# Prostate Cancer — GCMD Library living collection

Everything in the library about prostate cancer — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 41 cited statements

## Episodes
### Surgical Management
- [Cuts Like a Cyberknife: New Surgical Technique for Prostate Cancer](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662) — video · 3:27 · [machine version](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662.md)

### Evidence & Research
- [Overcoming cognitive bias in evidence-based surgical practice](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156) — video · 44:05 · [machine version](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156.md)

### Patient & Family Education
- [iQuestions: Cyberknife Procedure for Prostate Cancer](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661) — video · 3:34 · [machine version](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=0) Introduction and Definition of CyberKnife (Ep 1)
- [1:08](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=68) Patient Selection Criteria (Ep 1)
- [1:48](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=108) Treatment Duration and Schedule (Ep 1)
- [2:24](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=144) Side Effects and Outcomes (Ep 1)
- [3:22](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=202) Closing (Ep 1)
- [0:06](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=6) CyberKnife treatment planning and delivery mechanism (Ep 2)
- [1:21](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=81) Treatment schedules and clinical outcomes (Ep 2)
- [2:21](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=141) Cost-effectiveness and insurance coverage (Ep 2)
- [2:54](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=174) Questions patients should ask their physician (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=0) Introduction: Evidence-Based Care vs. Personal Bias (Ep 3)
- [4:08](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=248) Historical Example: Tonsillectomy for Pharyngitis (Ep 3)
- [10:00](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=600) Cognitive Biases: Deterministic vs. Probabilistic Reasoning (Ep 3)
- [21:00](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1260) Experience Does Not Equal Better Outcomes (Ep 3)
- [25:00](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1500) Prostate Cancer Screening and Treatment (Ep 3)
- [30:06](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1806) Pediatric Surgery Research Landscape (Ep 3)
- [34:27](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2067) Barriers to Adopting Evidence (Ep 3)
- [41:40](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2500) System Complexity and Checklists (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- CyberKnife is a newer technology that allows noninvasive treatment of prostate cancer — Lee Ponsky (clinical) [Ep 1 · 0:30](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=30)
- University Hospital's Case Medical Center is one of the initial institutions offering CyberKnife technology — Lee Ponsky (clinical) [Ep 1 · 0:36](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=36)
- CyberKnife delivers highly focused radiation directly at the prostate and tracks the movement as the prostate moves — Lee Ponsky (clinical) [Ep 1 · 0:46](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=46)
- CyberKnife allows very precise treatment of the prostate while minimizing injury or side effects from surrounding organs — Lee Ponsky (clinical) [Ep 1 · 0:53](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=53)
- CyberKnife treatment does not involve chemotherapy or other treatments and is standalone — Lee Ponsky (clinical) [Ep 1 · 1:01](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=61)
- CyberKnife is currently being used to treat patients with low risk or intermediate risk prostate cancer — Lee Ponsky (clinical) [Ep 1 · 1:12](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=72)
- Eligibility criteria for CyberKnife include PSA less than 10, Gleason score of 3+4 or less, and low to intermediate risk disease — Lee Ponsky (guideline) [Ep 1 · 1:22](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=82)
- Standard external beam radiation for prostate cancer can be 5 days a week for 6 to 9 weeks, up to 45 treatments — Lee Ponsky (clinical) [Ep 1 · 1:53](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=113)
- CyberKnife treatment consists of 5 treatments total — Lee Ponsky (clinical) [Ep 1 · 2:06](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=126)
- Each CyberKnife treatment takes about 1 hour, for a total of 5 hours of treatment — Lee Ponsky (clinical) [Ep 1 · 2:11](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=131)
- No prostate cancer treatment has been able to totally remove the possibility of having side effects — Lee Ponsky (clinical) [Ep 1 · 2:29](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=149)
- CyberKnife patients have been having about 2 to 3 weeks of either no side effects at all, very mild urinary or rectal side effects, or sometimes bothersome rectal or urinary side effects — Lee Ponsky (clinical) [Ep 1 · 2:46](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=166)
- Most side effects from CyberKnife have gone away by 3 to 4 weeks — Lee Ponsky (clinical) [Ep 1 · 3:00](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=180)
- Potential side effects of CyberKnife include urinary incontinence and erectile dysfunction — Lee Ponsky (clinical) [Ep 1 · 3:03](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=183)
