San Luis Obispo leads the nation in prostate removal

March 1, 2011


San Luis Obispo County doctors are pushing radical prostatectomys at a rate nearly three times the national average, according to a recently released health report.

Researchers from the Dartmouth Atlas Project and the Foundation for Informed Medical Decision Making found that male Medicare patients over 65 with early-stage prostate cancer, who live in San Luis Obispo County, are 12 times more likely to have surgery to remove their prostate than those who live in Albany, Ga.

San Luis Obispo County had the highest prostatectomy rate in the country at 3.8 surgeries per 1,000 men over 65 enrolled in traditional Medicare during 2003 to 2007 compared to the national average of 1.4 procedures, according to the findings. The low was Albany, Ga. at 0.3 surgeries per 1,000 men in the same category.

The study released late last week examined the latest available Medicare data and observed wide variations in elective surgery rates, or “preference-sensitive” procedures, among Medicare patients with similar conditions across the country. And researchers found–location matters.

“These striking variations are the by-product of a doctor-centric medical delivery system. In highlighting the variation from community to community for elective procedures, we hope to shine a light on the fact that patients’ preferences are not always taken into account when medical decisions are made,” said Shannon Brownlee, M.S., lead report author and instructor at the Dartmouth Institute for Health Policy and Clinical Practice in a statement.

Researchers attribute the geographical variations in surgical rates to differences in clinicians’ personal beliefs and opinions, a lack of consensus in the medical community about the best treatment and ill-informed patients.

The organization is advocating for shared decision making, a change from the common mentality “the doctor knows best.”

“All too often, patients facing elective surgery are not given an opportunity to learn about the full range of options, and that each choice has unique risks and benefits,” said David C. Goodman, M.D., M.S., report co-author and co-principal investigator for the Dartmouth Atlas Project, and director of the Center for Health Policy Research at the Dartmouth Institute for Health Policy and Clinical Practice.

“Many are not even aware that the decision about an elective procedure is actually a choice. Instead, they routinely delegate such important decisions to their clinicians, with the result being that patients often do not get the treatment they would prefer.”

When a treatment is elective, it means there is more than one option—each with different benefits and drawbacks. How a patient views those trade-offs differs from person to person.

The main options for addressing early-stage prostate cancer are active surveillance, surgery and radiation. Doctors receive more compensation for prostate removal surgery than radiation therapy and it requires a shorter period of patient care, according to the American Society of Clinical Oncology.

The report describes the treatment options in greater detail:

While active surveillance avoids the side effects of treatment, it involves regular biopsies and runs the risk that the cancer will progress and eventually cause symptoms or lead to death. Surgery may reduce the risk of dying of prostate cancer, but it has significant common side effects including incontinence and erectile dysfunction. Radiation also has side effects and it is unclear whether the risk of death is reduced.

“Surgery may reduce a man’s chances of dying from prostate cancer. But for many men, especially those with other health issues, the prostate cancer will never cause harm, even if left untreated,” the report explains. “If the cancer has spread beyond the prostate, removing it surgically may not offer a cure.”

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“significant common side effects including incontinence and erectile dysfunction.”

Hummm, I have a hard time believing that 3 times the men in SLO county would elect to suffer such permanent side effect. This favored radical surgery delivers some rather significant emasculating results.

Romance exchanged for sleeping with depends! When it comes to men, that’s unheard of, unless they change their thinking considerably by the age of 65, which I doubt. Something here doesn’t add up.

This smells a lot like the problems with the heart programs in this county.

The problem is there is only one group of uroligists in this county, so no compitition.

Do I smell Cartel.

Another study regarding where to have the surgery. I wonder if the Trib will pick up on this story like they did the “happiest place in America” story.

SanSimeonSam, you couldn’t be in better hands with Dr. Canfield! He’s the best.

Could it simply be that we’re a local society of just Newly Weds and Nearly Deads?

