I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error

Revolution on Prostate Cancer Care

User
Posted 12 Dec 2018 at 16:25

Welcome news :-  https://www.pressreader.com/uk/daily-mail/20181212/281547996979280


Click on right arrow to progress

Barry
User
Posted 12 Dec 2018 at 16:25

Welcome news :-  https://www.pressreader.com/uk/daily-mail/20181212/281547996979280


Click on right arrow to progress

Barry
Show Most Thanked Posts
User
Posted 12 Dec 2018 at 18:06
Mostly great news but the bit "28000 men could be sent home without a biopsy" fills me with dread. If they are going to fund MRI before biopsy, it should be that all men are considered for a follow up biopsy based on DRE, PSA and symptoms even if the MRI is clear.

I don't think John would still be with me if he hadn't had the biopsy first. PSA 3.1, smooth small gland, clear scan ... he would undoubtedly have been one of the 28%
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 12 Dec 2018 at 20:39
Seems to be a view expressed by some highly regarded consultants that good MRI's can mostly save need for biopsy in many cases but even with added biopsy significant cancer is missed in some men, more so with the TRUS one. It's a bit like the argument for and against PSA testing as leading to significant cancer being treated in a number of cases but that by testing and treating so many more men because some cancer is found, even insignificant ones, there will be a substantial number who are overtreated.
Barry
User
Posted 12 Dec 2018 at 21:10
I'm another one who had a clear MRI, but cancer found in a biopsy.

Chris
User
Posted 13 Dec 2018 at 01:21
I read the ‘news’ in the Daily Mail. If all MRI’s were mpMRI’s at 3T resolution then you might have more confidence in the result.

There is someone here who had a suspicious DRE, TRUS found some ‘abnormal’ non-cancerous cells, but his MRI was clear. I think it significant that he has not been discharged by urology back to his GP, and is now under observation.

Fingers crossed for him.

Cheers, John.
User
Posted 13 Dec 2018 at 01:45
Hhhm, but I think there are two 7T machines and only 20 3T machines in England and most of these are not available for prostate mapping, only high tariff cancers like brain tumours. I read something a while back that said half of all scanners currently in use in England are rated only adequate and 10% are obsolete.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Dec 2018 at 02:16

If the NHS had less pen-pushers and so-called managers, with more clinicians in charge, then we might be able to afford more scanners.


https://www.statista.com/statistics/282401/density-of-magnetic-resonance-imaging-units-by-country/

Edited by member 13 Dec 2018 at 02:17  | Reason: Not specified

User
Posted 13 Dec 2018 at 03:37
And if there was a businessman in charge, our billion-pound hospital here in Coventry wouldn’t PAY some car parking firm £600,000 a year to run its car parks, who also get to keep the millions in parking fees and fines on top.

How many scanners could that pay for? I think Theresa May must have negotiated that deal!

A nurse says she pays £9.60 daily to park her car. It wouldn’t be so bad as a patient if you could find somewhere to park.

No cheers this time, nothing to be cheery about Walsgrave Hospital UHCW (except it does save a few lives),

John.
User
Posted 13 Dec 2018 at 04:38

Originally Posted by: Online Community Member


If the NHS had less pen-pushers and so-called managers, with more clinicians in charge, then we might be able to afford more scanners.


 



 


Hmmmm Maybe slightly true in a few cases but organizing things in a hospital has many aspects that are broken down into time consuming processes that it would be too expensive and wasteful of their time for clinicians to oversee.  One example for instance, is allocating appointments to patients. For various reasons relating to hospital work load, equipment breakdown staff sickness and also patient related cancellations and alterations to appointments which are originally allocated by administrative staff that have to be changed and juggled around.  There can be insufficient staff and organization to deal with even this one area. I was allocated two different scans at overlapping times in two different buildings on one occasion for instance.  Perhaps this was due to human or system area or overload pressure I don't know.  Take delays in reporting back to GP's and patients on their progress as another example.  We all know what a time it can take to communicate results because some of the delay relates to inadequate administration. Only yesterday for instance , I received a copy of a letter from UCLH to my GP saying inter alia that I will be having a biopsy.  This was  some 2 weeks after the biopsy was actually done.  Some times the reports are a couple of months behind.  So in some areas we need more and better organized 'pen pushers' and supervisors as well as more clinical staff. Running a hospital is a very complex operation.  The main reason why we don't have the scanners and sufficient suitably qualified staff is that the NHS has not been properly funded and invested in to meet the ever growing needs of an expanding and ageing population in a more costly and technically advanced medical environment.