- Urinary incontinence and erectile dysfunction have been found to be very minimal in CyberKnife patients so far — Lee Ponsky (clinical) [Ep 1 · 3:10](https://library.globalcastmd.com/watch/iquestions-cyberknife-procedure-for-prostate-cancer-13661?t=190)
- CyberKnife is a newer technology that allows noninvasive treatment of prostate cancer. (clinical) [Ep 2 · 0:06](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=6)
- Treatment planning involves MRI and CT imaging that are fused into a single image, with radiation oncologist and surgeon collaborating to contour the prostate and surrounding structures. (clinical) [Ep 2 · 0:12](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=12)
- Dose planning aims to deliver tumoricidal dose to the prostate while protecting the rectum, bladder, and nerves controlling erections from high doses. (clinical) [Ep 2 · 0:33](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=33)
- The CyberKnife robotic arm moves approximately 360 degrees around the patient, delivering one beam of radiation from hundreds of different locations. (clinical) [Ep 2 · 0:51](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=51)
- Each individual beam is a very low dose, causing minimal side effects or damage to tissue it traverses, but the beams converge at the prostate focal point to destroy cancer. (clinical) [Ep 2 · 1:04](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=64)
- Initial CyberKnife treatment schedule was five consecutive days (Monday through Friday). (clinical) [Ep 2 · 1:21](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=81)
- Initial data on CyberKnife showed that treating patients in five fractions every other day (Monday, Wednesday, Friday, following Monday, Wednesday) may result in slightly fewer side effects than consecutive daily treatment. (clinical) [Ep 2 · 1:28](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=88)
- At this institution, treated patients are monitored with PSA and have shown a nice drop-off in PSA over the years, indicating cancer cure. (clinical) [Ep 2 · 1:41](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=101)
- Monitoring of urinary side effects and erectile dysfunction in this cohort has found very minimal side effects in the majority of patients. (clinical) [Ep 2 · 1:56](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=116)
- The overall cost of CyberKnife treatment is slightly less than some other treatments because of the shorter treatment period. (clinical) [Ep 2 · 2:21](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=141)
- CyberKnife treatment is covered by most insurance companies. (clinical) [Ep 2 · 2:40](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=160)
- Patients are pre-screened to ensure insurance coverage will not be a problem before CyberKnife is offered. (clinical) [Ep 2 · 2:46](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=166)
- Patients should ask their physician about experience (number of patients treated, duration of practice), treatment approach, follow-up plan, expected side effects and their management, and establish a working relationship. (opinion) [Ep 2 · 2:54](https://library.globalcastmd.com/watch/cuts-like-a-cyberknife-new-surgical-technique-for-prostate-cancer-13662?t=174)
- In 1959, 1.4 million tonsillectomies were performed in the United States for pharyngitis. (epidemiological) [Ep 3 · 6:47](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=407)
- There was never a study that showed tonsillectomy was an effective treatment for pharyngitis. (clinical) [Ep 3 · 6:52](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=412)
- By 2006, 535,000 tonsillectomies were performed in the US, while the population had almost doubled since 1959. (epidemiological) [Ep 3 · 7:00](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=420)
- Experienced clinicians perceived their patients did better after tonsillectomy and trained the next generation accordingly, perpetuating the practice. (opinion) [Ep 3 · 7:22](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=442)
- Humans have an innate weakness in inductive reasoning and prefer deterministic thinking over probabilistic reasoning. (opinion) [Ep 3 · 8:24](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=504)
- Experience is probably much less valuable than clinicians believe, and improving patient care requires rising above personal experience expectations through conscious effort. (opinion) [Ep 3 · 24:36](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1476)
- By age 50, 50% of all men will have carcinoma in situ or prostate cancer; by age 80, 100% of US men will have prostate cancer, but most die of other causes. (epidemiological) [Ep 3 · 25:27](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1527)
- Prostatectomy for prostate cancer was championed by thousands of urologists based on overwhelming single-institution case series (level three/four data), with randomized trials considered unethical. (clinical) [Ep 3 · 26:14](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1574)
- Hundreds of thousands of patients underwent radical prostatectomy that never should have, with terrible effects on quality of life and no benefit in long-term survival. (opinion) [Ep 3 · 28:51](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1731)
- When limited to pediatric surgery-specific journals, the rate of randomized controlled trials improved to 0.4%. (epidemiological) [Ep 3 · 33:42](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2022)
- Hand washing hygiene to prevent disease progression was first published in 1843, yet hand hygiene compliance remains a daily challenge in hospitals. (clinical) [Ep 3 · 34:50](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2090)
