Have sympathy for stressed surgeons; weighing prostate screening tests

Surgeons are stressed!

Your article “Rage in the OR” [March 5] was good, but it did not adequately address the surgeons’ side of the story.

(The Washington Post) - Front cover of Washington Post Health and Science, February 26, 2013.

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I’ve been a general surgeon for 17 years. Surgeons are under tremendous pressure from a million places, which can lead to stress in the OR. Almost nothing is being done to ameliorate this.

Jonathan Grife, MD, Frederick

Facing prostate cancer

I enjoyed “Doctors said remove the prostate. He wasn’t so sure” [Feb. 26] .

However, the story says that the United States Preventive Services Task Force (USPSTF) reversed its previous position. A reversal implies that the group previously recommended or endorsed PSA screening, which it did not. Instead, the USPSTF changed its position from “insufficient evidence to assess the balance of benefits and harms of the service” to “recommend against,” based on more data that had become available on the risks and benefits of PSA screening.

Eduardo Ortiz, MD, Rockville

I am very glad Jim Casell is doing well with “watch and wait” and hope his cancer has stabilized for good. The MRI scan sounds very promising and I hope it will be the answer for sorting out aggressive from slow-growing cancers.

That option was not made available to me five years ago when, at age 60, I was in the identical situation.

My urologist was great at laying out the options (including watchful waiting). However, when I asked him the “ultimate question” — what would you do? — he replied, “It’s cancer. Get rid of it.” He said there was no method to sort out an aggressive from a nonaggressive form. He predicted we would be having the same conversations every six months unless my PSA started to decline. Either the MRI scan wasn’t available or he didn’t know about it.

In any case, I chose brachytherapy, in which radioactive seeds are placed in or near the tumor, based on conversations with several men I knew who had gone that route. Having now talked with other men who had surgery resulting in severe erectile dysfunction and incontinence years out, I am thrilled with my choice, as I have no lingering adverse outcomes. I am also grateful that my urologist, unlike most of his surgical colleagues, actively promoted radiation over surgery.

I guess my message is to thank you for making men aware of the new MRI option. And to men who do choose therapy: Go for the least aggressive and invasive choice when possible. A Gleason score of 6 or 7 doesn’t warrant surgery, robotic, nerve-sparing or otherwise. The long-term side effects are much more severe compared with radiation. Burning tissues isn’t pleasant, but a year so after therapy, many of those choosing radiation can say, “That wasn’t so bad, and I’m cancer-free.”

Jim MacPherson, Washington