Rad Onc Twitter

[NotMattSpraker]

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"I don't understand, why is everyone leaving academics?" 🤔

I mean, to be fair, if someone called me hot shot I'd probably never talk to them again.

 

[sirspamalot]

The only way to turn a garbage dump into a dumpster fire is... oh never mind.

 

[TheWallnerus]

No spacer?

I can't stand the holier-than-thou attitude of these urologists and "experts." I have seen much more egregious cases with men inappropriately taken for surgery, many at high-volume centers like the one this "professor" works at.

There are folks calling this malpractice. This is just a case of some self-promoting finger-wagging at community rad oncs.

Twitter is such a garbage dump.

If I get me some low risk prostate cancer at age 52 will you guys IMRT me 45 times. “Active surveillance” is for preventing top secret documents from winding up in my garage, not for curing me of cancer.

 

[sirspamalot]

If I get me some low risk prostate cancer at age 52 will you guys IMRT me 45 times. “Active surveillance” is for preventing top secret documents from winding up in my garage, not for curing me of cancer.

Dammit beavis, you put it thru the uprights again. Also see: "How I paid for my vacation in the Bahamas, including my casino tab...(sigh).."

 

[thesauce]

Health economics has known since the late 90s that both for-profit and not-for-profit health systems behave in the exact same manner. Only difference is that in for-profit systems the money is diverted back to shareholders, while in not-for-profit systems it gets returned back to the institution.

All that art isn't going to pay for itself.

In many for-profit systems, it still gets returned to the institution.

The biggest difference is that non-profits get out of paying a lot of taxes.

Unfortunately, the term non-profit gives many the impression that they are doing a public good even though they are some of the most vile and corrupt organizations on this planet.

 

[thesauce]

I can't stand the holier-than-thou attitude of these urologists and "experts." I have seen much more egregious cases with men inappropriately taken for surgery, many at high-volume centers like the one this "professor" works at.

There are folks calling this malpractice. This is just a case of some self-promoting finger-wagging at community rad oncs.

Twitter is such a garbage dump.

I would probably have encouraged upfront AS, but treatment is fine if that’s what he wanted. The whole “he was told he had aggressive cancer” bit is always a little suspect. I have heard things I’ve said in plain English be misconstrued, misunderstood, or outright twisted. I doubt a radonc or urologist actually told him that.

 

[Palex80]

I would probably have encouraged upfront AS, but treatment is fine if that’s what he wanted. The whole “he was told he had aggressive cancer” bit is always a little suspect. I have heard things I’ve said in plain English be misconstrued, misunderstood, or outright twisted. I doubt a radonc or urologist actually told him that.

The flu is probably more dangerous than the cancer of this patient.

I would actively discourage every patient from undergoing any treatment for a cancer like this.

 

[Ray D. Ayshun]

52 yo with Gleason 6 disease in the apex, eh? We all know how great random biopsies are of the apex. I like the inclusion of the biopsy map as if that proves it. What do you tell the patient if they get an mpMRI with a PIRADS 5 lesion in the anterior portion of the prostate? MR-guided biopsy? Prostatectomy? No idea the rest of the story in this case, but I wouldn't feel guilty using the term "aggressive" in some context in a 52 yo with that biopsy result depending on other findings. He probably didn't need treatment, but I'm kinda predisposed to dismissing anyone who says, "we need to do better." Better would be my local urologist not giving 1 yr ADT in fav int risk prostate cancer to shrink the prostate and improve urinary sx.

 

[sirspamalot]

Urologists exposed! No pun intended.

News at 11.

After the ADT (remember when?) and urorad scandals (thanks red journal for following up.. Borat: not!) ... Nothing was learned. Except IMRT reimbursement was cut.

The urorad center not that far away is doin like 80 on treatment. The radonc refuses to do anything with nodes or SBRT (so my spies say) and just sits there for 12 hours a day.. Contours nothing. But I hear he makes 1m but had to stay crazy hours Direct Sup and I guess an NP isn't in the budget lol.

Prostate? Prostrate before the altar of cash money...

 

[OTN]

The flu is probably more dangerous than the cancer of this patient.

View attachment 365112

I would actively discourage every patient from undergoing any treatment for a cancer like this.

He's only 52 years old, though. If I get PCa at 52 I'm getting treated.

 

[Grubbe-a-dub-dub]

No one was in the room where the discussion happened. He's young without a family history - that's ALL we know.