- The number of research articles has almost doubled annually over the last decade, and the number of clinical trials has increased fourfold. (epidemiological) [Ep 3 · 36:01](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2161)
- From trial design to manuscript publication takes 59–65 months (approximately five years) on average. (epidemiological) [Ep 3 · 38:50](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2330)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- There is a broad body of evidence that people do not learn from experience when it consists of a series of cases (level three or four evidence). — The host summarizing the discussion [Ep 3 · 7:50](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=470)
- People will develop a deterministic rule to explain any series of observations rather than look for probabilism. — The host summarizing the discussion [Ep 3 · 20:00](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1200)
- Increasing the complexity of a problem does not decrease the likelihood that people will apply a deterministic rule. — The host summarizing the discussion [Ep 3 · 20:07](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1207)
- Even when specifically told an outcome is probabilistic, people still persistently develop deterministic rules. — The host summarizing the discussion [Ep 3 · 20:47](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1247)
- A 2005 study of 62 groups of physicians and 59 studies found that 52% showed negative association between experience and knowledge, adherence to diagnostic standards, adherence to treatment standards, and patient outcomes. — The host summarizing the discussion [Ep 3 · 21:50](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1310)
- In a study of 39,000 acute MI patients treated by 4,500 physicians, mortality increased 0.5% for every year since the doctor graduated from medical school. — The host summarizing the discussion [Ep 3 · 23:07](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1387)
- A 1999 cardiac surgery study of 275 cardiologists and 83,000 operations found that more years in practice was significantly associated with higher mortality rates (P=0.001). — The host summarizing the discussion [Ep 3 · 23:46](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1426)
- In a study of 1,033 hepatic resections, there was no difference in mortality based on surgeon volume or advanced training. — The host summarizing the discussion [Ep 3 · 24:10](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1450)
- A New England Journal of Medicine RCT of 695 men with newly diagnosed prostate cancer (mean follow-up 6.2 years) found radical prostatectomy was 50% less likely to result in death from prostate cancer but showed no difference in overall survival. — The host summarizing the discussion [Ep 3 · 26:39](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1599)
- Patients who had radical prostatectomy had much worse quality of life: erectile dysfunction was twice as high, urinary leakage three times as high, and dependence on diapers 15 times higher compared to watchful waiting. — The host summarizing the discussion [Ep 3 · 27:18](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1638)
- A British Medical Journal study comparing Seattle and Connecticut Medicare data found PSA screening was five times more likely in Seattle and radical prostatectomy was done five times more often, but age-adjusted prostate cancer mortality showed no difference between the two regions. — The host summarizing the discussion [Ep 3 · 27:50](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1670)
- A 1999 review of pediatric surgery journals from 1966–1998 found 34 randomized controlled trials out of 9,300 articles (0.3%). — The host summarizing the discussion [Ep 3 · 30:20](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1820)
- A broader review of 80,000 articles in all journals over the same period found 134 randomized controlled trials, with only 16 (12%) studying surgical therapy. — The host summarizing the discussion [Ep 3 · 31:15](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1875)
- A PubMed review from 1999–2012 identified 79 randomized controlled trials out of over 8,000 pediatric surgery publications, representing less than 1%. — The host summarizing the discussion [Ep 3 · 32:01](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=1921)
- After publication, it takes six years to get 25 citations in the literature. — The host summarizing the discussion [Ep 3 · 40:12](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2412)
- Adoption into practice occurs at only 3.2% per year, taking at least 10–12 years to reach clinical guideline status and 17 years to reach 50% adoption. Virtually nothing ever reaches 80% adoption. — The host summarizing the discussion [Ep 3 · 40:31](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2431)
- A New England Journal of Medicine study of surgical safety checklists in eight hospitals across eight countries found that a simple checklist decreased death rate from 1.5% to 0.8%. — The host summarizing the discussion [Ep 3 · 41:40](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2500)
- The surgical safety checklist included: correct patient, mark the site, introduce team members, give antibiotics, have X-rays in the room, and state the operative plan. — The host summarizing the discussion [Ep 3 · 42:11](https://library.globalcastmd.com/watch/overcoming-cognitive-bias-in-evidence-based-surgical-practice-16156?t=2531)

## Changelog
- Oct 31: 3 items added automatically

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