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161 of 166 people found the following review helpful:
2.0 out of 5 stars
A Case of Surgical Bias?, April 13, 2005
As an early stage prostate cancer patient who is trying to make a practical decision about my own best course of treatment, I was disappointed by Dr. Scardino's new book, not so much because of its readability or the general advice that he offers, but because of the recent medical data and information about prostate cancer treatments other than surgery which he either doesn't provide or doesn't discuss in great detail. There are several other recent books on prostate cancer that in my opinion seem to provide a somewhat more comprehensive and balanced picture of the pros and cons for those of us who are concerned about making these difficult treatment decisions. Dr. Scardino has a reputation for being one of the best surgeons in the country, and as you might expect since that is his particular specialty, he generally encourages surgery (radical prostatectomy) for the treatment of early stage prostate cancer. He summarizes the advantages and disadvantages as he sees them for each type of treatment, but for the most part, he doesn't offer much to balance his opinions with the published peer-reviewed data available from specialties other than his own and especially studies that might contradict or qualify his point of view. He offers only a limited sampling of the results with modern radiation therapy, although he does refer to some of the research done by several of his colleagues in the radiation oncology department at his own medical center, Memorial Sloan-Kettering, where emphasis appears to be focused primarily on the new Intensity Modulated Radiation Therapy (IMRT) -- which Dr. Scardino rates as the best type of radiation therapy currently available, better even than the more widely used radioactive seed implants (brachytherapy). There are a number of examples that seem to me to be serious omissions in Dr. Scardino's book, but I'll mention just one that I found disturbing. One study that Dr. Scardino cites without reporting the specific data prompts him to assert that medical studies have shown surgery or external radiation to be superior to seed implants for the treatment of intermediate and high risk patients (those with high Gleason scores and/or high PSAs). Dr. Scardino's footnote refers to a study by Dr. D'Amico et al at Harvard Medical School published in 1998 (JAMA). But Dr. Scardino doesn't mention that there have been numerous studies since that time widely reported in the press that have shown exactly the opposite to be true -- studies that demonstrate progress with the seed implants in recent years appears to have made that form of radiation therapy superior to surgery, especially for intermediate and high risk patients. Relying on only one outdated study, Dr. Scardino chooses not to discuss the more recent 10- and 12-year results reported by many established radiation therapists like Drs. Blasko, Grimm, Ragde, Merrick, Dattoli, Stock, Stone, Critz and others who are using seed implants, often in combination with IMRT or conformal radiation. In direct contradiction to what Dr. Scardino tells us, they report that seed implantation carries a much lower risk of serious complications like sexual dysfunction and urinary incontinence than radical prostatectomies. They may or may not be right, but these are issues that at least might have been addressed in the book even if Dr. Scardino is critical of those favorable results obtained by doctors using seed implants. According to his own published research, Dr. Scardino has a success rate of 75% with surgery, but that is less than or only comparable to the results being reported by a large number of radiation oncology groups, including all of those mentioned above. In a controversial field where so many doctors disagree, the most serious challenge we face as patients is deciding which treatment among the competing options is best for us. Because there are no randomized controlled studies that directly compare the primary treatments like surgery and radiation, all that doctors and patients can do is compare the results that have been published by the very best physicians with each treatment (while keeping in mind, as Dr. Scardino cautions us, that the results of our own doctors may not come close to those being reported by the best physicians in the field). I'm not a medical doctor, and I haven't made up my mind yet, though I'm obviously reluctant to jump into surgery when there appears to be equal or better options. There are some recent books from physicians specializing in radiation and oncology that offer a very different picture, in particular, Dr. Michael Dattoli's Surviving Prostate Cancer Without Surgery which just came out (by a radiation oncologist formerly at Memorial Sloan-Kettering), and the slightly less up to date Prostate Cancer Treatment Book by Dr. Peter Grimm that came out a couple years ago from several of the other doctors in this field. Both of those books make a more thorough effort to compare the data and treatments and they report very different results than does Dr. Scardino on both survival rates and complication rates. It's not easy, but I think there is no alternative for patients but to be sure to learn as much as we can about all the points of view, and then to use our own judgment to decide for ourselves what is best for us. A totally fair presentation of the facts may not be possible with the different specialties biased one way or another. In fairness, as Dr. Scardino suggests in his book, we need to consider the source when we weigh the statistics and opinions of others. But we also need to be given all of the most recent data. It's unfortunate that no single book provides us with the second and third opinions that would cover the whole range of treatments. One would like to see these specialists debate the issues under one cover. That book has yet to be written.
