“I Did It My Way”

One of Frank Sinatra’s most popular songs is “My Way,” and anyone who’s heard him sing it knows how he builds up to those last two syllables: myyyyyy waaay.

When I chose medicine as my career path, part of what influenced me was my idealism. I wanted to help people by curing disease and easing suffering, whether physical, emotional, mental or spiritual. I could not foresee that my path would take me to specialized multiparametric MRI of the prostate and an image- image-guided that is a prostate cancer game-changer. I wholeheartedly believe in focal laser ablation, and at the same time, it’s not for every patient because I don’t want to risk leaving cancer behind. When a man comes in for a focal laser ablation (FLA) evaluation, he and I become a team with his best interest at heart. If I know FLA is not a good choice for him, I explain how his images and his clinical factors brought me to this conclusion. It’s hard to see the disappointment if I have to deflate his hopes, but we have a thorough discussion about the treatment options that are still good choices for him. Offering the best of what I do, but also helping patients navigate to the best treatment decision based on what multiparametric MRI shows us means I have to be as objective as possible. For many patients, a whole gland treatment will simply be the right way to go. Being objective is my goal. It’s “my way” of practicing medicine.

I sometimes wonder what it’s like for urologic surgeons and radiation oncologists who offer only whole-gland treatments. These are the two main conventional specialists who treat prostate cancer by either prostatectomy or whole-gland radiation, respectively. Do they also strive to be objective? A recent French study was designed to examine whether surgeons and radiologists are uniform in how they would handle eleven prostate cancer scenarios.[i] “The scenarios cover most of the localized prostate cancer situations and were gradually organized depending on prostate cancer progression risk and the age of the patient.” Questionnaires were mailed to all French urologists and radiation oncologists to find out if they would prescribe treatment with the intent to cure, or palliative treatment if they deemed the patient too old or too far advanced in his disease. Each physician chose a treatment modality for each case, and the responses were compared. The authors found that each specialist “prefers the treatment that he himself delivers.” They report that for intermediate risk patients at age 65, 96.5% of urologists chose prostatectomy vs. 37.7% of radiologists, whereas a higher percentage of radiation oncologists (57.4%) were biased toward curative-intent radiation for older intermediate risk men, vs. 14.6% of urologists who would make the same choice. In other words, the majority did it “their way.”

Perhaps all of us physicians prefer to do it our way, but I am thankful that my professional path has brought me to the fortuitous place where my way allows a greater range of choices—including FLA with all its benefits for the right patients.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Ariane MM, Ploussard G, Rebillard X et al. Differences in practice patterns between urologists and radiation oncologists in the management of localized prostate cancer: A cross-sectional survey.  World J Urol. 2015 Mar 31. Doi: 10.1007/s00345-015-1543-2 Epub ahead of print.