I was thinking it was because we have more a**holes per capita than anywhere else. ;-)

My grandfather died from prostate cancer. My father died from brain cancer at 65. My PSA reading was 4.0 at age 57. The previous two years it had been 1.2 and 1.1 The difference, I later realized, was that this time the blood was taken immediately after my physical, which included a DRE (digital rectal exam). I was referred to a young local doctor, who was the area’s newest surgeon with Da Vinci robotic surgery. He examined and wanted a biopsy. I asked for another PSA test. Right to the blood test, unaware that DREs could cause elevated PSA, it came out as 4.0. He performed a biopsy that, in one microfocus, was “suspicious”. He wanted to take my prostate it out. He boasted how he had gotten his surgery time down to three hours. I wasn’t interested in how quickly he could work. I would be his 30th or so surgery. After much reading and research, I made an appointment with nationally known Dr. Peter Carroll at UCSF. My local urologist wanted my signature on a letter saying I was releasing him from consequences. At UCSF, everything was covered by Blue Cross. Dr. Carroll reviewed my biopsy slides (and agreed with the findings), performed a second biopsy and directed Dr. Shinohara to perform an ultrasound. I had another PSA test at UCSF prior to my exam. No DRE and no sex for 48 hours prior to the test. When I returned for a follow-up, my PSA results were in. The reading was 1.4. The biopsy, negative. No reason to continue. It hasn’t been above 1.5 for six years since. The lessons for me were: educate yourself, get a second opinion and strongly consider going to a nationally renowned specialist for something this critical.

Good for you slomike,

I’m sure that your story is appreciated and will probably save a few men who may find themselves in similar circumstances. It’s always imperative to pursue second and third opinions when faced with such a radical medical recommendation.

Interesting. Was it your own fear of dieing that made you go to the doctors in the first place? Did you have any symptoms of ..anything?

But now your caught up in the pharmaceutical gravy train and worrying about your health (Do you think they really care?)

Beyond an emergency. Go somewhere else.

My brother in law had this done, is now completely free of cancer and had almost no side effects.

Radiation therapy has come a long way

Good point. The cancer industry never claims to “cure” cancer, only that you are “cancer free” or a “survivor.”

I’d certainly have surgery before I did radiation. Radiation would be the absolute LAST choice. The side and after effects are horrendous.

Have you received any radiation? Perhaps before you leave negative remarks you need to walk in someone else’s shoes. Radiation can be tough on some people, depending on what part of the body they receive it. And there aren’t always side or after affects!

This is true, I know of many people who have received radiation therapy, the medical industry almost has it down to a science these days. They use small doses and target only the effected area’s while sparing the healthy tissues. The people I know of (in the last 5 years) tolerated radiation therapy extremely well and only had sickness from it (nausea and vomiting) for 24 to 48 hours. In some cases they used marijuana to stop the nausea and had no side effects at all.

I had six weeks daily radiation for nasopharyngeal cancer. This was after radical neck dissection surgery. Whose shoes would you like me to walk in? My father received radiation for prostate cancer. A few years later when he had a stroke, he nearly died from blood loss caused by radiation cystitis. He bled continually for over a week before the doctors were able to stop it.

I understand that radiation is the treatment for cancer. If I had it to do over again, I would still undergo the radiation therapy. I had superb doctors whose advice I followed. But anyone who denies that radiation has little or no after and side effects doesn’t know what they’re talking about.

How about you take a walk in my shoes.

“How about you take a walk in my shoes.”

NO Thank’s.

I’m sorry to hear the horrendous suffering you and your father experienced. Hopefully, one day soon, there will be something better to offer. Sometimes I have to wonder how it is that so little progress has been made after all these years of research?

Well the reseacher did not come to SLO and talk to our doctors. I had this surgery back in 2005 (middle of the study range). My doctor was Canfield and given the circumstances I could not be happier with the results, preparation or education. Dr C personally and on many occasions went over all the options with me and did not push me in any direction. I was well under 65 so it was likely the cancer would get me before old age. It took time to recover, perhaps longer than advertized but i returned to post surgery normalacy. I got no surprises (well the doc did lie about how long the catheter stays in). So SLO is a good place for this and our doctors are well practiced.

Well practiced because they do so many.

And that’s what makes SLO the happiest place in America!