Standard of Care for prostate cancer ... - Advanced Prostate...

Advanced Prostate Cancer

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Standard of Care for prostate cancer from one country to another

Islandboy2021 profile image
31 Replies

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 profile image
Islandboy2021
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31 Replies
MoonRocket profile image
MoonRocket

You're probably right. What drug are you seeking approval to use?

Islandboy2021 profile image
Islandboy2021 in reply toMoonRocket

Lu-177

in reply toIslandboy2021

You are quite right. In Norway they just said no to Pluvicto, too expensive.

Mascouche profile image
Mascouche

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.

MoonRocket profile image
MoonRocket in reply toMascouche

But you have MAID, which is cheaper and a much shorter duration of treatment

maley2711 profile image
maley2711 in reply toMoonRocket

MAID????

hopeful1956 profile image
hopeful1956 in reply tomaley2711

Medical Assistance in Dying

maley2711 profile image
maley2711 in reply tohopeful1956

My plan if/when things are just too bad....... refuse al liquids....I've read juust a 4-5 day period to death...and free.

Tall_Allen profile image
Tall_Allen in reply toMascouche

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.

God_Loves_Me profile image
God_Loves_Me in reply toTall_Allen

Learning question - What are your top radiation machine choices?

Tall_Allen profile image
Tall_Allen in reply toGod_Loves_Me

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.

God_Loves_Me profile image
God_Loves_Me in reply toTall_Allen

thank you

maley2711 profile image
maley2711 in reply toMascouche

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.

tsim profile image
tsim in reply toMascouche

$$$$$$$, cost vs benefit is not there. Hugely expensive to create the suite and install.

NanoMRI profile image
NanoMRI

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.

Tall_Allen profile image
Tall_Allen

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.

Ian99 profile image
Ian99

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.

ARIES29 profile image
ARIES29

It is about time somebody discussed this, why isnt SOC the same in all countries? Our bodies work the same & the desease is the same thing.

Lu-177 is around $11K AUD here.

vintage42 profile image
vintage42 in reply toARIES29

"... why isnt SOC the same in all countries? "

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.

packardlover1949 profile image
packardlover1949

For the same reason we deal with drug pricing, inflation, open borders, high gas prices, etc. Big money, and government corruption.

dentaltwin profile image
dentaltwin

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?

MarkBC profile image
MarkBC

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.

Mbnm profile image
Mbnm in reply toMarkBC

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

skiingfiend profile image
skiingfiend in reply toMarkBC

Both models have pros and cons.

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.

MarkBC profile image
MarkBC in reply toskiingfiend

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.

Sagewiz profile image
Sagewiz

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.

j-o-h-n profile image
j-o-h-n

Ya know........ I was just wondering, why do countries have different languages?....

Good Luck, Good Health and Good Humor.

j-o-h-n

RoseDoc profile image
RoseDoc

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.

Hailwood profile image
Hailwood in reply toRoseDoc

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

Adlon57 profile image
Adlon57

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🙄

positive-thinking profile image
positive-thinking

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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