Active surveillance for prostate cancer: The trader won the bet

Mike Steskal, a commodities trader who lives and works just outside Philadelphia, is 55 and was told last summer that he had prostate cancer after his doctor ordered a blood test for flu-like symptoms that happened to include a PSA test.  The PSA test looks for a protein linked to prostate cancers.  His PSA level was slightly elevated, which led to more tests, including a biopsy that showed a Gleason 6 cancer.  

He spent months seeing different doctors, most of whom recommended aggressive treatment because he is so young.  He also researched prostate cancer on the Internet and talked to men who had gone through various treatments.  Finally he chose active surveillance.

As part of the surveillance, he had two more PSA tests.  They came back with levels so low that no one would ever have suspected prostate cancer.  His higher level last summer was probably due to an infection, which can cause PSA levels to rise.  

“It was pure chance” that he got a prostate cancer diagnosis, Mr. Steskal said.  “That’s another thing that went into my decision.”  

Dr. Alan J. Wein, the Chief of Urology at the Perelman School of Medicine, advocates active surveillance for most men with low-risk cancers.  But he emphasizes that they should have a second biopsy within a year, followed by regular biopsies every year or two and regular PSA tests.  

“I tell patients, ‘This is a bet’”, he said. “You are betting that the disease is not going to progress, or if it progresses, you will be able to tell before it progresses to a situation where it less treatable.  You enhance the chances of winning the bet by doing a confirmatory biopsy.”

Ken’s comment:  The false positive PSA test led to a scary misdiagnosis, but Mike was wise to carefully consider the alternative to surgery.  

Thanks to Gina Kolata of the New York Times for the source story on May 24, “The Latest Trend in How to Treat Prostate Cancer:  Don’t.”  Read another story about decision-making on prostate cancer.

Patient-centered care at Planetree: Mom’s first smile

Debi Janway’s story, Part 1:

My mother is very active, 89 years old.  She comes over four days a week in her Thunderbird convertible. 

Recently she had pain in her lower left side, at an 8 or 9 on the ten-point scale.  I’d brought her to the E.R. of our local hospital, but because the pain was so severe, I got her transferred to Planetree’s medical center in Coronado [near San Diego], where I’m an employee.

They put my mother in a private room, and she sighed with relief.  It gave me peace, too.  I was right there with her during the evaluation, included in the conversations, since they knew I was her care advocate.  As a Care Partner, they offered me a tour, showing me where the healing garden was, where the kitchen was, where to get meals, etc.  It was amazing!  That’s routinely available to the Care Partners.  I put my name on the board, giving the information to the nurse about how to reach me and discuss the plan of care.  I had told the nurses I’d like to be in attendance when the physicians were rounding, because my Mom is hard of hearing.  They’d move in closer so she could hear.  The doctors were wonderful in taking care of her.  Even on the weekend when I wasn’t working in the hospital, they called me.

We weren’t even there an hour before the Environmental Services technician came in and offered a warm moist washcloth all rolled up.  Mom asked what she was doing. The answer, “to help you relax, and wash,” with an explanation about Planetree’s way of helping patients heal, brought the first smile I’d seen on my Mom in 15-20 hours!  She said it felt so good, it was amazing!

Susan Stone, RN, PhD, the CEO of Sharp Coronado Hospital, elaborated:

Handing washcloths to patients with aromatherapy twice a day was part of a program developed by Housekeeping to be a partner in the patient’s care.  This has been a cornerstone program for them in helping them change from a hierarchy to a team.  We’d made a commitment back in 2001 to spread the patient-centered model house-wide.  We created a hospital-wide work team to create a Designation Process.  We’ve identified 11 areas of expertise, including a Healing Environment, use of Alternative Therapies, etc.  These are the criteria used for awarding unit-specific Planetree Designations in addition to two Designation with Distinction honors.

As another example, if a patient’s pain is out of control, the patient might ask a housekeeper, Will you pray with me?  They might not ask that of a nurse, but they’d ask it of Housekeeping.  That can be really important for their healing.  Also, they can brush the patient’s hair.  It changes the whole dynamic; the patient understands the housekeeper isn’t just there to clean the room.

Ken’s comment:  The hospital’s patient satisfaction scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) were in the top 5% among U.S. hospitals.  Employee satisfaction rated in the top 2%, earning a Morehead Workplace Award, according to a presentation by the Chief Nursing Officer of Sharp Coronado Hospital. 

Thanks to Susan Stone and Debi Janway for sharing their story.  Look for Part 2 soon.

Knee replacement surgery: There’s some comfort in that

Here's a story from a California-based patient advisor who prefers to remain anonymous:

Two years ago I had a knee replacement.  They had a two-hour class for ten of us having a joint replacement.  They required it as preparation for surgery.  They gave us an overview, and then also tools, for instance a calendar.  They led us through an exercise: Put your surgery date on the calendar, then go ten days back and write down a note to stop your Motrin or other anti-inflammatory meds; and then lay out the future, with your post-op appointment ten days out.  They told us what kind of healing you should see within two weeks.  It was really comprehensive.  

They gave us a cleansing antibacterial to use at home prior to surgery, and demonstrated how you use those and work with those.  The class engaged you to do all you could to keep the risk of infections low.  They were very transparent about infection being the #1 concern, and how they’d support us as patients both before and after we’d go home.  

After the surgery, when I got home and took off the bandages, I had some redness.  They were able to help me through the smart phone.  I sent pictures to the nurse, and she said it wasn’t a problem.  That attention to the level of detail about possible infection was really reassuring.  They’re typically pretty forward-thinking.

I encouraged them to do some research to see the rates of infection before and after.  I found it so valuable, as did everyone in the class with me.  I was clearly on the young side of the class, by about 25 years.  For the 70- and 80-year-olds who were having this done, having a tangible tool like the calendar and having someone there to walk them through this was great!  This generation is often challenged to engage in their own care.  It moved them to do that, because they have the tools and the support to enable that to happen.

There was also something intangible for a group setting like that, with a number of people all going through that together.  With groups of patients, they get confidence from each other; that normalizes the experience.  There’s some comfort in that, that the surgeon is that experienced, but also that it’s routine.  It also normalizes the experience of our being engaged, like the way we all were doing our calendars.

I’m so impressed with the whole clinic and the surgeon, and their emphasis on safety, starting even prior to surgery at the pre-op visit and class.  

Read another story about a class for people with a common medical condition.