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125 of 130 people found the following review helpful:
1.0 out of 5 stars
Reality Check, May 15, 2005
I have to agree with the other reviewers who identified the surgical bias in this book. In my opinion Dr. Scardino gives surgery a sugar-coating. I was diagnosed with my prostate cancer and operated on by one of Dr. Scardino's associates eight years ago in Texas before he moved to NewYork. Dr. Scardino writes in this book that he cures 75% of his patients. Now that might sound like a lot, but another way to look at that figure is to realize that 1 out of every 4 men fails to be cured by surgery. That uncured minority of patients is a very large number, and in reality it's an even larger number than that since many urologists aren't nearly as skilled as Dr. Scardino and don't come close to getting his results. Unfortunately, I was one of those in the failed group. It took a long time for me to be able to admit that having a radical prostatectomy was the single biggest mistake of my life. I knew that I was in for trouble even before my cancer came back. This is one of those cases where in many ways the "cure" really is worse than this disease. It's been a living hell for me and I don't think I'm all that unusual, but you won't find much of that hard reality in Dr. Scardino's book or any other written by a surgeon. To get both sides, you might try comparing this book with one of those written by radiation doctors like Dattoli, Grimm or Wallner. The American Cancer Society's Web site also has more balanced advice. I'll tell you what I tell my support group. Men should be warned that this operation can be extremely gruesome and that afterwards, without your prostate gland, your sex life will never be the same. Because of this surgery, you will have no ejaculate whatsoever and you're also likely to be downsized in the most sensitive genital area because of all the cutting and scarring. It will shrink like after a cold shower, only it's permanant. If you're lucky enough to ever have an orgasm again, it's like what they call a "dry run," and that's exactly how it feels. Surgeons don't like to talk about this part of the human reality that we patients have to live through. I've recently had both salvage radiation and hormone therapy, and even though I'm thankfully in remission, my quality of life will never be the same as it was. There are other more humane, non-surgical alternatives that are available now. I only wish I had known more about them before. If I had first been treated with the radiation and hormones, I would still have my prostate and at least have a fighting chance. If you're a man who has prostate cancer, I can't urge you strongly enough to get a second opinion from a non-surgeon and find out the real story about your treatment choices. If you decide on having surgery, keep in mind that once they cut out your prostate, they can't put it back. Find out exactly what to expect from your own doctor and from other patients. I'm sorry if I come across as being a little bitter with my anti-surgery view. I guess we all have biases, but I know that I wasn't as fully informed as I might have been before I made my choices. I think that somebody needs to tell it like it really is for many of us after we leave the hospital and try to go back to our lives. For me it was and still is an ordeal, and each day the challenge boils down to hanging on to little things like dignity and pride. I wouldn't wish my fate on anyone. If you're wise, you'll search and find a better, safer path than I did.
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40 of 41 people found the following review helpful:
3.0 out of 5 stars
Read with caution and careful consideration, April 22, 2005
Dr. Scardino is a surgeon and since doctors like to tout their own specialties, it should come as no surprise that his book is slanted in favor of surgical treatment for early stage prostate cancer. That doesn't mean that it shouldn't be read even by patients hoping to avoid surgery; but I don't think that it should be the first or only book that we read on such a controversial subject. As a layman with some recent firsthand experience, I would suggest that Dr. Scardino's opinions be viewed with some caution, especially if you are a new patient who is just starting out on the process of evaluating your treatment options. I wasn't as bothered by this book as the fellow who wrote a previous review about its "surgical bias," but I do agree with him that it's point of view is limited and that men should be informed there are now more effective non-surgical approaches to treatment that carry less risk of permanent side effects than having major surgery like a radical prostatectomy. After not being given the straight story by a urologist to whom I was first referred by my HMO doctor, I was greatly relieved to find that non-surgical information in another new book by Dr. Michael Dattoli, a radiation specialist who has a somewhat higher cure rate than Dr. Scardino and also a lower rate of sexual side effects. I've already given the details of my case in a previous review of that book. If you're a man like me in the so called "watchful waiting club" keeping track of your PSA, take some time to find out about all your options and try to arrive at a comfort level with them. After all, it's our health and prostates that are on the line. For what it's worth, I read some of the other prostate books first, including Patrick Walsh's surgical book, and neither Dr. Scardino or Dr. Walsh have changed my mind about what I'm going to do in my situation if the time comes, but it was worth being challenged by their arguments, then being able to see beyond them with my own readings, and finally getting a second opinion to ease my mind about it. In my case, endless PSA anxieties and my own fears about a major operation weighed heavily until I found out more about the other options I have. With all of that said, I'm grateful to all the doctors who have written books. They're all patient-friendly and accessible for lay readers. I work in a relatively small university library and since my search began, we now have more of them on our shelves than we did even just a year ago. To those of you who buy medical books, I would like to suggest that it's not a bad idea to donate them to your local libraries when you're done with them.
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