Edited by member 13 Dec 2018 at 04:41  | Reason: Not specified

Barry
User
Posted 13 Dec 2018 at 08:02

Bollinge, check out the recent scandal of Bright Tribe academy Trust, Aventure Academies Trust and their CEO Mike Dwan. Then have a look at his core business. There is another scandal in there somewhere.

Edited by member 13 Dec 2018 at 14:00  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Dec 2018 at 08:18
Matron, I did mention Tesco running the NHS, but there was a scandal there recently.

Maybe I should have suggested Waitrose?

Cheers, John.
User
Posted 13 Dec 2018 at 08:33
The way the NHS is structured does mean a lot of money is spent on executive and non executive directors. Each trust has its own board with a non executive chair, then around 8 execs plus another 8 non execs. This adds to to a big annual spend per trust before any medical procedure is carried out and that is multiplied by the total number of trusts. On a single site location in a city you can have more than one trust each with their own board.

You don’t find this replicated in any other geographically spread organisation that I am aware of.

Interesting discussion
User
Posted 13 Dec 2018 at 11:50
Too many Chiefs and two few Indians (as the saying goes (no racial slur implied) agreed.
Barry
User
Posted 13 Dec 2018 at 15:19
I can't believe the media have missed the link between Dwan and the NHS - and that is where he made his multi-millions
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 13 Dec 2018 at 19:07

Originally Posted by: Online Community Member
Too many Chiefs and two few Indians (as the saying goes (no racial slur implied) agreed.


What’s wrong with Indians? People from the sub-continent are the backbone of the NHS 😉


 

User
Posted 13 Dec 2018 at 19:36

And then for each trust (especially questionable for those on the same geographical site, but organised by function such as a trust for general, a trust for children and a trust for women) in addition to each having their own executive board, non exec chair and non execs they replicate some basic functions - each runs their own payroll, has their own IT for supplier payment etc. Sometimes literally a few minutes apart and frequently in the same city.


I am not aware of any other organisation structured like this so I agree there are lots and lots of chiefs but also a lot of duplicate spend on central systems and staffing central functions.


 


 

User
Posted 13 Dec 2018 at 20:48

Complex organisations are often heavy on pen pushers and managers.   If you run a factory with a 1000 machines doing similar things you can have a few managers but if you run a diverse, changing and responsive organisation you most likely need more pen pushers and managers.


If you want focussed high quality attention on specialisms then you need people with enough status to have credibility and weight in an organisation.

User
Posted 14 Dec 2018 at 11:50

My MpMRI had “an appearance suggestive of prostatitus with no suspicious areas”. 4 months later a biopsy revealed 4.3 in 5 out of 6 cores on the R side and 3.3 in 3 out of 5 cores in the L side. To be fair the consultant said that MRIs are most reliable at showing up high grade cancers, so he at least was not taking the result as a certainty. My MpMRI missed a significant cancer in the R side of my prostate. My PSA was 4.3 and up until then DRE had been “entirely benign”, it would have been quite easy to chalk my slightly elevated PSA up to prostatitus. I think MRIs are useful diagnostic tools but my case suggests that they can be wrong. This highlights more then anything the need for a reliable test which will give a clear yes or no for the presence of prostate cancer, without the uncertainty of a negative MRI or biopsy, both of which can miss significant cancers.

Edited by member 14 Dec 2018 at 11:55  | Reason: Not specified

 
Forum Jump  
©2019 Prostate Cancer UK