Why is the standard of care for prostate cancer different between countries. The science should be the same. Why don’t we recognize the science between countries. Every country has to compete there own drug trials. This seems like a waste of time and resources when these trials have been conducted by other countries and scientists. I don’t understand why we can’t share this information between countries. We can share goods and services but not science.
Excuse my rant but I am waiting approval for a drug that is SOC in most countries except for Canada. I can only assume it comes down to the fact that it is expensive and the government doesn’t want to pay for it.
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Islandboy2021
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I understand your frustration and not just for SOC but for choices too. Proton radiation machine allow better control on how deep radiation goes, unlike Photon radiation machines that have been the norm for years and goes from one side to the other.
There are over 20 countries in the world that using Proton radiation machines. Canada is the ONLY country in the G8 that does not possess even a single Proton radiation machine and does not even have a schedule to eventually get one.
And yet about half of the large income tax that is taken from our salaries goes to our deficient health care system. Very regrettable.
That's because proton beam toxicity has not been proven to be any less than X-rays, in spite of the hype from the very expensive proton centers that are trying to recoup their enormous costs.
The machine doesn't matter as much as the radiation oncologist. All modern linacs use very precise image guidance systems and are excellent. For whole pelvic treatment, I favor MRI targeting because the RO can use gating on organs that move separately. I can't prove that yet.
So, there are no conclusive studies showing the superiority of proton vs photon...the theory is good, but the actual practive has been disappointing in actual results Suggest you do some Googling and try to find something of a consensus of studies showing proton superiority. The question that might be better asked... Why do some US insurers cover proton???
As you know extremely expensive.....so there should be superiority, don't you think? Tall_Allen has posted on that subject both here and on his blog.
SoC is a legal concept - I recently did my own post on this. 'SoC' medical care ranges from from (sub)minimal to ultimate. An example, screening and not screening for prostate fall within this range. When the US was conducting trials on PSMA imaging it was already well-established in other countries; I traveled abroad for my first one.
Many countries make a separate determination about whether a treatment is worth the cost. The US doesn't -- I think every drug approved by the FDA is routinely approved by Medicare. However, if one has private insurance in the US, the private insurance company may not pay for the drug based on their own cost/benefit analysis. Canada and most countries accept the FDA determination of safety and efficacy of new drugs but may decide it's not worth the cost.
I know it’s little consolation but LU-177 has not been approved in Uk either, for use under the NHS. It is available privately and each session is around £20,000 (~C$35k). It is far cheaper in countries like Germany and India.
For both drugs and procedures, it seems to depend on a country's technology and approvals, and on whether any government or private insurance will cover it.
Yeah, it's regulatory agencies. What does the USPSTF say? What does Medicare pay for? Why are colonoscopies so big in the U.S. and in the EU it's mostly sigmoidoscopy and fecal occult blood or FIT?
In the United States, basic and expensive treatments are available to those with lots of money or excellent insurance. Those without money or excellent private insurance sometimes do without even basic treatments.
In Canada, our philosophy is that basic treatments are available to everybody without cost but that means some very expensive treatments needed by only a few are not provided. Personally, I prefer the Canadian model.
Most agree with you but the Canada model can be detrimental….my urologist is busy and despite my pleading to move faster my first referral to an oncologist to my complete surprise resulted in advanced pc diagnosis
As a Canadian I don't have a knee-jerk reaction response oh our system is so great. There are a lot of problems with it: its slow, its under resourced, it is not even a close call when compared to the USA for innovation or the range of treatments available as SOC, a significant percent of the population gets diagnosed late with worse outcomes because they can't access a primary care physician, etc, etc, etc.
I agree that there are pros and cons. I didn't have a lot of interaction with the medical system until cancer hit me 6 years ago. Personally, I've had excellent care. When my first PSA test registered 103.0 I had a very quick response. Saw a urologist the next day. Within a week I had a biopsy, MRI, CT scan, and bone scan. With stage 4 confirmed, I started chemo a few weeks later.
Information is shared but each country has their own regulations for approval of meds and treatments. In Germany, for example, they regularly offer thermal treatments for PC and trying to find anyone in the US who does it is very difficult.
As seen from the other comments, it all comes down to money. Countries with a socialized system have limited options as the cost is considered in the decision.
As cost v proven results are the decision makers, and the "socialized" system has provided me with Erleada and Lupron free of charge for the past 4 years, together with free bloodwork, free PSMA/PET scan, free bone scans, free visits to emergencies, free stays in hospital, free medications in hospitals as well as subsidised home care if required and free MAID if pain/discomfort can't be handled and free palliative care and free hospice support, but I suppose that's why there are taxes, and I would be happy to pay more taxes as long as there was direct correlation to health care. I wish all of you could get the same care
In theory yes, 100%, the likes of makers of medical products, getting their financial 'cuts' worth, different named medical products for basically the same medical product, everyone everywhere has to get their own "cut"🥺 thus the patients always lose🙄
I can so relate to your rant ! We also live in Canada and basic care is so different in our experience ! My husband does not even have an oncologist and the urologist never ever calls. He has an assistant call and they have no idea what his PSA is, what meds he is on. They ask him all these questions and he knows they have no even looked at his files. The urologist just says unless my husbands PSA changes ( goes up ) he does not need an oncologist and than at that time he will speak with his "team " !! I'm so upset that he has only gotten a bone scan for diagnosis and told unless his PSA goes up they dont need a scan . His PSA never was normally high ? He also has BRCA 2 which usually shows lower PSA. I know how you feel and hope that things have changed. It is scary living in Canada right now as our health care is horrid !
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Critical statements about the current standards of care for treating prostate cancer.
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