The patient consented to the treatment- a treatment option on NCCN guidelines. He had some sort of toxicity after a few fractions (weird, but stranger things have happened). Obviously, the radiation will get blamed.

This urologist just wants to wear his retrospectoscope and promote himself by shaming. That's not the way to change people's behavior.

That's all Twitter is good for - self-promotion. It is not a town hall as people want it to be. It's all about ego-driven narcism.

 

[sirspamalot]

That's all ________is good for - self-promotion. It is not a town hall as people want it to be. It's all about ego-driven narcism.

Welcome to SDN. Lol.

also the Grammar Nazis would like a word..

 

[OTN]

Welcome to SDN. Lol.

also the Grammar Nazis would like a word..

Hard to argue this is about ego-driven narcissism when we're anonymous - or, sorry, using "pen names" as I like to call them

 

[sirspamalot]

You jest sir. The thrill of writing something to elicit a response is not merely for the known. There is another group.

We have special name for these elite keyboard warriors..

 

[OTN]

You jest sir. The thrill of writing something to elicit a response is not merely for the known. There is another group.

We have special name for these elite keyboard warriors..

I don't disagree, I would just label it as something other than narcissism

 

[Ray D. Ayshun]

I don't disagree, I would just label it as something other than narcissism

Are you accusing me of not being a narcissist?

 

[Grubbe-a-dub-dub]

The guy has his own website:

Home - Lee Ponsky, MD, Cleveland Oncology Urologist

Lee Ponsky, MD, FACS, is highly regarded board-certified urologist, with special interests in urologic oncology, particularly kidney and prostate cancer. He is also the founder of MedWish, a non-profit organization that collects and sends unused medical supplies to developing countries.

www.leeponskymd.com

How is that anything but narcissistic?

 

[TheWallnerus]

The flu is probably more dangerous than the cancer of this patient.

View attachment 365112

I would actively discourage every patient from undergoing any treatment for a cancer like this.

Oh cmon. Way worse than the flu. The p value on mortality from flu versus Gleason 6 prostate cancer is 1 divided by a million or less. Plus, before flu kills you it doesn’t offer you those fun anti-androgen years, plus minus chemo, bone met pain, urinary difficulties, droopy wiener, droopy libido, etc. Flu causes pneumonia, and in the states we sometimes call pneumonia “the old man’s friend.” Metastatic prostate cancer is nobody’s friend. I look at the MSKCC nomogram and still want my 45 IMRTs.

If I’m your patient, and you actively try to discourage me from RT, but I’m not dissuaded and actively try to get you to treat me, who will win. Will you get discouraged that you couldn’t make me quit my get-treated thoughts.

 

[sirspamalot]

Are you accusing me of not being a narcissist?

 

[Ray D. Ayshun]

I post on SDN. You suggested narcissism is driving our posts. OTN suggested it is not. I take issue with that as I'm very confident that I am posting because I'm a narcissist. And proud of it.

 

[Ray D. Ayshun]

Online Ponsky review:

"Our experience with Dr. Ponsky and his office was very unfortunate. We were first for a biopsy in the morning - waited a long time while hearing his resident and anesthesiologist question whether he might show up. Then waited 2 weeks for results only to show up for the appointment to find out it was cancelled, without informing us. They said an alternate appt was scheduled - but as they checked further they saw that that appt was also cancelled - again no notice to us. Very disconcerting !"

 

[sirspamalot]

I post on SDN. You suggested narcissism is driving our posts. OTN suggested it is not. I take issue with that as I'm very confident that I am posting because I'm a narcissist. And proud of it.

I know, I know. I share your sense of humor/narcissism as my 450+ posts will attest..

 

[radoncftw]

Online Ponsky review:

"Our experience with Dr. Ponsky and his office was very unfortunate. We were first for a biopsy in the morning - waited a long time while hearing his resident and anesthesiologist question whether he might show up. Then waited 2 weeks for results only to show up for the appointment to find out it was cancelled, without informing us. They said an alternate appt was scheduled - but as they checked further they saw that that appt was also cancelled - again no notice to us. Very disconcerting !"

lol many attendings in academia try to spend as little time w/patient as possible. allows more time to get into twitter arguments

 

[sirspamalot]

Ponsky? Ponsky Scheme?

Reviewed On 3/1/2022
Doctor was rude and did not want to take my case. Waited two months to see him. And he sent me to his colleague. Now have to wait another month. So much for world class *** care.

