eventually, hormone therapy will fail. So, if you are only 65 when you are diagnosed, chances are you WILL die from PC, considering medical technology nowadays can keep you alive much longer than the old days. Living to 80 is very common now, and even longer sounds good to me!

Get the cancer out now, (Of course IF it's localized), and then treat with radiation or proton therapy if necessary. But get it out if it's still localized. That's the point: catch it early, get it out, and get on with life. Please don't "wait and die".

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