“If all you have is a hammer, everything looks like a nail”

Here’s an interesting article that a former boss of mine would call a “B.G.O.”—a blinding glimpse of the obvious.

If you go to a radiation oncologist, they’re likely to recommend radiation as your treatment option of choice, and if you go to a urologist, they’re more likely to recommend surgery. Doh!

This study was focused on treatment of patients with high risk prostate cancer. I’d be interested to see if the recommendations become a little more muddied for those of us with Gleason 3+4 or 4+3. I’d really like to see what their answers would be to the last question in the second table: Lowest PSA at which SRT is appropriate. That’s of obvious interest to me.

THE "NEW" PROSTATE CANCER INFOLINK

It was called “instrument bias” by Abraham Maslow and Abraham Kaplan, but for present purposes, we’ll call it “specialty bias” — over-reliance on the tool one is most familiar with.

Kishan et al. conducted a survey among urologists (“UROs”) and radiation oncologists (“ROs”) concerning their opinions about how best to treat high-risk prostate cancer patients in various situations from initial treatment to recurrence after initial treatment. They tabulated responses from 846 ROs and 407 UROs:

  • 63 percent of ROs and 96 percent of UROs practiced in the US; the rest mainly in Australia and NZ.
  • They had a median of > 10 years of experience.
  • 41 percent of ROs and 51 percent of UROs were in private practice.

Initial Treatment of High-Risk Patients

ROs were five times more likely to believe that initial treatment with radiotherapy (RT) with androgen deprivation therapy (ADT) and with local salvage therapy, if needed, was…

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4 thoughts on ““If all you have is a hammer, everything looks like a nail”

  1. I hear you Dan. My urologist wanted to do radioactive seed implanting surgery because that was his favorite treatment. Amongst other things, his demeanor put me off. Based on my current situation it wasn’t the right decision for me, but he didn’t offer any alternatives other than removing the prostate. I still have my prostate and am in remission:)

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  2. Charles McGill

    Great cautionary article about human bias Dan. Something for those with Prostate Cancer to hold in their minds when seeking the most appropriate treatment for themselves. Those with Prostate Cancer have the most to gain or lose.

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    1. Yep. It makes sense, too. Healthcare is a business, after all, and each practitioner has to pay off those student loans somehow.

      Although I once went to a neurosurgeon when my three herniated discs were acting up, and she flat-out told me that she wouldn’t operate on me. “If you want an operation, find another doctor,” she said.

      She wouldn’t operate because the risk was greater than any potential reward. I admired that in her. (That, and the fact she rolled into her office on her Harley in a leather jacket.) We found an alternate therapy that did the trick.

      Liked by 1 person

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