 

[Gfunk6]

MSKCC lays off ~ 2% of employees

Uh oh, how can they afford active surveillance in low-risk prostate cancer? Those in-house botanical gardens, Olympic size swimming pools, and herbal acupuncturists aren't going to pay for themselves!

 

[sirspamalot]

The janitors, clerks, and nurses will just have to suck it up I guess lol.

Meanwhile, the fatcat admin and docs will have to accept a slightly reduced tasting menu in the lounge. Just kidding, only the docs will have to have that ignominy.

The c-suite will endeavor to carry on.

Nothing to see here..

 

[Ray D. Ayshun]

lol many attendings in academia try to spend as little time w/patient as possible. allows more time to get into twitter arguments

And they train their residents to as well...

 

[thesauce]

The flu is probably more dangerous than the cancer of this patient.

View attachment 365112

I would actively discourage every patient from undergoing any treatment for a cancer like this.

15 years is not a long time for 52-year-old. He is very likely to progress to the point of needing treatment during his lifetime and it will never be more curable than it is now. Plus I would argue the primary endpoint here is not death from prostate cancer, but rather avoiding spread that then requires ADT which sucks much more than the radiation.

The fact that the patient came for a consult to radiation suggest that he expressed a desire for treatment to the surgeon, who then referred him on for RT.

Everyone has the right to have their cancer treated. It is not necessarily what I would have recommended but it is not wrong.

 

[NotMattSpraker]

lol many attendings in academia try to spend as little time w/patient as possible. allows more time to get into twitter arguments

I am finding this isn't limited to academia, but there is a big disconnect between what patients actually want (responsiveness, access, and communication) and what HOT SHOT doctors think they want (name brand doc and center).

I have a few family members with chronic diseases (not cancer), and they hate the large academic centers in the last few years for those reasons. One of them saw a physician scientist and at one point asked me if I thought the doctor cares more about them or their research. Oof.

 

[OTN]

I am finding this isn't limited to academia, but there is a big disconnect between what patients actually want (responsiveness, access, and communication) and what HOT SHOT doctors think they want (name brand doc and center).

I have a few family members with chronic diseases (not cancer), and they hate the large academic centers in the last few years for those reasons. One of them saw a physician scientist and at one point asked me if I thought the doctor cares more about them or their research. Oof.

Oof indeed- did you tell them the truth when you answered their question?

 

[evilbooyaa]

I am finding this isn't limited to academia, but there is a big disconnect between what patients actually want (responsiveness, access, and communication) and what HOT SHOT doctors think they want (name brand doc and center).

I have a few family members with chronic diseases (not cancer), and they hate the large academic centers in the last few years for those reasons. One of them saw a physician scientist and at one point asked me if I thought the doctor cares more about them or their research. Oof.

Not one iota of doubt in mind that the doctor cares more about their research than them.

 

[evilbooyaa]

If I get me some low risk prostate cancer at age 52 will you guys IMRT me 45 times. “Active surveillance” is for preventing top secret documents from winding up in my garage, not for curing me of cancer.

This was the weirdest virtue signalling of all - doing something that is on NCCN guidelines!!!111 The HORROR!

 

[Palex80]

He's only 52 years old, though. If I get PCa at 52 I'm getting treated.

15 years is not a long time for 52-year-old. He is very likely to progress to the point of needing treatment during his lifetime and it will never be more curable than it is now. Plus I would argue the primary endpoint here is not death from prostate cancer, but rather avoiding spread that then requires ADT which sucks much more than the radiation.

The fact that the patient came for a consult to radiation suggest that he expressed a desire for treatment to the surgeon, who then referred him on for RT.

Everyone has the right to have their cancer treated. It is not necessarily what I would have recommended but it is not wrong.

I don't want to end my sex life before I turn 60. 😆

Ok, let's stay serious. The PROTECT trial demonstrated quite nicely that about 50% of men with a low risk disease (and this patient here has like ultra-low risk disease) required treatment down the road.
So, if I can skip active treatment for 5 years or so, before that 1 core GS6, PSA<5 ng/ml, goes up to 3 cores GS6, PSA 8 ng/ml, then that's fine with me. My chances of cure are likely the same whether or not I have this treated at 52 or 56.

