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E.O.E Newsletter | www.huanet.gr
F.N.: Nowadays, it has been established that the doctor must share the decision making with the patient about the management of his disease. How can a doctor empower his patients to participate in their own care and in the decision making?
P.W.: This is where I find my book for lay people very useful. I tell patients they must read certain sections of the book before coming to see me. In this way, we are all literally on the same page. They will understand low risk prostate cancer, the Gleason score, and the probability that they are curable. With that background, they know what options are best for them: surgery, active surveillance or radiation. It takes time to have a conversation like this, but it is important, because patients can have regret. Some jump into an operation and then they are sorry about it. Actually, I go down that avenue with patients when they have the option of surgery versus radiation. I say to them: “Let’s go out five years from now and let’s say that you had surgery and you are leaking urine or your sexual function didn’t come back. How would you feel? Or let’s say you had radiation and you had fewer complications, but all of the sudden your PSA has come back and someone has told you that there is no way now to go back and take the prostate out. How would you feel? Which outcome would bother you the most?”. Patients always think about how they would feel if they had a good outcome. It’s very helpful for them to understand what they would feel if it wasn’t so good.
F.N.: What do you hope the next step in the field of prostate cancer management is in the future? Could you predict the future of prostate cancer surgery?
P.W.: I am the eternal optimist. So, let me go back to when I was at the Boston Children’s Hospital, in pediatric surgery. I spent three months with Robert Gross, one of the founders of pediatric surgery, doing pediatric cardiac surgery. These were very complicated cardiac anomalies, like tetralogy of Fallot, which you may have
heard about in medical school. Back in 1940s and 1950s, Doctor Blalock at Hopkins developed a shunt, which temporarily put oxygenated blood back into the arterial system of a child. When these individuals started to grow up and get larger, that shunt didn’t work anymore and all of the sudden those children were teenagers who required a very extensive reconstruction. I spent three months with Doctor Gross helping on those operations. About a third of those children died on the table. As the junior resident, it was my responsibility to go out and tell the families. Dr Gross, who was doing these very complicated operations, had a sign hanging in the operating room that said: “If the operation is difficult, you are not doing it properly.” When I saw the complications that we were having with radical prostatectomy, I said to myself: “We are not doing it properly.”. I am still saying “We are not doing it properly.” I firmly believe that it should be possible, for good surgeons at least, to have better outcomes. Right now, there are good surgeons that have bad results. I still think it will be possible to help them have good results. Our Chairman, Dr. Allaf, has recruited Dr. Ahmed Ghazi to develop a new laboratory for surgical innovation, discovery and teaching. He has some very good ideas about how the robotic operation could be analyzed through advanced mathematics to teach other people how to make some of these strategic moves correctly. So, I haven’t given up on surgery. The simple answer is, if everyone could undergo surgery with fewer side effects, there would be much less argument about how they should be treated.
T.S.: You have been invited to speak in Greece on many occasions. What do you love the most in Greece? Could you name your favorite place?
P.W.: I love the people! Everyone has been so kind and I have met many wonderful urologists. I also had many patients from Greece who became our friends and I have enjoyed many trips. It’s always been a joy to come there. If I had to pick one place, that would the island of Santorini. That, among many other places, was a very special trip. Also, I am very grateful for all the invitations I’ve had, including this invitation to talk to you today.
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