And yes, I agree it is not wrong to treat. But I would suggest not treating now and pursuing active surveillance as the more preferable way.
Patient compliance is paramount in this. If he goes down the active surveillance road, he will need a confirmatory biopsy after 1 year, regular MRIs, PSA measurements and futher biopsies. Some patients hate that, others are fine with it.

I have two patients on AS right now. They both didn't want surgery and were sent to me by the urologists, both very-low risk PCA. I have been managing them (they like me more than the urologist) for several years now. Both are super happy, no sign of progression.

Oh cmon. Way worse than the flu.
If I’m your patient, and you actively try to discourage me from RT, but I’m not dissuaded and actively try to get you to treat me, who will win. Will you get discouraged that you couldn’t make me quit my get-treated thoughts.

I know, I was merely being provocative.
If I cannot persuade you, I will offer active treatment. But my first advice will be active surveillance.

 

[sirspamalot]

Just not gonna.

 

[TheWallnerus]

don't want to end my sex life before I turn 60

My own retrospective data on about 250 patients is that only about one in four guys who get 45 prostate only, tight margin IG IMRTs have their sex life ended

EDIT: and lest we not forget a Gleason 6 cancer can also be a sex life ender in and of itself; put another way, getting diagnosed with prostate cancer is a risk factor for impotence

 

[RadOncDoc21]

To be fair, I think I would choose SBRT over annual biopsies. If not annually, I would be scared the next one might buy me ADT.

 

[Palex80]

To be fair, I think I would choose SBRT over annual biopsies.

Annual biopsies are no longer strictly recommended, in the MRI-era.

 

[TheWallnerus]

Annual biopsies are no longer strictly recommended, in the MRI-era.

Scorpions are also recommended not to sting

 

[Palex80]

My own retrospective data on about 250 patients is that only about one in four guys who get 45 prostate only, tight margin IG IMRTs have their sex life ended

The other 3 didn't have a sex life to start with? 😆

 

[RadOncDoc21]

Just not gonna.

Now this song is in my head!

 

[Ray D. Ayshun]

It was a single core with 4% 3+3. Just cryo that ****. Amirite?

 

[sirspamalot]

HIFU

"Highly F$)$ Up"

 

[RickyScott]

My own retrospective data on about 250 patients is that only about one in four guys who get 45 prostate only, tight margin IG IMRTs have their sex life ended

EDIT: and lest we not forget a Gleason 6 cancer can also be a sex life ender in and of itself; put another way, getting diagnosed with prostate cancer is a risk factor for impotence

If remember correctly, In protect trial, 50% of fully potent men who had active surveillance at 60 had ED at 65. It was about 60% in xrt arm, so 10% increase, and usually responsive to PDIs (which are good for overall health anyway)

 

[salubalu]

Urologists exposed! No pun intended.

News at 11.

After the ADT (remember when?) and urorad scandals (thanks red journal for following up.. Borat: not!) ... Nothing was learned. Except IMRT reimbursement was cut.

The urorad center not that far away is doin like 80 on treatment. The radonc refuses to do anything with nodes or SBRT (so my spies say) and just sits there for 12 hours a day.. Contours nothing. But I hear he makes 1m but had to stay crazy hours Direct Sup and I guess an NP isn't in the budget lol.

Prostate? Prostrate before the altar of cash money...

80 on treat and only making 1 mil? Fire the biller

 

[RickyScott]

Feel bad that dan spratt probably has to kiss this schmucks a—. Definitely get the American psycho business card vibe from this guys appearence and web page.

 

[medgator]

80 on treat and only making 1 mil? Fire the biller

Could be a **** pro fees contract. Not unheard of in urorads setups

 

[Ray D. Ayshun]

Id treat 80 prostates for a million. That's like 8 prostate consults a week. Could knock it out in a day.

 

[Fpg1245]

Id treat 80 prostates for a million. That's like 8 prostate consults a week. Could knock it out in a day.

They aint payijng you a mil for any of this. Those were the first movers that got that deal like 10 years ago. Your deal will be 400K and a token bonus if youre a good lemming.

 

[medgator]

They aint payijng you a mil for any of this. Those were the first movers that got that deal like 10 years ago. Your deal will be 400K and a token bonus if youre a good lemming.

Urorads gigs still paying well above this if you are BC with experience

 

[A_DeMichele]

Urorad guy not treating the nodes? Got bless him. Everyone now is treating the nodes, since that’s the only way to get 45 fx approved